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1.
Wien Med Wochenschr ; 174(5-6): 123-125, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37079176

RESUMEN

Acute bilateral vision loss (ABVL) is a rare and challenging diagnostic issue that is most often caused by a neurological disorder. Since it can be the presenting symptom of potentially life-threatening diseases, priority should be given to excluding such diagnoses. Special caution is required if ABVL symptoms result after an intracranial intervention. This article reports on a diagnostic approach for a patient suffering from ABVL due to vitreous hemorrhage related to a subarachnoid hemorrhage (SAH) after endovascular intracranial aneurysm treatment. This case study highlights the importance of imaging interpretation and its consequences.


Asunto(s)
Aneurisma Intracraneal , Hemorragia Subaracnoidea , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/cirugía , Hemorragia Vítrea/complicaciones , Hemorragia Vítrea/diagnóstico
2.
Neurol Sci ; 42(6): 2391-2396, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33052575

RESUMEN

BACKGROUND: Tandem occlusions can complicate medical and endovascular stroke treatment. To identify these occlusions, computed tomography angiography (CTA) represents the best imaging modality. However, CTA is still not initially performed in some patients not admitted directly to stroke centers. Early identification of an additional occlusion of the proximal extracranial internal carotid artery may improve the best suitable treatment strategy. The purpose of this study was to find a valuable threshold of thrombus attenuation in a non-contrast head CT (NCCT) scan to facilitate a safe diagnosis of tandem occlusions. MATERIALS AND METHODS: Consecutive patients with acute middle cerebral artery (MCA) occlusions who underwent endovascular treatment were identified from our registry of neuroendovascular interventions. Thrombus attenuations of the affected MCA and contralateral vessel were measured by NCCT. To compare individual baseline blood attenuations, the difference between the thrombus attenuation and the contralateral MCA attenuation (referred to as ΔTM) was calculated. RESULTS: Three hundred and twenty-five patients were included. There was a highly significant difference between mean thrombus attenuation with isolated MCA occlusion and additional extracranial internal carotid artery (ICA) occlusion (49.9 ± 8 vs. 56.2 ± 10 Hounsfield units (HU); P < 0.001). The area under the receiver operating characteristic curve of ΔTM was 0.72. The optimal threshold value was 13.5 HU, with a sensitivity of 67.5% and a specificity of 68.6%. CONCLUSION: Despite a significant difference in thrombus attenuation in MCA occlusions with an additional extracranial ICA occlusion compared with isolated MCA occlusions, a relevant threshold of thrombus attenuation was not found.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/terapia , Arteria Carótida Interna/diagnóstico por imagen , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/terapia , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Resultado del Tratamiento
3.
Stroke ; 51(10): 2895-2900, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32967576

RESUMEN

BACKGROUND AND PURPOSE: This randomized study aimed to evaluate whether the use of a stroke clock demanding active feedback from the stroke physician accelerates acute stroke management. METHODS: For this randomized controlled study, a large-display alarm clock was installed in the computed tomography room, where admission, diagnostic work-up, and intravenous thrombolysis occurred. Alarms were set at the following target times after admission: (1) 15 minutes (neurological examination completed); (2) 25 minutes (computed tomography scanning and international normalized ratio determination by point-of-care laboratory completed); and (3) 30 minutes (intravenous thrombolysis started). The responsible stroke physician had to actively provide feedback by pressing a buzzer button. The alarm could be avoided by pressing the button before time out. Times to therapy decision (primary end point, defined as the end of all diagnostic work-up required for decision for or against recanalizing treatment), neurological examination, imaging, point-of-care laboratory, needle, and groin puncture were assessed by a neutral observer. Functional outcome (modified Rankin Scale) was assessed at day 90. RESULTS: Of 107 participants, 51 stroke clock patients exhibited better stroke-management metrics than 56 control patients. Times from door to (1) end of all indicated diagnostic work-up (treatment decision time; 16.73 versus 26.00 minutes, P<0.001), (2) end of neurological examination (7.28 versus 10.00 minutes, P<0.001), (3) end of computed tomography (11.17 versus 14.00 minutes, P=0.002), (4) end of computed tomography angiography (14.00 versus 17.17 minutes, P=0.001), (5) end of point-of-care laboratory testing (12.14 versus 20.00 minutes, P<0.001), and (6) needle times (18.83 versus 47.00 minutes, P=0.016) were improved. In contrast, door-to-groin puncture times and functional outcomes at day 90 were not significantly different. CONCLUSIONS: This study showed that the use of a stroke clock demanding active feedback significantly improves acute stroke-management metrics and, thus, represents a potential low-cost strategy for streamlining time-sensitive stroke treatment.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Manejo de la Enfermedad , Retroalimentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada por Rayos X
4.
Neurol Sci ; 41(6): 1547-1555, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31974796

