Utility of virtual stenting in treatment of cerebral aneurysms by flow diverter devices.

Successful endovascular treatment by stenting of intracranial aneurysms requires proper placement of the device and appropriate choice of its diameter and length. To date, several methods have been employed to achieve these goals, although each has inherent critical issues. Recently developed stent planning software applications can be used to assist interventional neuroradiologists. Based on a 3D-DSA image acquired before stenting, these applications simulate and visualize the final placement of the deployed stent. In this single-centre retrospective study, 27 patients undergoing an intravascular procedure for the treatment of intracranial aneurysms from June 2019 to July 2020 were evaluated according to strict inclusion criteria. Stent virtualization was performed with Syngo 3D Aneurysm Guidance Neuro software. We compared the software-generated stent measurement and measurements taken by the interventional radiologist. Statistical analysis was performed using the STAC web platform. Mean and standard deviations of absolute and relative discrepancies between predicted and implanted stents were recorded. Friedman's nonparametric test was used to refute the null hypotheses, i.e. (I) discrepancies between the size of virtual and implanted stents would occur, and (II) operator influence does not affect the outcome of the virtual stenting process. Based on these observations, it is believed that the virtual stenting process can validly assist interventional neuroradiologists in selecting the appropriate device and reducing peri- and post-procedural complications. The results of our study suggest that virtual reality simulation of devices used for endovascular treatment of intracranial aneurysms is a useful, rapid, and accurate tool for interventional procedure planning.

Efficacy of recanalization therapy for ischemic stroke: multicenter hospital network experience.

PURPOSE: Stroke is a leading cause of long-term disability with high mortality rate in the first year after the event. In Campania, mechanical thrombectomy treatment significantly increases in the last 3 years, as well as hospitals delivering acute stroke treatments. The aim of this study is to demonstrate how a full opening of our stroke network improves stroke management and stroked patients' survival in Campania. MATERIAL AND METHODS: In Federico II University Hospital of Naples acting as a HUB center of 7 peripheral SPOKE hospitals in regional territory, 68 patients with acute ischemic stroke were evaluated with NIHSS and m-RS clinical scores and neuroradiological ASPECT scores, from January 1 to December 31, 2021. At hospital discharge, NIHSS score and three months after m-RS score were re-assessed to evaluate the therapeutic effects. RESULTS: Forty-two of 68 patients (63%) admitted to our hub center had ischemic acute stroke at CT evaluation; 29 patients had ASPECT score > 7 (69%), and 6 a score < 7 (14%). At admission, NIHSS score mean value was 10.75, and m-RS score mean value was 0.74. At discharge, NIHSS score mean value was 7.09. After three months, m-RS score mean value was 0.74. DISCUSSION: The inter-company agreement between Federico II University and several peripheral hospitals allows an absolute and relative increase in endovascular mechanical thrombectomy and intravenous thrombolysis procedures, with a relative prevalence of mechanical thrombectomy. A regional implementation of the stroke multi-disciplinary care system is hardly needed to ensure the optimum treatment for the largest number of patients, improving patient's outcome.

Dissective tandem stroke: an endovascular approach.

Ischemic stroke due to internal carotid artery occlusion is a potential devastating condition. More frequently the occlusions are embolic in nature, but sometimes they are caused by arterial dissection and their treatment is a challenge. We describe an illustrative case where a young patient with middle cerebral artery stroke caused by carotid artery dissection was submitted to endovascular treatment of mechanical thrombectomy and stenting, giving an excellent outcome. We believe that tandem approach is a treatment of choice in these cases.

Basilar Artery Occlusion (BAO) revascularization after more than 12 hours from the onset of symptoms with excellent outcome: Report of a case.

This paper reports a case of basilar artery occlusion (BAO), a relatively rare event associated with high mortality rate and high risk of disability. A 77-year-old man arrived at our Stroke Unit approximately 14 hours after the onset of symptoms (dysarthria and complete left hemiparesis) with progressive worsening up to coma and with a National Institute Health Stroke Scale (NIHSS) of 22. The patient was treated and, at discharge, the modified Rankin scale and NIHSS were 2 and 5, respectively. The aim of this paper is to illustrate how revascularization treatment, also after 12 hours, could be a viable option to ensure survival and a good life quality for the patient. Furthermore, it is essential to encourage the publication of a greater number of trials about the posterior circulation emphasizing how many favorable prognosis indicators are now recognized.

Endovascular treatment of chronic hemoptysis in patients with pulmonary tuberculosis.

