Effect of sarcopenia on mortality in acute stroke patients receiving endovascular treatment.

BACKGROUND: To investigate the effect of sarcopenia on mortality in patients with acute ischemic stroke caused by anterior circulation large artery occlusion who underwent endovascular treatment. METHODS: Acute ischemic stroke patients (n = 194) treated with mechanical thrombectomy who underwent chest computed tomography between 2019 and 2022 (median age, 69 [interquartile range: 61-77], 95 females, 99 males) were evaluated retrospectively. The cross-sectional area and density of the pectoralis muscle [pectoralis muscle area (PMA) and pectoralis muscle density (PMD)] at the level of the aortic arch and the erector spinae muscle at the T12 level [erector spinae muscle area (ESMA) and erector spinae muscle density (ESMD)] were measured. The association between skeletal muscle parameters and mortality outcomes was investigated using the receiver operating characteristic (ROC) curve and multivariable logistic regression analyses. RESULTS: The 90-day mortality rate was 32% in the study population (n = 62). The ROC analysis revealed that ESMD [area under the curve (AUC): 0.765] and PMD (AUC: 0.759) performed best in the prediction of 90-day mortality. In the multivariable logistic regression analysis, PMD [odds ratio (OR): 0.896; 95% confidence interval (CI): 0.846-0.948; p < 0.001], ESMA (OR: 0.929; 95% CI: 0.878-0.983; p = 0.011), and ESMD (OR: 0.947; 95% CI: 0.913-0.983; p = 0.004), but not PMA, were independent risk factors for 90-day mortality. CONCLUSION: PMD, ESMA, and ESMD may be risk factors for 90-day mortality after mechanical thrombectomy for acute ischemic stroke.

Treatment of Ruptured Anterior Choroidal Artery Aneurysms by Acute Coiling Followed by Flow Diversion.

BACKGROUND: Flow-diverter treatments are successful endovascular treatments in protecting important perforating branches during aneurysm treatments. Because these treatments are performed under antiplatelet therapy, acute flow-diverter treatments in ruptured aneurysms are still controversial. Acute coiling followed by flow diversion has emerged as an intriguing and feasible treatment option for ruptured anterior choroidal artery aneurysm treatment. As a single-center retrospective case series study, this study reported the clinical and angiographic results of staged endovascular treatment in patients with a ruptured anterior choroidal aneurysm. METHODS: This is a single-center retrospective case series study between March 2011 and May 2021. Patients with ruptured anterior choroidal aneurysm received flow-diverter therapy in a different session after acute coiling. Patients treated with primary coiling or only flow diversion were excluded. Preoperative demographic and presenting symptoms, aneurysm morphology, perioperative and postoperative complications, and long-term clinical and angiographic outcome as measured using the modified Rankin Scale and O'Kelly Morata Grading scale and also Raymond-Roy occlusion classification respectively. RESULTS: Sixteen patients underwent coiling in the acute phase to undergo flow diversion later. The mean maximum aneurysm diameter is 5.44 ± 3.39 mm. All patients had a subarachnoid hemorrhage and were treated acutely between days 0 and 3 of acute bleeding. The mean age at the presentation was 54.12 ± 12 years (32-73 years). Two patients (12.5%) had minor ischemic complications, which are seen on magnetic resonance angiography as clinically silent infarcts, after the procedure. One patient (6.2%) had a technical complication with the flow-diverter shortening and deployed a second flow diverter telescopically. No mortality or permanent morbidity was reported. The mean interval time between the 2 treatments was 24.06 ± 11.83 days. All patients were followed up with digital subtraction angiography; 14/16 patients (87.5%) had aneurysms that were completely occluded and 2/16 (12.5%) showed near-complete occlusion. Mean follow-up was 16.62 ± 3.22 months; all patients had modified Rankin Scale scores ≤2; 14/16 (87.5%) had a total occlusion 14/16 (87.5%) had near-complete occlusion. None of the patients had retreatment or rebleeding. CONCLUSIONS: Staged treatment of ruptured anterior choroidal artery aneurysms with acute coiling and flow-diverter treatment after recovery from subarachnoid hemorrhage is safe and effective. In this series, no cases of rebleeding occurred during the interval between coiling and flow diversion. Staged treatment should be considered a valid option in patients with challenging ruptured anterior choroidal aneurysms.

