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    Aggregometry Response to Half-dose Prasugrel in Flow-diverting Stent Implantation
    (Springer Heidelberg, 2020) Oran, Ismail; Cinar, Celal; Gok, Mustafa; Duzgun, Fatih
    Purpose the aim of this study was to determine whether half-dose loading (30/mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10/mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation. Methods Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented. Results A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). the 6-month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate. Conclusion Half-dose (30/mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm.
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    Applications of the Amplatzer Vascular Plug to various vascular lesions
    (Turkish Soc Radiology, 2014) Guneyli, Serkan; Cinar, Celal; Bozkaya, Halil; Parildar, Mustafa; Oran, Ismail
    The Amplatzer (R) Vascular Plug (AVP) can be used to embolize medium-to-large high-flow vessels in various locations. Between 2009 and 2012, 41 AVPs (device size, 6-22 mm in diameter) were used to achieve occlusion in 31 patients (24 males, seven females) aged 9-92 years (mean age, 54.5 years). The locations and indications for embolotherapy were as follows: internal iliac artery embolization before stent-graft repair for aorto-iliac (n=6) and common iliac artery (n=3) aneurysms, subclavian artery embolization before stent-graft repair for thoracic aorta (n=3) and arcus aorta (n=1) aneurysms, brachiocephalic trunk embolization before stent-graft repair for a thoracic aorta aneurysm (n=1), embolization of aneurysms and pseudoaneurysms (n=5), embolization for carotid blow-out syndrome (n=3), closure of arteriovenous fistula (n=8), and closure of a portosystemic fistula (n=1). Of the 41 AVPs, 30 were AVP 2 and 11 were AVP 4. The mean follow-up duration was 4.7 months (range, 1-24 months). During follow-up, there was one migration, one insufficient embolization, and one recanalization. The remaining vascular lesions were successfully excluded from the circulation. The AVP, which can be used in a wide spectrum of pathologies, is easy to use and causes few complications. This essay presents our experience with the AVP.
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    Behcet's disease-associated aneurysm of the internal carotid artery within the cavernous sinus: Report of a patient
    (Taylor & Francis Inc, 2007) Goekcay, Figen; Celebisoy, Nese; Oran, Ismail; Aksu, Kenan
    Behcet's disease ( BD) is a type of vasculitis with a chronic relapsing course that affects arteries and veins of all sizes. Intracranial aneurysms are rare manifestations. We report a patient with the diagnosis of BD, who had a fusiform aneurysm of the internal carotid artery at the level of the sinus cavernosus. He presented with sinus cavernosus syndrome findings. The aneurysm was treated endovascularly.
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    Blister aneurysms
    (Journal Neurological Sciences, 2009) Oktar, Nezih; Oran, Ismail; Ozdamar, Nurcan; Dalbasti, Tayfun
    The majority of saccular cerebral aneurysms arise at arterial branchings; those arising elsewhere are rare. Blister aneurysms are elusive and technically challenging rare lesions characterized by a hemispherical shape and fragile walls for both neurosurgeon and endovascular radiologist to treat. Blister aneurysms also exhibit rapid change in size and morphology in followup angiograms. Small size of blood-blister aneurysm and atypical location may result in incomplete visualization of these lesions. Therefore, multiple oblique views are essential during angiography. The weak nature and small size of blister aneurysms with a broad neck renders endovascular treatment technically challenging. Wrapping with cellulose fabric (Bemsheet) and holding clipping technique could be chosen as the optimal surgical modality for prevention of rebleeding from these lesions.
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    Brain infarction in a young patient with Buerger's disease - a case of cerebral thromboangiitis obliterans
    (Asean Neurological Assoc, 2016) Aydin, Elcin; Cinar, Celal; Bozkaya, Halil; Oran, Ismail
    Buerger's disease (BD) or thromboangiitis obliterans is a vasculitis that most commonly affects the small and medium-sized arteries and veins in the extremities. 1 It is most frequently seen in the young men who smoke and is associated with low socioeconomic status. BD is diagnosed on the basis of the clinical findings; the pathogenesis is not completely be understood. 1-4 In this report, we aim to present the clinical, magnetic resonance imaging (MRI) and angiographic findings of a 30-year-old man with ischemic stroke as a rare complication of BD.
