SPECT and transcranial color-coded real-time sonography studies are useful in predicting HPS.

An early 60s-year-old man suffered reversible dysfunction of the blood-brain barrier (BBB) induced by repeated injection of contrast medium during coil embolization of intracranial unruptured aneurysm. He presented with convulsion during coil embolization, and neurological symptoms of aphasia and right hemiparesis continued for 5 days, and then improved completely. All transient radiological abnormalities were limited to the territory of the left internal carotid artery, where contrast medium was injected repeatedly. Repeated computed tomography, magnetic resonance imaging, single-photon emission computed tomography, and cerebrospinal fluid test findings indicated that temporary dysfunction of the BBB might have occurred. Dysfunction of the BBB in the anterior circulation induced by contrast medium is rare. Tolerance to toxicity of contrast medium may depend on the individual patient, and repeated injection of contrast medium may cause dysfunction of the BBB, leading to toxic dysfunction directly in the brain.

SUMMARY:A 69-year-old woman had a symptomatic cervical carotid stenosis coupled with a coincidental unruptured cerebral aneurysm in the carotid distal segment. She underwent endovascular coiling for the aneurysm and then carotid stent placement (CAS) 1 month later. Both lesions were treated successfully and neither complications nor strokes occurred after the procedures. Staged endovascular treatment of coiling and subsequent CAS may be safe for patients with a cervical carotid stenosis coupled with cerebral aneurysms.

COs of the cervical carotid or vertebral arteries older than 3 months can be opened safely with FRT, and 1-year angiographic and long-term clinical outcome is favorable.

Stenting using the combination technique of reverse flow and downstream filtering can safely open even long chronic cervical VA occlusion and may be effective in the treatment of patients experiencing vertebrobasilar insufficiency due to bilateral chronic VA occlusion.