Endovascular Treatment of Cerebrovascular Lesions Using Nickel- or Nitinol-Containing Devices in Patients with Nickel Allergies.

Nickel is used in many cerebral endovascular treatment devices. However, nickel hypersensitivity is the most common metal allergy, and the relative risk of treatment in these patients is unknown. This retrospective analysis identified patients with nickel or metal allergies who underwent cerebral endovascular treatment with nickel-containing devices. Seven patients with nickel and/or other metal allergies underwent treatment with 9 nickel-containing devices. None experienced periprocedural complications. No patient received treatment with corticosteroids or antihistamines. At a mean clinical follow-up for all patients of 22.8 months (range, 10.5-38.0 months), no patients had symptoms attributable to nickel allergic reactions. The mean radiographic follow-up for all patients at 18.4 months (range, 2.5-37.5 months) showed successful treatment of the targeted vascular pathologies, with no evidence of in-stent stenosis or other allergic or hypersensitivity sequelae. The treatment of cerebrovascular lesions with a nickel-containing device resulted in no adverse outcomes among these patients and was safe and effective.

Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms.

BACKGROUND AND PURPOSE: The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent. MATERIALS AND METHODS: On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up. RESULTS: Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (<7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS ≤2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P < .0001) and rupture status during treatment (P = .03). CONCLUSIONS: This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.

[Computed serial densitometry of the tissue components of renal angiomyolipoma. A new radiohistologic method of in vivo pathologic diagnosis]. / Die Computer-Serien-Densitometrie der Gewebskomponenten des Nierenangiomyolipoms. Eine neue radiohistologische Methode zur pathologischen In-vivo-Diagnostik.

Computerised serial densitometry (CSD) of renal angiomyolipoma (AML) and its three tissue components was done in order to find out whether this procedure could help in differential diagnosis and provide better data for the understanding of AML presentation in CT imaging. It was found that AML detection in plain scan tomography requires a fat fraction of more than 50%. Angiomyolipomas with a fat fraction of less than 50% need computerised serial densitometry to enable differentiation from other unidentified tumours. The criteria to be used in these cases are 1) the low curve level and 2) the presence and slim shape of the initial circulatory peak. The principle of using standard densitometric curves of single tissue components and cells in in vivo tissue analysis might gain significance in the noninvasive, computerised qualitative and quantitative analysis of the composition of tumours and organs thus creating new possibilities for the diagnosis, follow-up and prognosis of diseases.

[On the problem of angiographic differential diagnosis between hypernephroma, angiomyolipoma and carcinoma of the renal pelvis (author's transl)]. / Zur Problematik der angiographischen Differentialdiagnose zwischen Hypernephrom, Angiomyolipom und Nierenbeckenkarzinom.

Pretherapeutic type diagnosis of a renal tumour will be decisive for further clinical measures and for the fate of the patient. The incidence and relative significance of the angiographic signs of three types of tumours are critically reviewed on the occasion of a carcinoma of the renal pelvis which had at first been wrongly diagnosed via angiography as a hypernephroma and then as an angiomyolipoma. For the first time, the article goes into the details of differential diagnosis between angiomyolipoma and a tumour of the renal pelvis growing into the renal parenchyma. It is concluded that the angiographic signs described in literature will mostly occur with the other two types of tumours as well, besides being non-obligatory. For the purpose of enabling angiographic tendency diagnosis despite this difficulty, the article suggests to employ sequential paired differentiation of the type which would be a prerequisite for any future computer-supported diagnostic method.