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1.
AJNR Am J Neuroradiol ; 41(6): 1054-1060, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32499248

RESUMO

BACKGROUND AND PURPOSE: Carotid near-occlusion has been subclassified into near-occlusion with and without collapse. We aimed to compare the technical success and perioperative complication rates of carotid artery stent placement with special attention to these subtypes to see whether there is a clinical relevance of this subclassification. MATERIALS AND METHODS: From January 2014 to January 2018, we retrospectively evaluated all patients with atherosclerotic extracranial carotid stenosis treated by carotid artery stent placement. Patients with near-occlusion were identified based on DSA findings. Patient characteristics, the presence of criteria for near-occlusion and collapse, arterial diameters, technical success rate, and perioperative (≤30 days) complications were analyzed. RESULTS: We identified 59 near-occlusions in 58 (46 men, 11 with collapse) patients. Forty-one patients (70.7%) were symptomatic. Technical success rate was 98.3% (58 of 59 procedures). In 1 case of near-occlusion with collapse, we were not able to pass through the stenosis. Compared with patients without collapse (4.2% of 48 cases), those with collapse (30% of 10 stented patients) had significantly higher rates of postintervention hyperperfusion syndrome (P = .032). In the whole cohort, the permanent morbidity and mortality rate was 3.4% (1.7% permanent morbidity and 1.7% mortality). For asymptomatic and symptomatic near-occlusion groups, the rates were 0% and 4.9%, respectively. The composite risk of stroke, death, and myocardial infarction was similar between the groups with and without collapse (P = .682). Rate of hyperperfusion syndrome (with or without permanent deficit) was similar (P = 1) in preoperatively symptomatic patients versus asymptomatic patients (9.8% vs 5.9%). Internal carotid artery diameter consistently increased after carotid artery stent placement in patients with collapse and was not related to the development of hyperperfusion syndrome. CONCLUSIONS: Care should be taken to minimize hyperperfusion risk in patients with near-occlusion undergoing CAS, especially in the subgroup of patients with collapse and in patients with both symptomatic and asymptomatic carotid stenosis.


Assuntos
Estenose das Carótidas/patologia , Estenose das Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Stents , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
AJNR Am J Neuroradiol ; 28(7): 1409-14, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17698554

RESUMO

BACKGROUND AND PURPOSE: Various techniques and materials have been used for the endovascular treatment of craniofacial high-flow arteriovenous vascular malformations, because their rarity precludes standardization of their treatment. The aim of this retrospective review is to assess Onyx as the primary embolic agent in the treatment of these vascular malformations. MATERIALS AND METHODS: Six patients with arteriovenous fistulas and 3 with arteriovenous malformations (AVMs) of the head and neck region were treated with intra-arterial (IA)/direct percutaneous injections of Onyx. Adjunctive maneuvers used during embolization included external compression of the arterial feeders or venous outflow (6 patients), balloon assist (4 patients), and direct embolization of the draining vein remote to the fistula site (1 patient). n-butyl-2-cyanoacrylate (n-BCA) was used in addition to Onyx for rapid induction of thrombosis in a large venous pouch (1 patient) and for cost containment purposes (1 patient). Four patients were treated surgically after the embolization. RESULTS: There were no neurologic complications secondary to the embolization procedure. The arteriovenous shunt was eliminated in all of the fistulous lesions and 2 of the 3 AVMs. The embolization was incomplete in 1 patient with a large AVM who declined further endovascular or surgical procedures. Untoward events included 2 instances of catheter entrapment (of 9 IA injections), blackish skin discoloration necessitating surgical revision in 1 patient, and difficulty of balloon deflation/wire withdrawal during a balloon-assisted embolization. CONCLUSION: Onyx appears to be a safe and effective liquid embolic agent for use in the treatment of craniofacial high-flow vascular malformations with distinct advantages and disadvantages compared with n-BCA.


