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        Mechanical Thrombectomy for Acute Ischemic Stroke due to Thrombus in the Pulmonary Vein Stump after Left Pulmonary Lobectomy: A Case Series

        Tsuji Yuichiro,Yagi Ryokichi,Hiramatsu Ryo,Wanibuchi Masahiko 대한신경중재치료의학회 2022 Neurointervention Vol.17 No.3

        Cerebral embolic stroke caused by a thrombus in the pulmonary vein stump after left pulmonary lobectomy is a serious complication. We retrospectively analyzed four patients who underwent mechanical thrombectomy for large-vessel occlusion after left pulmonary lobectomy between January 2014 and March 2022. Two cases occurred after left upper lobectomy and the others occurred after left lower lobectomy. All patients presented with cerebral embolic stroke from the day after surgery to the 9th postoperative day, and successful reperfusion was achieved in all cases. Two patients had good outcomes at 90 days. Thrombus in the pulmonary vein stump is the probable cause of cerebral embolism, and mechanical thrombectomy is effective. Further studies are required to establish preventive measures and perioperative management strategies.

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        <i>De Novo</i> Vertebral Artery Dissecting Aneurysm after Parent Artery Occlusion of the Contralateral Vertebral Artery

        Yuichiro Tsuji,Sho Murase,Yuzo Kuroda,Masahiko Wanibuchi 대한신경외과학회 2024 Journal of Korean neurosurgical society Vol.67 No.1

        After treatment of unilateral vertebral artery dissecting aneurysm (VADA), de novo VADA rarely occurs on the contralateral side. In this article, we report a case of subarachnoid hemorrhage (SAH) due to de novo VADA in the contralateral vertebral artery (VA) 3 years after parent artery occlusion of unilateral VADA, with a review of the literature. A 47-year-old woman was admitted to our hospital complaining of headache and impaired consciousness. Head computed tomography showed SAH, and three-dimensional computed tomography angiography showed a fusiform aneurysm in the left VA. We performed an emergency parent artery occlusion. Three years and 3 months after the initial treatment, the patient presented to our hospital with complaints of headache and neck pain. Magnetic resonance imaging revealed SAH, and magnetic resonance angiography revealed de novo VADA in the right VA. We performed a stent-assisted coil embolization. The patient had a good postoperative course and was discharged with a modified Rankin scale score of 0. Long-term follow-up is necessary in patients with VADA because contralateral de novo VADA can develop even several years after the initial treatment.

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        The Effectiveness of Vertebral Height Restoration Based on the Vertebroplasty Procedure Used to Treat Osteoporotic Vertebral Fractures

        Kunio Yokoyama,Naokado Ikeda,Hidekazu Tanaka,Yutaka Ito,Akira Sugie,Makoto Yamada,Masahiko Wanibuchi,Masahiro Kawanishi 대한척추신경외과학회 2023 Neurospine Vol.20 No.4

        Objective: Whether the use of a balloon or stent in vertebroplasty for vertebral fractures, such as balloon kyphoplasty (BKP) or vertebral body stenting (VBS), actually contributes to the restoration of postoperative vertebral height is unclear. The aim of the current study was to compare the effectiveness of percutaneous vertebroplasty (PVP), BKP, and VBS in the correction of collapsed vertebrae in patients with painful vertebral fractures. Methods: The cases studied involved 34 vertebrae in 28 patients treated with PVP, 43 vertebrae in 38 patients treated with BKP, and 20 vertebrae in 20 patients treated with VBS at Izinkai Takeda General Hospital. Changes in the vertebral height and local kyphosis angle were measured based on standing lumbar radiographs before and after surgery and were compared among the treatment groups. Results: There were no differences in changes in the height of the anterior wall, middle body, or posterior wall of the treated vertebrae among the 3 treatment groups. The same was true for changes in the local kyphosis angle. The effectiveness of vertebral height restoration depended heavily upon preoperative vertebral instability in all the treatment groups. Correction loss due to balloon deflation effect or balloon sinking was noted with VBS or BKP. Conclusion: BKP and VBS have the advantage of reducing the risk of extravertebral leakage of injected bone cement, but they have a disadvantage in that they are no more effective than PVP in restoring collapsed vertebrae despite the use of a balloon or metal stent.

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