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1.
AJNR Am J Neuroradiol ; 44(4): 467-473, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36997284

RESUMEN

BACKGROUND AND PURPOSE: This retrospective, 2-center study investigated the feasibility, safety, and efficacy at 12-month follow-up of the treatment of ruptured, unruptured, and recurrent intracranial aneurysms using the latest generation of the Woven EndoBridge (WEB) device, the WEB-17 system. MATERIALS AND METHODS: Aneurysms treated with WEB-17 were extracted from the databases of 2 neurovascular centers. Patients, aneurysm characteristics, complications, and clinical and anatomic results were analyzed. RESULTS: From February 2017 to May 2021, two hundred twelve patients with 233 aneurysms (181/233, 77.7%, unruptured-recurrent, and 52/233, 22.3%, ruptured) were included. High treatment feasibility (95.3%) was reported and was similar in ruptured aneurysms (94.2%) and unruptured-recurrent aneurysms (95.6%) (P = .71) and in typical (95.4%) and atypical (94.7%) locations (P = .70), but it was lower in aneurysms with an angle between the parent artery and main aneurysm axis of ≥45° (90.2%) compared with those with an angle of <45° (97.1%) (P = .03). Global mortality and morbidity were 1.9% and 3.8% at 1 month, respectively, and 4.4% and 1.9% at 12 months, respectively. One-month morbidity (P = .02) and mortality (P = .003) were higher in the ruptured group (10.0% and 8.0%, respectively) compared with unruptured-recurrent group (1.9% and 0.0%, respectively). Overall adequate occlusion (complete occlusion and neck remnant) was 86.3%. The percentage of adequate occlusion was higher (P = .05) in the unruptured-recurrent group (88.5%) compared with the ruptured group (77.5%). CONCLUSIONS: The WEB-17 system showed high feasibility for ruptured and unruptured aneurysms, typical and atypical locations, and some aneurysms with an angle of ≥45°. As the most recent generation device, the WEB-17 also demonstrates high safety and good efficacy.


Asunto(s)
Aneurisma Roto , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Resultado del Tratamiento , Estudios Retrospectivos , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/terapia
2.
AJNR Am J Neuroradiol ; 44(3): 291-296, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36759143

RESUMEN

BACKGROUND AND PURPOSE: Some Woven EndoBridge devices present a persistent intradevice opacification at imaging follow-up, described as the Bicêtre Occlusion Scale Score 1 (BOSS 1) phenomenon. The clinical implications remain unknown. We aimed here to analyze the factors influencing this occurrence and to precisely describe the evolution of BOSS 1 with time using conebeam CT. MATERIALS AND METHODS: We retrospectively analyzed a prospectively maintained Woven EndoBridge database at our tertiary center and included all patients with isolated BOSS 1 and BOSS 1 associated with small neck remnant (BOSS 1 + 2). RESULTS: Two hundred sixty-seven aneurysms were treated with a Woven EndoBridge device between July 2012 and December 2021. Follow-up with DSA was available for 220 aneurysms (median, 5 months), among which BOSS 1 and 1 + 2 were found in 9.1% (20/220) (95% CI, 5.5%-12.7%). A second DSA follow-up (median, 17 months) was performed in 15 of these 20 aneurysms, which revealed that 40% had evolved to complete Woven EndoBridge occlusion, 33% showed a decreased persistent opacification, and 27% remained stable. BOSS 1 was significantly associated with postoperative antiplatelet medication, a lower aneurysm aspect ratio, and the use of the Woven EndoBridge 17 (P < .05). The average Woven EndoBridge shape modification was less pronounced in the BOSS 1 population (P < .02). None of the BOSS 1 or 1 + 2 aneurysms required retreatment or were associated with hemorrhage occurrence. CONCLUSIONS: Isolated persistent flow inside the Woven EndoBridge device at follow-up is rare and notably associated with antiplatelet prescription. It seems to present a benign course in most cases.


Asunto(s)
Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Resultado del Tratamiento , Estudios Retrospectivos , Aneurisma Intracraneal/terapia , Procedimientos Endovasculares/métodos , Embolización Terapéutica/métodos , Tomografía Computarizada por Rayos X
3.
AJNR Am J Neuroradiol ; 43(3): 410-415, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35241418

RESUMEN

BACKGROUND AND PURPOSE: Rescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke. MATERIALS AND METHODS: We performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion). RESULTS: In the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%). CONCLUSIONS: Cangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.


