scholarly journals Dose reduction in cone-beam CT scanning for intracranial stent deployment before coil embolization of intracranial wide-neck aneurysms

2016 ◽  
Vol 22 (4) ◽  
pp. 420-425 ◽  
Author(s):  
Takumi Kuriyama ◽  
Nobuyuki Sakai ◽  
Norimitsu Niida ◽  
Masaki Sueoka ◽  
Mikiya Beppu ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cone Beam Ct ◽  
Ct Scanning ◽  
Cone Beam ◽  
Stent Deployment ◽  
Intracranial Stent ◽  
Aneurysm Embolization ◽  
Coil Occlusion ◽  
Treatment Procedures ◽  
Wide Neck

Purpose Flat panel detector (FD)-equipped angiography machines are increasingly used for neuro-angiographic imaging. During intracranial stent-assisted coil embolization procedures, it is very important to clearly and quickly visualize stent shape after deployment in the vessel. It is necessary to quickly visualize stents by cone-beam computed tomography (CBCT). The aim of this study was to compare CBCTs at 10 and 20 s, and to confirm that this method is useful for neuro-endovascular treatment procedures. Materials and methods We treated 30 patients with wide-necked intracranial aneurysms with a flexible, self-expanding neurovascular stent and subsequent aneurysm embolization with platinum micro-coils. We performed the CBCT after stent deployment. We compared the 10 s and 20 s CBCTs, using the full width one-half maximum (FWHM) visualization. Results Accurate stent placement with subsequent coil occlusion of the aneurysms was feasible in all patients. Stent struts were clearly visualized on both 10 s and 20 s CBCTs. Importantly, 10 s CBCT can reduce the radiation dose by about 42%, compared with 20 s CBCT. Performing 10 s CBCT with a 14% dilution of the contrast medium may significantly improve image acquisition during stent-assisted coil embolization. Conclusions Reduced-dose, 10 s CBCT can visualize stents in clinical cases, while significantly reducing radiation exposure.

scholarly journals Influence of cone beam CT scanning parameters on grey value measurements at an implant site

2013 ◽  
Vol 42 (3) ◽  
pp. 79884780 ◽  
Author(s):  
A Parsa ◽  
N Ibrahim ◽  
B Hassan ◽  
A Motroni ◽  
P van der Stelt ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Ct Scanning ◽  
Cone Beam

scholarly journals Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization

2015 ◽  
Vol 21 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Hideaki Ishihara ◽  
Shoichiro Ishihara ◽  
Jun Niimi ◽  
Hiroaki Neki ◽  
Yoshiaki Kakehi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Operation Time ◽  
Vascular Reconstruction ◽  
Parent Artery ◽  
Unruptured Cerebral Aneurysm ◽  
Aneurysm Embolization ◽  
Wide Neck

Objective Advances in vascular reconstruction devices and coil technologies have made coil embolization a popular and effective strategy for treatment of relatively wide-neck cerebral aneurysms. However, coil protrusion occurs occasionally, and little is known about the frequency, the risk factors and the risk of thrombo-embolic complications. Method We assessed the frequency and the risk factors for coil protrusion in 330 unruptured aneurysm embolization cases, and examined the occurrence of cerebral infarction by diffusion-weighted magnetic resonance imaging (DW-MRI). Result Forty-four instances of coil protrusion were encountered during coil embolization (13.3% of cases), but incidence was reduced to 33 (10% of cases) by balloon press or insertion of the next coil. Coil protrusion occurred more frequently during the last phase of the procedure, and both a wide neck (large fundus to neck ratio) (OR = 1.84, P = 0.03) and an inadequately stable neck frame (OR = 5.49, P = 0.0007) increased protrusion risk. Coil protrusions did not increase the incidence of high-intensity lesions (infarcts) on DW-MRI (33.3% vs 29% of cases with no coil protrusion). However, longer operation time did increase infarct risk ( P = 0.0003). Thus, tail or loop type coil protrusion did not increase the risk of thrombo-embolic complications, if adequate blood flow was maintained. Conclusion Coil protrusion tended to occur more frequently in cases of wide-neck aneurysms with loose neck framing. Moderate and less coil protrusion carries no additional thrombo-embolic risk, if blood flow is maintained, which can be aided by additional post-operative antiplatelet therapy.

NEUROFORM STENT-ASSISTED COIL EMBOLIZATION OF WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 460-469 ◽  
Author(s):  
Alessandra Biondi ◽  
Vallabh Janardhan ◽  
Jeffrey M. Katz ◽  
Kimberly Salvaggio ◽  
Howard A. Riina ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Effective Technique ◽  
Stent Deployment ◽  
Unruptured Aneurysms ◽  
Aneurysm Occlusion ◽  
Neuroform Stent ◽  
Wide Neck