RESUMEN

PURPOSE: Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke. However, recanalization fails in about 16.5% of interventions. We report our experience with unsuccessful MT and analyze technical reasons plus patient-related parameters for failure. METHODS: Five hundred ninety-six patients with acute ischemic stroke in the anterior circulation and intention to perform MT with an aspiration catheter and/or stent retriever were analyzed. Failure was defined as 0, 1, or 2a on the mTICI scale. Patients with failing MT were analyzed for interventional progress and compared to patients with successful intervention, whereby parameters included demographics, medical history, stroke presentation, and treatment. RESULTS: One hundred of the 596 (16.8%) interventions failed. In 20 cases, thrombus could not be accessed or passed with the device. Peripheral arterial occlusive disease is common in those patients. In 80 patients, true stent retriever failure occurred. In this group, coagulation disorders are associated with poor results, whereas atrial fibrillation is associated with success. The administration of intravenous thrombolysis and intake of nitric oxide donors are associated with recanalization success. Intervention duration was significantly longer in the failing group. CONCLUSION: In 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases. In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.


Asunto(s)
Enfermedades de las Arterias Carótidas/terapia , Infarto de la Arteria Cerebral Media/terapia , Accidente Cerebrovascular Isquémico/terapia , Trombolisis Mecánica , Evaluación de Resultado en la Atención de Salud , Evaluación de Procesos, Atención de Salud , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Humanos , Masculino , Trombolisis Mecánica/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Evaluación de Procesos, Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Stents/estadística & datos numéricos , Terapia Trombolítica/estadística & datos numéricos , Insuficiencia del Tratamiento
5.
J Mater Sci Mater Med ; 31(12): 131, 2020 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-33270156

RESUMEN

This study aimed to investigate in vivo two stent technologies, with particular emphasis on thrombogenicity and inflammatory vessel remodeling processes. The micro-stents tested in this study were developed for intracranial aneurysm treatment. In our study twelve, New Zealand white rabbits were divided into two groups: 18 laser-cut stents (LCS) and 18 braided stents (BS) were impanated without admiration of antiplatelet medication. Three stents were implanted into each animal in the common carotid artery, subclavian artery, and abdominal aorta. Digital subtraction angiography was performed before and after stent implantation and at follow-up for the visualization of occurring In-stent thromboembolism or stenosis. The Stents were explanted for histopathological examination at two different timepoints, after 3 and 28 days. Angiographically neither in-stent thrombosis nor stenosis for both groups was seen. There was a progressive increase in the vessel diameter, which was more pronounced for BS than for LCS. We detected a higher number of thrombi adherent to the foreign material on day 3 for BS. On day 3, the neointima was absent, whereas the complete formation observed was on day 28. There was no significant difference between both groups regarding the thickness of the neointima. The in vivo model of our study enabled the evaluation of blood and vessel reactions for two different stent technologies. Differences in vessel dimension and tissue around the stents were observed on day 28. Histological analysis on day 3 enabled the assessment of thrombotic reactions, representing an important complementary result in long-term studies.