BACKGROUND: We aimed to demonstrate the safety and efficacy of bronchial artery embolization (BAE) in patients with pulmonary tuberculosis in the planned management of "mild" hemoptysis. This treatment, already widely documented and used as a life-saving therapy in an emergency regimen, if properly planned in poorly controlled patients through medical therapy alone, can provide a valid opportunity by reducing the frequency and extent of non-fatal bleeding, but which still worsen the quality of life of these already significantly traumatized patients. METHODS: All procedures were conducted through a right common femoral access with a 5 Fr catheter and a 2.7 Fr super-selective catheter coaxial technique of the branches of the bronchial arteries with suspected bleeding sources. Embolizations were performed with 500-700 micron Terumo PVA plastic microparticles. We decided to adopt the following inclusion criteria for the selection of patients to be enrolled: documented diagnosis of pulmonary TB, the presence of at least one bleeding episode that required at least two blood transfusions, evaluation with bronchoscopic examination to ascertain the bronchial origin of bleeding and the affected lobar site, execution of an angio-ct radiological study for the evaluation of the bronchial systemic anatomy as well as the patency of the pulmonary arterial circulation, general hemodynamic compensation and an age of enrollment between 25 and 65 years. RESULTS: All selective embolization interventions demonstrated a technical success of 100% of the total number of patients. 11 out of 12 patients did not show any signs of relapse or complications related to the interventional procedure at a first check-up carried out at 48 hours, instead a fatal massive hemoptysis occurred in only one patient. At the next three-month follow-up, no relapses were documented in all selected patients. Only one patient required a second embolization four months after the first procedure. CONCLUSIONS: Radiological-interventional approach in the elective regimen of super-selective embolization of the bronchial arteries (BAE) in the management and control of "mild" hemoptysis in patients with pulmonary tuberculosis not controlled exclusively by medical therapy, according to a strategy systematic of planned intervention and respecting clear and standardized inclusion criteria, represented in our experience a safe and effective procedure, free from significant short and long term complications, especially in well selected patients, which, although not always allows a definitive and stable control of hemoptysis, can in any case significantly limit the risks, also allowing a better planning of the most appropriate therapeutic intervention strategy.

Diagnostic imaging in the diagnosis of acute complications of bariatric surgery.

PURPOSE: The aim of study is to identify the frequency of acute complications and imaging findings at gastro-intestinal transit (GI) and computerised tomography (CT) in a group of obese patients who developed clinical suspicion of acute complications (painful and meteoric abdomen, nausea, vomiting, fever, intestinal blockage) in post bariatric surgery. MATERIAL AND METHODS: We retrospectively review 954 obese patients who underwent bariatric surgery between 2013 and 2019. The study included 72 patients who developed clinical suspicion of acute complications (painful and meteoric abdomen, nausea, vomiting, fever, intestinal blockage) within 6 days of bariatric surgery of sleeve gastrectomy, gastric banding, gastric bypass with Roux loop confirmed by CT, and who underwent a gastrointestinal transit before the CT examination. RESULTS: GI exam allowed visualisation of 58% of complications. Analysing the data for each surgical technique, 46 post-operative complications were found involve gastric banding. The most frequent was bandage migration (26 cases, 56 %), identified in all cases at GI transit and then confirmed on CT. CONCLUSIONS: The study suggests that CT should be used to clarify all doubtful or clinically discordant GI transit exam results. The participation of a radiologist in qualification and post-operative evaluation is important for bariatric surgery patients.

Calcium pyrophosphate deposition disease: The role of imaging in their detection and in differential diagnosis of crystal arthropathies.

Calcium pyrophosphate deposition disease is characterized by the deposition of pyrophosphate crystals in various joint structures. Calcium pyrophosphate deposition disease can be linked to underlying metabolic disorders such as hemochromatosis, hyperparathyroidism, hypophosphatemia, hypomagnesaemia, and hypothyroidism, all of which increase the risk of calcium pyrophosphate deposition. We present the case of a 55-year-old male who underwent diagnostic examination for the onset of recurrent joint pain in the right knee.

Amplatzer vascular plug IV in the treatment of high flow renal arteriovenous fistula: Case considerations.

Renal arteriovenous fistula is classified into idiopathic, acquired and congenital. Endovascular therapy has become the gold standard compared to surgery. We present the embolization procedure of a renal fistula postbiopsy in a 57-year-old female patient through the use of St. Jude Medical Amplatzer vascular Plug IV. Although numerous embolizing agents are available, plug type IV has numerous advantages in terms of procedure times, speed of embolization and precision of the occlusion, but with a relative increase in costs.