Journal Of Cardiovascular, Neurovascular & Stroke

A Keyhole Review of the Large Paradigm Shift in Aortic Surgery

Matthew Wong — Mon, 31 Mar 2025 00:00:00 +0000

Open aortic surgery is well known to be associated with a high mortality rate, with up to 10% in elective setting and up to 30% in emergency setting.

Since the advent of open aortic repair in the 1950s, we see the advancement of aortic surgical technique and technology – all for the sole purpose of improving the survival benefit of patient post surgery.

Here we discuss a case study of utilizing the advancement of technology and knowledge in aortic repair in the form of Thoracic Endo Vascular Aortic Repair (TEVAR), in a complex case of a 69 years old patient with incidental finding of distal aortic arch pseudoaneurysm. His case was complicated with several debilitating medical conditions including left papillary renal cell carcinoma (RCC), toxic nodular goiter, and hypertension.

This case study is a successful story of how far aortic surgical intervention has come along through the years - with smaller incision needed for the surgery, improvement in overall survival benefit, shorter hospital stay with early return to normal routine life, and making it a possibility to perform aortic repair surgery in a patient with multiple severe underlying medical conditions.

Clinical and Radiological Approach to the Diagnosis of Branch Atheromatous Disease: Case Report and Review of Literature

Mon, 31 Mar 2025 00:00:00 +0000

Branch atheromatous disease (BAD) is a subtype of ischemic stroke caused by stenosis or occlusion at the entrance of the penetrating branch due to the presence of plaque. Despite its clinical importance, this concept is understudied and not commonly used in clinical and research settings. BAD is highly associated with high early neurological deterioration (END) and disability. There are several characteristics of BAD based on clinical condition, risk factors, laboratory results, and most importantly, radiographic features of infarct and blood vessels morphologies, also associated features. Early diagnosis of BAD is critical for determining treatment decisions and the prognosis of individual patients.

Case Report: Successful Staged Embolization of a Direct Carotid-Cavernous Fistula Using Combined Coil and Liquid Embolic Technique

Mon, 31 Mar 2025 00:00:00 +0000

Carotid-cavernous fistulae (CCFs) is the common complication following head trauma, accounting 75% for all CCFs. They can manifest as proptosis, ocular bruit, and chemosis known as classical triad, even though other symptoms may developed depend on involvement of vascular and neural structure in the cavernous sinus. Digital Subtraction Angiography (DSA) is the gold standard for detecting CCFs. CCFs used to routinely treat with open surgical procedures such as carotid ligation or trapping and cavernous sinus exploration. Other options for treatment including conservative management and radiosurgery. In the recent years endovascular treatment (EVT) has become the main choice for managing CCFs. Both trans arterial and trans venous embolization using various embolic agents has been widely used, with the main purpose complete occlusion of CCF while maintaining main carotid artery flow. This report details the successful management of a right direct carotid-cavernous fistula (CCF) in a 47-year-old male following a motor vehicle accident. A staged embolization approach, combining trans venous and trans arterial techniques, effectively reduced the residual fistula with no immediate complications. This case highlights the complexities of treating post-traumatic CCFs and the importance of tailored endovascular strategies.