Asunto(s)
Prótesis Vascular , Aneurisma Intracraneal/fisiopatología , Stents Metálicos Autoexpandibles , Stents , Angiografía , Animales , Aorta/fisiopatología , Aorta Abdominal , Arteria Carótida Común , Circulación Cerebrovascular , Constricción Patológica , Rayos Láser , Ensayo de Materiales , Modelos Animales , Neointima , Inhibidores de Agregación Plaquetaria/farmacología , Diseño de Prótesis , Conejos , Arteria Subclavia , Trombosis
6.
Radiologe ; 60(4): 317-320, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32152651

RESUMEN

The development of microstents for aneurysm treatment has greatly expanded endovascular aneurysm therapy. Due to the increased amount of foreign material, the use of such stents is associated with an increased risk of thrombus formation and therewith the associated risk of ischemic stroke. For this reason, various surface coatings have recently been developed. The primary aim of these coatings is to reduce the foreign matter-mediated platelet adhesion to the stent surfaces. The potential reduction of dual antiplatelet therapy when using coated stents was recently discussed. But currently, no neurointerventional guidelines or recommendations endorse the stent implantation under single antiplatelet therapy. This article describes the different coatings in the field of neurointervention and their mode of action.


Asunto(s)
Aneurisma de la Aorta Abdominal/terapia , Materiales Biocompatibles Revestidos , Procedimientos Endovasculares/instrumentación , Stents , Humanos , Inhibidores de Agregación Plaquetaria
7.
Radiologe ; 60(12): 1172-1176, 2020 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-32821966

RESUMEN

BACKGROUND: The therapy strategy of patients with acute stroke of the middle cerebral artery (MCA) is influenced by the location of the occlusion. The purpose of this study was to analyze the clinical outcome in patients with acute ischemic MCA occlusion according to the location of occlusion who underwent endovascular treatment (EVT). METHODS: A total of 54 patients (age 73 ± 15 years; 59% female) with acute ACM occlusion treated with EVT were included. In coronary reformatted CT angiography images, the distance to the thrombus (DT), i.e. the distance from the carotid T to the beginning of the thrombus, was measured. Correlations between DT, clinical symptoms, and clinical outcome of patients who underwent EVT were analyzed. RESULTS: DT correlated with clinical symptoms measured by the National Institutes of Health Stroke Scale (NIHSS; p = 0.017; R = -0.324) at baseline. DT also correlated with the modified Rankin scale after 90 days (90-day mRS; p = 0.014; R = -0.333). DT was a predictor for a good clinical outcome (mRS after 90 days) after EVT; odds ratio 1.113 (P = 0.02; 95% confidence interval [CI] 1.017-1.219). A DT >10 mm correlated significantly (p = 0.036) with a good clinical outcome (90-day mRS ≤2). CONCLUSION: DT correlates with the clinical symptoms of patients with acute MCA occlusion. In addition, DT is an independent predictor of the clinical outcome of patients suffering from acute stroke due to MCA occlusion.


Asunto(s)
Procedimientos Endovasculares , Infarto de la Arteria Cerebral Media , Accidente Cerebrovascular , Trombosis , Angiografía Cerebral , Femenino , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Masculino , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Terapia Trombolítica , Trombosis/diagnóstico por imagen , Resultado del Tratamiento
8.
Stroke ; 48(8): 2171-2175, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28679854

