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BACKGROUND AND PURPOSE: This study aims to elucidate the early changes in blood biochemistry thrombosis parameters following stent-assisted endovascular treatment of intracranial aneurysms. METHODS: Consecutive patients with unruptured aneurysms undergoing stent implantation during endovascular treatment were included in this prospective study with approval from the local ethics committee. Blood samples were collected immediately before and 24â h after the procedure for biochemical analysis, including basic thrombosis indicators, bleeding tests, and a complete blood count. RESULTS: The study included 80 patients (60 women, 20 men) with 134 aneurysms. A total of 135 stents (110 flow-diverting, 25 standard) were used. Additionally, intrasaccular coiling was utilized in 28 aneurysms among 27 patients. Following the procedure, there was a significant decrease in activated partial thromboplastin time, fibrinogen, hemoglobin, and platelet levels, and a significant increase in prothrombin time, D-dimer, von Willebrand factor (vWF) activity/antigen ratio, and leukocyte levels in all patients. Correlation analyses revealed significant positive associations between platelet and fibrinogen levels, and a negative association between D-dimer and fibrinogen levels in the coil (-) group. Additionally, there was a significant negative correlation between aneurysm volume and vWF activity/antigen ratio, and procedure duration and thrombocyte count, while a positive association was found between aneurysm number and leukocyte count in the coil (-) group. CONCLUSIONS: Analysis of blood chemistry alterations indicates that intravascular thrombosis occurs in the intracranial circulation following stent-assisted endovascular treatment of intracranial aneurysms. This thrombotic process is more pronounced in patients whose aneurysms were left open (i.e. flow-diverting stent alone).
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OBJECTIVE: Three-dimensional (3D) printing in vascular surgery is trending and is useful for the visualisation of intracranial aneurysms for both surgeons and trainees. The 3D models give the surgeon time to practice before hand and plan the surgery accordingly. The aim of this study was to examine the effect of preoperative planning with 3D printing models of aneurysms in terms of surgical time and patient outcomes. METHODS: Forty patients were prospectively enrolled in this study and divided into two groups : groups I and II. In group I, only the angiograms were studied before surgery. Solid 3D modelling was performed only for group II before the operation and was studied accordingly. All surgeries were performed by the same senior vascular neurosurgeon. Demographic data, surgical data, both preoperative and postoperative modified Rankin scale (mRS) scores, and Glasgow outcome scores (GOS) were evaluated. RESULTS: The average time of surgery was shorter in group II, and the difference was statistically significant between the two groups (p<0.001). However, no major differences were found for the GOS, hospitalisation time, or mRS. CONCLUSION: This study is the first prospective study of the utility of 3D aneurysm models. We show that 3D models are useful in surgery preparation. In the near future, these models will be used widely to educate trainees and pre-plan surgical options for senior surgeons.
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The procollagen-lysine, 2-oxoglutarate 5-dioxygenase 1 (PLOD1) gene may affect arterial integrity through enzymatic roles and the modulation of vascular smooth muscle cells. We present a complicated vascular case of an 8-year-old male child with Ehlers-Danlos syndrome type VI. The patient was diagnosed with a ruptured pseudoaneurysm of the infrarenal abdominal aorta. Endovascular treatment was performed using a covered self-expandable endograft. However, complications arose at the vascular access sites during the procedure, highlighting arterial fragility. PLOD1 mutations can be associated with false abdominal aortic aneurysms or arterial fragility. Open repair poses a high risk for patients with Ehlers-Danlos syndrome. Although the long-term results are unknown, endovascular stent grafts may be a suitable option for emergency clinical scenarios such as ruptured abdominal aortic pseudoaneurysms.
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AIM: To evaluate the safety and efficacy of flow diverter stents (FDSs) for treating remnant or recurrent intracranial aneurysms that were treated surgically. MATERIAL AND METHODS: The patients who were treated with FDSs due to remnant or recurrent intracranial aneurysms after microsurgery were included in the study. The patients' demographics, treatment histories, aneurysm features, complications associated with flow diversion, and neurological and angiographic follow-up findings were evaluated. RESULTS: Twenty patients (eight males) with 20 aneurysms were included in the study. Of 20 aneurysms, 18 (90%) were in the anterior, and two (10%) were in the posterior circulation. The initial treatment methods were clipping in 17 (85%) and wrapping in three (15%) aneurysms. The endovascular procedure was successful in all patients. In three patients (15%), periprocedural and postprocedural complications were encountered. No hemorrhagic complications were detected on cone-beam computed tomography. One patient with a basilary aneurysm died because of brain stem ischemia. The total morbimortality was 5%. The mean length of follow-up was 13.7 ± 7.3 months in 18 patients. The first angiographic follow-up (3-6 months) revealed the complete occlusion in 7 of 11 aneurysms (63.6%). By contrast, 16 aneurysms (94.1%) were occluded at the last angiographic follow-up, one aneurysm (5.9%) was still filling. CONCLUSION: An FDS seems effective, safe, and extremely attractive in treating remnant and recurrent intracranial aneurysms treated surgically.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Masculino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/etiologia , Resultado do Tratamento , Estudos Retrospectivos , Angiografia Cerebral , Stents , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodosRESUMO
Left ventricular assist device (LVAD) systems are preferred as a bridging to transplantation or as a destination therapy in the treatment of end-stage heart failure. LVAD-related complications are seen in different clinical variations with the widespread use of LVADs. Some of these complications are seen as related to outflow graft, such as graft stenosis, graft kinking and graft thrombosis. Outflow graft complications have a direct impact on LVAD flow rate and acutely impair the clinical condition of patients. Treatment modalities include surgical approach, endovascular approach, and medical approach. In this case report, we aim to share a 57-year-old male patient, who had outflow graft stenosis near the anastomosis line between ascending aorta and the left ventricular assist device outflow graft, and the endovascular treatment.