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    Carotid Endarterectomy versus Carotid Artery Stenting Findings in Regard to Neuroclinical Outcomes and Diffusion-Weighted Imaging
    (Texas Heart Inst, 2008) Posacioglu, Hakan; Engin, Cagatay; Cinar, Celal; Apaydin, Anil Z.; Oran, Ismail; Parildar, Mustafa; Calli, Cem; Oguz, Emrah; Memis, Ahmet
    The purpose of our study was to evaluate prospectively the frequency and significance of brain lesions after elective carotid endarterectomy (CAE) and carotid artery stenting (CAS) by using diffusion-weighted magnetic resonance imaging (DW MRI) and then to correlate imaging findings with neuroclinical outcomes. From February 2003 through March 2005, 95 consecutive patients underwent surgical endarterectomy or CAS (with a cerebral protection device) at our institution. A total of 59 CAE procedures were performed in 46 consecutive patients (mean age, 65.8 +/- 9 yr), and 56 CAS procedures were performed in 49 consecutive patients (mean age, 66.3 +/- 9 yr). Diffusion-weighted magnetic resonance imaging of the brain was performed in all patients within 24 hours of the procedure, both before and after. The post-procedural stroke rate was slightly higher in the CAS group, but this difference was not significant (5.4% vs 0). One early and I late death occurred in the stent group. Although the incidence of ischemic lesions was similar in both groups (surgery group, 12.5%; stent group, 73.5%), new DIN MRI lesions were higher in the endarterectomy group (27.1% vs 12.5%, P=0.041). This difference was due chiefly to nonischemic lesions such as hemorrhage and watershed ischemia. In the analysis of patients with embolic ischemia, incidences of symptomatic stroke (P=0.046) and large infarct (P=0.013) were higher in the stent group. When we used protective devices during CAS, the incidence of embolic complications was similar to that of surgical enarterectomy. On the other hand, the clinical results of CAS need improvement. (Tex Heart Inst J 2008;35(4):395-401)
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    Changes in blood biochemistry thrombosis parameters 24 hours after stent-assisted endovascular treatment of intracranial aneurysms
    (Sage Publications Inc, 2024) Cinar, Celal; Oran, Ismail; Ozdemir, Halil Ibrahim; Kusbeci, Mahmut; Kavakli, Ramazan Kaan; Tobu, Mahmut; Parildar, Zuhal
    Background and purpose This study aims to elucidate the early changes in blood biochemistry thrombosis parameters following stent-assisted endovascular treatment of intracranial aneurysms.Methods Consecutive patients with unruptured aneurysms undergoing stent implantation during endovascular treatment were included in this prospective study with approval from the local ethics committee. Blood samples were collected immediately before and 24 h after the procedure for biochemical analysis, including basic thrombosis indicators, bleeding tests, and a complete blood count.Results The study included 80 patients (60 women, 20 men) with 134 aneurysms. A total of 135 stents (110 flow-diverting, 25 standard) were used. Additionally, intrasaccular coiling was utilized in 28 aneurysms among 27 patients. Following the procedure, there was a significant decrease in activated partial thromboplastin time, fibrinogen, hemoglobin, and platelet levels, and a significant increase in prothrombin time, D-dimer, von Willebrand factor (vWF) activity/antigen ratio, and leukocyte levels in all patients. Correlation analyses revealed significant positive associations between platelet and fibrinogen levels, and a negative association between D-dimer and fibrinogen levels in the coil (-) group. Additionally, there was a significant negative correlation between aneurysm volume and vWF activity/antigen ratio, and procedure duration and thrombocyte count, while a positive association was found between aneurysm number and leukocyte count in the coil (-) group.Conclusions Analysis of blood chemistry alterations indicates that intravascular thrombosis occurs in the intracranial circulation following stent-assisted endovascular treatment of intracranial aneurysms. This thrombotic process is more pronounced in patients whose aneurysms were left open (i.e. flow-diverting stent alone).