RESUMEN

BACKGROUND AND PURPOSE: A new generation of carotid artery stents that uses a second micromesh layer to reduce embolic events during carotid artery stenting has recently been introduced. The purpose of this study was to compare acute occlusion rates of these new dual-layer stents with those of single-layer stents in the setting of emergency carotid artery stenting with intracranial mechanical thrombectomy in acute ischemic stroke. METHODS: Consecutive patients with acute tandem (intra- and extracranial) lesions of the anterior circulation who were endovascularly treated at our institution were identified from our registry of neuroendovascular interventions. Clinical, angiographic, and neuroimaging data were analyzed. End points included acute occlusions of the carotid stents (within 72 hours after stenting) and symptomatic intracerebral hemorrhage. RESULTS: Forty-seven patients were included. Dual-layer stents (n=20) had a significantly higher rate of acute occlusions than single-layer stents (n=27; 45% versus 3.7%; P=0.001; odds ratio, 21.3; 95% confidence interval, 2.4-188.4). There were no significant differences in the rates of patients who had any antiplatelet or dual antiplatelet medication before admission, in the rates of postinterventional symptomatic intracerebral hemorrhage, the mean National Institutes of Health Stroke Scale scores at admission, or the modified Rankin Scale scores at discharge. CONCLUSIONS: The recently introduced dual-layer stents have a higher risk of acute occlusion compared with single-layer stents in the treatment of acute stroke.


Asunto(s)
Isquemia Encefálica/cirugía , Estenosis Carotídea/diagnóstico , Tratamiento de Urgencia/efectos adversos , Procedimientos Endovasculares/efectos adversos , Stents/efectos adversos , Accidente Cerebrovascular/cirugía , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Estenosis Carotídea/etiología , Tratamiento de Urgencia/métodos , Procedimientos Endovasculares/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Trombectomía/efectos adversos , Trombectomía/métodos , Resultado del Tratamiento
9.
Wien Med Wochenschr ; 167(11-12): 282-284, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28755020

RESUMEN

Spinal perimedullary arteriovenous fistulas (PMAVFs) are rare entities among vascular malformations of the spinal cord. Due to progressive myelopathy, spastic paresis, sensory disturbance, and bowl and bladder dysfunction can be the presenting symptoms. Cervical spinal arteriovenous fistulas (AVFs) are even rarer. These lesions differ from the ones in the thoracolumbar region and have an even wider mode of presentation. We report on a 9-year-old boy with a cervical PMAVF manifesting with headache and vertigo.


Asunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Cefalea/etiología , Médula Espinal/irrigación sanguínea , Vértigo/etiología , Angiografía de Substracción Digital , Malformaciones Arteriovenosas/terapia , Angiografía Cerebral , Niño , Embolización Terapéutica , Estudios de Seguimiento , Cefalea/terapia , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/terapia , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Examen Neurológico , Médula Espinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vértigo/terapia
10.
Neuroradiology ; 58(10): 987-996, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27457491

RESUMEN

INTRODUCTION: Flow diverters are increasingly being used to treat intracranial aneurysms. This study evaluates occurring complications of flow-diverting devices in the treatment of experimental aneurysms, involving the use of micro-CT and small animal MRI at 9.4 T, in correlation to angiographic and histological findings. METHODS: We previously published two preclinical studies, in which we assessed two different flow diverters in the treatment of elastase-induced aneurysms. Devices have been implanted across the aneurysm neck as well as in the abdominal aorta. From these studies, a total of 65 devices (prototype FD (n = 30) and Derivo embolization device (n = 35)) additionally underwent micro-CT and MRI after angiographic follow-up and before being histologically examined. RESULTS: The different architectures of both devices were precisely comparable due to high-resolution micro-CT imaging. Micro-CT revealed wire fractures in nine cases (30 %) only with the prototype FD. In three cases (10 %), severe wire fractures correlated with an in-stent stenosis due to intimal hyperplasia. Other complications, like distal stent occlusions and post-stent stenosis, were seen in both groups and verified with both imaging techniques. Osseous metaplasia were correlated to calcifications seen with micro-CT. MRI enabled visualization of the position of the implanted devices relative to the aneurysm and revealed incomplete aneurysm neck coverage with the prototype FD in two cases (6.7 %). CONCLUSION: Micro-CT and 9.4-T MRI are valid to discover and understand occurring complications of flow diverters in the preclinical phase and can serve as evaluation tools to minimize complication rates of endovascular devices in the future.