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BACKGROUND: As an extremely rare entity reported in children, Rasmussen`s aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of the pulmonary artery adjacent to or within a tuberculous cavity. CASE: Here, we reported a 9-year-old child with Down syndrome who presented with massive hemoptysis. Endovascular coil embolization was performed for Rasmussen`s aneurysm. During the 2-year follow-up period, she had no further episodes of bleeding. CONCLUSIONS: In case of the development of massive hemoptysis in the follow-up of a patient with pulmonary tuberculosis and Down syndrome, this lethal complication should be considered.
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Aneurisma , Síndrome de Down , Embolização Terapêutica , Tuberculose Pulmonar , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/terapia , Criança , Síndrome de Down/complicações , Feminino , Hemoptise/etiologia , Humanos , Tuberculose Pulmonar/complicaçõesRESUMO
Background: Renal vein aneurysms (RVAs) are considered rare clinical entities. RVAs can be secondary to thrombosis, venous hypertension, or renal arteriovenous fistula (RAVF). RVAs secondary to RAVF are rare. Patients with RVA may present with hypertension, abdominal pain, hematuria, or may even be asymptomatic. However, there may be life-threatening emergencies including aneurysm rupture, thrombosis, and pulmonary embolism. The treatment of RVAs includes reconstruction of the renal vein, nephrectomy, and endovascular treatment. Purpose: In this technical note, we report the endovascular treatment of a giant RVA that developed secondary to an acquired RAVF by the placement of multiple vascular plugs. Conclusion: Endovascular occlusion of the RAVF with vascular plugs is effective to prevent a life-threatening rupture of RVA. Clinical follow-up is crucial to detect leakage or migration of the vascular plugs.
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Aneurisma Roto , Fístula Arteriovenosa , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Humanos , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Veias Renais/diagnóstico por imagem , Veias Renais/cirurgia , Resultado do TratamentoRESUMO
Patients with indirect carotid cavernous fistulas (CCF) were reviewed to emphasize the importance of diagnosing patients even with trivial findings and to raise awareness. Eighteen patients diagnosed as CCF were included. Neuro-ophthalmological findings before and after treatment, diagnostic investigations, treatment, clinical course was noted. Twelve patients were female (67%), 6 were males (33%) and the mean age at presentation was 54 years (range: 29-70 years). Conjunctival hyperemia was present in all patients. Seventeen (94%) patients had proptosis and diplopia, nine (50%) had orbital pain and/or headache, four (22%) had blurred vision, one (5.5%) had ptosis. On examination, 17 patients (94%) had restricted eye movements, four (22%) had low visual acuity and five patients had (28%) increased intraocular pressure (IOP). One patient had been diagnosed as myasthenia gravis and two as thyroid orbitopathy and had been on treatment accordingly before CCF was diagnosed. In two patients, bilateral findings were present despite unilateral CCF on angiography. Barrow Type B fistula was found in 7 (38%), Barrow Type D in 11 (62%) patients. In three bilateral CCF was detected. All were treated by endovascular intervention. Residual deficits at the sixth month control were, eye movement deficits in seven (39%), decrease in visual acuity in one (5.5%) and elevated IOP in one (5.5%) patient. Indirect CCF patients generally present with mild symptoms and the diagnosis may be overlooked. Mild progressive ophthalmoparesis with conjunctival hyperemia must be warning. Though rare bilateral CCF can be detected as well as unilateral CCF with bilateral findings.