Asunto(s)
Adenosina Monofosfato , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico/terapia , Trombectomía , Adenosina Monofosfato/efectos adversos , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Hemorragia Cerebral/etiología , Terapia Combinada , Humanos , Resultado del Tratamiento
4.
AJNR Am J Neuroradiol ; 42(8): 1479-1485, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34117022

RESUMEN

BACKGROUND AND PURPOSE: Woven EndoBridge (WEB) devices are increasingly used to treat intracranial aneurysms. A1 asymmetry contributes to anterior communicating artery aneurysm formation and to treatment instability after coiling. We sought to evaluate whether A1 asymmetry had an impact on angiographic outcome in anterior communicating artery aneurysms treated with the WEB. MATERIALS AND METHODS: Anterior communicating artery aneurysms treated between July 2012 and July 2020 with the WEB from an institutional review board-approved database were reviewed. A1 asymmetry was categorized as the following: absence of the A1 segment on 1 side (unilateral A1) versus bilateral A1. Univariate and multivariable analyses assessed independent predictors of adequate (WEB Occlusion Scale A, B, and C) and complete occlusion (WEB Occlusion Scale A and B). RESULTS: Forty-eight individual aneurysms (47 patients) were included in the final analysis, of which 16 (33%) were acutely ruptured. The mean size was 6.5 (SD, 2.2) mm. Adequate and complete occlusion was achieved in 33 (69%) and 30 (63%) cases, respectively. Unilateral A1 was associated with significantly higher rates of adequate (92% versus 60% for bilateral A1; P = .03) and complete occlusion (92% versus 50% for bilateral A1; P < .01). Multivariable logistic regression confirmed unilateral A1 as an independent predictor of both adequate (OR = 10.6; 95% CI, 1.6-220.7; P = .04) and complete occlusion (OR = 9.5, 95% CI, 1.5-190.2; P = .04. A sensitivity analysis comparing unilateral "functional" A1 with bilateral "functional" A1 showed similar results. WEB shape modification was not influenced by the unilateral A1 configuration (P = .70). CONCLUSIONS: Anterior communicating artery aneurysms with a unilateral A1 configuration treated with WEB devices are associated with better angiographic outcome than those with bilateral A1. This finding supports the hypothesis that WEB devices are resistant to unilateral flow in the aneurysm as opposed to coils.


Asunto(s)
Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Estudios Retrospectivos , Resultado del Tratamiento
5.
AJNR Am J Neuroradiol ; 42(7): 1276-1281, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33926902

RESUMEN

BACKGROUND AND PURPOSE: The Woven EndoBridge has proved to be a safe and effective treatment, especially for wide-neck intracranial aneurysms. The recent fifth-generation Woven EndoBridge came with smaller devices. The purpose of this study was to assess the safety and efficiency of Woven EndoBridge treatment of small and very small aneurysms. MATERIALS AND METHODS: Between September 2017 and March 2020, all consecutive patients treated with a 3- or 3.5 mm-width Woven EndoBridge device were included in this retrospective intention-to-treat study. Clinical and radiologic findings were evaluated at immediate and last-available follow-up. Angiographic outcome was assessed by an external expert reader. RESULTS: One hundred twenty-eight aneurysms were treated with a fifth-generation Woven EndoBridge device including 29 with a width of ≤3.5 mm. Ten aneurysms were ruptured (34%). In 3 cases (10%), Woven EndoBridge treatment could not be performed because the aneurysm was still too small for the smallest available Woven EndoBridge device and another endovascular strategy was chosen. The median follow-up time was 11.2 months. Complete and adequate occlusion was obtained in 71% and 90% of the treated aneurysms, respectively. Retreatment was needed in 2 cases (10%). Symptomatic ischemic complications leading to transient neurologic deficits occurred in 2 cases (7%) (1 procedure-related and 1 device-related) but with full spontaneous recovery at discharge. CONCLUSIONS: The fifth-generation Woven EndoBridge device seems to be a safe and technically feasible treatment for both ruptured and unruptured small and very small intracranial aneurysms, with satisfactory occlusion rates on midterm follow-up. However, further study is needed to evaluate longer-term efficiency.