Abstract OBJECTIVE To evaluate the midterm results of intracranial stent-assisted coil embolization in the treatment of wide-necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment. METHODS A retrospective study of 42 patients with 46 wide-necked cerebral aneurysms enrolled in a prospective single-center registry of patients treated with a Neuroform stent (Boston Scientific/Target, Fremont, CA), a flexible self-expanding nitinol stent, was performed. Twenty-seven of 46 aneurysms were unruptured aneurysms, 14 were recanalized aneurysms, and five were acutely ruptured. Thirty-nine aneurysms were located in the anterior and seven in the posterior circulation. Mean aneurysm size was 9.8 mm. Stenting before coiling was performed in 13 of 45 aneurysms (29%), coiling before stenting in 27 of 45 aneurysms (60%), and stenting alone in five of 45 aneurysms (11%). The balloon remodeling technique for coiling before stenting was performed in 77% of patients. Angiographic and clinical follow up was available in 31 patients with 33 aneurysms and ranged from 3 to 24 months. RESULTS Neuroform stenting was attempted in 46 wide-necked aneurysms (42 patients). Forty-nine stent sessions were performed, including three poststent retreatments. In 46 of 49 sessions (94%), successful deployment of 47 stents for 45 aneurysms was obtained. In 40 aneurysms treated with stent-assisted coiling, angiographic results showed 14 (35%) aneurysm occlusions, 18 (45%) neck remnants, and eight (20%) residual aneurysms. In five recanalized aneurysms treated with stenting alone, no changes were observed in four (80%) aneurysms and one (20%) neck remnant reduced in size. At angiographic follow-up in 30 aneurysms treated with stent-assisted coiling, there were 17 (57%) aneurysm occlusions, seven (23%) neck remnants, and six (20%) residual aneurysms. In three recanalized aneurysms treated with stent alone, two (67%) neck remnants remained unchanged and one (33%) neck remnant decreased in size. Procedural morbidity was observed in two of 42 patients (4.8%) and one patient died. On clinical follow-up, the modified Rankin Scale score was 0 in 27 patients (87%), 1 in three patients (10%), and 2 (3%) in one patient. No aneurysm bled during the follow-up period. CONCLUSION These results indicate that Neuroform stent-assisted coil embolization is a safe and effective technique in the treatment of wide-necked cerebral aneurysms. Further studies are needed to evaluate the long-term durability of stent-assisted aneurysm occlusion and tolerance to the stent.

Transvenous coil embolization with intra-operative cone beam CT assistance in the treatment of hypoglossal canal dural arteriovenous fistulae

2018 ◽  
Vol 11 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Matthew Thomas Crockett ◽  
Albert Ho Yuen Chiu ◽  
Tejinder P Singh ◽  
William McAuliffe ◽  
Timothy John Phillips
Keyword(s):  
Coil Embolization ◽  
Low Dose ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Complication Rates ◽  
Effective Treatment Option ◽  
Arteriovenous Fistulae ◽  
Hypoglossal Canal ◽  
Patient Cohort ◽  
Entire Patient Cohort

BackgroundHypoglossal canal dural arteriovenous fistulae (HC-dAVF) are a rare subtype of skull base fistulae involving the anterior condylar confluence or anterior condular vein within the hypoglossal canal. Transvenous coil embolization is a preferred treatment strategy, however delineation of fistula angio-architecture during workup and localization of microcatheter tip during embolization remain challenging on planar DSA. For this reason, our group have utilized intra-operative cone beam CT (CBCT) and selective cone beam CT angiography (sCBCTA) as adjuncts to planar DSA during workup and treatment. The purpose of this article is to present our experience in the treatment of HC-dAVF using transvenous coil embolization (TVCE) with cone beam CT assistance, describing our technique as well as presenting our angiographic and clinical outcomes.MethodsTen patients with symptomatic HC-dAVF were treated using TVCE with intra-operative cone beam CT assistance. Prospectively collected data regarding clinical and angiographic results and complication rates was recorded and reviewed.ResultsComplication-free fistula occlusion was achieved in our entire patient cohort. The dominant symptom of pulsatile tinnitus resolved in all 10 patients.ConclusionsThis study demonstrates that TVCE with CBCT assistance is a highly effective treatment option for HC-dAVF, achieving complication-free fistula occlusion in our entire patient cohort. We have found low-dose sCBCTA and CBCT to be an extremely useful adjunct to planar DSA imaging during both workup and treatment of these rare fistulae.

scholarly journals The detection of vertical root fractures in post-core restored teeth with cone-beam CT: in vivo and ex vivo

2019 ◽  
Vol 48 (6) ◽  
pp. 20180327 ◽  
Author(s):  
Svetlana F. Byakova ◽  
Nina E. Novozhilova ◽  
Irina M. Makeeva ◽  
Vasiliy I. Grachev ◽  
Inna V. Kasatkina
Keyword(s):  
Image Quality ◽  
Ex Vivo ◽  
Cone Beam Ct ◽  
Ct Scanning ◽  
Cone Beam ◽  
Human Teeth ◽  
Fracture Width ◽  
Root Fractures

Objectives: To compare the accuracy of cone-beam CT ex vivo and in vivo for the detection of artificially created large and small vertical root fractures in extracted teeth restored with post-core. Methods: Individual metal cast post-cores were fixed in the root canals of 50 extracted single-rooted human teeth. In 30 teeth fractures were created by tapping posts with a hammer. The teeth were sterilised in autoclave and embedded into bite-plates made of silicon impression material. Cone-beam CT scanning was performed ex vivo and in vivo . For the in vivo scanning, teeth in sterile plastic bags were inserted into the mouths of volunteers. Then the teeth were sectioned with low-speed saw and the widths of the VRFs were measured microscopically. The teeth were distributed into 2 groups in accordance with the measured fractures’ widths: large (wider than 180–250 µm) and small (80–150 µm). Five observers assessed the presence of vertical root fractures on axial CBCT slices. Sensitivity, specificity, accuracy and inter examiner agreement were calculated. Results: The accuracy of cone-beam CT in vitro for large and small vertical root fractures detection was 0.56 and 0.40 respectively (p = 0.043). The sensitivity values were 0.53 and 0.27 for large and small vertical root fractures, respectively (p = 0.043). The visualisation of fracture lines in vivo was impossible in 90 % of cases, because of low image quality. Inter examiner reliability analysis showed κ values ranging from 0.02 to 0.54. Conclusions: Fracture width affected the in vitro detectability of vertical root fractures by cone-beam CT in teeth with metal cast post-cores. The detectability of root fractures in vivo was decreased because of low image quality, making the assessment of sound tooth tissue impossible.

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