We report renal artery injury by a guidewire during coil embolization of a cerebral artery aneurysm, which was successfully treated by transarterial embolization using n-butyl-2-cianoacrylate (NBCA). Case Presentation: A 65-year-old woman underwent coil embolization for an unruptured cerebral aneurysm, resulting in its complete occlusion. However, her blood pressure decreased during embolization and postoperative abdominal computed tomography (CT) revealed a retroperitoneal hematoma. Intraoperative video revealed that the 0.035-inch guidewire had passed deeply into the right renal artery when the guiding sheath was navigated into the abdominal aorta, suggesting renal artery perforation. Transarterial embolization using NBCA was performed immediately, which resulted in hemostasis. Conclusion: Although renal artery perforation with a guidewire is a rare complication, it can have severe consequences. Early diagnosis with prompt and definitive hemostasis is important.
Objective: Plaque protrusion is one of the current problems with carotid artery stenting (CAS) for carotid artery stenosis, and it may induce delayed postprocedural cerebral infarction. In this study, we evaluate the possibility of using threedimensional rotational angiography (3DRA) to examine the stent lumen during CAS.Methods: First, as a basic experiment, we determined the optimal contrast medium concentration for 3DRA. We then studied the presence or absence of plaque protrusion in 43 patients who underwent CAS at our hospital using 3DRA, intravascular ultrasound (IVUS), or DSA.Results: Optimal contrast medium concentration was determined to be 50% by the basic experiment. In clinical evaluation, plaque protrusion was detected in 12 patients (27.9%) by 3DRA, compared to 7 (16.2%) by IVUS and in 3 (6.9%) by DSA. In patients where plague protrusion was undetected by 3DRA, it was also undetected by IVUS and DSA after CAS.
Conclusion:Three dimensional rotational angiography appears to be useful for in-stent plaque protrusion detection.
Objectives The aim was to identify the factors related to inadequate hemostasis with five minutes of manual compression using the EXOSEAL vascular closure device (VCD), and to evaluate the optimal time to hemostasis (TTH). Methods A total of 119 consecutive patients who underwent neuro-endovascular therapy via common femoral arterial puncture between February 2019 and August 2021 were included. These patients underwent hemostasis using an EXOSEAL with manual compression for five minutes. In this retrospective study, the 119 patients were divided into two groups: (1) achieved hemostasis with five minutes (n = 76); and (2) required more than five minutes to achieve hemostasis (n = 43, Add group). In both groups, patient's characteristics, endovascular procedures, and closure procedures were assessed. Results On univariable analysis, activated clotting time (ACT), multiple antiplatelets, closure with an under-sized EXOSEAL VCD (U-VCD), endovascular procedure, and use of a 7Fr. VCD were significantly associated with additional compression ( p < 0.05). On multivariate logistic regression analysis, the following three factors were found to be associated with additional compression: pre-closure ACT (adjusted OR, 0.136; 95% CI, 1.017–1.056; p < 0.001); multiple antithrombotics (adjusted OR, 12.843; 95% CI, 3.458–47.693; p < 0.001); and closure with a U-VCD (adjusted OR, 5.653; 95% CI, 1.751–18.151; p = 0.004). On the receiver-operating characteristic curve analysis for prediction of the need for additional compression, the cutoff point for pre-closure ACT was calculated to be 268 s. In the Add group, mean TTH was 9.8 ± 1.5 min. Conclusion Multiple antiplatelets and closure with a U-VCD may increase the risk of insufficient hemostasis with five-minutes compression using an EXOSEAL VCD for femoral puncture sites if the pre-closure ACT is greater than 268 s. In these patients, mean TTH was 9.8 ± 1.5 min.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.