Asunto(s)
Aneurisma Intracraneal , Prótesis Vascular , Embolización Terapéutica , Procedimientos Endovasculares , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
7.
AJNR Am J Neuroradiol ; 38(6): 1156-1162, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28450438

RESUMEN

BACKGROUND AND PURPOSE: The treatment of wide-neck, large basilar apex aneurysms is challenging with either an endovascular or a surgical approach. The aim of the present study was to report our experience treating basilar apex aneurysms with flow-diverter stents and to evaluate their efficacy and safety profile in this specific anatomic condition. MATERIALS AND METHODS: We retrospectively analyzed data from all consecutive patients treated with flow-diverter stents at our institution between January 2011 and January 2015. Patients with large basilar apex aneurysms treated with a flow-diverter stent were included in the study. Clinical presentations, technical details, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a midterm follow-up. RESULTS: Of the 175 aneurysms treated with flow-diverter stents at our institution, 5 patients (2 women and 3 men; age range, 44-58 years) received flow-diverter stent for basilar apex aneurysms. The mean follow-up after stent deployment was 21 months (range, 15-24 months). One patient died on day 31 from an early postprocedural midbrain hemorrhage. One patient had a right cerebellar hemispheric ischemic lesion with a transient cerebellar syndrome resolved within 24 hours without neurologic sequelae at the latest follow-up. The mRS was 0 in 4 patients and 6 in 1 patient at last follow-up. CONCLUSIONS: Flow diversion is a feasible technique with an efficacy demonstrated at a midterm follow-up, especially in the case of basilar apex aneurysm recurrences after previous endovascular treatments. Concern about its safety profile still exists.


Asunto(s)
Aneurisma Intracraneal/terapia , Stents , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
8.
J Neuroradiol ; 44(3): 203-209, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28262374

RESUMEN

BACKGROUND AND PURPOSE: Flow disruption with the WEB device is an innovative technique for the endovascular treatment of wide neck bifurcation aneurysms. Good clinical practice trials have shown high safety of this treatment with good efficacy. Technical developments (single layer devices and smaller microcatheters) facilitate the treatment, potentially leading to enlargement of indications. This series is collecting aneurysms in "atypical" locations for WEB treatment and analyzing safety and efficacy of this treatment. MATERIALS AND METHODS: In each participating center, patients with aneurysms treated with WEB were prospectively included in a local database. Patients treated for aneurysms in "atypical" locations were extracted. Patient and aneurysm characteristics, intraoperative complications, and anatomical results at the end of the procedure and at last follow-up were collected and analyzed. RESULTS: Five French neurointerventional centers included 20 patients with 20 aneurysms in "atypical" locations for WEB treatment treated with WEB. Aneurysm locations were ICA carotid-ophthalmic in 9 aneurysms (45.0%), ICA posterior communicating in 4 (20.0%), Pericallosal artery in 5 (25.0%), and basilar artery between P1 and superior cerebellar artery in 2 (10.0%). There were no complications (thromboembolic or intraoperative rupture) in this series. At follow-up (mean: 7.4 months), adequate occlusion was obtained in 100.0% of aneurysms. CONCLUSIONS: This series confirms that it is possible to enlarge indications of WEB treatment to "atypical" locations with good safety and efficacy. These data have to be confirmed in large prospective series.


Asunto(s)
Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Adulto , Anciano , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
9.
AJNR Am J Neuroradiol ; 37(2): 279-84, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26405085