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Fístula Carótido-Cavernosa/diagnóstico , Fístula Carótido-Cavernosa/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Fístula Carótido-Cavernosa/complicações , Exoftalmia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Visão/etiologiaRESUMO
Background/aim: The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods: A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. Results: Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion: Although the number of cases is low in our study, to our knowledge, it is the widest series in the literature until today. Our results demonstrate that BAF aneurysms can be treated successfully and safely with different endovascular techniques, with more stent use in recent years.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study was to determine whether half-dose loading (30â¯mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10â¯mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation. METHODS: Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented. RESULTS: A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). The 6month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate. CONCLUSION: Half-dose (30â¯mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm.
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Aneurisma Intracraniano/terapia , Inibidores da Agregação Plaquetária/administração & dosagem , Cloridrato de Prasugrel/administração & dosagem , Stents , Aspirina/administração & dosagem , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Spinal dural arteriovenous fistula (SDAVF) is the most common type of spinal vascular malformation. The main purpose of endovascular treatment is to occlude the fistula site and the proximal part of the draining vein. However, this is not always possible because of the difficulty of selective catheterization in patients with tortuous feeding arteries, as well as the risk of reflux of the liquid embolic agent. Herein, we present three cases in which a dual-lumen balloon catheter together with a liquid embolic agent was used to occlude the SDAVF. Complete and persistent occlusion was confirmed by magnetic resonance images taken at 6 months after the treatment. Using the dual-lumen balloon catheter technique in cases of long and tortuous feeder arteries supplying the SDAVF can result in safe and successful embolization.
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An ideal anastomosis method will obtain the highest post-anastomotic vessel patency and will repair the vessel anatomically with minimal thrombosis in an easier, faster and cheaper fashion. To achieve these goals an anastomosis model using an amniotic membrane is introduced. The study was performed on the femoral arteries of 22 Wistar Albino rats (11 control group, 11 experimental group). In the experiment group, the microvascular anastomosis was completed with three sutures and a patch of amniotic membrane which was wrapped around the anastomotic site. The conventional anastomosis technique with eight sutures was performed in the control group. The effects of the model on the patency and histological structure of the vessels were evaluated. As a result, normal patency was determined radiologically and macroscopically in all of the anastomoses. No thrombosis or aneurysm was detected in any of the anastomoses. In the angiographic study, vessel patency was detected in both the control and experimental groups. The average time to complete the arterial anastomosis was 18.14 (±2.84) and 10.39 (±2.45) minutes in the control and the experiment groups respectively. In the histological studies, anti-eNOS staining revealed that endothelin levels were significantly higher in the experimental group. This method describes a new anastomosis model in microvascular surgery with promising results that call for additional experimental studies and further clinical implementations. We believe that this experimental technique can be put into clinical practice as an alternative to the conventional microvascular anastomosis technique.
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Âmnio , Anastomose Cirúrgica/métodos , Microcirurgia/métodos , Suturas , Angiografia , Animais , Endotelinas/metabolismo , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Veia Femoral/diagnóstico por imagem , Veia Femoral/cirurgia , Modelos Animais , Ratos Wistar , Grau de Desobstrução VascularRESUMO
AIM: Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Surgical management of these injuries is challenging with high morbidity rates. In this study we aim to present the results of endovascular management of iatrogenic vascular injuries due to spinal surgeries. MATERIAL AND METHODS: We retrospectively reviewed 11 patients (5 male, 6 female) who had vascular injuries due to cervical and lumbar spinal surgeries. Clinical findings were bleeding (n=5), leg edema (n=6) and right heart failure with severe dyspnea (n=1). The age range of the patients were between 42-67 (mean: 57.1). Six patients were reviewed with imaging before the procedures and the rest of the patients (n=5) were directly referred to the angiography unit for diagnosis and possible endovascular treatment. RESULTS: The types of surgeries were; cervical surgery (n=5) and lumbar disc operation (n=6). The type of vascular injuries were; vertebral artery stenosis (n=1), vertebral artery pseudoaneurysm (n=3), vertebral artery occlusion (n=1) and iliac arteriovenous fistula (n=6). The type of endovascular treatments were; parent artery occlusion (PAO) (n=2), covered stent graft implantation (n=6) and intrasaccular coil embolization of pseudoaneurysm (n=1). The remaining 2 patients were managed conservatively. No major complications or mortality occured during endovascular interventions. No bleeding or ischemia occured in the follow-up period. CONCLUSION: Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Endovascular interventions are safe and effective in the diagnosis and treatment of such vascular injuries.