The Evaluation of Low-Profile Surpass EvolveTM Flow Diverter for Endovascular Treatment of Distal Cerebral Artery Aneurysms: A Single-Center Experience.

AIM: To report our experience with the 2.5-mm Surpass EvolveTM flow diverter (FD) in the treatment of distal small cerebral artery aneurysms. MATERIAL AND METHODS: This study included 41 patients with 52 aneurysms. Clinical and radiological records and procedural and follow-up outcomes were reviewed retrospectively. RESULTS: The aneurysm morphology was saccular in 45 patients, dissecting in five patients, and fusiform in two patients. Fifty-two aneurysms were treated with 41 Surpass Evolve FDs. The mean diameters of the proximal and distal parent arteries were 2.56 and 2.17 mm, respectively. The mean duration of follow-up was 16.2 ± 6.6 (6-28) months. Four (10%) patients had acute subarachnoid hemorrhage. In the same session, two patients with two tandem aneurysms and one patient with four tandem aneurysms were treated using a single FD. Intraprocedural hemorrhage and femoral artery pseudoaneurysm occurred in two patients during the procedure. Digital subtraction angiography was performed on 38/41 (92%) patients with 47/52 (88%) having aneurysms. Complete occlusion (OKM D) was observed in 39/47 (82%) aneurysms, and near complete-complete occlusion (OKM C-D) was observed in 46/47 (98%) aneurysms. CONCLUSION: Endovascular treatment of distal cerebral artery aneurysms with the 2.5-mm Surpass Evolve < sup > TM < /sup > FD provides a high rate of aneurysm occlusion with low periprocedural complications, even in ruptured and tandem aneurysms.

Craniovertebral junction aneurysms.

OBJECTIVE: The course of the vertebral artery and its relationship to the C0-1-2 structures render it particularly vulnerable to mechanical trauma. In the present study, we investigated the course of vertebral arteries along the craniovertebral junction (CJ) to cast light on the biomechanical aspects of aneurysm formation, focusing mainly on the relation of the vertebral artery injuries to the CJ bony landmarks. Herein, we report our experience with fourteen cases of craniovertebral junction vertebral artery (CJVA) aneurysms and their presentations, management, and outcomes. MATERIALS AND METHODS: We extracted from 83 vertebral artery aneurysms only those 14 cases whose aneurysms were located at the C0-1-2. We reviewed all medical records, including operative reports and radiologic images. We divided the CJVA into 5 segments and then carefully reviewed the cases, largely focusing on the CJVA segments involved in the aneurysm. Angiographic outcomes were determined by angiography, which was scheduled at 3-6 months, 1, 2.5, and 5 years postoperatively. RESULTS: A total of 14 patients with CJVA aneurysms were included in the present study. 35.7 % had cerebrovascular risk factors, while 23.5 % had other predisposing factors such as an AVM, an AVF, or a foramen magnum tumor. Predisposing factors in the form of neck trauma, both direct and indirect, were identified in 50 % of cases. The segmental distribution of aneurysms was as follows: three (21.4 %) at CJV 1, one (7.1 %) at CJV 2, four (28.6 %) at CJV 3, two (14.3 %) at CJV 4, and four (28.6 %) isolated to the CJV 5 segment. Of the 6 indirect traumatic aneurysms, 1 (16.7 %) was located at CJV 1, 4 (66.7 %) were located at CJV 3 and 1 (16.7 %) was located at CJV 5. The 1/1 direct traumatic aneurysm (100 %) from the penetrating injury was located at CJV 1. 100 % of cases with cerebrovascular risk factors, the affected vessels were on the dominant side. 42.9 % of cases presented symptoms of a vertebrobasilar stroke. All 14 aneurysms were managed only endovascularly. 85.8 % of patients we implemented flow diverters only. 57.1 % of follow-up cases were completely occluded angiographically, and 42.9 % of cases were near-completely or incompletely occluded at 1, 2.5, and 5-year follow-ups. CONCLUSIONS: The current article is the first report of a series of vertebral artery aneurysms located in CJ. Herein, the association of vertebral artery aneurysm, hemodynamics, and trauma is well established. We clarified all segments of the CJVA and showed that the segmental distribution of CJVA aneurysms significantly differs between traumatic and spontaneous cases. We showed that treatment with flow diverters should be the mainstay of CJVA aneurysm treatment.

