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1.
Hum Mol Genet ; 27(22): 3827-3839, 2018 11 15.
Article in English | MEDLINE | ID: mdl-30007339

ABSTRACT

Gain-of-function mutations in fibroblast growth factor receptors (FGFRs) cause congenital skeletal anomalies, including craniosynostosis (CS), which is characterized by the premature closure of craniofacial sutures. Apert syndrome (AS) is one of the severest forms of CS, and the only treatment is surgical expansion of prematurely fused sutures in infants. Previously, we demonstrated that the prolyl isomerase peptidyl-prolyl cis-trans isomerase interacting 1 (PIN1) plays a critical role in mediating FGFR signaling and that Pin1+/- mice exhibit delayed closure of cranial sutures. In this study, using both genetic and pharmacological approaches, we tested whether PIN1 modulation could be used as a therapeutic regimen against AS. In the genetic approach, we crossbred Fgfr2S252W/+, a mouse model of AS, and Pin1+/- mice. Downregulation of Pin1 gene dosage attenuated premature cranial suture closure and other phenotypes of AS in Fgfr2S252W/+ mutant mice. In the pharmacological approach, we intraperitoneally administered juglone, a PIN1 enzyme inhibitor, to pregnant Fgfr2S252W/+ mutant mice and found that this treatment successfully interrupted fetal development of AS phenotypes. Primary cultured osteoblasts from Fgfr2S252W/+ mutant mice expressed high levels of FGFR2 downstream target genes, but this phenotype was attenuated by PIN1 inhibition. Post-translational stabilization and activation of Runt-related transcription factor 2 (RUNX2) in Fgfr2S252W/+ osteoblasts were also attenuated by PIN1 inhibition. Based on these observations, we conclude that PIN1 enzyme activity is important for FGFR2-induced RUNX2 activation and craniofacial suture morphogenesis. Moreover, these findings highlight that juglone or other PIN1 inhibitors represent viable alternatives to surgical intervention for treatment of CS and other hyperostotic diseases.


Subject(s)
Acrocephalosyndactylia/genetics , Core Binding Factor Alpha 1 Subunit/genetics , Craniosynostoses/genetics , NIMA-Interacting Peptidylprolyl Isomerase/genetics , Receptor, Fibroblast Growth Factor, Type 2/genetics , Acrocephalosyndactylia/drug therapy , Acrocephalosyndactylia/physiopathology , Animals , Cranial Sutures/physiopathology , Craniosynostoses/drug therapy , Craniosynostoses/physiopathology , Disease Models, Animal , Female , Gain of Function Mutation/genetics , Gene Expression Regulation/drug effects , Humans , Mice , Morphogenesis , NIMA-Interacting Peptidylprolyl Isomerase/antagonists & inhibitors , Naphthoquinones/administration & dosage , Osteoblasts/drug effects , Osteoblasts/metabolism , Pregnancy , Primary Cell Culture , Signal Transduction
2.
Clin Radiol ; 69(6): e273-9, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24625690

ABSTRACT

AIM: To present the clinical and radiological results of coil embolization in internal carotid artery (ICA) bifurcation aneurysms (BA). MATERIALS AND METHODS: The records of 65 patients with 66 ICA BA were retrieved from data prospectively accrued between September 1999 and July 2013. Clinical and morphological outcomes of the aneurysms were assessed, including technical aspects of treatment. RESULTS: The aneurysms under study were directed either superiorly (41/66, 62.1%), anteriorly (24/66, 36.4%), or posteriorly (1/66, 1.5%), and all were devoid of perforators. Aneurysmal necks were situated symmetrically at the terminal ICA (37/66, 56.1%) or slightly deviated to the proximal A1 segment (29/66, 43.9%). The steam-shaped S microcatheter (73.8%) was most commonly used to select the aneurysms, and the single microcatheter technique was most commonly applied (56.1%) to perform coil embolization, followed by balloon remodelling (21.2%), multiple microcatheter (15.1%), and stent-protection (7.6%). Successful aneurysmal occlusion was achieved in 100% of cases, with no procedure-related morbidity or mortality. Imaging performed in the course of follow-up (mean duration 27.3 months) confirmed stable occlusion of most lesions (47/53, 88.7%). CONCLUSION: Through tailored technical strategies, ICA BA are amenable to safe and effective endovascular coil embolization, with a tendency for stable occlusion long-term.


