Deep venous thrombosis (DVT) is a common disorder with a significant mortality rate. Successful endovascular treatment of acute DVT is most likely to be achieved in patients with recently formed thrombus, (<10-14 days) with acute iliofemoral DVT. Endovascular treatment options include: Catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), percutaneous aspiration thrombectomy (PAT), vena cava filter protection, venous balloon dilatation and venous stent implantation. Current practice shows strong clinical tendency for the use of PCDT with or without other endovascular methods and an individualized approach for each DVT patient. PMT has not received general acceptance because of the associated risk of PE and damage to venous valves caused by thrombectomy devices. PAT is most commonly used as an adjunctive endovascular technique like balloon maceration to fragment thrombus, balloon angioplasty, stent implantation and vena cava filter placement. Interventional endovascular therapies for DVT have the potential to provide PE protection and prevention of PTS. Patient centered individualized approach for endovascular DVT treatment is recommended to optimize the ideal clinical result.Acute stroke is the leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15-59. Mortality during the first 30 days of ischemic stroke is 20 % and 30 % of survivors will remain permanently disabled. Acute stroke patients within the therapeutic window must receive IVrtPA unless there is a contraindication. In case of contraindication to IVrtPA or for patients out of the therapeutic window for thrombolytics, standart of care is the intraarterial treatment. Patients have to be transferred to a comprehensive stroke center with capacity of dedicated neurovascular imaging and interventional neuroradiology. Noncontrast head CT that is used to rule out hemorrhage is followed by imaging studies dedicated to show if there is reasonable penumbra to save. Intraarterial thrombolysis has the main advantage of extended therapy window, earlier and more efficient recanalization and less risk of hemorrhage due to lower doses of thrombolytics. Mechanical thrombectomy has several advantages over IV/IA fibrinolysis including faster recanalization and less risk of hemorrhage especially in large artery occlusions. ASA guidelines recommend choosing stent retrievers over other devices for mechanical thrombectomy. Better recanalization rates and less infarct volume after mechanical thrombectomy result in higher numbers of functionally independent patients compared with other treatments. Two landmark studies that were published recently, SWIFT PRIME and MR CLEAN, showed that IA treatment especially with the new stent retrievers lead to a significant increase in functional recovery and independence in daily life after an acute stroke.Cerebral venous and sinus thrombosis (CVST) comprises nearly 0.5-1 % of all stroke cases. CVST causes different neurological deficits depending on the sinu...

Arteriovenous malformations (AVM) are vascular malformations composed of a network of abnormal vessels connecting directly between the artery and vein without an intervening capillary bed. Cerebral arteriovenous malformations have an incidence of 0.8-1.3 per 100.000 person years. Clinical symptoms include intracranial hemorrhage, seizure, headache, and focal neurological deficit. Annual mortality rate associated with hemorrhage is 1-5%, and 10-30% of survivors will have disability. Treatment options for cerebral AVMs include open surgery, embolization, and radiosurgery. Depending on the grade and angioarchitectural characteristics, a combination of these modalities can be used. Endovascular treatment can be performed for size and grade reduction, presurgical devascularization, size reduction before radiosurgery, targeted embolization, and as stand-alone treatment for cure. Targeted embolization can address intranidal or flow-related aneurysms and high flow arteriovenous shunts. Complications of the endovascular treatment include hemorrhage related to vessel perforation or normal pressure breakthrough phenomenon, ischemia, microcatheter retention, and other general complications associated with angiographic procedures. Mortality associated with endovascular treatment is less than 2% and permanent neurological deficit can be seen up to 2-8.9% of cases. New endovascular techniques include balloon-assisted embolization, transvenous embolization, and double microcatheter techniques like pressure cooker technique.

This study sought to compare the most frequently used embolic particles in an animal model. In 16 New Zealand white rabbits, right renal arteries were embolized using four different embolic particles (polyvinyl alcohol [PVA] particles, 150-250 microm; PVA microspheres [PVAMs], 150-300 microm; Tris-acryl gelatin microspheres [TGMs], 100-300 microm; expanding microspheres [EXMs], 50-100 microm). Quantity of embolic material used, embolization time, and angiographic patterns were documented. Fourteen days later, a control angiography was done to document angiographic recanalization and all animals were sacrificed. Histopathological specimens were analyzed for microscopic appearance and granulometric size of the particles, extravasation of the particles, perivascular inflammation, and neocapillarization. The volume of the infarct area in each kidney was calculated. Results revealed a significantly lesser amount of embolic material used in the EXM group (p = 0.020). The angiographic recanalization rate in the EXM group (100%), compared with the PVA (0%) and TGM (0%) groups, was found to be statistically significant (p = 0.014). Although 75% of the renal arteries embolized with PVAMs were recanalized, this was not found to be statistically significant (p = 0.071). Occlusion levels in the PVA group were more proximal than with any of the microspheres. While there was no extravasation in the TGM group, extravasation rates in the PVA, PVAM, and EXM groups were 50%, 25%, and 75%, respectively. A mild degree of inflammation was noted in the PVA, PVAM, and TGM groups. EXMs caused a moderate degree of inflammation in two kidneys (50%). There was neocapillarization in the vessel lumen in all kidneys in the PVA and PVAM groups. The difference was significant (p = 0.014) compared with the TGM and EXM groups, which did not have any neocapillarization. Regarding infarct area volumes, the difference among the groups was significant (p = 0.022). EXMs caused significantly (p = 0.021) less infarction than the other embolic agents. We conclude that EXMs are less efficient due to a high recanalization rate and lesser volume of infarct compared with the other embolic agents in the rabbit kidney model. The most efficient embolization was seen in kidneys embolized with TGMs.

We report a case where migrated Onyx could be removed safely with a mechanical thrombectomy device after withdrawal of the damaged microcatheter. A microcatheter was retained in the superior cerebellar artery with attached Onyx fragments on its tip during embolization of a bled cerebellar AVM. During retrieval maneuvers microcatheter shaft was ruptured and Onyx fragments were released into the vertebrobasilar system causing occlusion. Finally, Onyx fragment on tip of the microcatheter could be detached with dimethyl sulfoxide injection and the microcatheter could be withdrawn. A Merci retriever device (Concentric Medical, Mountain View, CA, USA) was successfully used to retrieve most of the dislodged Onyx material and recanalize the vertebrobasilar circulation.