Continued progress in the evolution of endovascular therapy.
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Embolization, Therapeutic↗
Biomedical subjects
C M Strother
Publications and source records attributed to C M Strother.
Does reduction in vascular trauma during treatment of acutely ruptured saccular aneurysms reduce the incidence of vasospasm?
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Acute Disease↗
Understanding the natural history of saccular aneurysms.
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Aneurysm, Ruptured↗
Upside down in the Journal.
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Diagnostic Imaging↗
MR angiography of saccular aneurysms after treatment with Guglielmi detachable coils: preliminary experience.
PURPOSE: To review our experience using MR angiography to assess the cerebral vasculature after aneurysmal treatment with Guglielmi detachable coils (GDCs). METHODS: Forty three-dimensional time-of-flight MR angiographic studies were performed in 23 patients after endovascular aneurysmal therapy with GDCs. Digital subtraction angiographic (DSA) studies were evaluated retrospectively for the following findings: parent artery patency, branch vessel patency, residual flow within the aneurysm, and residual aneurysmal neck. The MR angiographic examinations were inspected for the same findings, as well as for the degree of signal loss surrounding the coil mass. Clinical histories were reviewed to determine the impact of MR angiographic findings on therapy. RESULTS: Patency status of the parent artery was correctly identified on 25 of 26 MR angiographic examinations with DSA confirmation. Thirty-four of 37 patent branch vessels were identified by MR angiography. Residual neck was correctly identified in seven studies of six aneurysms, with no false-negative or false-positive results. Intraaneurysmal flow was correctly identified in five of eight studies of six aneurysms with residual flow shown by DSA. Artifact and hemorrhage mimicked residual flow in two of 18 MR angiographic studies of aneurysms with no residual flow shown by DSA. In eight patients, MR angiography provided clinically useful information that affected therapy. CONCLUSIONS: MR angiography can identify flow within an aneurysm after treatment with GDCs as well as in the adjacent parent and branch vessels. This technique may be a useful adjunct to DSA in some clinical situations.
Adult↗
Endovascular occlusion of the carotid or vertebral artery with temporary proximal flow arrest and microcoils: clinical results.
PURPOSE: To determine the clinical effectiveness of parent artery occlusion of the carotid or vertebral artery by means of temporary proximal flow arrest and microcoils. METHODS: Nineteen parent artery occlusions (15 carotid, four vertebral) were performed in 19 patients who successfully passed a balloon test occlusion. In these patients, endovascular occlusion of the carotid or vertebral artery was accomplished with the use of temporary proximal flow arrest and microcoils. RESULTS: All 19 parent arteries were occluded. Eighteen patients (95%) had good outcomes and one (5%) had a poor outcome. Fourteen patients (74%) had no complications and five (26%) had complications, of whom only one was left with a permanent neurologic deficit. Three (60%) of the complications were the result of delayed ischemic events after parent artery occlusion and were not predicted by balloon test occlusion. CONCLUSION: Endovascular occlusion with temporary proximal flow arrest and microcoils can be done effectively and successfully. The predictive value of the balloon test occlusion is the major complicating factor, as it is with balloon occlusion. This technique offers an additional tool that can be used for endovascular occlusion of the carotid or vertebral artery and seems to be less difficult technically. It is our primary technique for parent artery occlusion.
Adolescent↗
Measuring intraaneurysmal flow: risk of perforation.
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Arteries↗
Vertebrobasilar junction aneurysms associated with fenestration: treatment with Guglielmi detachable coils.
Three patients with vertebrobasilar junction aneurysms and associated fenestration were treated with Guglielmi detachable coils. The structure and hemodynamics of fenestrations may account for their frequent association with aneurysms. The complex hemodynamics of these aneurysms requires evaluation of both vertebral arteries. One treatment complication occurred but resulted in no deficit. All patients have returned to normal activity and remain healthy at 14 to 46 months.
Aged↗
In vitro study of haemodynamics in a giant saccular aneurysm model: influence of flow dynamics in the parent vessel and effects of coil embolisation.
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Blood Flow Velocity↗
Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding.
The major causes of mortality and morbidity in patients surviving the rupture of a saccular aneurysm are subsequent bleeding and vasospasm. The purpose of this study was to evaluate the influence of early treatment of ruptured aneurysms with Guglielmi detachable coils on the incidence of subsequent bleeding. Thirteen patients were treated within 72 hours of initial aneurysm rupture with Guglielmi detachable coils. Excluding three patients who died 2, 4, and 12 weeks after initial hemorrhage, all others have been followed up for intervals between 6 and 36 months (mean, 16 mo). None of these have had either clinical or radiographic evidence of subsequent bleeding. Assuming that there is a 30% incidence of subsequent bleeding in conservatively (nonsurgically) treated patients, the 0% subsequent bleed rate observed in this subgroup was significant at a P value of 0.01. Only one procedure-related complication occurred in this series, and 9 of 13 (69%) aneurysms were 100% occluded at the time of initial treatment. All aneurysms were at least 90% occluded at the end of initial treatment. In addition to reducing the risk of subsequent bleeding, early treatment facilitated the institution of an aggressive approach for management of both vasospasm and increased intracranial pressure. Patient outcome, as measured by the Glasgow Outcome Scale, was good in 9 of 13 (69%), poor in 1 of 13 (8%), and death in 3 of 13 (23%) patients. The results of this study suggest that early Guglielmi detachable coil treatment of ruptured aneurysms may be effective in reducing the incidence of subsequent bleeding and can be performed with a low incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics.