Asunto(s)
Revascularización Cerebral/efectos adversos , Revascularización Cerebral/instrumentación , Oclusión de Injerto Vascular/etiología , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Angiografía por Resonancia Magnética/métodos , Microtomografía por Rayos X/métodos , Animales , Angiografía Cerebral/métodos , Revascularización Cerebral/métodos , Angiografía por Tomografía Computarizada/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Aneurisma Intracraneal/inducido químicamente , Elastasa Pancreática , Conejos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento
13.
Neuroradiology ; 56(2): 129-37, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24496551

RESUMEN

INTRODUCTION: In this study, we analyzed angiographic and histologic aneurysm occlusion of a newly designed flow diverting device. Visibility and flexibility, as well as occlusions of side branches and neointimal proliferation were also evaluated. METHODS: Aneurysms were induced in 18 New Zealand white rabbits and treated with a braided, "closed-loop-designed" device of nitinol. Additional devices were implanted in the abdominal aorta to cover the origin of branch arteries.Angiographic follow-ups were performed immediately after placement of the device, after 3 months (n=9) and 6 months(n =9). The status of aneurysm occlusion (using a five-point scale) and the patency of branch arteries were assessed. RESULTS: Aneurysm occlusion rates were noted as grade 0 in 2 (11 %), grade I in 1 (6 %), grade II in 1 (6 %), grade III in 9(50 %), and grade IV in 5 (28 %) of 18 aneurysms, respectively, indicating a complete or near-complete occlusion of 78 % under double antiplatelet therapy. Aneurysm occlusion was significantly higher at 6 months follow-up (P =0.025). Radiopaque markers provided excellent visibility. Limited device flexibility led to incomplete aneurysm neck coverage and grade 0 occlusion rates in two cases. Distal device occlusions were found in three cases, most likely due to an extremely undersized vessel diameter in the subclavian artery.No case of branch artery occlusion was seen. Intimal proliferation and diameter stenosis were moderate. CONCLUSION: The tested flow diverter achieved near-complete and complete aneurysm occlusion under double antiplatelet therapy of elastase-induced aneurysms in 78 %, while preserving branch arteries.


Asunto(s)
Prótesis Vascular , Revascularización Cerebral/instrumentación , Modelos Animales de Enfermedad , Aneurisma Intracraneal/patología , Aneurisma Intracraneal/cirugía , Stents , Animales , Revascularización Cerebral/métodos , Análisis de Falla de Equipo , Femenino , Humanos , Aneurisma Intracraneal/inducido químicamente , Angiografía por Resonancia Magnética/métodos , Elastasa Pancreática , Diseño de Prótesis , Conejos , Resultado del Tratamiento
14.
Arch Toxicol ; 88(1): 89-96, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23877120

RESUMEN

Darbepoetin (DPO), an erythropoietin (EPO) derivative, was licensed in 2002 to treat patients with solid tumors suffering from chemotherapy-dependent anemia, although various tumors express EPO to improve vascularization, thus favoring tumor growth and spreading. Therefore, we wanted to investigate direct effects of DPO on the liver tumor cell lines HepG2, SkHep1, Huh-7, AKN1, HCC-T and HCC-M, as well as on primary human hepatocytes (hHeps). DPO (0-40 ng/ml) did not affect viability of hHeps, HepG2, SkHep1, AKN1, HCC-T and HCC-M cells, as determined by Resazurin conversion. However, Huh-7 cells' viability dose-dependently decreased from 5 ng/ml DPO on. Lack of LDH release into culture medium and negative DNA laddering excluded apoptosis or necrosis as the cause for the reduced Resazurin conversion. In Huh-7 cells, DPO increased the expression of p53. Interestingly, Huh-7 cells showed the highest basal TGF-ß1 expression as compared to the other cell lines. Upon inhibition of TGF-ß1 signaling, DPO no longer reduced viability in Huh-7 cells. On the contrary, co-incubation with TGF-ß1 made the other cell lines responsive to DPO. Summarizing our data, we show that DPO reduces the growth of Huh-7 cells by up-regulation of the tumor-suppressor gene p53. This mechanism seems to be dependent on a strong TGF-ß expression and corresponding signaling in these cells, as other cell lines became responsive to DPO with TGF-ß1 supplementation. The knowledge of this mechanism offers great perspectives for the understanding and treatment of solid liver tumors.


