Stenting for stenosis of the proximal vertebral artery (VA) is commonly performed via a femoral approach. However, iliofemoral occlusive disease such as arteriosclerosis obliterans sometimes prevents safe transfemoral access. In certain situations where both femoral access and ipsilateral brachial access are difficult because of a concomitant vascular diseases or particular anatomic setting, a contralateral brachial approach using the brachiobrachial pull-through technique may allow efficient and accurate stenting. A case of VA origin symptomatic stenosis successfully treated with stenting using the new pull-through technique from the contralateral brachial artery to the brachial artery on the affected side is described.
Percutaneous angioplasty is a useful method for improvement of posterior circulation of the brain in subclavian artery stenosis and occlusion. Recently, the Palmaz stent was introduced for peripheral vessels stenosis. We evaluated the efficacy and care point of Palmaz stent deployment for subclavian artery stenosis in seven cases (5 stenosis and 2 occlusion) with symptoms and a mean age of 65.1 years. The stents could be deployed exactly at the stenotic region in all cases. The pressure gradient disappeared in all cases, and the clots were fixed between vessel wall and stent. Antegrade circulation and significant clinical symptoms improvement were obtained in all cases. In angioplasty of subclavian artery stenosis, as compared with balloon angioplasty alone, Palmaz stent is a very useful device with fewer complications including distal thrombosis of the vertebrobasilar circulation.
A 57-year-old female presented with a left petroclival meningioma fed by the meningohypophyseal trunk of the internal carotid artery (ICA). The enlarged tentorial marginal artery and inferior hypophyseal artery were successfully embolized with the TruFill DCS Detachable Coil System through a 0.019-inch inner diameter microcatheter. Superselective catheterization into the dorsal meningeal artery could not be achieved with the same microcatheter, because the catheter tip was too large to pass into the vessel. Subsequently the feeding artery was successfully embolized with a Guglielmi detachable coil (GDC) through a 0.016-inch inner diameter microcatheter. The patient underwent surgery without blood loss on the day after embolization. Our subjective impression was that the TruFill DCS was softer and had less resistance during insertion, whereas the GDC could be delivered through a smaller caliber system for smaller vessels. Appropriate use of the TruFill DCS and GDCs can allow efficient embolization of the feeding branches of the ICA.
A 53-year-old man presented with malignant lymphoma manifesting as disturbances of walking and standing. Magnetic resonance (MR) imaging showed multifocal bifrontal lesions which were enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Positron emission tomography (PET) with [ 18 F]fluorodeoxyglucose showed high uptake of tracer in the lesion. The PET-MR coregistered image was used to determine the biopsy target. After right frontal craniotomy, a sterilized probe controlled by a neuronavigation system was directly passed into the tumor, and a guide tube was inserted along the same track. After dura opening, a small corticotomy was performed along the guide tube track and the tumor was biopsied. Histological examination revealed malignant lymphoma. The stereotactically inserted tube-guided brain biopsy was less invasive and provided an accurate diagnosis. The PET-MR coregistered image was helpful for determining the most active lesion of the brain tumor.
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