An Illustrative Case of Bilateral Internal Carotid Artery Occlusion Concomitant with Aneurysm of the Obstructed ICA Reconstituted via Collaterals: Emphasizing the Role of Rescue Collaterals in Decision-Making.

In patients with bilateral internal carotid artery (ICA) obstruction, the basilar and ophthalmic arteries become the most critical arteries for brain perfusion, and the location of aneurysm formation may be associated with increased wall shear stress induced by compromised carotid circulation. Consideration of collateral routes may have an impact on therapeutic decisions for patients undergoing extracranial to intracranial (EC-IC) bypass and aneurysm surgery. We report a rare case of a young woman with bilateral ICA occlusion simultaneous with dissecting aneurysm of the obstructed ICA reconstituted via collaterals, emphasizing the functional value of collaterals and therapeutic strategy. We present a young woman with angiographic evidence of cerebrovascular early atherosclerotic disease. A young patient was found to have bilateral ICA occlusion and dissecting aneurysm of the obstructed ICA. A large fusiform aneurysm was clipped. Then, an anastomosis was performed from the left superficial temporal to the M3 segment of the middle cerebral artery. The patient's postoperative course was uneventful, and she was discharged to rehabilitation with no residual sequelae. This case illustrates a rare case of bilateral ICA occlusions, presented with robust collaterals, and dissecting aneurysm of the obstructed ICA reconstituted via collaterals. We also demonstrate excellent surgical clipping of a challenging ICA aneurysm and cerebral bypass surgery.

Utility of flow diverters in treatment of acutely ruptured uncoilable aneurysms of the posterior circulation of the brain.

PURPOSE: Aim of this study is to evaluate safety and efficacy of flow diverters (FDs) in treatment of acutely ruptured posterior circulation aneurysms MATERIALS AND METHODS: Databases of three participating institutions were retrospectively scanned for patients in whom FD placement was attempted for treatment of acutely ruptured vertebrobasilar aneurysms. An interval of 14 days or fewer between the latest ictus and treatment was used as inclusion criterion. Patients with dolichoectasia of vertebrobasilar arteries were excluded. If necessary, adjunctive techniques including coiling or stenting were utilized. Clinical outcomes were graded using mWFNS (modified World Federation of Neurosurgical Societies Scale) and mRS (modified Rankin Scale). Aneurysmal occlusion was defined as Raymond-Roy Class 1. Spearman's (ρ) test was used to assess the correlation between variables. Univariate and multivariate logistic regression were used to assess outcomes. RESULTS: 31 patients (25 women, mean age: 52.7 ± 15.2) harboring 32 aneurysms (16 non-saccular, mean size: 11.4 ± 7 mm) were included. Mean number of FDs used was 1.22 ± 0.42. In six cases, adjunctive coiling and in five cases, apposing stent placement were used. Overall mortality rate and procedure-related mortality rates were 22.5% (7/31) and 9.6% (3/31), respectively. At a mean imaging follow-up of 17.2 ± 12.6 months, total occlusion was achieved in 22 aneurysms (91.6%). Univariate analysis showed that mortality was positively correlated with vasospasm (ρ = 0.600, p < 0.05), higher mWFNS Scale (ρ = 0.685, p < 0.05), higher modified Fischer Score (ρ = 0.609, p < 0.05), higher mRS (ρ = 0.594, p < 0.05) on admission and negatively correlated with saccular morphology (ρ = -0.529, p < 0.05). Multivariate logistic regression identified mWFNS on admission as a significant predictor. (OR: 7.148, 95% CI 1.777-28.758, p: 0.01). Adjunctive coiling positively correlated with aneurysm occlusion. (ρ = 0.522, p < 0.05). CONCLUSION: The procedure-related morbidity and mortality is not negligible. However, the risks and efficacy associated with FDs are acceptable, especially when adjunctive coiling is possible, given the lack of treatment alternatives.

Comparative clinical efficacy of novel bidirectional cannula in cardiac surgery via peripheral cannulation for cardiopulmonary bypass.

