Endovascular Treatment of Ruptured Blood Blister-like Aneurysms Using the LVIS EVO Stents.

Blood blister-like aneurysms (BBAs) are rare cerebrovascular lesions that face serious challenges in surgical as well as endovascular treatment. In this paper, we present our experience in treating BBAs using the LVIS EVO stents. A total of 10 patients (mean age of 56.1 years) with 13 BBAs, who were admitted to our university hospital between April 2020 and November 2021 with a subarachnoid hemorrhage (SAH) due to aneurysm rupture, were treated using the LVIS EVO stents. Treatment of the BBAs consisted of stent-assisted coiling in four patients and stenting in six patients. The aneurysms were located within ICA (84.6%), VA (7.7%), and MCA (7.7%). Placement of the LVIS EVO stents was successful in all patients. No technical complications were observed. One in-stent thrombotic event occurred during the procedure. MRA for one-year follow-up was performed in nine patients. One patient died (Hunt and Hess Grade IV). LVIS EVO stents may be a beneficial treatment option for BBAs, as they provide high occlusion rates. However, the long-term efficacy remains uncertain.

Initial Experience with LVIS EVO Stents for the Treatment of Intracranial Aneurysms.

BACKGROUND: Over the years, a variety of intracranial stents have been developed, which has expanded the therapy options available for cerebral aneurysms. The Low profile visible intraluminal support (LVIS) EVO stents are new devices, which officially appeared on the market in 2020. The purpose of the study is to report the initial technical and clinical experience with the new stent in the treatment of intracranial aneurysms. MATERIALS AND METHODS: Between February and September 2020, 30 patients with 35 intracranial aneurysms (29 unruptured and 6 ruptured) were treated using the LVIS EVO stent in our department. The aneurysms were located within internal carotid artery (ICA) (42.9%), middle cerebral artery (MCA) (31.4%), anterior communicating artery (AComA) (11.4%), basilar artery (BA) (11.4%) and anterior cerebral artery (ACA) (2.9%). Stent-assisted coil embolization was performed in all cases. RESULTS: All stents were deployed successfully in the desired position. Immediate complete occlusion of the treated aneurysms, described as Raymond-Roy occlusion classification (RROC) class 1, was achieved in all cases. No technical complications were observed. One thromboembolic complication occurred in the group of unruptured aneurysms and one patient died due to cerebral edema from aneurysms rupture group. CONCLUSION: In our observation, the showed a satisfactory safety profile LVIS EVO stents seem to be very flexible, can be safely maneuvered and deployed in tortuous vessels. They showed a good initial occlusion rate when used for treating intracranial aneurysms with SAC (stent-assisted coiling).

Root Canal Transportation after Root Canal Preparation with ProTaper Next, WaveOne Gold, and Twisted Files.

BACKGROUND: Root canal preparation during endodontic treatment may be associated with various complications, including a change in the original pathway of the root canal lumen. The aim of our study was to determine whether files of similar sizes that use various movement kinematics (rotary, reciprocal, adaptive motion) cause root canal transportation, and whether the differences between such systems are statistically significant. METHODS: The degree of root canal transportation (DT) was calculated with the use of computed tomography scans for 3 groups of teeth (for each group: n = 20) in which the root canals were prepared using either rotary (ProTaper Next-PTN), reciprocal (WaveOne Gold-WOG), or adaptive movement (Twisted Files-TF) instruments. RESULTS: For rotary ProTaper Next instruments, the mean value of the DT index was 0.0795 (SD = 0.0179) for 3 mm from the apex, 0.09 (SD = 0.0262) for 6 mm from the apex, and 0.106 (SD = 0.0221) for 9 mm from the apex. For reciprocal WaveOne Gold Primary instruments, the mean value of the DT index was 0.0355 (SD = 0.015) for 3 mm from the apex, 0.061 (SD = 0.02) for 6 mm from the apex, and 0.08 (SD = 0.25) for 9 mm from the apex. For Twisted Files, the mean value of the DT index was 0.05 (SD = 0.03) for 3 mm from the apex, 0.092 (SD = 0.17) for 6 mm from the apex, and 0.08 (SD = 0.02) for 9 mm from the apex. CONCLUSIONS: The use of PTN, WOG, and TF files resulted in root canal transportation to a different degree. The use of rotary PTN files produced the most transported preparation, whereas the use of WOG files produced the conservative root canal preparation that allowed the retention of the original shape of the root canal.

Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up.

BACKGROUND: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. MATERIALS AND METHODS: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. RESULTS: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. CONCLUSION: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

Percutaneous direct thrombin injection with hydrodissection to manage type II endoleak after endovascular abdominal aortic aneurysm repair.

Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR). The management remains controversial. We present a case in which endoleak was successfully treated by direct percutaneous thrombin injection with hydrodissection. This method seems to be a safe and feasible alternative method for treatment of type II endoleak.