The coexistence of carotid artery stenosis and cerebral aneurysm in a patient presents challenges for treatment decision-making. The purpose of this study was to evaluate the technical feasibility and clinical outcome after single-stage extracranial carotid artery stenting (CAS) and ipsilateral intracranial aneurysm coiling in a single institution. From March 2005 to February 2011, 17 patients with 21 aneurysms underwent single-stage CAS and coiling for ipsilateral aneurysms. There were symptomatic atherosclerotic carotid stenoses with unruptured aneurysms in eight, ruptured or symptomatic aneurysms with simultaneous asymptomatic carotid stenoses in two and asymptomatic lesions in seven. CAS was followed by aneurysm coiling in all 17 patients. Clinical and radiological data were reviewed. There were two procedure-related complications: acute in-stent thrombosis in one and premature aneurysmal rupture in the other. After aneurysm coiling, complete occlusion was demonstrated in 17 aneurysms and near-total occlusion in four. No neurological deficit was found at discharge and follow-up outcomes were excellent in all the patients (mean, 32.9 months). Follow-up imaging studies were performed in all the patients, including neck CT angiography in 14 (mean, 26.1 months), brain MR angiography in 14 (mean, 31.2 months), and conventional angiography in three (mean, 14.7 months). They revealed two asymptomatic, mild carotid re-stenoses and one major aneurysmal recanalization requiring re-coiling. A single-stage CAS and coiling procedure appears to be feasible and the complication rate seems to be reasonable. We suggest that there is no need for separate therapeutic procedures when a patient has carotid artery stenosis and accompanying ipsilateral intracranial aneurysm.

Several endovascular approaches have been used in the treatment of dissecting aneurysms of the vertebrobasilar system. We present a case of a bilateral spontaneous vertebral artery (VA) dissecting aneurysms presenting with a subarachnoid haemorrhage. The dominant left VA aneurysm was treated with a stent-within-a-stent construct and the contralateral VA aneurysm was proximally occluded, with no complications, by an unintentional mechanically-induced arterial occlusion.

Study design: Case report Objective: To examine the resolution of holocord myelopathy based on the hypothesis of altered cerebrospinal fluid (CSF) dynamics. Setting: Seoul National University Hospital, Seoul, Korea. Method: We describe a case of thoracic stenosis with holocord myelopathy, which suggests an alternative mechanism for the myelopathy. Result:Decompression of the thoracic stenosis resulted in the resolution of holocord myelopathy. Conclusion: Myelopathy may be caused by altered CSF dynamics and this type of myelopathy seems to be interstitial edema. Improvement of altered CSF flow dynamics could resolve this type of myelopathy.

In this study, we present our experiences of personal computer-based 3D reconstructions of MRA for pre-treatment planning and post-treatment follow-up for cerebral aneurysms. Twenty-nine ruptured or unruptured intracranial aneurysm patients with 36 intracranial aneurysms, who underwent embolization and pretreatment and/or follow up 3D MRA were included in this study. All 29 patients were examined by DSA and MRA before (18 patients, 24 aneurysms) and/or after embolization (16 patients, 17 aneurysms). The MRA source images were transported to a personal computer in DICOM format for viewing, post-processing, and 3D reconstruction. DSA and PC based SSD 3D MRA equally well demonstrated most aneurysms before embolization (17 patients, 22 aneurysms). The depiction of aneurysm morphology, neck evaluation and branch vessel interpretation were much easier on 3D MRA, which has the ability to manipulate images in real time. When the vascular anatomy was complicated by another vascular system, the anterior or posterior circulations were separately reconstructed easily by using PC based reconstruction software. The 3D MRA also well demonstrated post-embolization recurrence or remnant aneurysmal cavities. In one giant aneurysm, the 3D MRA was unable to show the entire aneurysmal sac due to a blood flow saturation effect, but this was resolved by additional contrast material injection. PC-based 3D MRA proved to be a useful tool for the pretreatment planning of embolization procedures and for follow up after treatment in the case of cerebral aneurysms.