OBJECTIVES: The aim of this study is to evaluate the safety and efficacy of the novel bidirectional cannula that ensures stable distal perfusion compared to conventional cannula in patients undergoing femoral arterial cannulation for cardiopulmonary bypass (CPB). METHODS: During a 1-year period, 64 patients undergoing surgery via peripheral cannulation were prospectively randomized to receive 19 F bidirectional (Biflow™, LivaNova, Italy) or 19 F conventional (HLS Peripheral cannula, Getinge Group™, Germany) cannula with 6 F downstream line (Bicakcilar™, Turkey) for femoral artery cannulation. The primary outcome included the efficacy (adequacy of antegrade/retrograde comparative flow via cannula measured by doppler ultrasonography) and the secondary outcome was the safety (early/late complications and adverse events). RESULTS: Percent flow (distal/proximal) after cannulation measured by doppler ultrasonography was significantly better in study group (33.1 ± 5 ml/min) versus downstream cannula (16.1 ± 4, p = 0.012). SpO2 measured by near infrared spectroscopy (NIRS) also demonstrated significantly better saturation in distal calf of the cannulated leg in bidirectional cannula group (67.5% ± 10% vs 52.5 ± 8, p = 0.04). The incidence of serious adverse events was seroma on femoral region (one patient), superficial wound infection (one patient), pseudo-hematoma (two patients) in bidirectional cannula group and in-hospital femoral embolectomy/artery repair (two patients), superficial wound infection (three patients), cannulation site hematoma (three patients) in conventional cannula group. CONCLUSIONS: This study demonstrates that in patients undergoing femoral arterial cannulation for CPB during cardiac surgery, the use of a novel bidirectional cannula is safe and easy to insert and provides stable distal perfusion of the cannulated limb.

Unilateral Axillary Lymphadenopathy after the Inactivated SARS-COV-2 (CoronaVac) Vaccine: Ultrasonographic Imaging

Background: Currently, unilateral clinical and subclinical axillary adenopathy cases associated with the Pfizer-BioNTech and Moderna vaccines are increasingly reported. However, only one study on axillary adenopathy due to the CoronaVac vaccine is published. Aims: To present the incidence, severity, and ultrasonographic findings of axillary adenopathy that developed in healthcare professionals in Turkey after they were vaccinated with CoronaVac against coronavirus disease-19. Study Design: A prospective study. Methods: In Turkey, the first dose of the CoronaVac vaccine for coronavirus disease-19 was administered to healthcare professionals on January 14, 2021, and the second dose on February 11, 2021. This study covered the period from January 21, 2021 (1 week after the first dose), and April 15, 2021 (9 weeks after the second dose). Individuals who had a history of COVID-19 more than 3 weeks after vaccine doses, systemic disease, and diagnosis and treatment history of breast cancer were excluded. The axillary lymph nodes of the vaccinated and contralateral arms were evaluated in 101 volunteer healthcare professionals using axillary ultrasonography. Results: A significant difference was found in the cortical thicknesses of the lymph nodes between the vaccinated and contralateral axilla after both the first (*p < 0.01) and second (*p < 0.01) doses. Accordingly, the rates of subclinical lymphatic hyperplasia on the vaccinated side were 25.7% (n = 26/101) after the first and 31.1% (n = 28/90) after the second dose. Lymph nodes with pathological appearance based on a reduced echogenic hilum with marked cortical thickening were found only in 2.2%. Among the 39 cases in which antibodies (immunoglobulin G and immunoglobulin M) were measured, the antibody level was classified as <10 and ≥10. No statistically significant difference was found in the cortical thickness of the axillary lymph nodes between patients with high antibody levels (≥10) and those with low antibody levels (<10) (p > 0.05). Conclusion: In this study, clinical signs of axillary lymph node hyperplasia were not detected after vaccination with CoronaVac. Mild and diffuse thickening of the CoronaVac vaccine-induced lymph nodes was more common than pathological and palpable lymph nodes.

Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience.

PURPOSE: To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. MATERIALS AND METHODS: Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9-85). Mean follow-up was 21 months (6-28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). RESULTS: In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete-complete occlusion (O'Kelly-Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0-1) was achieved in 24/25 (96%) of patients. CONCLUSION: Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.