Asunto(s)
Eritropoyetina/análogos & derivados , Neoplasias Hepáticas/tratamiento farmacológico , Factor de Crecimiento Transformador beta/metabolismo , Apoptosis/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Darbepoetina alfa , Relación Dosis-Respuesta a Droga , Eritropoyetina/farmacología , Hepatocitos/efectos de los fármacos , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Fosforilación/efectos de los fármacos , Transducción de Señal/efectos de los fármacos , Factor de Crecimiento Transformador beta1/farmacología , Proteína p53 Supresora de Tumor/metabolismo , Regulación hacia Arriba/efectos de los fármacos
15.
Radiologie (Heidelb) ; 64(3): 215-218, 2024 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-38321288

RESUMEN

Endocrine orbitopathy (EO), also known as Graves' orbitopathy or thyroid-associated orbitopathy, is a self-limiting, immunologically induced co-reaction of the retrobulbar tissue of the eye triggered by an autoimmune disease of the thyroid gland. It is particularly associated with Graves' disease and is its most common extrathyroidal manifestation. In addition to typical anamnestic data, characteristic local findings and laboratory changes in immunothyroidism, orbital imaging plays a central role in the diagnosis and management of this disease. This review article provides comprehensive insight into various imaging modalities used to assess morphologic changes associated with EO. A detailed presentation of imaging findings provides a better understanding of orbital physiology.


Asunto(s)
Enfermedades Autoinmunes , Enfermedad de Graves , Oftalmopatía de Graves , Humanos , Oftalmopatía de Graves/diagnóstico , Oftalmopatía de Graves/terapia , Enfermedad de Graves/diagnóstico , Órbita/diagnóstico por imagen
16.
Neuroradiol J ; 37(1): 31-38, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37586720

RESUMEN

BACKGROUND AND PURPOSE: The results of the preclinical study of a novel polymer coil in treatment of elastase induced aneurysms will be presented in this paper. MATERIAL AND METHODS: We induced 16 aneurysms in 16 New Zealand white rabbits at the origin of the right common carotid artery at the brachiocephalic trunk. Newly developed polymer coils in both groups for six aneurysms each and platinum coils for two aneurysms each were used. Control angiographies followed in both groups immediately after coiling as well as in the first eight animals 30 days after intervention (30 days group) and in the other eight animals 90 days after (90 days group). An explanation and histological evaluation of the treated aneurysms followed. RESULTS: The 12 animals in which the aneurysms were treated with polymer coils showed a complete occlusion (grade IV) in only 6 out of 12 aneurysms (50%), an almost complete occlusion (grade III) in 5 out of 12 (42%) and an incomplete occlusion in the treatment of one aneurysm (8%). Histologically, we observed a significantly more pronounced inflammatory response and neoangiogenesis in aneurysms treated with polymer coils only in the 30 days group. CONCLUSION: Most difficulties and concerns with the polymer coils were related to the flexibility and detachment behaviour. Therefore, and due to the technical challenges of delivery, the novel polymer coil cannot be considered an alternative to the current platinum coils.