RESUMEN

BACKGROUND AND PURPOSE: The flow-diverter stent has been proved a feasible, safe, and efficient technique, particularly for the treatment of large and broad-neck carotid siphon aneurysms. Wide-neck bifurcation aneurysms remain, in some cases, a challenge for neurointerventionalists. We report the outcomes of the treatment of saccular middle cerebral artery bifurcation aneurysms with flow diversion in our institution. MATERIALS AND METHODS: From the institution data base, all saccular, nondissecting MCA bifurcation aneurysms, treated with flow-diverter stents, were retrospectively reviewed. Technical issues, immediate posttreatment and follow-up angiographic findings, and clinical outcomes were assessed. RESULTS: Fourteen patients with 15 aneurysms were included in the study. Ischemic complications, as confirmed by MR imaging, occurred in 6 patients (43%). Procedure-related morbidity and mortality at last follow-up were 21% and 0%, respectively. Angiographic follow-up was available for 13 aneurysms, with a mean follow-up of 16 months. Complete occlusion was obtained for 8 aneurysms (62%). CONCLUSIONS: Compared with other available therapeutic options, the flow-diverter stent does not appear to be a suitable solution for the treatment of saccular MCA bifurcation aneurysms.


Asunto(s)
Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Stents , Adolescente , Adulto , Anciano , Angiografía Cerebral , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Femenino , Estudios de Seguimiento , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents/efectos adversos , Resultado del Tratamiento
10.
AJNR Am J Neuroradiol ; 37(5): 844-8, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26564443

RESUMEN

BACKGROUND AND PURPOSE: Both the Meyer and Raymond scales are commonly used to report angiographic outcomes following coil embolization of intracranial aneurysms. The objectives of this study were the following: 1) to assess the interobserver agreement of the Meyer and Raymond scales, and 2) to evaluate and compare their performance in predicting major recurrence at follow-up. MATERIALS AND METHODS: A retrospective series of 120 coiled aneurysms was included. Four investigators independently graded DSA images immediately posttreatment and at follow-up according to the Meyer and Raymond scales. On follow-up DSA, readers also evaluated recurrence outcome. Interobserver agreement was assessed via the intraclass correlation coefficient. The ability of posttreatment Meyer and Raymond scales to predict major recurrence was modeled by using logistic regression and assessed by using receiver operating characteristic analysis. RESULTS: For the Meyer scale, interobserver intraclass correlation coefficients were 0.58 (95% CI, 0.46-0.68) on posttreatment and 0.78 (95% CI, 0.72-0.83) on follow-up evaluations. For the Raymond scale, interobserver intraclass correlation coefficients were 0.50 (95% CI, 0.39-0.61) and 0.69 (95% CI, 0.62-0.76), respectively, for posttreatment and follow-up. The areas under the curve for the receiver operating characteristic analyses regarding the performance to predict major recurrence at follow-up were 0.69 (95% CI, 0.60-0.79) for the Meyer and 0.70 (95% CI, 0.61-0.78) for the Raymond scale. CONCLUSIONS: The Meyer scale appears consistent and reliable with observer agreement as high or higher than that of the Raymond scale. Performance of both scales in predicting the risk of major recurrence at follow-up is adequate, with no statistical difference between the scales.


Asunto(s)
Angiografía de Substracción Digital/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Área Bajo la Curva , Embolización Terapéutica/métodos , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Variaciones Dependientes del Observador , Curva ROC , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
11.
AJNR Am J Neuroradiol ; 37(2): E14, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26659342
12.
AJNR Am J Neuroradiol ; 36(10): 1942-6, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26159516

RESUMEN

BACKGROUND AND PURPOSE: The safety and efficiency of the dual-layer Woven EndoBridge (WEB) device has already been published. However, this international multicenter study sought to evaluate the safety of single-layer devices, which are the newest generation of the WEB intrasaccular flow-disrupter family. They have been designed to offer smaller-sized devices with a lower profile to optimize navigability and delivery, which may, in turn, broaden their range of use. MATERIALS AND METHODS: Data from all consecutive patients treated with a single-layer WEB device, in 10 European centers from June 2013 to May 2014 were included. Clinical presentations, technical details, intra- and perioperative complications, and outcomes at discharge were recorded. Clinical and angiographic data at last follow-up were also analyzed when available. RESULTS: Ninety patients with 98 WEB-treated aneurysms were included in this study. In 93 cases (95%), WEB placement was possible. Complete occlusion at the end of the procedure was obtained in 26 instances (26%). Additional treatment during the procedure (coiling and/or stent placement) was necessary in 12 cases (12.7%). Procedure-related complications occurred in 13 cases, leading to permanent neurologic deficits in 4 patients (4.4%). Early vascular imaging follow-up data were available for 44 patients (57%), with an average time interval of 3.3 months. Treatment-related morbidity and mortality rates at last follow-up were 2.2% and 1.1%, respectively. CONCLUSIONS: In this study, the feasibility and safety of the single-layer WEB device was comparable with that of the double-layer. However, further studies are needed to evaluate long-term efficacies.