Endovascular Stroke Therapy Focused on Direct Clot Aspiration Using the SOFIATM Catheter for Acute Ischemic Stroke.

AIM: To report our experience of mechanical thrombectomy using the SOFIA < sup > TM < /sup > catheter, in terms of its effectivenessicacy and safety. MATERIAL AND METHODS: Acute ischemic stroke patients with large vessel occlusions who underwent mechanical thrombectomy, with the SOFIA < sup > TM < /sup > aspiration catheter as the first-line approach, were retrospectively identified. For all patients, the data, including reperfusion success (modified Thrombolysis in Cerebral Infarction [mTICI]), procedural details, clinical status at the baseline and post-discharge at 90 days, and complications, were analysed. RESULTS: During the study period (January 2017-July 2020), 73 patients underwent endovascular thrombectomy. The mean age and the baseline National Institutes of Health Stroke scores were 72 (41-83) and 16 (12-25), respectively. Successful reperfusion (mTICI≥2b-3) was obtained in 80.8 % (n=59) of the patients. Using ADAPT, a first-pass effect was achieved in 63.01% (n=46) of the patients. Rescue stent retriever (SRV) had to be utilized in 36.98% (n=27) of the patients; all presented with a favourable clinical outcome (modified Rankin score ≤0-2) at 90 days. The complication rate in the study was 13.7% (n=10). CONCLUSION: The contact aspiration approach with SOFIA < sup > TM < /sup > catheters as a first-line device appears to be fast, safe, and effective. Our results were comparable to the findings of other series. In the case of insufficient response on contact aspiration, we could easily modify the SOFIA < sup > TM < /sup > catheter approach for an additional stent retriever rescue treatment.

Dual Stenting with New-Generation Stents for Aneurysm Embolization in Acute Subarachnoid Hemorrhage.

OBJECTIVE: Endosaccular treatment is the backbone of endovascular treatment for acutely ruptured aneurysms. Stent-assisted coiling is a niche technique in this context. Data on X-stenting or Y-stenting (dual crossing stenting, DCS) in the acute phase after subarachnoid hemorrhage (aSAH) are scarce, and the impact of stent properties on the outcome is unknown. We retrospectively evaluated the clinical and imaging results of DCS in patients treated for aSAH. METHODS: Patients with aSAH treated with DCS were evaluated retrospectively. Patient and procedural characteristics were evaluated to determine clinical outcomes, associated complications, and follow-up imaging findings. RESULTS: Sixteen procedures (16 patients; 10 women, mean age 55.8) were performed within 3.2 ± 2.6 days (range 1-10 days) of aSAH. Only the latest generation of intracranial stents (dual Neuroform Atlas-12 cases, dual Leo Baby-2 cases, Neuroform Atlas with Acclino Flex, or Leo Baby-2 cases) were used. Technical success rate was 100%; however, 25% of the procedures were complicated, leading to adverse events in 3 procedures (18.8%; 2 stent thrombosis, 1aneurysm rupture). Procedure-related morbidity and mortality and overall permanent morbidity and mortality were 6.3%, none, 6.3%, and 12.5%, respectively. No additional neurologic events were noted on a mean clinical follow-up of 160 ± 156 (range: 1-540) days. CONCLUSIONS: Our findings and the patient-by-patient data we extracted from the literature suggest that DCS can be performed with new-generation, low-profile stents in aSAH if a definite procedural risk is acceptable for a specific patient. New-generation open-cell stent combinations appear as a viable choice for DCS in aSAH.

Intravoxel incoherent motion parameters in the evaluation of chronic hepatitis B virus-induced hepatic injury: fibrosis and capillarity changes.