Asunto(s)
Embolización Terapéutica , Aneurisma Intracraneal , Conejos , Animales , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Aneurisma Intracraneal/patología , Platino (Metal) , Polímeros , Embolización Terapéutica/métodos , Resultado del Tratamiento
17.
J Neurointerv Surg ; 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38760168

RESUMEN

BACKGROUND: Neurointerventional devices, particularly laser-cut thin-strut stents made of self-expanding nickel-titanium alloy, are increasingly utilized for endovascular applications in intracranial arteries and dural venous sinuses. Preventing thrombosis and stroke necessitates systemic anticoagulant and antiplatelet therapies with the risk of bleeding complications. Antithrombotic coatings present a promising solution. METHODS: In this study, we investigated the potential of hydrogels composed of four-armed poly(ethylene glycol) (starPEG) and heparin, with or without coagulation-responsive heparin release, as coatings for neurovascular devices to mitigate blood clot formation. We evaluated the feasibility and efficacy of these coatings on neurovascular devices through in vitro Chandler-Loop assays and implantation experiments in the supra-aortic arteries of rabbits. RESULTS: Stable and coagulation-responsive starPEG-heparin hydrogel coatings exhibited antithrombotic efficacy in vitro, although with a slightly reduced thromboprotection observed in vivo. Furthermore, the hydrogel coatings demonstrated robustness against shear forces encountered during deployment and elicited only marginal humoral and cellular inflammatory responses compared with the reference standards. CONCLUSION: Heparin hydrogel coatings offer promising benefits for enhancing the hemocompatibility of neurointerventional devices made of self-expanding nickel-titanium alloy. The variance in performance between in vitro and in vivo settings may be attributed to differences in low- and high-shear blood flow conditions inherent to these models. These models may represent the differences in venous and arterial systems. Further optimization is warranted to tailor the hydrogel coatings for improved efficacy in arterial applications.

18.
J Am Heart Assoc ; 13(9): e031816, 2024 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-38639365

RESUMEN

BACKGROUND: Data on impact of COVID-19 vaccination and outcomes of patients with COVID-19 and acute ischemic stroke undergoing mechanical thrombectomy are scarce. Addressing this subject, we report our multicenter experience. METHODS AND RESULTS: This was a retrospective analysis of patients with COVID-19 and known vaccination status treated with mechanical thrombectomy for acute ischemic stroke at 20 tertiary care centers between January 2020 and January 2023. Baseline demographics, angiographic outcome, and clinical outcome evaluated by the modified Rankin Scale score at discharge were noted. A multivariate analysis was conducted to test whether these variables were associated with an unfavorable outcome, defined as modified Rankin Scale score >3. A total of 137 patients with acute ischemic stroke (48 vaccinated and 89 unvaccinated) with acute or subsided COVID-19 infection who underwent mechanical thrombectomy attributable to vessel occlusion were included in the study. Angiographic outcomes between vaccinated and unvaccinated patients were similar (modified Thrombolysis in Cerebral Infarction ≥2b: 85.4% in vaccinated patients versus 86.5% in unvaccinated patients; P=0.859). The rate of functional independence (modified Rankin Scale score, ≤2) was 23.3% in the vaccinated group and 20.9% in the unvaccinated group (P=0.763). The mortality rate was 30% in both groups. In the multivariable analysis, vaccination status was not a significant predictor for an unfavorable outcome (P=0.957). However, acute COVID-19 infection remained significant (odds ratio, 1.197 [95% CI, 1.007-1.417]; P=0.041). CONCLUSIONS: Our study demonstrated no impact of COVID-19 vaccination on angiographic or clinical outcome of COVID-19-positive patients with acute ischemic stroke undergoing mechanical thrombectomy, whereas worsening attributable to COVID-19 was confirmed.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Accidente Cerebrovascular Isquémico , Trombectomía , Vacunación , Humanos , COVID-19/complicaciones , COVID-19/terapia , COVID-19/mortalidad , Masculino , Femenino , Accidente Cerebrovascular Isquémico/mortalidad , Accidente Cerebrovascular Isquémico/cirugía , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Vacunas contra la COVID-19/efectos adversos , SARS-CoV-2 , Anciano de 80 o más Años
19.
Neuroradiology ; 2013 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-24233131

