No abstract

No abstract

Objective: We report a case of accidental N-butyl-2-cyanoacrylate (NBCA) glue migration into the vertebral artery (VA) via dangerous anastomosis during transarterial embolization (TAE) for transverse sinus (TS)-dural arteriovenous fistula (DAVF), which was rescued by mechanical retrieval using a stent retriever and aspiration devices.Case Presentation: A 49-year-old right-handed female patient was admitted to our hospital with motor aphasia. MRI revealed congestion in the left temporal and occipital lobes, involving a small hemorrhage. DSA revealed a DAVF complicated by a sinus thrombus in the left TS. The DAVF was mostly fed by the left occipital artery (OA) and drained into the cortical veins of the temporal and occipital lobes through the patent part of the sinus. TAE was performed via the left OA with low-concentration NBCA. However, NBCA glue migrated into the left VA through a dangerous anastomosis, and a left VA angiogram revealed severe VA stenosis and floating NBCA glue. There was a fragile attachment of the NBCA glue to the arterial inner wall; therefore, we successfully retrieved the NBCA glue with a stent retriever and aspiration devices without complications. Finally, TAE was performed using another feeder, and the DAVF was completely obliterated. Conclusion: TAE using NBCA is useful for the treatment of DAVF; however, it should be noted that there is a risk of migration via potential anastomotic routes. Low-concentration NBCA glue can be retrieved using these devices in limited cases.

Background: With aging of the Japanese population, there is an increasing number of senile patients with subarachnoid hemorrhage (SAH) undergoing direct surgery. However, the long-term prognosis remains to be elucidated. This study aimed to clarify treatment outcome and long-term prognosis of direct aneurysm surgery in SAH patients aged 80 and over. Methods: Medical charts of 34 consecutive patients with SAH over 80 years old, who underwent direct aneurysm surgery between February 2010 and August 2017, were retrospectively reviewed. The patients were classified into a good outcome group (mRS [modified Rankin Scale]: 0-3) and a poor outcome group (mRS: 4-6), and the characteristics, perioperative data, and long-term prognosis of each patient were analyzed. Results: Twelve patients (36%) had good outcome and 22 patients (64%) had poor outcome at discharge. Factors associated with good outcome included good activities of daily living (ADL) (mRS: 0-3) before the hemorrhagic event, short hospital stays, early walking exercise (within 14 days), and no postoperative symptomatic cerebral infarctions. There was no significant difference in the surgical time between the two groups. Patients with good outcome at discharge were associated with a significantly better long-term survival rate compared to those of the poor outcome group. Conclusions: Even in SAH patients older than 80 years, good outcome can be expected if they had good ADL before the event and if they do not present postoperative cerebral infarctions. Independent walking at discharge can be considered a good indicator of good prognosis in the long long-term.