As of January 2021, the Surpass Streamline (SS) is the most recently approved flow diverter in Japan. A total of 28 Japanese patients, including 9 clinical trial patients, with 28 large or giant unruptured internal carotid artery (ICA) aneurysms, underwent SS embolization at Juntendo University Hospital. Procedural failure occurred in two patients due to the difficulty to navigate the device in the tortuous parent artery. Therefore, 26 patients with 26 aneurysms were available for clinical and anatomical assessments. Patients' mean age was 62.6 years (range 46-86), and 24 patients (92.3%) were female. Mean aneurysm size and neck width were 15.4 mm and 7.7 mm, respectively, with 20 saccular and 6 fusiform aneurysms. Seven aneurysms were symptomatic due to the aneurysmal mass effect. Twenty patients underwent a 6-month follow-up angiography to evaluate the degree of occlusion. Anatomical outcomes were 12 (60%) complete occlusion (CO), 4 (20%) residual neck (RN), and 4 (20%) residual aneurysm. Favorable aneurysm occlusion consisted of CO, and RN was achieved in 16 (80.0%). There were no significant device stenoses. Aneurysmal mass effect improved in one and was unchanged in eight patients. There were three device-related complications, namely, delayed aneurysm rupture, minor ischemic stroke, and device occlusion (11.5%). One patient with minor ischemic stroke fully recovered before 30 days, and our series showed 7.7% risk of major ipsilateral stroke and neurological death at 30 days. The SS embolization for large and giant unruptured ICA aneurysms offers satisfactory anatomical and clinical outcomes with a low risk of device-related complications.
Recent reports have revealed cases of contrast-induced encephalopathy after endovascular therapy. Neurotoxicity caused by blood brain barrier (BBB) disruption or contrast media migration into the brain cortex and subarachnoid space is an important factor, but details are unknown.Here, we present two cases of contrast-induced encephalopathy that developed after endovascular therapy, and findings of hypoperfusion followed by hyperperfusion on single photon emission computed tomography (SPECT).Case 1: A 63-year-old woman underwent flow-diverter stenting for treatment of an unruptured aneurysm. Owing to difficulty in navigation of the microcatheter into the distal parent artery, the operation time was extended. She developed contrast-induced encephalopathy after the procedure, and her symptoms disappeared three days after the procedure. On the day after the procedure, SPECT showed decreased uptake in the region of the left middle cerebral artery (MCA) territory. Seven days after the procedure, SPECT showed increased uptake in the same area.Case 2: A 77-year-old man underwent carotid artery stenting using MOMA Ultra for treatment of asymptomatic left internal carotid artery stenosis. Ischemic complications or hyper-perfusion syndrome was negative on examination. Therefore, we diagnosed him with contrast-induced encephalopathy.The following day, SPECT showed decreased uptake in the left MCA territory. He recovered nine days later. At this time point, SPECT showed increased uptake in the same area.Contrast-induced encephalopathy is a rare complication, and recovery is natural in most cases.SPECT findings in our cases suggest that rapid changes in the cerebral blood flow and/or metabolism are seen in the early stages of contrast-induced encephalopathy.
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