Asunto(s)
Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Prótesis e Implantes , Adulto , Anciano , Diseño de Equipo , Seguridad de Equipos , Europa (Continente) , Estudios de Factibilidad , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
13.
AJNR Am J Neuroradiol ; 35(7): 1353-7, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24524918

RESUMEN

BACKGROUND AND PURPOSE: The WEB aneurysm embolization system is still under evaluation but seems to be a promising technique to treat wide-neck bifurcation aneurysms. However, this device is barely visible using conventional DSA; thus, high-resolution contrast-enhanced flat panel detector CT (VasoCT) may be useful before detachment to assess the sizing and positioning of the WEB. The purpose of this study was to evaluate the interest of VasoCT during WEB procedures. MATERIALS AND METHODS: From March 2012 to July 2013, twelve patients (10 women and 2 men; age range, 44-55 years) were treated for 13 intracranial aneurysms with the WEB device. DSA and VasoCT were used and compared to depict any protrusion of the device in parent arteries before detachment. Two neuroradiologists reviewed each VasoCT scan, and the quality was graded on a subjective quality scale. RESULTS: The mesh of the WEB was very well-depicted in all cases, allowing a very good assessment of its deployment. Device protrusion was clearly detected with VasoCT in 5 cases, leading to WEB repositioning or size substitution. During follow-up, VasoCT also allows good assessment of eventual residual blood flow inside the aneurysm or the WEB device. CONCLUSIONS: Unlike DSA, VasoCT is an excellent tool to assess WEB deployment and positioning. In our experience, it allowed a precise evaluation of the WEB sizing and its relation to the parent vessel. Such information very likely enhances the ability to safely use this device, avoiding potential thromboembolic events in cases of protrusion in the parent arteries.


Asunto(s)
Angiografía Cerebral/instrumentación , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Radiografía Intervencional/métodos , Stents , Tomografía Computarizada por Rayos X/instrumentación , Pantallas Intensificadoras de Rayos X , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica/instrumentación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento
14.
Diagn Interv Imaging ; 93(3): 159-70, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22421280

RESUMEN

AIMS: To describe and illustrate the main applications of phase-contrast flow quantification in cardiovascular imaging. CONCLUSION: Phase-contrast velocimetry sequences provide an accurate, reliable, reproducible and non-invasive study of blood flow, information which is sometimes not available from other investigation methods. The haemodynamic information obtained from these complement MRI angiography images. They appear to have a range of clinical applications, firstly improving pathophysiological understanding but also contributing to the treatment and follow-up strategy after surgical or endovascular treatment.


Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Cardiopatías Congénitas/diagnóstico , Hemodinámica/fisiología , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional , Angiografía por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/métodos , Reología/métodos , Disección Aórtica/diagnóstico , Disección Aórtica/fisiopatología , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Cardiopatías Congénitas/fisiopatología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/fisiopatología , Volumen Sistólico/fisiología
15.
J Radiol ; 91(11 Pt 2): 1220-4, 2010 Nov.
Artículo en Francés | MEDLINE | ID: mdl-21178895

RESUMEN

Dose delivery during CT coronary angiography with retrospective ECG gating is high especially due to the important slice overlapping. Optimization of the acquisition parameters is necessary to reduce patient exposure. First, the height of the scan field should be limited to the heart. Both kV and mA should be adjusted based on patient morphology. ECG gated exposure modulation with mA reduction during systole, a technique most applicable for patients with slow and regular heart rate, can result in a dose reduction up to 50%. The use of prospective ECG gating can also reduce patient dose. This technique also requires patients with slow and regular heart rate.