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Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Doença Iatrogênica , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/etiologiaRESUMO
AIM: To evaluate iatrogenic vascular injuries in the craniocervical region and their endovascular management. MATERIAL AND METHODS: Twenty-one patients (9 women, 12 men) with a mean age of 53.6 years (range 16-87 years), who underwent endovascular embolization for iatrogenic vascular injury in the craniocervical region between December 2000 and October 2015, were included in this retrospective study. Types of iatrogenic injuries, etiologies that caused these injuries and details of endovascular managements were reported. RESULTS: The etiologies of the vascular injuries were as follows: transsphenoidal surgery (n=9), skull-base surgery (n=2), cholesteatoma surgery (n=1), tracheostomy (n=2), central venous catheterization (n=2), oropharyngeal tumor operation (n=1), endovascular treatment of internal carotid artery (ICA) stenosis (n=1), suprasellar epidermoid tumor operation (n=1), sphenoid sinus tumor surgery (n=1), and speech prosthesis device placement (n=1). The types of vascular injuries diagnosed at the time of angiography were; 2 occlusions, 2 stenoses, 2 dissections, 1 carotid cavernous fistula, 8 artery rupture with extravasation, and 9 pseudoaneurysms. Endovascular management of these vascular injuries were; parent artery occlusion (PAO) (n=15), aneurysm occlusion (n=3), covered stent (n=1) and conservative management (n=2). All patients except two were successfully treated. No patient had bleeding within a 30-day period after angiography. Long-term follow-up was available in all patients without occurrence of re-bleeding. One patient died due to complications related to primary vascular injury. CONCLUSION: Although iatrogenic vascular injuries are rare, early diagnosis and management may be lifesaving. Endovascular techniques are reliable and safe in most of the patients.
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Transtornos Cerebrovasculares/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/cirurgia , Vértebras Cervicais/irrigação sanguínea , Vértebras Cervicais/cirurgia , Gerenciamento Clínico , Embolização Terapêutica/instrumentação , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Crânio/irrigação sanguínea , Crânio/diagnóstico por imagem , Crânio/cirurgia , Lesões do Sistema Vascular/etiologia , Adulto JovemRESUMO
AIM: Eagle syndrome is a rare entity that causes recurrent throat pain, neck pain, dysphagia, or facial pain due to an elongated styloid process or calcified stylohyoid ligament. Clinical findings related to lower cranial nerve compression have also been reported. In some cases, it is reported that carotid artery compression or dissection can be seen due to elongated styloid process and this is called carotid artery syndrome. Carotid artery compression causes flow reduction and carotidynia or neurological symptoms can be seen. Dural sinuses and the jugular vein can be compressed. Eagle syndrome with neurological symptoms has been rarely reported. MATERIAL AND METHODS: The data of 5 patients (aged between 22 and 68 years), who presented to the hospital with various neurological symptoms, were retrospectively reviewed. Each patient underwent computed tomography (CT) that revealed a long styloid process. RESULTS: An elongated styloid process caused neurological symptoms. Two patients had venous compression by the styloid process and the other patients had transient ischemic attacks due to internal carotid artery compression by the styloid process. Only one patient underwent surgical removal. All patients" outcomes were good after treatment and no symptoms remained. CONCLUSION: Eagle syndrome may be presented with neurological symptoms. It should be kept in mind in the differential diagnosis of patients who have neurological symptoms without any objective etiological factors. To the best of our knowledge, Eagle syndrome with arterial and venous compression due to elongated styloid process has not been previously presented in the literature.
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Ataque Isquêmico Transitório/etiologia , Veias Jugulares/patologia , Ossificação Heterotópica/complicações , Osso Temporal/anormalidades , Adulto , Idoso , Constrição Patológica/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trombose dos Seios Intracranianos/etiologia , Adulto JovemAssuntos
Cistos Ósseos Aneurismáticos/complicações , Hidrocefalia/etiologia , Osso Occipital/patologia , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Criança , Feminino , Quarto Ventrículo/diagnóstico por imagem , Humanos , Hidrocefalia/diagnóstico por imagem , Imageamento por Ressonância Magnética , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The purpose of our study was to retrospectively evaluate traumatic aortic transection patients and their bedside plain chest radiographs for signs of aortic injury. METHODS: Emergency department (ED) patients from a 5-year period with traumatic aortic transection who were over 18 years of age were included in the study. Demographic characteristics, mechanism of trauma, Revised Trauma Score, Glasgow Coma Score, vital signs, physical exam findings, laboratory parameters, length of stay in the ED, and patient outcomes were documented. Bedside plain chest radiograph images were interpreted by 2 emergency medicine specialists and 1 radiologist. RESULTS: Thirty patients, mean age 45.87±16.14 years (70% male), were enrolled. Most common trauma mechanism was motor vehicle accident (53.3%). Agreement rates between emergency medicine specialists and radiologist were found to be "excellent" and "substantial" in identifying mediastinal widening and multiple left sided rib fractures; and "fair" in identifying widened paraspinal line, and transthoracic vertebral fractures. CONCLUSION: Though not completely reliable, bedside plain chest radiographs and physical examination findings may be useful in detecting aortic injury during primary survey when the patient is unstable and cannot be sent for chest computerized tomography. Appropriate further imaging studies should be carried out as appropriate based on patient's hemodynamic status.