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    Congenital and Acquired Renal Arteriovenous Malformations: Curative Embolization with Onyx
    (Kowsar Publ, 2017) Guneyli, Serkan; Cinar, Celal; Bozkaya, Halil; Korkmaz, Mehmet; Acar, Turker; Parildar, Mustafa; Oran, Ismail
    Renal arteriovenous malformations are rare, as is their embolization with Onyx. Endovascular curative embolization of renal arteriovenous malformations with Onyx is a relatively new procedure. Herein we present two cases of congenital and one case of acquired renal arteriovenous malformation embolized with Onyx 18 and their good results in the follow-up period. We used detachable microcatheters, which may be more advantageous than the nondetachable ones, during the superselective embolizations. Onyx, as an efficient embolic material, can be commonly used for curative embolization of the renal arteriovenous malformations.
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    Developmental venous anomaly (DVA) with arterial component: a rare cause of intracranial haemorrhage
    (Springer, 2009) Oran, Ismail; Kiroglu, Yilmaz; Yurt, Alaattin; Ozer, Fisun Demircivi; Acar, Feridun; Dalbasti, Tayfun; Yagci, Baki; Sirikci, Akif; Calli, Cem
    To examine the clinical and radiologic findings of patients with developmental venous anomaly (DVA) associated with intracranial haemorrhage but unrelated to cavernoma. Computed tomography (CT) was used to obtain intracranial images from seven patients ranging in age from 6 to 51 years. Magnetic resonance imaging (MRI) was then performed on six patients, and two patients were further examined via CT angiography. Finally, digital subtraction angiography (DSA) was performed to confirm the initial diagnosis. CT showed intraparenchymal supratentorial haemorrhage in all patients. The combined imaging modalities eventually confirmed a diagnosis of arterialised DVA in four patients and arterialised DVA associated with arteriovenus malformation (AVM) in three. Two patients were managed symptomatically, two underwent radiosurgery, one underwent surgery, one underwent combined embolisation plus radiosurgery and the remaining patient underwent combined embolisation plus surgery. Two patients died, one as a result of re-bleeding, and the other due to radiation necrosis. The mean follow-up period was 33 months (6 months to 6 years) for the remaining five patients with favourable outcome. DVA associated with intraparenchymal haemorrhage, but not related to cavernoma, was confirmed. Though very rare, DVA may present with non-cavernoma-related haemorrhage in the form of arterialised DVA or DVA with AVM.
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    Eagle Syndrome Presenting with Neurological Symptoms
    (Turkish Neurosurgical Soc, 2018) Aydin, Elcin; Quliyev, Huseyin; Cinar, Celal; Bozkaya, Halil; Oran, Ismail
    AIM: Eagle syndrome is a rare entity that causes recurrent throat pain, neck pain, dysphagia, or facial pain due to an elongated styloid process or calcified stylohyoid ligament. Clinical findings related to lower cranial nerve compression have also been reported. In some cases, it is reported that carotid artery compression or dissection can be seen due to elongated styloid process and this is called carotid artery syndrome. Carotid artery compression causes flow reduction and carotidynia or neurological symptoms can be seen. Dural sinuses and the jugular vein can be compressed. Eagle syndrome with neurological symptoms has been rarely reported. MATERIAL and METHODS: The data of 5 patients (aged between 22 and 68 years), who presented to the hospital with various neurological symptoms, were retrospectively reviewed. Each patient underwent computed tomography (CT) that revealed a long styloid process. RESULTS: An elongated styloid process caused neurological symptoms. Two patients had venous compression by the styloid process and the other patients had transient ischemic attacks due to internal carotid artery compression by the styloid process. Only one patient underwent surgical removal. All patients' outcomes were good after treatment and no symptoms remained. CONCLUSION: Eagle syndrome may be presented with neurological symptoms. It should be kept in mind in the differential diagnosis of patients who have neurological symptoms without any objective etiological factors. To the best of our knowledge, Eagle syndrome with arterial and venous compression due to elongated styloid process has not been previously presented in the literature.
