The authors believe that by close collaboration between endovascular therapists and vascular neurosurgeons, high-risk DAVFs in the lateral sinus and the confluence of sinuses can be successfully managed without treatment-related morbidity and mortality.

Objective PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. Method We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. Results There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%–94%) and 91% (95% CI, 85%–96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%–56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%–72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%–37%) of aneurysms immediately after coiling, and 25% (17–33) after six-month follow-up. Complications occur in 5% (95% CI, 1%–8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. Conclusions PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

The authors describe their experience in treating dural arteriovenous fistulas (DAVFs) in the lateral sinus and the confluence of sinuses in 17 patients who presented with signs and symptoms related to intracranial hemorrhage, infarction, and diffuse brain swelling. Angiographic examination revealed three different types of DAVFs in these high-risk patients: 1) extremely high flow DAVF not associated with sinus occlusion or leptomeningeal retrograde venous drainage (LRVD); 2) localized DAVF with exclusive LRVD and without sinus occlusion; and 3) diffuse DAVF with sinus occlusion and LRVD. Because of the complex nature of these lesions, the authors adopted a staged protocol in which they combined endovascular and surgical treatments. The authors believe that by close collaboration between endovascular therapists and vascular neurosurgeons, high-risk DAVFs in the lateral sinus and the confluence of sinuses can be successfully treated without treatment-related morbidity and mortality.

Background: Acquired uterine arteriovenous malformation (AVM) is a rare conditiondue to traumatic episodes in cesarean section. The patient can suffer from lifethreateninghemorrhage or recurrent vaginal bleeding. Establishing this diagnosis isdifficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of thecases were found with history of massive bleeding and diagnosed lately after recurrentbleeding history. Even though promising, one of our cases failed to be managed withTAE. It is important to diagnose early symptoms of AVM in order to prevent the lifethreatening event.Case presentation: In these case series, four cases of AVMs after cesarean procedureswill be reviewed. One could be diagnosed in less than a month but the other three tookseveral months. The symptom of vaginal bleeding might occur a few weeks after theprocedure is done, and most patients need transfusion and hospitalization. Three out offour patients were initially sent to the hospital in order to recover from shock condition,and one patient was sent for a diagnostic procedure. AVMs diagnostic was establishedwith ultrasound with or without angiography. Three of our cases were succeeded byperforming TAE procedure without further severe vaginal bleeding. One case failed tobe treated with embolization and had to proceed with hysterectomy.Conclusion: AVM should be considered early-on in patient with abnormal uterinebleeding and history of cesarean section. Embolization is still the first-choice treatmentof AVMs, otherwise definitive treatment is hysterectomy in a patient without fertilityneed, or impossible to perform TAE.