Asunto(s)
Técnicas de Imagen Sincronizada Cardíacas/efectos adversos , Angiografía Coronaria/efectos adversos , Angiografía Coronaria/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/efectos adversos , Imagenología Tridimensional/métodos , Dosis de Radiación , Protección Radiológica/métodos , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Carga Corporal (Radioterapia) , Índice de Masa Corporal , Francia , Humanos , Traumatismos por Radiación/etiología , Traumatismos por Radiación/prevención & control , Radiometría/métodos
16.
Biol Neonate ; 75(3): 152-9, 1999 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9925902

RESUMEN

Cerebrospinal fluid (CSF) levels of 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, homovanillic acid, tryptophan, and gamma-aminobutyric acid were measured using high-performance liquid chromatography in 102 infants during the 1st year of life (preterm and term neonates included). CSF levels are expressed versus corrected age (postnatal days - preterm days) which reflects the stage of maturity of the central nervous system. These results are compared to those obtained in CSF of 53 victims of sudden infant death syndrome (SIDS). All components were significantly higher in SIDS than in the age-matched control group. This increase does not seem to be an artefact related to death. Indeed, under the same conditions concerning postmortem time interval before CSF sampling and analysis, the levels are not significantly higher in infants who died from a known pathology than in living infants. Moreover, in living infants as regards a pathology such as asphyxia or hypoventilation in comparison with SIDS, similar profiles are observed in some neurotransmitters or metabolites. Other studies are necessary to explore further neurotransmission systems in SIDS.


Asunto(s)
Ácido Homovanílico/líquido cefalorraquídeo , Ácido Hidroxiindolacético/líquido cefalorraquídeo , Metoxihidroxifenilglicol/líquido cefalorraquídeo , Muerte Súbita del Lactante/líquido cefalorraquídeo , Triptófano/líquido cefalorraquídeo , Ácido gamma-Aminobutírico/líquido cefalorraquídeo , Factores de Edad , Cromatografía Líquida de Alta Presión , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro/líquido cefalorraquídeo , Muerte Súbita del Lactante/etiología , Muerte Súbita del Lactante/patología
17.
J Chromatogr B Biomed Sci Appl ; 716(1-2): 350-3, 1998 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-9824250

RESUMEN

A reversed-phase chromatographic method with electrochemical detection was developed for the simultaneous determination of 2,3- and 2,5-dihydroxybenzoates, indicators of in vivo hydroxyl free radical formation, monoamines (NE, DA, 5-HT) and their metabolites (MHPG, DOPAC, HVA, 3MT, 5-HIAA). Linearity was observed from 10 pg to 10 ng injected. Reproducibility is correct (C.V. about 9%) except for 3MT and 5-HT. The limit of detection for almost all products was about 20 pg injected on the column. An application of this method in the study of the neurotoxicity of high pressure oxygen in rat is described. The limit of quantification for all compounds was 5 ng/ml except for HVA (10 ng/ml). Some basal levels DA, 5-HT, 5-HIAA, HVA, DOPAC, 3MT, 2,5-DHBA and 2,3-DHBA in microdialysates coming from striatum of normoxic restrained rats are given.


Asunto(s)
Monoaminas Biogénicas/análisis , Cuerpo Estriado/química , Gentisatos , Hidroxibenzoatos/análisis , Ácido 3,4-Dihidroxifenilacético/análisis , Animales , Cuerpo Estriado/efectos de los fármacos , Cuerpo Estriado/metabolismo , Dopamina/análogos & derivados , Dopamina/análisis , Ácido Homovanílico/análisis , Ácido Hidroxiindolacético/análisis , Radical Hidroxilo/metabolismo , Metoxihidroxifenilglicol/análisis , Norepinefrina/análisis , Oxígeno/administración & dosificación , Oxígeno/toxicidad , Ratas , Restricción Física , Serotonina/análisis
18.
Acta Paediatr ; 85(5): 595-7, 1996 May.
Artículo en Inglés | MEDLINE | ID: mdl-8827105

RESUMEN

gamma-Aminobutyric acid (GABA), a major inhibitory amino acid, has a central role in cardiorespiratory regulation. Its measurement in the cerebrospinal fluid (CSF) complements the study of neurotransmission systems. Forty-one children were studied (postnatal age < 1 year). For each child, date of birth, date of sampling and current treatments were collated and their postnatal (days) and postconception (weeks) ages were calculated. CSF samples were studied using reverse phase high performance liquid chromatography (HPLC) with o-phthaldialdehyde derivation and spectro-fluorimetric measurement. A clear increase in levels of GABA was observed around 41 weeks postconception, followed by a progressive decrease, with levels stabilizing after 57 weeks postconception. GABA-regulated neuromodulation therefore appears to be mature at 41 weeks postconception and not at birth. The data could be used in further studies investigating amino acid metabolism in relation to brain function in various neurological disorders.


