Objective: We report a case of deformation of open-cell stent that occurred during carotid artery stenting (CAS) using Mo.Ma Ultra (MOMA) device in stenotic common carotid artery (CCA). Case presentation: A 66-year-old man was admitted to our hospital with recurrent right amaurosis fugax, and was diagnosed with symptomatic severe stenosis of the right carotid artery. CAS was performed under proximal protection with MOMA. A Protégé stent was placed in the stenosis from the internal carotid artery to the CCA. After the MOMA was removed, cone-beam computed tomography revealed a folding deformation of the Protégé stent in the CCA. The patient had no ischemic complications after the procedure. Later, using simple stenosis models, we tested whether any stents could be folded in such situations. We found that the stent could be folded inward under specific circumstances such that the stent does not expand enough to be placed in the stenosis with the device that has a relatively larger diameter outside of the stent. This situation can lead the stent to be folded when post-dilatation is performed. Conclusion: Because our experiment indicated that an open-cell stent can be folded inward in some cases, this possibility should be kept in mind by surgeons.

Objective Case presentation Conclusion Key Words JNET 5:118-125, 2011

Objective: We report a case of intracranial pial arteriovenous fi stula (pial AVF) with a giant varix completely obliterated by endovascular treatment. Case presentation: A 17-year-old man presented with mild left hemiparesis and dizziness. Cerebral angiography revealed an intracranial pial AVF with a giant varix arising from the right middle cerebral artery (MCA). By transarterial approach through the fi stula into the varix, detachable coils were placed in the varix and the right MCA just proximal to the fi stula. This strategy preserved the normal branches of the right MCA arising about 10 mm proximal to the fi stula. We then injected n-butyl cyanoacrylate. The pial AVF was obliterated after applying these procedures. Conclusion: Endovascular treatment is an effective and valuable alternative treatment for patients with pial AVF when a surgical approach is diffi cult.

要旨　頭部外傷に伴う頭蓋底骨折はときに仮性動脈瘤を合併する。今回我々は，頭蓋底骨折後受傷時に損傷を認めなかった右内頸動脈に遅発性に仮性動脈瘤を形成した1例を経験したので報告する。症例は74歳の男性。約3mの高さから墜落し顔面を強打した。救急隊接触時，外表上頭部・顔面に外傷を認め，発語不能であったため，重症頭部外傷が疑われ当院へ搬送された。来院時CT検査において右視神経損傷を伴う頭蓋底骨折，脳挫傷，外傷性くも膜下出血，右肩甲骨骨折，多発肋骨骨折を認めたが，仮性動脈瘤は認めなかった。上記各外傷に対し保存的加療を行い，第19病日軽快転医となった。第38病日初回の鼻出血を認めた。第47病日中等量の鼻出血を認め，鼻腔内ガーゼ充填で止血を得た。第79病日より隔日で鼻出血を認めるようになったが，耳鼻科診察では鼻粘膜に特記すべき異常を認めなかった。第84病日多量の鼻出血と血圧低下，冷汗を認め，造影CTで右内頸動脈に仮性動脈瘤を認めたため，当院へ再度転医となった。第85病日右浅側頭動脈–中大脳動脈吻合術および右内頸動脈瘤コイル塞栓術を行い，第90病日MRAで瘤への血流がないことを確認した。第96病日に転医し，第106病日独歩退院となった。本症例では頭部外傷後の鼻出血により，仮性動脈瘤を発見し得た。頭蓋底骨折後の血管評価は受傷時に損傷を認めなくても継時的な画像評価などを慎重に行う必要がある。