There is strong evidence indicating hemodynamic stress as an underlying cause for saccular intracranial aneurysm growth, thrombosis, and/or rupture. We examined flow fields encountered in models of cerebral aneurysms having a lateral (originating from the side of an artery, not at a branch point) geometric configuration. Shear stress and pressure gradients acting on aneurysm walls under a variety of flow and geometric conditions were evaluated. For this purpose, a two-dimensional finite-element computer model of lateral aneurysms in a steady-flow state was developed. Three idealized aneurysm shapes were studied, half-spherical, spherical, and pear-shaped. The ostium width of the cerebral aneurysm, relative to the radius of the parent artery and the Reynolds number, were also varied. Maximal shear stresses and maximum pressures (for an ostium width of 2 times the radius of the parent artery) were typically found at the downstream site of the ostium, rather than at the dome of the aneurysm. In general, the highest shear stresses and the lowest pressures (at the distal portion of the ostium) were obtained in the spherical aneurysm, whereas the lowest shear stresses and the highest pressures were found in the half-spherical aneurysm. The location of maximal stresses (shear and pressure) at the distal region of the ostium suggests that growth and/or rupture may well proceed from this point. Such findings are in contrast to the commonly held opinion that aneurysm rupture occurs at the dome. Careful pathological investigation will need to be performed to clarify this finding. The results of this preliminary investigation also indicate that the flow field in lateral aneurysms is highly dependent on a number of factors related to flow and geometric parameters. Geometry seems to be a significant mediator of local magnitudes of stress. Thus, the tendency for growth or thrombosis may be influenced by variations in size or shape.
Aneurysm, Ruptured↗
Neuroendovascular training.
Neuroendovascular therapy in North America is performed by neuroradiologists and neurosurgeons. Representatives of both specialties are working together in defining training standards to apply to practitioners from either field so that patient care can be improved and complications minimized. Perhaps the ideal combination of therapists may be neuroradiologists with imaging skills collaborating with clinically skilled neurosurgeons.
Education, Medical, Graduate↗
Delayed visual loss due to trauma of the internal carotid artery.
The group of six patients in this study experienced delayed visual loss following head trauma. Visual loss occurred from 1 day to 13 years after the initial injury. All patients suffered indirect trauma to the internal carotid artery resulting in formation of either an aneurysm or pseudoaneurysm or a carotid-cavernous fistula. Review of the radiologic and clinical findings was performed in six patients. The diagnosis was established by computed tomography, magnetic resonance imaging, and angiography. All patients had follow-up clinical evaluation and imaging studies. Treatment by neurosurgical or interventional neuroradiologic procedures resulted in significant visual improvement in five patients. Different pathophysiologic mechanisms could be correlated with the delayed visual loss produced by the two types of lesions. The pathologic changes associated with the aneurysms/pseudoaneurysms included direct compression of optic nerves and/or chiasm and intracranial hematoma. A carotid-cavernous fistula caused delayed visual loss by either hematoma at the orbital apex or compression of the chiasm and/or optic nerves by saccular dilatation of the cavernous sinus. The delayed onset of decreased vision following head trauma should alert the physician to the possibility of a traumatic aneurysm/pseudoaneurysm or a carotid-cavernous fistula. Different neuro-ophthalmologic symptoms can usually be correlated with the pathologic changes demonstrated by neuroimaging procedures.
Adolescent↗
Neonatal intracranial choriocarcinoma.
A 1-month-old infant died from extensive intracerebral hemorrhage due to a metastatic choriocarcinoma to the brain that presumably originated in the placenta. The clinical course was characterized by hyperbilirubinemia, repeated episodes of seizures, and intracranial hemorrhage. A computed tomographic scan revealed a large vascular mass in the left parieto-occipital region and a small lesion in the left frontal lobe. The placenta was expelled during the delivery and was not examined. In view of the high level of maternal human chorionic gonadotropic hormone and the autopsy finding of metastasis, we presumed that the mass was a metastatic choriocarcinoma that had originated in the maternal placenta. To our knowledge, only one previous instance of this phenomenon has been reported.
Brain Neoplasms↗
Aneurysms of the vein of Galen: embryonic considerations and anatomical features relating to the pathogenesis of the malformation.
Vein of Galen aneurysms may be defined as direct arteriovenous fistulas between choroidal and/or quadrigeminal arteries and an overlying single median venous sac. Anatomic analysis of 23 cases of vein of Galen aneurysm and correlation with known embryologic data indicate that the venous sac most probably represents persistence of the embryonic median prosencephalic vein of Markowski, not the vein of Galen, per se. The frequent concurrent venous abnormalities are easily understood as (a) retention of fetal anatomical features and (b) frequent occlusions of the dural sinuses of the posterior fossa, especially the sigmoid sinuses.
Adolescent↗
Late paraophthalmic aneurysm rupture following endovascular treatment. Case report.
A fatal rupture of a large paraophthalmic aneurysm 11 months following treatment with detachable balloons is described. This case illustrates the potential consequences of incomplete aneurysm obliteration with endovascular techniques and emphasizes the need for adequate posttreatment evaluation when this method is used for aneurysm therapy.
Adult↗
Sensitivity of Gd-DTPA-enhanced MR imaging of benign extraaxial tumors.
The effect of gadolinium diethylenetriaminepentaacetic acid (DTPA) on the sensitivity of cranial magnetic resonance (MR) imaging was measured in a prospective blinded study. Twenty-two consecutive patients with benign extraaxial tumors underwent MR imaging on a 1.5-T system without and with intravenous administration of Gd-DTPA. Readers independently interpreted the unenhanced and enhanced images without clinical information. The interpretations were compared with the anatomically verified diagnoses. Gd-DTPA improved the sensitivity of MR imaging for benign extraaxial tumors, especially in cases of residual or recurrent acoustic neuromas, multiple tumors (e.g., neurofibromatosis), or inconclusive unenhanced MR images. Enhancement with Gd-DTPA impaired the identification of a skull base tumor.
Adenoma↗