Asunto(s)
Recién Nacido/líquido cefalorraquídeo , Ácido gamma-Aminobutírico/líquido cefalorraquídeo , Factores de Edad , Cromatografía Líquida de Alta Presión , Humanos , Lactante , Espectrometría de Fluorescencia
19.
Brain Res ; 676(2): 352-7, 1995 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-7614005

RESUMEN

The contents of amino acids (AA) and ammonia (NH3) were measured in corpus striatum, brain stem and cerebral cortex of two strains of mice exposed to hyperbaric oxygen (HBO). Mice of the HBO-sensitive strain (CD1) were exposed to 600 kPa O2 for 24 min versus 90 min for mice of the normal C57 strain, so that 50% of the mice in both strains developed a generalized convulsion. In the cortex of exposed but unconvulsed (EXUN) C57 mice, the contents of taurine, glutamine and NH3 increased while that of GABA decreased when compared to control mice. In the CD1 mice, NH3 content was increased while that of Asp decreased. After a convulsion, NH3 was increased in both strains, the AA contents returned to normal in C57 but Asp remained low in CD1 mice. Somewhat similar changes occurred in the striatum except that NH3 levels were less affected while GABA ones were significantly decreased in the CD1 mice exposed to HBO, whether convulsed or not. In the EXUN brain stem, Asp and Glu contents decreased. These decreases were greater in C57 on a percentage basis than in CD1 mice. GABA content was decreased in the C57 strain. After a convulsion, Asp and Glu levels remained low and NH3 accumulated in CD1 whereas in C57 only the Glu level was decreased. The cortical and striatal changes may indicate a lesser GABA supply in C57 strain and some Asp release in CD1 strain. In the brain stem of both strains, Asp and Glu release is possible in addition to GABA in C57 strain.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Aminoácidos/metabolismo , Amoníaco/metabolismo , Tronco Encefálico/metabolismo , Oxigenoterapia Hiperbárica/efectos adversos , Convulsiones/metabolismo , Telencéfalo/metabolismo , Análisis de Varianza , Animales , Ganglios Basales , Corteza Cerebral/metabolismo , Cuerpo Estriado/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Convulsiones/inducido químicamente , Factores de Tiempo
20.
Pathol Biol (Paris) ; 41(7): 610-2, 1993 Sep.
Artículo en Francés | MEDLINE | ID: mdl-8255613

RESUMEN

The aim of the study was to determine plasma dopamine-beta-hydroxylase activity (DBH) in newborn infants and possible changes with maturation, mode of delivery and maternal disease: pregnancy-induced hypertension and gestational diabetes. DBH activity was determined by high performance liquid chromatography from 82 neonates divided in 2 groups: group I: 27 neonates (age: 1 to 8 days) including 6 preterm and 21 full-term neonates; group II: 55 full-term neonates divided in 5 classes: A: vaginal delivery; B: forceps; C: elective caesarean section; D: vaginal delivery and maternal hypertension; E: vaginal delivery and gestational diabetes. The plasma DBH activity was low in neonates and not influenced by prematurity. Significantly lower DBH activity was found after caesarean section. Hypertension and gestational diabetes did not affect umbilical cord plasma DBH activity.


Asunto(s)
Complicaciones de la Diabetes , Dopamina beta-Hidroxilasa/sangre , Retardo del Crecimiento Fetal/sangre , Hipertensión/complicaciones , Enfermedades del Prematuro/sangre , Adulto , Cesárea , Femenino , Sangre Fetal/química , Humanos , Recién Nacido , Enfermedades del Prematuro/etiología , Embarazo , Complicaciones del Embarazo , Complicaciones Cardiovasculares del Embarazo , Estudios Prospectivos
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