OBJECTIVE: To evaluate the diagnostic efficacy of intravoxel incoherent motion (IVIM) parameters in hepatitis B virus (HBV)-induced hepatic fibrosis using different calculation methods and to investigate histopathologic origins. MATERIALS AND METHODS: Liver biopsies from 37 prospectively recruited chronic hepatitis B patients were obtained. Twelve b-value (0-1000 s/mm2) diffusion-weighted imaging (DWI) was performed with a 1.5 T scanner and was followed by blinded percutaneous liver biopsy. All biopsy specimens were evaluated with Ishak staging, and the microvascular density (MVD) was calculated. Patients were classified as having no/mild (F0-1), moderate (F2-3), or marked (F4-5) fibrosis. Pseudodiffusion (D*), the perfusion fraction (f), and the apparent diffusion coefficient (ADC) were calculated using all b-values, while true diffusion (D) was calculated using all b-values [D0-1000] and b-values greater than 200 s/mm2 [D200-1000]. Three concentric regions of interest (ROIs) (5, 10, and 20 mm) centered on the biopsy site were used. RESULTS: D* was correlated with the MVD (p = 0.015, Pearson's r = 0.415), but f was not (p = 0.119). D0-1000 was inversely correlated with Ishak stage (p = 0.000, Spearman's rs = - 0.685) and was significantly decreased in all the fibrosis groups; however, only the no/mild and marked fibrosis groups had significantly different D200-1000 values. A pairwise comparison of receiver operating characteristic (ROC) curves of D0-1000 and D200-1000 showed significant differences (p = 0.039). D* was the best at discriminating early fibrosis (AUC = 0.861), while the ADC best discriminated advanced fibrosis (AUC = 0.964). CONCLUSION: D* was correlated with the MVD and is a powerful parameter to discriminate early hepatic fibrosis. D significantly decreased with advanced fibrosis stage when using b-values less than 200 s/mm2 in calculations.

The Experience of the Derivo® Embolisation Device in Intracranial Aneurysms.

AIM: To investigate the safety and efficacy of Derivo® embolisation device (DED), a new-generation flow diverter designed to treat cerebrovascular aneurysms, and its long-term clinical outcomes. MATERIAL AND METHODS: In total, 146 patients with 182 aneurysms were treated with DED. The mean age of the participants was 51.5 years; among them, 46 (31.5%) presented with acute subarachnoid haemorrhage. The mean aneurysm size was 8.3 mm, and 12 aneurysms were involved the vertebrobasilar system. Ophthalmic aneurysms account for most internal carotid artery (ICA) aneurysms. RESULTS: The Glasgow Coma Scale (GCS) score of 12 patients was < 15. DED was associated with a mortality rate of 2.7% and permanent morbidity rate of 3.4%, and a complete aneurysm occlusion rate was achieved in 78.7% of cases after 7.02 months. CONCLUSION: The DED device is a new-generation flow diverter with excellent opening behaviour and navigational benefits. Our results indicated a safe aneurysm occlusion with optimum morbidity and mortality values despite the fact that almost one-third of the patients presented with subarachnoid haemorrhage.

Endovascular Treatment of Superior Cerebellar Artery Aneurysms.

AIM: To present our experience on superior cerebellar artery (SCA) aneurysms treated with embolization by using current endovascular techniques. MATERIAL AND METHODS: All SCA aneurysms treated by our endovascular team since 2013 were retrospectively evaluated. Clinical information and angiographic findings on presentation, during treatment and on follow-up were noted. RESULTS: Endovascular treatment was the primary treatment method for SCA aneurysms during the study period. Twenty three patients (15 female, 8 male) with a mean age of 50.6 years, 12 of whom with subarachnoid hemorrhage were treated. Treatments included coiling (56%), stent assisted coiling, stentriever assisted coiling, Y stent assisted coiling and flow diversion with either flow diverter placement or telescopic stenting. Two patients died secondary to consequences of subarachnoid hemorrhage. The outcome of 1 patient was Modified Rankin Scale (mRS) 3 and the outcome of remaining 20 patients was mRS 0. The rates of aneurysm occlusion according to Raymond-Roy classification were: class 1 in 11 patients, class 2 in 6 patients and class 3 in 2 patients on a mean follow-up of 15.3 months. Only one patient required retreatment. CONCLUSION: Current endovascular techniques are able to address the high rate of recanalization and retreatment of SCA aneurysms which are currently the major drawbacks associated with primary coiling when compared with surgical treatment. It remains to be shown if use of these latest techniques are associated with increased risk of thromboembolic events.

Multiple simultaneous venous and arterial thromboses in a patient with factor V Leiden disorder: Detection by multislice computed tomography.

