Angiographic risk factors causing VI/ICH are CVD only, varix formation, agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the superior orbital vein, lateral half of the superior petrosal sinus, and distal CVD.

Acute symptomatic occlusion of the cervical internal carotid artery (ICA) can be treated by intravenous administration of tissue plasminogen activator, percutaneous transluminal angioplasty, and carotid endarterectomy. Carotid artery stenting (CAS) is now indicated for cervical ICA stenosis, but the safety and the efficacy of urgent CAS have not been established. We retrospectively reviewed 10 patients treated by urgent CAS for atherosclerotic occlusive lesions of cervical ICA with acute stroke. Five patients had complete occlusions and five had near total occlusions. Five of the 10 patients had intracranial tandem occlusions. Indication for urgent CAS was determined by mismatch of diffusion-weighted and perfusion-weighted magnetic resonance imaging findings. Stents were successfully deployed in all lesions. Three of five patients with concomitant intracranial tandem occlusions were treated by additional intraarterial fibrinolysis after the CAS. Intracranial artery occlusions were completely recanalized in one patient, and partially recanalized in two by fibrinolysis. Hyperperfusion syndrome did not occur in any of the patients. A favorable outcome (modified Rankin Scale Ã1) was obtained in all of the five patients with isolated cervical ICA occlusion and one of the five patients with intracranial tandem occlusions. Urgent CAS is a safe and effective treatment in patients with isolated cervical ICA occlusion. Treatment of intracranial tandem occlusions is an issue that must be resolved.

We report six cases of transverse-sigmoid dural arteriovenous fistulae (TS DAVF) treated with percutaneous transvenous embolisation through the occluded sinus. All patients had sinus occlusive lesions: an isolated sinus in five cases and a distal occlusion of the affected sinus in one. Leptomeningeal retrograde venous drainage via the vein of Labbé or the sylvian vein was observed in all patients with an isolated sinus. In five patients a microcatheter was easily passed through the occluded sinus. In four of them, a complete angiographic cure was achieved by packing the sinus with coils. However, in one, sinus packing was ineffective and surgical excision of the affected sinus was necessary. The microcatheter could not be passed through the occluded sinus in one case, and direct packing of the isolated sinus was later required. In all cases, complete cure was achieved without complications. This safe, not very invasive and highly effective treatment for TS DAVF with sinus occlusion is thus worth trying when the occluded segment is relatively short.

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Three of 16 patients with vertebral artery (VA) aneurysms treated by parent artery occlusion suffered ischemic complications. The cause of the ischemic complications was brain stem or upper cervical spinal cord infarction due to occlusion of the anterior spinal artery (ASA), posterior spinal artery (PSA) and perforating arteries arising from the VA. Angiographic detection of ASA and PSA was studied in 71 consecutive patients (142 VAs) with various diseases who underwent digital subtraction angiography. The ASA and PSA originated from the bilateral VAs in 14% and 9%, unilateral VA in 73% and 35%, and were not detected in 13% and 56%, respectively. These results indicate that the rate of angiographic detection of the ASA originating from the bilateral VAs is considerably lower than that of previously reported anatomical studies. Special attention must be paid to the ASA, PSA and perforating arteries on preoperative vertebral angiography to prevent ischemic complications associated with therapeutic parent artery occlusion for VA aneurysms.