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    Edaravone Leads To Increased Internal Luminal Vascular Circumference Following Subarachnoid Hemorrhage in An Animal Model of Vasospasm
    (Journal Neurological Sciences, 2012) Mete, Mesut; Ozer, Fusun Demircivi; Duransoy, Yusuf Kurtulus; Kocaman, Umit; Oran, Ismail; Demirtas, Eren; Selcuki, Mehmet
    Purpose: Cerebral vasospasm is the leading cause of morbidity and mortality following subarachnoid hemorrhage. Although a number of factors have been examined in clinical and experimental studies, the agent(s) responsible for developing and diminishing vasospasm remain poorly understood. Here, the role of edaravone, an antioxidant agent, was evaluated for its ability to diminish vasospasm in an animal model of subarachnoid hemorrhage. Materials and Methods: A rat basilar artery subarachnoid hemorrhage model was used. Rats were divided into three groups: sham (n=7; Group 1), subarachnoid hemorrhage (n=7 Group 2), and subarachnoid hemorrhage plus edaravone (4 mg/kg intraperitoneally, n=7; Group 3). At the end of the seventh day, the rats were sacrificed, their brains were removed, and sections were taken from the basilar artery. These were examined using a light microscope, comparing the internal luminal circumference of the basilar artery of each group. Results: The circumference was largest in Group 1, followed by Group 3 and then Group 2. That of Group 3 was 2% higher than that of Group 2, but this difference was not statistically significant. Conclusion: This animal model for vasospasm suggests that edaravone helps enlarge internal luminal circumference following vasospasm caused by subarachnoid hemorrhage. It may do this by blocking lipid peroxidation and thereby reducing the effects of oxyhemoglobin and reactive oxygen species.
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    Endovascular management of iatrogenic renal arterial lesions and clinical outcomes
    (Turkish Soc Radiology, 2015) Guneyli, Serkan; Gok, Mustafa; Bozkaya, Halil; Cinar, Celal; Tizro, Arastu; Korkmaz, Mehmet; Akin, Yigit; Parildar, Mustafa; Oran, Ismail
    PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODS Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTS Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.
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    Endovascular management of iatrogenic renal arterial lesions and clinical outcomes
    (Turkish Soc Radiology, 2015) Guneyli, Serkan; Gok, Mustafa; Bozkaya, Halil; Cinar, Celal; Tizro, Arastu; Korkmaz, Mehmet; Akin, Yigit; Parildar, Mustafa; Oran, Ismail
    PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODS Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTS Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.
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    Endovascular management of iatrogenic renal arterial lesions and clinical outcomes
    (Turkish Soc Radiology, 2015) Guneyli, Serkan; Gok, Mustafa; Bozkaya, Halil; Cinar, Celal; Tizro, Arastu; Korkmaz, Mehmet; Akin, Yigit; Parildar, Mustafa; Oran, Ismail
    PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODS Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTS Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.