Subject(s)
Aneurysm, Ruptured/therapy , Aneurysm/therapy , Carotid Artery, Internal , Embolization, Therapeutic/methods , Aneurysm/diagnostic imaging , Aneurysm, Ruptured/diagnostic imaging , Female , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Prospective Studies , Radiography , Treatment Outcome
3.
Clin Radiol ; 69(2): e63-70, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24286934

ABSTRACT

AIM: To investigate the angle changes of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms. MATERIALS AND METHODS: The adjacent parent arterial angles before and after stent-assisted coil embolization were measured in 38 patients with aneurysms of the anterior communicating artery (ACoAA) and 41 patients with bifurcation aneurysms of the middle cerebral artery (MCABA). Variables were analysed in relation to the angle changes. RESULTS: Vascular angles of the parent arteries significantly increased by 27.8° (±18.5°) immediately after stent-assisted coil embolization in 79 cases (p < 0.001), with 25.7° (±14.8°) in ACoAA and 29.7° (±21.4°) in MCABA, respectively. In 51 (64.6%) cases with follow-up angiography (mean interval 13.5 ± 4.1 months), vascular angles increased by 27.2° (±17.1°) immediately after treatment and further increased by 20.7° (±14.3°) at the last follow-up (all p < 0.001). More acute pre-stent angles of the parent arteries correlated with greater post-stent angle changes (p = 0.006). Younger age tended to be inversely related to post-stent angle changes (p = 0.091). CONCLUSION: Stent placement during coil embolization induced significant changes in the aneurysm-parent artery relationship. Further study is needed to elicit the association between angle change of the parent arteries and aneurysmal stability after coil embolization.


Subject(s)
Anterior Cerebral Artery/diagnostic imaging , Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Middle Cerebral Artery/diagnostic imaging , Stents , Adult , Aged , Embolization, Therapeutic/instrumentation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Radiography , Treatment Outcome
4.
Endoscopy ; 45(2): 106-13, 2013.
Article in English | MEDLINE | ID: mdl-23212727

ABSTRACT

BACKGROUND AND STUDY AIMS: Endoscopic bilateral drainage for inoperable malignant hilar biliary strictures (HBS) using metal stents is considered to be technically difficult. Furthermore, endoscopic revision of bilateral stenting after occlusion can be challenging. This study was performed to evaluate the long-term efficacy of endoscopic bilateral stent-in-stent placement of cross-wired metallic stents in high-grade malignant HBS and planned endoscopic bilateral revision. PATIENTS AND METHODS: A total of 84 patients with inoperable high-grade malignant HBS were enrolled from three academic tertiary referral centers. Two cross-wired metal stents were inserted using a bilateral stent-in-stent placement method. Bilateral endoscopic revision was also performed during follow-up using either identical metal stents or plastic stents. The main outcome measurements were technical and functional success, complications, stent patency, and endoscopic revision efficacy. RESULTS: The technical and clinical success rates of endoscopic bilateral stent-in-stent placement of cross-wired metallic stents were 95.2% (80/84) and 92.9% (78/84), respectively. Median patency (range) and survival were 238 days (10-429) and 256 days (10-1130), respectively. Obstruction of primary bilateral stents occurred in 30.8% (24/78) of patients with functionally successful stent placement. The technical and clinical success rates of planned bilateral endoscopic revision for occluded stents were 83.3% (20/24) and 79.2% (19/24), respectively. For revision, bilateral metallic stents were placed in 11 patients (55.0%); the remaining patients received plastic stents. CONCLUSIONS: Palliative endoscopic bilateral stent-in-stent placement of cross-wired metallic stents was effective in patients with inoperable HBS. Revision endoscopic bilateral stenting may be feasible and successful in cases where the primary deployed metal stents are occluded.