Arterial thrombosis is extremely rare in patients with factor V Leiden (FVL) mutation. Recent advances in multislice computed tomography (MSCT) technology facilitated diagnosis of thromboembolic events accurately without delay. We report a patient with FVL mutation and acute bilateral lower extremity deep venous thromboses, pulmonary thromboembolism, and acute left anterior descending artery thrombosis, all diagnosed by MSCT. MSCT has been utilized for prompt diagnosis of the concomitant thrombotic pathologies simultaneously.

The evaluation of the retrobulbar orbital fat tissue and optic nerve with strain ratio elastography.

AIM: The aim of this study was to evaluate the diagnostic performance of strain ratio elastography in the assessment of retrobulbar orbital fat tissue. MATERIALS AND METHODS: The retrobulbar fat tissue of 14 eyes in 14 participants was scanned by sonoelastography. All the participants had permanent vision loss secondary to glaucoma in at least one eye. The elasticity scores were determined and the strain ratio was based on the comparison of the average strain measured in the retrobulbar fat tissue around the optic nerve at the same depth. RESULTS: The mean strain values for the optic nerve (B) and the retrobulbar fat tissue (A) were 0.78+/-0.61 and 1.43+/-0.99, respectively (p=0.005). The mean strain ratio (B/A) was 0.56+/-0.24. CONCLUSION: This preliminary study showed that by providing strain values and ratios of different orbital tissues sonoelastography may have a potential use in the diagnosis and follow-up of orbital inflammatory and infiltrative diseases.

Hydatid cyst: an unusual solid breast mass.

Breast involvement of the hydatid cyst is very rare, and it accounts for 0.27% of all cases. Cases reported in the literature are generally about various cystic and calcified forms, but the solid form of hydatid cyst in the breast is quite rare. It is difficult to differentiate the breast's malignant and benign lesions from this form of hydatid cyst by imaging methods. Therefore, we aimed to present the mammographical and sonographic findings of a 50-year-old woman patient consulted to our mammography unit of whom we determined a Breast Imaging-Reporting and Data System class 4 solid lesion in the right breast and come out as hydatid cyst pathologically.

Serum D-lactate: a useful diagnostic marker for acute appendicitis.

BACKGROUND/AIMS: Acute appendicitis is the most common acute surgical infection seen in emergency department. The present study aims to evaluate the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of the serum D-lactate levels as a marker for the diagnosis of acute appendicitis. D-lactate is the stereoisomer of the mammalian L(+)-lactate, and is produced by indigenous bacteria (Escherichia coli, Klebsiella, Bacteroides, Lactobacillus) in the gastrointestinal tract. Once obstruction occurs, appendix is a good medium for bacterial proliferation, and ischemic injury leads to an increase in D-lactate levels. METHODOLOGY: A total of thirty-two consecutive patients with the suspicion of acute appendicitis were prospectively included in the study. Patient characteristics, ultrasonography (US) and laboratory assessment including white blood cell (WBC), C-reactive protein (CRP), D-lactate and intraoperative findings, histology results, clinical outcome were evaluated. RESULTS: WBC level above 10(9)/L had an accuracy of 66%, whereas a CRP level above 5 mg/L had an accuracy of 75%. We observed that when the D-lactate level was greater than 0.25 mmol/L in acute appendicitis, the specificity was 60%, the false negative rate was 25% and the accuracy was 90%. The false negative rate of CRP (67%) was higher than that of D-lactate levels (25%). Ultrasound had a sensitivity of 96%, specificity 40% and accuracy 87% in our study. CONCLUSIONS: We found positive correlations between serum D-lactate levels and acute appendicitis and serum D-lactate had the lowest false negative rate among the other parameters. Therefore, we conclude that D-lactate might be a simple and reliable diagnostic marker for appendicitis.

Isolated pericardial hydatid cyst in an asymptomatic patient: a remark on its radiologic diagnosis.

Cardiac hydatid cyst disease is uncommon, representing approximately 0.2% to 2% of all cyst-related cases. Cardiac hydatid cysts are found mostly within the myocardium. Most cardiac hydatid cysts are located in the interventricular septum or in the left ventricular wall. Only few cases of pericardial location have been reported; isolated pericardial hydatid cysts are especially extremely rare. Patients with a cardiac hydatid cyst are usually asymptomatic. We present the case of an asymptomatic patient with isolated pericardial hydatid cyst disease and discuss the role of chest X-rays in the incidental diagnosis of this condition.