Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.

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Purpose Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS. Methods In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic C50 %, asymptomatic C80 %) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C C120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C \120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed. Results Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8 %) in the PS group and 16 of 30 patients (53.3 %) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0 %) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (b = 0.74, 95 % confidence interval 0.070-1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions.This study was conducted on behalf of the EPOCH-CAS Investigators. The members of EPOCH-CAS Investigators are given in Appendix. 123Cardiovasc Intervent Radiol (2014) 37:1436-1443 DOI 10.1007 Conclusion Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.

We report the results of 26 patients who underwent stent deployment for chronic total occlusion of proximal subclavian artery. From January 1998 to October 2005, 26 patients (18 male; mean age, 62.7 years, range 22 to 83 years), 28 lesions, underwent 29 procedures of stenting for chronic total occlusion of the proximal subclavian artery. Twenty-three patients had symptoms of claudication in their arm, no patients had subclavian steal syndrome. A brachial approach was used in 21 procedures, a femoral approach was used in five procedures, and combined femoral-brachial approach was required in three procedures. Primary stent deployment was success in 24 lesions (85.7%), and secondary procedure was success in one patient, totally 25 lesions (89.3%) were successfully treated by stenting. Procedure related complication occurred in four cases, including stent migration without symptoms in two procedures, hemianopsia on next day in a case, and TIA on unclear reason in one case. Permanent morbidity rate is 3.4% in procedure. Target lesion re-treatment required in three lesions, caused by subacute thrombosis, in-stent-restenosis, and dissection of the vessel by stent edge. The cases of subacute thrombosis and in-stent-restenosis were treated by re-PTA, and the case of dissection was treated by additional stenting. Secondary patency was 100%. We conclude that stenting for chronic total occlusion of subclavian arteries appears feasible and safe.

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The treatment of dural arteriovenous fistulas (DAVFs) at the foramen magnum remains controversial by reason that DAVFs appearing from the foramen magnum represent only a minority of spinal DAVFs. We present our treatment for an asymptomatic patient suffering from a foramen magnum DAVF. A 53-year-old man presented to our hospital with the complaint of a floating sensation. Although there was no subarachnoid hemorrhage or cerebral infarction on magnetic resonance imaging, a magnetic resonance angiography revealed a number of dilated veins and a large varix surrounding the medulla oblongata. Cerebral digital subtraction angiography (DSA) showed a foramen magnum DAVF fed by the neuromeningeal branch of the left ascending pharyngeal artery and occipital artery, draining into the posterior spinal vein. Occlusion of the fistula was achieved by a microsurgical technique combined with a feeder occlusion using transarterial coil embolization, without complications. We verified the complete occlusion on post-operative cerebral DSA. While this combined therapy was already established for the treatment of DAVFs, there were no reports of the combined therapy for foramen magnum DAVFs. This treatment was considered to be useful for foramen magnum DAVFs, especially those DAVFs at the foramen magnum with a number of dilated veins and a large varix.KeywOrds: Ascending pharyngeal artery, Combination therapy, Dural arteriovenous fistula, Foramen magnum, Transarterial coil embolization ÖZForamen magnum'daki dural arteriovenöz fistüllerin (DAVF) tedavisi spinal DAVF'in çok azı foramen magnumda yerleştiği için tartışmalıdır. Makalede asemptomatik bir hastada tesbit edilen foramen magnum DAVF'ünde uyguladığımız tedaviyi sunuyoruz. 53 yaşında erkek hasta hastanemize duyularında dalgalanma şikayeti ile başvurdu. Hastanın manyetik rezonans incelemesinde subaraknoid kanama veya serebral enfarkt olmamakla birlikte manyetik rezonans anjiyografi medulla oblongata çevresinde çok sayıda genişlemiş ven ve bir adet büyük bir varis olduğunu gösterdi. Serebral dijital subtraksiyon anjiyografi (DSA) sol asendan farengeal arterin nöromeningeal dalından ve oksipital arterden beslenen, posterior spinal vene drene olan bir foramen magnum DAVF'nü gösterdi. Fistülün oklüzyonu mikrocerrahi teknikle kombine olarak uygulanan besleyici damarın transarteriyal koil ile embolizasyonu yoluyla komplikasyonsuz olarak sağlandı. Postoperatif serebral DSA ile tam oklüzyonu doğruladık. DAVF'ler için kombine tedavi daha önce tanımlanmış olmakla birlikte, foramen magnumda yerleşmiş DAVF'ler bu yöntem hiç yayınlanmamıştır. Bu tedavi yöntemi foramen magnum DAVF'leri için, özellikle çok sayıda dilate ven ve geniş varisi olan olgularda, oldukça kullanışlıdır.AnAhtAr sÖZCÜKler: Asendan farengeal arter, Kombine tedavi, Dural arteriovenöz fistül, Foramen magnum, Transarteriyal koil embolizasyonu

Chronic total occlusion of cerebrovascular lesions is regarded as a contraindication to revascularization. We describe a case of chronic total occlusion of intracranial internal carotid artery that iwass successfully recanalized by endovascular treatment. A 72-year-old man who presented with slight right hemiparesis was proved to have chronic total occlusion of the left intracranial internal carotid artery. Percutaneous transluminal angioplasty/stenting was achieved using reversal of flow with the Parodi Anti-Embolic System. The present case indicates that percutaneous transluminal angioplasty/stenting can be an effective therapeutic option in selected patients with chronic total occlusion of cerebrovascular lesions.

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