RESUMEN

INTRODUCTION: In this study, we analyzed angiographic and histologic aneurysm occlusion of a newly designed flow-diverting device. Visibility and flexibility, as well as occlusions of side branches and neointimal proliferation were also evaluated. METHODS: Aneurysms were induced in 18 New Zealand white rabbits and treated with a braided, "closed-loop-designed" device of nitinol. Additional devices were implanted in the abdominal aorta to cover the origin of branch arteries. Angiographic follow-ups were performed immediately after placement of the device, after 3 months (n = 9) and 6 months (n = 9). The status of aneurysm occlusion (using a five-point scale) and the patency of branch arteries were assessed. RESULTS: Aneurysm occlusion rates were noted as grade 0 in 2 (11 %), grade I in 1 (6 %), grade II in 1 (6 %), grade III in 9 (50 %), and grade IV in 5 (28 %) of 18 aneurysms, respectively, indicating a complete or near-complete occlusion of 78 % under double antiplatelet therapy. Aneurysm occlusion was significantly higher at 6 months follow-up (P = 0.025). Radiopaque markers provided excellent visibility. Limited device flexibility led to incomplete aneurysm neck coverage and grade 0 occlusion rates in two cases. Distal device occlusions were found in three cases, most likely due to an extremely undersized vessel diameter in the subclavian artery. No case of branch artery occlusion was seen. Intimal proliferation and diameter stenosis were moderate. CONCLUSION: The tested flow diverter achieved near-complete and complete aneurysm occlusion under double antiplatelet therapy of elastase-induced aneurysms in 78 %, while preserving branch arteries.

20.
Neuroradiol J ; 36(1): 76-85, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35695038

RESUMEN

PURPOSE: The introduction of flow diverters (FDs) in 2007 greatly enhanced the treatment of intracranial aneurysms. Here, we present our long-term clinical experience in treating unruptured intracranial aneurysms with FDs. METHODS: 107 patients with unruptured aneurysms and treated with an FD between 2010 and 2019 were retrospectively reviewed. Aneurysm occlusion, procedural complications, and clinical outcome were evaluated. RESULTS: Angiographic follow-up was available for 93 patients with a mean long-term follow-up time of 28.4 ± 21.6 months. Additional coiling was performed in 15.1% of patients (n = 14). Adequate aneurysm occlusion (Kamran grades 3 and 4) at long-term follow-up was achieved in 94.6% of patients (n = 88). 3.2% (n = 3) required endovascular retreatment since the last follow-up showed a lack of aneurysm occlusion (Kamran grade 0) due to a foreshortening of the FD. Incomplete opening of the FD and parent vessel occlusion was seen in 1.1% (n = 1) and 3.2% (n = 3) of patients, respectively. In-stent stenosis was observed in 57% (n = 53) of cases at short-term follow-up and 22.6% (n = 21) at long-term, which were moderate and asymptomatic overall. In-stent stenosis decreased significantly between short- and long-term follow-ups (31.4 ± 17.0% vs 9.7 ± 13.6%, respectively; p ≤ 0.001). Thromboembolic and hemorrhagic events occurred in 7.5% (n = 7) and 1.1% (n = 1) of patients, respectively. Good clinical outcome (modified Rankin scale: 0-2) was obtained in 97.8% (n = 91) leading to an overall treatment-related morbidity of 2.2% (n = 2). There was no procedural mortality. CONCLUSION: Our study shows that FD treatment of unruptured intracranial aneurysms is effective and safe with high occlusion rates and low rates of permanent morbidity at long-term follow-up.


Asunto(s)
Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Aneurisma Intracraneal/terapia , Constricción Patológica , Stents , Estudios de Seguimiento
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