A new endovascular technique for small anterior choroidal artery aneurysms. A consecutive series using the 3-catheter-protective technique.

INTRODUCTION: Endovascular treatment of small anterior choroidal artery (AChA) aneurysms can be challenging, especially if the AChA arises from the sac. Preserving its patency during embolization is as important as obliterating the aneurysm. We describe a variant of the "protective microcatheter technique" (PMT) in a series of six patients with AChA aneurysms where the AChA emerged from the sac. METHODS: Three different microcatheters (KT) were used. The first microcatheter was placed in the AChA to protect it. A remodeling balloon-catheter was then positioned in the internal carotid artery to stabilize the coils during embolization and to control a potential rupture. The third microcatheter was finally used to coil the aneurysm. RESULTS: Mean sac size of anterior choroidal artery aneurysms was 2×2×2mm. All aneurysms were successfully occluded. There was neither ischemic complication nor ruptured aneurysm during endovascular treatment. A final angiogram demonstrated AChA patency in all cases. CONCLUSION: The 3KT-PMT for AChA aneurysms appears to be safe and effective to prevent AChA occlusion during aneurysm coiling, especially when the AChA arises from the sac.

Digestive perforations related to endoscopy procedures: a local management charter based on local evidence and experts' opinion.

Background and study aims Perforations are a known adverse event of endoscopy procedures; a proposal for appropriate management should be available in each center as recommended by the European Society of Gastrointestinal Endoscopy. The objective of this study was to establish a charter for the management of endoscopic perforations, based on local evidence. Patients and methods Patients were included if they experienced partial or complete perforation during an endoscopic procedure between 2008 and 2018 (retrospectively until 2016, then prospectively). Perforations (size, location, closure) and management (imagery, antibiotics, surgery) were analyzed. Using these results, a panel of experts was asked to propose a consensual management charter. Results A total of 105 patients were included. Perforations occurred mainly during therapeutic procedures (91, 86.7%). Of the perforations, 78 (74.3 %) were diagnosed immediately and managed during the procedure; 69 of 78 (88.5 %) were successfully closed. Closures were more effective during therapeutic procedures (60 of 66, 90.9 %) than during diagnostic procedures (9 of 12, 75.0 %, P  = 0.06). Endoscopic closure was effective for 37 of 38 perforations (97.4 %) < 0.5 cm, and for 26 of 34 perforations (76.5 %) ≥ 0.5 cm ( P  < 0.05). For perforations < 0.5 cm, systematic computed tomography (CT) scan, antibiotics, or surgical evaluation did not improve the outcome. Four of 105 deaths (3.8 %) occurred after perforation, one of which was attributable to the perforation itself. Conclusions Detection and closure of perforations during endoscopic procedure had a better outcome compared to delayed perforations; perforations < 0.5 cm had a very good prognosis and CT scan, surgeon evaluation, or antibiotics are probably not necessary when the endoscopic closure is confidently performed. This work led to proposal of a local management charter.

Is pelvic MRI in women presenting with pelvic endometriosis suggestive of associated ileal, appendicular, or cecal involvement?

PURPOSE: To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. METHODS: Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. RESULTS: Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98-42.19), 5.8 (95% CI 1.12-30.07), and 6.74 (95% CI 1.23-36.77), respectively. CONCLUSIONS: Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.