{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T22:45:04Z","timestamp":1777848304933,"version":"3.51.4"},"reference-count":7,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>\n                      To describe the successful treatment of a Moyamoya type II endoleak (T2EL) using\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      -butyl cyanoacrylate (NBCA) assisted by intra-arterial carbon dioxide (CO\n                      <jats:sub>2<\/jats:sub>\n                      ) flow modulation in a patient with post-endovascular abdominal aortic repair (EVAR) aneurysm sac enlargement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report:<\/jats:title>\n                    <jats:p>\n                      An 84-year-old woman developed progressive aneurysm enlargement due to a refractory Moyamoya T2EL 5 years after EVAR with an AFX II stent graft. Angiography demonstrated persistent retrograde perfusion through the inferior mesenteric artery via complex vasa vasorum-dominant collaterals. Because of unfavorable flow dynamics for embolization, CO\n                      <jats:sub>2<\/jats:sub>\n                      was intentionally injected to transiently suppress antegrade flow from the sigmoid artery, generating a controlled \u201cto-and-fro\u201d pattern. Under these hemodynamic conditions, NBCA was carefully administered, resulting in complete occlusion of the endoleak without reflux or non-target embolization. Follow-up computed tomography (CT) at 1 year confirmed stable sac size with no re-dilation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>\n                      Moyamoya type II ELs are associated with microcollateral networks that complicate embolization and increase the risk of sac enlargement. Although NBCA can penetrate complex channels, reflux poses a significant hazard. In this case, targeted CO\n                      <jats:sub>2<\/jats:sub>\n                      injection effectively displaced competing flow, enabling safe, selective NBCA deposition. This CO\n                      <jats:sub>2<\/jats:sub>\n                      -assisted strategy represents a feasible option for treating anatomically complex, refractory type II endoleaks.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261436277","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T05:45:07Z","timestamp":1774676707000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Endovascular Management of Moyamoya Type II Endoleak Utilizing a CO\n                    <sub>2<\/sub>\n                    -Assisted Protection Strategy: A Case Report"],"prefix":"10.1177","author":[{"given":"Takuma","family":"Fukunishi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shintaro","family":"Nawata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Nishimaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiki","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Kinebuchi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daijyun","family":"Tomimoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahide","family":"Komagamine","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7739-8545","authenticated-orcid":false,"given":"Kan","family":"Nawata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66628-7"},{"issue":"16","key":"e_1_3_3_3_2","first-page":"1619","article-title":"A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms","volume":"351","author":"Greenhalgh RM","year":"2004","unstructured":"Greenhalgh RM, Brown LC, Kwong GP, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1619\u20131628.","journal-title":"N Engl J Med"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2024.03.457"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2022.07.168"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2023.12.573"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2024.09.060"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2011.195"}],"container-title":["Journal of Endovascular Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028261436277","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15266028261436277","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028261436277","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:32:31Z","timestamp":1777498351000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15266028261436277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":7,"alternative-id":["10.1177\/15266028261436277"],"URL":"https:\/\/doi.org\/10.1177\/15266028261436277","relation":{},"ISSN":["1526-6028","1545-1550"],"issn-type":[{"value":"1526-6028","type":"print"},{"value":"1545-1550","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"article-number":"15266028261436277"}}