ObjectiveTo investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis.Materials and MethodsFor 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography.ResultsComplete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention.ConclusionIn patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.

Parastichy, the spiral arrangement of plant organs, is an example of the long-range apparent order seen in biological systems. These ordered arrangements provide scientists with both an aesthetic challenge and a mathematical inspiration. Synthetic efforts to replicate the regularity of parastichy may allow for molecular-scale control over particle arrangement processes. Here we report the packing of a supramolecular truncated cuboctahedron (TCO) into double-helical (DH) nanowires on a graphite surface with a non-natural parastichy pattern ascribed to the symmetry of the TCOs and interactions between TCOs. Such a study is expected to advance our understanding of the design inputs needed to create complex, but precisely controlled, hierarchical materials. It is also one of the few reported helical packing structures based on Platonic or Archimedean solids since the discovery of the Boerdijk–Coxeter helix. As such, it may provide experimental support for studies of packing theory at the molecular level.

Introduction Penetrating neck injuries (PNI) are common and associated with arterial and other neuronal injuries. Although many authors have written on penetrating and blunt carotid artery injuries as a result of PNI or traumatic neck injuries, no one has reported a case or case series on PNI that resulted in blunt carotid dissection and stenosis. Case Presentation We present a case of 40-year-old building and construction male worker who slipped and fell on an iron rod that resulted in penetrating wound on the right side of the anterior neck a week prior to presenting at our facility. He pulled out the iron rod immediately. Computer tomography angiography (CTA) done revealed C2-C4 transverse process fractures on the right side and a fracture at the right lamina of C3 and right common carotid artery dissection with stenosis. He was successfully treated with stenting via endovascular approach. Conclusions We adopt the view that patient should never pull out objects that result in PNI because of complex neurovascular architecture of the neck. The mortality rate of our patient will have doubled if the iron rode penetrated the common carotid artery. The gold standard treatment option for carotid artery dissection and stenosis is endovascular approaches.

Rationale: Dural arteriovenous fistulae (DAVF) are vascular disorders depicted with direct interconnection between dural arteries and cerebral venous sinuses and/or cortical veins. Only a hand full of cases have been reported in literature. DAVF obstructing the 3rd ventricle and quadrigeminal cistern resulting in hydrocephalus is very rare. Patient concerns: We present a 55-year-old female with 2 years history of headaches and blurring of vision. Cranial nerves examinations were unremarkable. Diagnoses: Magnetic Resonance Imaging (MRI) and digital subtraction angiography showed multiple tortuous vascular malformation in the 3rd ventricle and quadrigeminal cistern resulting in obstructive hydrocephalus (OHC). Interventions: We utilized endovascular embolization treatment option to obliterate the lesion. We used Onyx embolization agent (ev3 Neurovascular, Irvine, CA) to embolize the lesion via the transarterial route. Outcomes: The OHC resolved spontaneously after the endovascular embolization of the DAVF. The patient recovered with no further neurologic complication. Two years follow-up reveal no recurrence of the DAVF as well as hydrocephalus. Lessons: Adequate knowledge on the vascular anatomy is very crucial in managing DAVF.

IntroductionIatrogenic vertebral artery injury (IVAI) is a rare intricacy after cervical spine screw fixation surgery. The overall incidence of vertebral artery (VA) injury as a result of after cervical spine screw fixation surgery is about 0.2% that is about 17/8213 operations annually [1]. VA injury can lead to severe blood loss, intradural or extradural hemorrhage, and the development of arteriovenous fistulae or pseudoaneurysms [2][3][4][5][6][7][8]. Furthermore, the consequences of VA injure can be fetal and even result in death because of the difficulty in controlling the pulsating hemorrhage which can cause severe hypotension resulting in cardiac arrest and finally death. Therefore, timely diagnosis and intervention of these spontaneous occurrences is crucial in determining the interventional outcome. We represent a case report of iatrogenic vertebral artery pseudoaneurysm, which we successfully managed via urgent endovascular embolization with no neurological deficit. We also discussed the causes for the iatrogenic VAI as well as suitable management options with very minimal or no neurological deficits. Case ReportWe report a case of 52-year-old male who suffered iatrogenic vertebral artery injury (VAI) as a result of surgical removal of C1-2 screw that was successfully fixed at posterior cervical spine on account of traumatic atlantoaxial dislocation four (4) years ago (Figure 1). The surgical removal was on going at a periphery hospital when the patient suffered this intricacy with massive bleeding and was immediately transferred to our facility. The patient opted for the removal of the screws because of stiffness of his neck. He was not able to flex, extend or rotate his neck one (1) month prior to the surgery. Intraoperatively, while removing of the screw was on going, a sudden, non-pulsatile welling of bright red blood was appeared. Although the blood was adequately tamponaded, the patient remained hemodynamically and neurologically stable during the procedure. CT angiogram done at our facility revealed a pseudoaneurysm arising from the right vertebral artery (V3 segment), just superior to the posterior arch of C1 while DSA revealed a pseudoaneurysm and extravasation of contrast media in the right vertebral artery at the level of C1-2 (Figure 2). Emergency laboratory investigations done at our facility were all at normal ranges. An emergency interventional operation was carried after his relatives had signed the concern form. The procedure was performed using 1% lidocaine as local anesthetic and standard Seldinger technique to access the left femoral artery and placement of 6-French sheath. A 6 F Envoy catheter was advanced over a 0.035 guidewire and placed at the distal cervical segment of the right vertebral artery. A DSA run showed the pseudoaneurysm arising from the V3 segment. The aneurysm was selected with a 0.014-inch microcatheter (Enchalon-10, eV3, Plymouth, MN) and a 0.010-inch microguidewire (Transend, Boston Scientific, Natick, MA). Overall, one detachable coil, measuring 15 mm × 30 mm, ...