Silk Vista Baby flow diverter stent for ruptured intracranial aneurysms: a retrospective observational study.

PURPOSE: Flow diversion changed the approach to complex intracranial aneurysms, leading to a widespread use and a rapid technological evolution. Indeed, indications continued to expand, including ruptured intracranial aneurysms in selected cases. Recently, new devices have been designed specifically to target smaller vessels. Therefore, we conducted a multicenter study to evaluate clinical outcome, complications, and occlusion rate of patients with ruptured aneurysms treated with new generation low profile Silk Vista Baby (SVB) flow diverter stent (FD). METHODS: We performed a retrospective observational study on consecutive patients who underwent treatment with SVB for ruptured aneurysms at 12 Italian centers. Primary end point was favorable clinical outcome rate, defined as modified ranking score (mRS) of 0-2 at the 3 months. Secondary outcomes were complication rate, aneurysm re-rupture, and complete aneurysm occlusion at last radiological follow-up. RESULTS: Twenty-five patients were included; at 3 months' follow-up, 19 patients (79.1%) had favorable clinical outcome (mRS 0-2). Three patients (12.5%) died during follow-up. In-stent thrombosis occurred in two cases (8.3%), managed with glycoprotein IIb/IIIA and intra-stent angioplasty, without clinical consequences. In 18 (85.7%) patients, complete occlusion at 3 months was demonstrated. No rebleeding occurred during follow-up. Presentation with unfavorable World Federation of Neurosurgical Societies grading system (WFNS) and posterior circulation location were both significantly correlated with unfavorable clinical outcome (p = 0.005 and p = 0.02). CONCLUSIONS: Our data suggests that low profile FD treatment of ruptured intracranial aneurysms located distally of the circle of Willis is feasible. New generation low profile FD may represent an alternative option in carefully selected cases.

Multicentric Experience with an Intermediate Aspiration Catheter for Distal M2 Ischemic Stroke.

BACKGROUND: To assess technical and clinical outcomes of an intermediate bore aspiration catheter (AXS Catalyst 5; Stryker) as front-line therapy for M2-M3 acute occlusions. METHODS: A multicentric, retrospective data collection of patients with symptomatic M2-M3 ischemic stroke, treated with direct aspiration first-pass technique was obtained. Time to recanalization, first attempt recanalization, and number of attempts were recorded. Successful recanalization was defined as a modified thrombolysis in cerebral infarction score ≥2b; incidence of procedure-related complications was recorded. National Institutes of Health Stroke Scale at discharge and modified Rankin Scale score at 90 days were evaluated by a dedicated neurologist. RESULTS: A total of 44 acute occlusions of distal M2-M3 segment were treated with a direct aspiration first-pass technique using CAT 5 (mean age 68,4 years). Median NIHSS at baseline was 10. Overall modified thrombolysis in cerebral infarction score ≥2b was obtained in 90,9% of patients with mean time to recanalization of 49,7 minutes and a mean of 1.6 attempts. First-attempt recanalization with CAT 5 was obtained in 52,3% of patients with a mean time to recanalization of 29.2 min. A stent retriever with proximal aspiration was incorporated as a rescue device in 3 cases. No major complications was detected. The median National Institutes of Health Stroke Scale score at discharge was 4. At 90 days, a modified Rankin Scale score of 0-2 was achieved in 70,5% of patients. CONCLUSIONS: ADAPT technique with the intermediate aspiration catheter CAT 5 system achieves successful revascularization and functional independence for patients with acute ischemic stroke secondary to distal M2 occlusions.

Congenital kidney malformation: Computed tomography and scintigraphy findings of renal reversed rotation.

Renal reversed rotation is a congenital abnormality due to anomalous kidney rotation around its long axis, resulting in faced laterally renal hilum; this condition is associated with several vascular variants. The aim of this report is to describe the case of a 47-year-old male with renal reversed rotation who came to our attention after ultrasound exam. The association of renal rotation and vascular anomalies increases long-term complications as kidney lithiasis, hydronephrosis, colic pain, hematuria, and renal failure. We decided to study the anatomy and renal function of the reversed rotated kidney by multiphasic computed tomography and renal dimercaptosuccinic acid-scintigraphy. It is critical for urologists and radiologists to recognize this abnormality in order to plan the best treatment and follow-up.

Ruptured Intracranial Aneurysms Treated with Woven Endobridge Intrasaccular Flow Disruptor: A Multicenter Experience.

BACKGROUND: The woven endobridge intrasaccular flow disruptor (WEB) device for ruptured broad-based intracranial aneurysm (rBBA) remains underrepresented in existing studies. In this case series, the safety and efficacy results of the use of WEB in rBBA were evaluated from a multi-center experience. MATERIALS AND METHODS: Between November 2014 and October 2017, data of all patients with rBBA (≥4 mm and/or dome/neck ratio ≥1 and ≤1.6) treated with WEB were prospectively collected and retrospectively analyzed from 3 Italian neurointerventional centers. The interventional procedures and the clinical and angiographic outcomes are reported for the periprocedural phase with midterm follow-up. RESULTS: 33 patients were included in this series (10 patients with Hunt-Hess scores 4-5; 23 patients with Hunt-Hess scores 1-3). Technical success was obtained for all 33 patients (100%). The mean fluoroscopy time was 24 minutes (range, 8-40 minutes). Adjunctive devices were used in 6% of patients (2 stents). At the 1-month follow-up visit, the overall mortality was 33%. The overall rate of WEB-related complications was 27% (5 device protrusion, 2 sac perforation, 2 thromboembolism), with a WEB-related mortality of 12% and permanent neurologic deficit of 3%. Of the surviving patients, 1 was lost to follow-up. At 14 months, the mean follow-up (range, 2-35 months), no early or delayed reruptured aneurysms were observed; complete occlusion was obtained in 7/21 patients (33%), neck remnant in 8/21 (38%), and residual aneurysm filling in 6/21 (29%) patients, with a modified Rankin Scale of 0sto 2 observed in 17/21 patients (80%). CONCLUSIONS: The WEB device for rBBA is a fast and effective treatment, with a low rate of aneurysm rebleeding; however, procedure-related complications seem not negligible. Further evaluation comparing this device with other treatment options should be performed.

Anomalous development of the inferior vena cava: Case reports of agenesis and hypoplasia.

We reported the cases of two adult male patients who were admitted to our emergency room with abdominal pain and dyspnea caused by gallstones and pulmonary embolism respectively. During the radiological investigations, as collateral findings, we found two anomalous development of the inferior vena cava. These conditions affect about 4% of population and, although asymptomatic or mildly symptomatic, are associated with thrombotic manifestations as deep vein thrombosis and pulmonary embolism. The prompt recognition of these anomalies is necessary in order to prevent the complications associated with these conditions and to set the best therapy for patients.

Bifid sternum in a young woman: Multimodality imaging features.

Bifid sternum is a rare fusion anomaly of the chest wall that accounts for 0.15% of all chest deformities and may be associated with cardiac or vascular anomalies. It is usually diagnosed and surgically corrected at birth or within the first month of life. Being a diagnosis made during the neonatal period, computed tomography scan and magnetic resonance imaging are not often performed; not so many cases in literature have been studied with II level diagnostic imaging, such as computed tomography or magnetic resonance. We describe a case of bifid sternum, rarely diagnosed in adults, discovered in a 21-year-old woman who came to our Diagnostic Imaging Department to perform a chest magnetic resonance after a chest X-ray.