Atulabh Vajpeyee

Abstract

Purpose: Wide neck aneurysms can be treated with several methods. In this study, we share our experience of intra aneurysmal double microcatheter technique to treat complex intracranial wide-neck aneurysms with unusual shapes. Materials and Methods: Ten patients with wide-neck intracranial aneurysms were treated using the endovascular method of the double microcatheter between December 2013 to September 2014. All patients had presented with acute subarachnoid hemorrhage on plain CT brain. Detailed demographic information and aneurysm morphology by DSA were noted. Aneurysms were coiled using a double microcatheter technique. Follow up done up to 1 year. Result: All aneurysms were completely embolised using a double microcatheter technique. DSA has done immediately post embolization showed class I filling in 9 patients and class II filling in 1 patient using the Raymond-Roy Classification system. The mean neck diameter was2.91 mm (range 2 to 4 mm) and the mean dome of neck ratio was 1.34 (range 0.89 to 2.14). All these patients were relatively in good grade before the procedure, an improvement was noted during the one year of follow-up. Conclusion: In our series, this modified intra aneurysmal double catheter technique is safe, effective, not costly, and not technically demanding. Keywords: Complex aneurysm, Double microcatheter, Wideneck aneurysm.

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Abstract

Stroke is a major medical health problem. The goal of stroke prevention can be achieved by modification of vascular risk factors and by use of antiplatelet and anticoagulant drugs. Unfortunately many patients with intracranial disease are refractory to medical management. In recent past there has been significant advancement in intracranial angioplasty and stenting due to better understanding of the disease and availability of better tools and technology. We are reporting 2 cases with 3 lesions dealt with intracranial angioplasty with or without stenting with excellent clinical results, of which we have follow up of more than 1 year. In our cases there was no periprocedural morbidity and mortality with no restenosis till 2 years of follow-up. In addition it also adds to quality of life as evident in our patients. Cerebral angioplasty and stenting may be beneficial to manage an intracranial atherosclerotic stenosis and to improve quality of life of patients. This initial result for cerebral angioplasty and stenting is promising and requires further studies. Keywords: Stroke, Intracranial atherosclerotic stenosis, Vascular risk, Neuro-radiological technique.

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Abstract

Background: The atherosclerotic stenotic disease forms an important cause of secondary prevention of stroke. In the recent past with the availability of various imaging modalities and cerebral digital subtraction angiography (DSA) for the evaluation of stroke patients, the number of atherosclerotic stenotic diseases is at rising. This study analyses retrospectively and prospectively angiographic data in ischemic stroke patients referred to our center, which is a territory care hospital. Materials and Methods: Between January 2016 to March 2019, 224 cerebral DSA was performed in the patients referred to us in university medical college, who had small or large vessel disease diagnosed by Doppler, CTA, or MRA. The degrees of stenosis of bilateral cervical carotid arteries, vertebrobasilar system, and their major intracranial branches were recorded. Lesions were described as being single or multiple according to the number of lesions. Results: Of the total 1024 patients, 224 patients were enrolled in the study, 54 were females. The mean age was 54years. A total of 404 lesions were present in 224 patients. Amongthese patients, single lesions were found in 64 (15.8%) and multiplelesions in 340 (84.15%). Of the single lesion, 40 were extracranial and 14 were intracranial stenosis. Out of 340 multiple lesions 88 (25.88%) were intracranial, 186(57.70%) extracranial, and combined in 66(19.41%). Lesions were located in the anterior circulation in 132 patients(58.9%) and the posterior circulation 62 patients (27.67%) and at the combined location in 30 patients (13.39%). Conclusion: This study is the first report from the Indian subcontinent depicting a higher incidence of intracranial stenosis based on angiography. The reason for relatively higher incidence could be shared geographical region (Asia) in concordance with Chinese and Korean studies but relatively lower incidence from this population may be due to different prevalence of risk factors in this population. Keywords: Angiography, Multiple lesions, Single lesions, Atherosclerotic stenotic disease.

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