Assuntos
Anormalidades Craniofaciais/terapia , Dimetil Sulfóxido/uso terapêutico , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Adulto , Criança , Feminino , Humanos , Masculino , Resultado do Tratamento
3.
AJNR Am J Neuroradiol ; 22(7): 1419-23, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11498440

RESUMO

We describe a giant left orbital vascular malformation that was treated with both percutaneous and transarterial embolization. Feeder artery aneurysms thrombosed as a result of retrograde reflux of embolic material into the distal ophthalmic artery. In this presentation, we emphasize the efficacy of percutaneous embolization and retrograde thromboses of two intradural saccular ophthalmic artery aneurysms.


Assuntos
Aneurisma/terapia , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Artéria Oftálmica , Órbita/irrigação sanguínea , Aneurisma/diagnóstico por imagem , Angiografia , Malformações Arteriovenosas/diagnóstico por imagem , Dura-Máter/irrigação sanguínea , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Retratamento
4.
Br J Radiol ; 73(866): 209-10, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10884737

RESUMO

Contrast enhanced CT examination of a 22-year-old male with pleuritic chest pain showed pleural-based nodular thickening and masses without any parenchymal involvement or mediastinal lymphadenopathy. Pathological examination following right parietal pleural decortication showed multiple granulomas with caseation necrosis typical of tuberculosis. Pleural tuberculosis presenting with multiple pleural nodules and masses without parenchymal involvement or lymphadenopathy has, to our knowledge, never been reported in the English literature.


Assuntos
Tuberculose Pleural/diagnóstico por imagem , Adulto , Meios de Contraste , Humanos , Masculino , Tomografia Computadorizada por Raios X
5.
Br J Radiol ; 77(915): 197-203, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15020360

RESUMO

Benign vascular lesions can be classified into two categories depending on clinical behaviour and endothelial cell characteristics: neoplasms (haemangiomas) and vascular malformations. However, intraosseous vascular anomaly, previously called intraosseous haemangioma, is a very rare malformation. In our previous study, we described the first hereditary form of intraosseous vascular malformation of the craniofacial region, vascular malformation osseous (VMOS). Characteristic findings are autosomal recessive inheritance, severe and diffuse intraosseous vascular malformation in all craniofacial bones without soft tissue involvement and associated mid-line abnormalities such as umbilical hernia and supra-umbilical raphe. In this paper, we discuss the imaging findings of this new disorder in detail.


Assuntos
Malformações Arteriovenosas/diagnóstico , Anormalidades Craniofaciais/diagnóstico , Hemangioma/diagnóstico , Neoplasias Cranianas/diagnóstico , Adolescente , Adulto , Malformações Arteriovenosas/genética , Criança , Anormalidades Craniofaciais/genética , Feminino , Hemangioma/genética , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Linhagem , Crânio/irrigação sanguínea , Neoplasias Cranianas/genética , Tomografia Computadorizada por Raios X/métodos
6.
Br J Radiol ; 81(972): 935-9, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18824500

RESUMO

Craniofacial venous vascular malformations cause severe cosmetic problems and yet these lesions are not candidates for transcatheter embolisation owing to the lack of arterial feeders. The purpose of this study was to evaluate the effectiveness of pre-operative embolisation of these lesions with N-butyl 2-cyanoacrylate (NBCA) via direct puncture. Between September 2003 and April 2006, 13 patients (7 female; age range, 6-64 years; mean, 16.7 years) were embolised with direct puncture and injection of NBCA. All of the patients were referred from plastic surgery with an operational plan. Angiography performed in all patients showed no or little arterial staining. NBCA diluted with iodized oil at a ratio of 1:6 (18%) was injected via a percutaneously placed 21 gauge needle. Complete embolisation was achieved in 8 patients and partial embolisation in the remaining 5. A total of 18 sessions of embolisation were performed on 13 patients. Nine patients underwent only one embolisation session, three patients underwent two sessions and only one patient underwent three sessions. The mean volume of NBCA used per session was 5.8 ml, ranging from 1-12 ml. All patients underwent a successful surgical resection to improve cosmetic disfigurement within 10-15 days after the embolisation procedure. Mean follow-up time was 22 months. One patient experienced skin necrosis on her nose after embolisation. No other complications related to the procedure were observed. In conclusion, pre-operative NBCA embolisation with direct puncture is a safe and easy procedure. It can increase the success of the surgical treatment of these lesions.


