Introduction An intermediate catheter (IMC) may pose a risk of intraprocedural rupture (IPR) during coil embolization of ruptured intracranial aneurysms (RIAs), because the pressure on the microcatheter and coil might be more direct. To verify this hypothesis, this study explored whether use of an IMC might correlate with an increased rate of IPR during coil embolization for RIAs. Methods We retrospectively reviewed 195 consecutive aneurysms in 192 patients who underwent initial coil embolization for saccular RIAs at our institution between January 2007 and December 2023. Patients were divided into two groups with aneurysms treated either with an IMC (IMC group) or without an IMC (non-IMC group). To investigate whether IMC use increased the rate of IPR, a propensity score-matched analysis was employed to control for age, sex, maximal aneurysm size, neck size, bleb formation, aneurysm location, proximal vessel tortuosity, balloon-assisted coiling, type of microcatheter, and type of framing coil. Results Ultimately, 43 (22%) coil embolization used IMC. In univariate analysis, the incidence of IPR was significantly higher in the IMC group compared with the non-IMC group (14.0 vs. 3.3%, p = 0.016). Propensity score matching was successful for pairs of 26 aneurysms in the IMC group and 52 aneurysms in the non-IMC group. The incidence of IPR was still significantly higher in the IMC group than in the non-IMC group (23.1 vs. 3.8%, p = 0.015). No significant differences in the incidences of ischemic complications and IMC-related parent artery dissection were observed between the two groups. Discussion When using IMC for coil embolization of RIAs, the surgeons should be more careful and delicate in manipulating the microcatheter and inserting the coils to avoid IPR.
We have analyzed motion of DNA molecules in the microchannel with nanofences in order to clarify the mechanism of size-based separation. The traces of DNA molecules were obtained from video images taken by a CCD camera with an image intensifier unit. We developed a program to trace DNA molecules in the microchannel during electrophoresis. It was found that smaller DNA molecules had longer detours around nanofences and the detour had nearly inverse relationship with applied voltage.
Radial artery diameter may limit whether a guiding sheath (GS) can be used via transradial artery access (TRA). A smaller GS may reduce the risk of access site-related complications. This study investigated the feasibility and safety of endovascular treatment (EVT) using a straight-shaped 3-Fr GS (Axcelguide; Medikit).
To investigate on three-dimensional (3D) fusion images the apposition of low-profile visualized intraluminal support (LVIS) stents in intracranial aneurysms after treatment and assess inter-rater reliability. Records of all patients with unruptured intracranial aneurysms who were treated with the LVIS stent were retrospectively accessed and included in this study. Two neurosurgeons evaluated the presence of malapposition between the vessel walls and the stent trunk (crescent sign) and the vessel wall and the stent edges (edge malappostion) on 3D fusion images. These images were high-resolution cone-beam computed tomography images of the LVIS stent fused with 3D-digital subtraction angiography images of the vessels. Associations between malapposition and aneurysm location were assessed by Fisher's exact test, and inter-rater agreement was estimated using Cohen's kappa statistic. Forty consecutive patients were included. In all patients, 3D fusion imaging successfully visualized the tantalum helical strands and the closed-cell structure of the nitinol material of the low-profile visualized intraluminal support. A crescent sign was observed in 27.5% and edge malapposition in 47.5% of the patients. Malapposition was not significantly associated with location (p=0.23 crescent sign, p=0.07 edge malapposition). Almost perfect (κ=0.88) and substantial (κ=0.76) agreements between the two raters were found for the detection of crescent signs and edge appositions, respectively. 3D fusion imaging provided clear visualization of the LVIS stent and parent arteries, and could detect malapposition with excellent inter-rater reliability. This technique may provide valuable guidance for surgeons in determining postoperative management.
Fracture of the anterior arch of the atlas is a rare complication of foramen magnum decompression (FMD) for Chiari malformation. We report a case of a fracture of the anterior arch of the atlas after FMD. A 42-year-old woman was referred to our hospital from a nearby clinic where Chiari malformation and syringomyelia were incidentally detected during head magnetic resonance imaging (MRI) examination for headache. We performed FMD and tonsillectomy for the Chiari malformation. The patient had an uneventful postoperative course and was in good condition when discharged. She developed neck pain without any preceding incident approximately 7 months after surgery. Subsequently, she experienced neck pain during flexion, extension, and sneezing. Neck computed tomography (CT) performed at a nearby clinic revealed a fracture of the anterior arch of the atlas, and she was referred to our hospital once again. Although neck radiography did not confirm an instability of the craniocervical junction, the neck pain progressed ; thus, posterior atlantoaxial fusion was performed. Due to the thinning of the C2 vertebral pedicles, part of the C2 vertebral arch was removed during FMD, and pars screws were inserted into the C2 vertebra with lateral mass screws inserted into the C1 vertebra. The subsequent postoperative course was uneventful. Three cases have been reported in the literature, and the mechanism of injury (e.g., trauma) was not confirmed in all of them. Posterior fusion was used in 2 cases, external immobilization with a halo vest was used in 1 case, and fracture healing was achieved with a good prognosis in all three cases. When neck pain develops a few months after FMD, fracture of the anterior arch of the atlas should be suspected and preferably confirmed using CT.