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    Endovascular Management of Iatrogenic Vascular Injury in the Craniocervical Region
    (Turkish Neurosurgical Soc, 2018) Aydin, Elcin; Gok, Mustafa; Esenkaya, Asim; Cinar, Celal; Oran, Ismail
    AIM: To evaluate iatrogenic vascular injuries in the craniocervical region and their endovascular management. MATERIAL AND METHODS: Twenty-one patients (9 women, 12 men) with a mean age of 53.6 years (range 16-87 years), who underwent endovascular embolization for iatrogenic vascular injury in the craniocervical region between December 2000 and October 2015, were included in this retrospective study. Types of iatrogenic injuries, etiologies that caused these injuries and details of endovascular managements were reported. RESULTS: The etiologies of the vascular injuries were as follows: transsphenoidal surgery (n=9), skull-base surgery (n=2), cholesteatoma surgery (n=1), tracheostomy (n=2), central venous catheterization (n=2), oropharyngeal tumor operation (n=1), endovascular treatment of internal carotid artery (ICA) stenosis (n=1), suprasellar epidermoid tumor operation (n=1), sphenoid sinus tumor surgery (n=1), and speech prosthesis device placement (n=1). The types of vascular injuries diagnosed at the time of angiography were; 2 occlusions, 2 stenoses, 2 dissections, 1 carotid cavernous fistula, 8 artery rupture with extravasation, and 9 pseudoaneurysms. Endovascular management of these vascular injuries were; parent artery occlusion (PAO) (n=15), aneurysm occlusion (n=3), covered stent (n=1) and conservative management (n=2). All patients except two were successfully treated. No patient had bleeding within a 30-day period after angiography. Long-term follow-up was available in all patients without occurrence of re-bleeding. One patient died due to complications related to primary vascular injury. CONCLUSION: Although iatrogenic vascular injuries are rare, early diagnosis and management may be lifesaving. Endovascular techniques are reliable and safe in most of the patients.
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    Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review
    (Tubitak Scientific & Technical Research Council Turkey, 2021) Korkmaz, Mehmet; Cinar, Celal; Nas, Omer Fatih; Hakyemez, Bahattin; Oran, Ismail
    Background/aim: The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods: A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. Results: Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion: Although the number of cases is low in our study, to our knowledge, it is the widest series in the literature until today. Our results demonstrate that BAF aneurysms can be treated successfully and safely with different endovascular techniques, with more stent use in recent years.
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    Endovascular treatment of cranial aneurysms with the pipeline flow-diverting stent: preliminary mid-term results
    (Turkish Soc Radiology, 2013) Cinar, Celal; Bozkaya, Halil; Oran, Ismail
    PURPOSE We aimed to present our initial experience with a new self-expanding flow diverter device designed for wide-neck aneurysm treatment, assess its safety for intracranial deployment and efficacy of occlusion at mid-term follow-up. MATERIALS AND METHODS Forty-five consecutive patients with difficult aneurysmal anatomy underwent an endovascular treatment. Fifty-five intracranial aneurysms were clipped using the Pipeline flow-diverting stent (ev3 Inc., Plymouth, Minnesota, USA) between November 2009 and December 2011. Data including antiplatelet therapy, technical issues, complications, and imaging findings were recorded during the follow-up period. RESULTS Twenty-seven aneurysms were asymptomatic, 13 were symptomatic due to mass effect, seven were recurrent, six had subarachnoid hemorrhage, and two subjects presented with ischemia. There were 45 saccular, six fusiform-dissecting, and four blister aneurysms. The six-month control angiography was available in 34 subjects with an 85.3% (29/34 patients) complete occlusion rate. The overall occlusion rate according to the last angiography was 91.9% (34/37 patients). The following three major technical complications without clinical consequences were encountered: one distal wire fracture of the stent delivery system and two insufficient stent expansion. There was one fatal nonaneurysmal cerebellar hemorrhage. The overall mortality rate was 2.2% with no permanent morbidity. CONCLUSION The Pipeline flow-diverting stent represents an important advancement in endovascular therapy for cerebral aneurysms. Standard endovascular techniques are typically not suitable for these types of aneurysms. The device targets primary parent vessel reconstruction rather than endosaccular occlusion to achieve exclusion of the aneurysm and maintain a relatively high occlusion rate at six months.