Assuntos
Embolização Terapêutica/métodos , Embucrilato/uso terapêutico , Face/irrigação sanguínea , Malformações Vasculares/terapia , Adolescente , Adulto , Criança , Terapia Combinada , Face/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/cirurgia , Adulto Jovem
7.
Acta Radiol ; 48(6): 613-9, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17611867

RESUMO

BACKGROUND: Tunneled central venous catheters placed by interventional radiologists are now widely used for hemodialysis and infusion therapies throughout the world. However, complications such as infections and malfunctions still remain a major concern in oncology and hemodialysis patients. PURPOSE: To evaluate the long-term follow-up results of tunneled central venous catheters in an adult population in terms of infectious complications and malfunction rates in dialysis and oncology patients. MATERIAL AND METHODS: We retrospectively reviewed the hospital charts and our electronic database for 434 tunneled internal jugular catheters in 335 consecutive patients between December 2002 and March 2006. Mean patient age was 57 years (range 23-86 years) in the hemodialysis group and 45 years (range 18-83 years) in the infusion group. A total of 224 hemodialysis catheters were placed in 168 patients (68 females, 100 males) and 210 infusion catheters in 167 patients (48 females, 119 males). RESULTS: Technical success rate was 100%. Mean duration of catheter use was 86 days (1-652 days) and 60 days (2-686 days) for hemodialysis and infusion catheters, respectively. A total of 107 hemodialysis (47%) and 95 infusion catheters (45%) were electively removed due to completion of therapy and resolution of need for dialysis. Revisions were performed 0.22 and 0.11 per 100 catheters days in the hemodialysis and infusion groups, respectively. Our total infection rate was 0.10 episodes per 100 catheter days, and the rate of infections necessitating catheter removal was 0.05 episodes per 100 catheter days in the hemodialysis group, which is lower than that reported in other big series. However, in the infusion group, the rate of infections necessitating catheter removal was 0.28 episodes per 100 catheter days. CONCLUSION: Long-term central venous accesses using tunneled internal jugular catheters appeared to be safe and effective for both hemodialysis and long-term infusion therapies, with relatively higher infection rates in oncologic patients.


Assuntos
Cateterismo Venoso Central/instrumentação , Veias Jugulares , Diálise Renal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Falha de Equipamento , Feminino , Seguimentos , Humanos , Infusões Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
Acta Radiol ; 48(2): 171-2, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17354137

RESUMO

Coronary artery fistulas are rare and usually asymptomatic congenital anomalies generally diagnosed incidentally during coronary angiographies. Herein, we present a case of bronchial to coronary artery fistula which was diagnosed incidentally during bronchial artery embolization. Embolization was performed successfully without complication, and an underlying important coronary artery stenosis was subsequently found by coronary computed tomography angiography.


Assuntos
Fístula Artério-Arterial/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Hemoptise/diagnóstico por imagem , Angiografia Digital , Artérias Brônquicas , Meios de Contraste , Embolização Terapêutica , Hemoptise/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
9.
Australas Radiol ; 51 Suppl: B331-3, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17991099

RESUMO

We report an intracranial stenting procedure complicated by active bleeding from the femoral puncture site because of high arterial puncture. The patient was treated by placement of two PTFE-covered self-expanding coronary stent-grafts. To our knowledge, there have been very few reports on stent-grafting of femoral artery in the literature. The low profile and flexibility of the coronary stent-graft enabled treatment via a six French sheath and 12th month patency is demonstrated with CT angiography.


Assuntos
Vasos Coronários/transplante , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Radiografia Intervencionista/métodos , Stents/efeitos adversos , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgia , Angiografia/métodos , Prótese Vascular , Serviços Médicos de Emergência/métodos , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos Penetrantes/etiologia
10.
Acta Radiol ; 47(9): 944-6, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17077046

RESUMO

A case of bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer is reported. The patient presented with massive hemoptysis, diagnosis was made with multidetector computed tomography, and the pseudoaneurysm was successfully embolized with platinum coils. Hemoptysis ceased following the procedure.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Carcinoma de Células Escamosas/complicações , Embolização Terapêutica , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Neoplasias Pulmonares/complicações , Artéria Pulmonar , Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-Idade
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