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    Endovascular treatment of cranial aneurysms with the pipeline flow-diverting stent: preliminary mid-term results
    (Turkish Soc Radiology, 2013) Cinar, Celal; Bozkaya, Halil; Oran, Ismail
    PURPOSE We aimed to present our initial experience with a new self-expanding flow diverter device designed for wide-neck aneurysm treatment, assess its safety for intracranial deployment and efficacy of occlusion at mid-term follow-up. MATERIALS AND METHODS Forty-five consecutive patients with difficult aneurysmal anatomy underwent an endovascular treatment. Fifty-five intracranial aneurysms were clipped using the Pipeline flow-diverting stent (ev3 Inc., Plymouth, Minnesota, USA) between November 2009 and December 2011. Data including antiplatelet therapy, technical issues, complications, and imaging findings were recorded during the follow-up period. RESULTS Twenty-seven aneurysms were asymptomatic, 13 were symptomatic due to mass effect, seven were recurrent, six had subarachnoid hemorrhage, and two subjects presented with ischemia. There were 45 saccular, six fusiform-dissecting, and four blister aneurysms. The six-month control angiography was available in 34 subjects with an 85.3% (29/34 patients) complete occlusion rate. The overall occlusion rate according to the last angiography was 91.9% (34/37 patients). The following three major technical complications without clinical consequences were encountered: one distal wire fracture of the stent delivery system and two insufficient stent expansion. There was one fatal nonaneurysmal cerebellar hemorrhage. The overall mortality rate was 2.2% with no permanent morbidity. CONCLUSION The Pipeline flow-diverting stent represents an important advancement in endovascular therapy for cerebral aneurysms. Standard endovascular techniques are typically not suitable for these types of aneurysms. The device targets primary parent vessel reconstruction rather than endosaccular occlusion to achieve exclusion of the aneurysm and maintain a relatively high occlusion rate at six months.
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    Endovascular Treatment of Indirect Carotid-Cavernous Fistula via Thrombosed Superior Ophthalmic Vein in Patient with Trapped Sinus
    (Journal Neurological Sciences, 2013) Guven Yilmaz, Suzan; Cinar, Celal; Yagci, Ayse; Oran, Ismail; Gokcay, Figen; Celebisoy, Nese
    In the endovascular treatment of indirect carotid-cavernous sinus fistulas (CCF's) when access to the cavernous sinus via transfemoral approach could not be obtained due to various reasons (vascular variation, thrombosis, trapped sinus), superior ophthalmic vein (SOV) is the main way that can be used. SOV provides direct access to the cavernous sinus. However, SOV may be thrombosed in some cases. In these cases the recognization and catheterization of SOV is quite diffucult although successful catheterization is possible with the angiojet passing through thrombosis in case of which thrombosis is segmental. Herein we aimed to report a 58-year- old woman who underwent embolization of indirect CCF (Barrow Type D) through thrombosed SOV with liquid agent Onyx 18 because of trapped sinus. Clinical features, endovascular embolization technique and results are discussed.
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    Endovascular Treatment of Indirect Carotid-Cavernous Fistula via Thrombosed Superior Ophthalmic Vein in Patient with Trapped Sinus
    (Journal Neurological Sciences, 2013) Guven Yilmaz, Suzan; Cinar, Celal; Yagci, Ayse; Oran, Ismail; Gokcay, Figen; Celebisoy, Nese
    In the endovascular treatment of indirect carotid-cavernous sinus fistulas (CCF's) when access to the cavernous sinus via transfemoral approach could not be obtained due to various reasons (vascular variation, thrombosis, trapped sinus), superior ophthalmic vein (SOV) is the main way that can be used. SOV provides direct access to the cavernous sinus. However, SOV may be thrombosed in some cases. In these cases the recognization and catheterization of SOV is quite diffucult although successful catheterization is possible with the angiojet passing through thrombosis in case of which thrombosis is segmental. Herein we aimed to report a 58-year- old woman who underwent embolization of indirect CCF (Barrow Type D) through thrombosed SOV with liquid agent Onyx 18 because of trapped sinus. Clinical features, endovascular embolization technique and results are discussed.