Subject(s)
Bile Duct Neoplasms/complications , Bile Ducts, Intrahepatic , Cholangiocarcinoma/complications , Cholestasis, Intrahepatic/therapy , Drainage/methods , Gallbladder Neoplasms/complications , Prosthesis Implantation/methods , Stents , Aged , Aged, 80 and over , Cholestasis, Intrahepatic/etiology , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Metals , Middle Aged , Prospective Studies , Prosthesis Design , Prosthesis Failure , Prosthesis Implantation/adverse effects , Reoperation , Stents/adverse effects , Time Factors
5.
Clin Radiol ; 68(3): 256-63, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23017739

ABSTRACT

AIM: To present the clinical and radiological follow-up results of coil embolization using the Enterprise stent for intracranial saccular aneurysms. MATERIALS AND METHODS: The clinical and morphological outcomes of 261 consecutive patients with a total of 289 aneurysms that were treated with a stent-protected coiling technique using the Enterprise stent from June 2008 to August 2011 were assessed. RESULTS: Stents were delivered before first coil insertion in 162 aneurysms (56.1%), during coiling in 68 (23.5%), and after completion of coil insertion in 59 (20.4%). Procedure-related complications occurred in 36 patients (13.8%), and four (1.5%) suffered permanent neurological sequelae. Successful occlusion after coil embolization was achieved in 205 aneurysms (70.9%) and subtotal occlusion was achieved in 84. During the mean follow-up of 12.4 (±5.8) months, follow-up imaging of 229 aneurysms (79.2%) documented stable occlusion in 183 (79.9%) of the lesions, minor recanalization in 17 (7.4%), and major recanalization in 29 (12.7%). Follow-up angiography of 110 aneurysms (38.1%) demonstrated in-stent stenosis in 14 (12.7%) and stent migration in five (4.5%). Eleven patients (4.2%) suffered late delayed infarction during the follow-up period, which was related to cessation or modification of anti-platelet medication. CONCLUSION: The stent-protection technique using the Enterprise stent is useful and effective for coil embolization of wide-necked aneurysms due to easy navigation and precise placement. However, the possibility of procedure-related complications, in-stent stenosis, and delayed cerebral infarction should be noted.


Subject(s)
Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Stents , Cerebral Angiography , Chi-Square Distribution , Embolization, Therapeutic/instrumentation , Female , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Postoperative Complications/diagnostic imaging , Treatment Outcome
6.
AJNR Am J Neuroradiol ; 44(8): 916-921, 2023 08.
Article in English | MEDLINE | ID: mdl-37385682

ABSTRACT

BACKGROUND AND PURPOSE: Venous-predominant AVMs are almost identical in appearance to developmental venous anomalies on conventional MR imaging. Herein, we compared and analyzed arterial spin-labeling findings in patients with developmental venous anomalies or venous-predominant AVMs, using DSA as the criterion standard. MATERIALS AND METHODS: We retrospectively collected patients with either DVAs or venous-predominant AVMs, each available on both DSA and arterial spin-labeling images. Arterial spin-labeling imaging was visually assessed for the presence of hyperintense signal. CBF measured at the most representative section was normalized to the contralateral gray matter. The temporal phase of developmental venous anomalies or venous-predominant AVMs was measured on DSA as a delay between the first appearance of the intracranial artery and the lesion. Correlation between the normalized CBF and the temporal phase was evaluated. RESULTS: Analysis of 15 lesions (13 patients) resulted in categorization into 3 groups: typical venous-predominant AVMs (temporal phase, <2 seconds), intermediate group (temporal phase between 2.5 and 5 seconds), and classic developmental venous anomalies (temporal phase, >10 seconds). Arterial spin-labeling signal was markedly increased in the typical venous-predominant AVM group, while there was no discernible signal in the classic developmental venous anomaly group. In the intermediate group, however, 3 of 6 lesions showed mildly increased arterial spin-labeling signal. The normalized CBF on arterial spin-labeling and the temporal phase on DSA were moderately negatively correlated: r(13) = 0.66, P = .008. CONCLUSIONS: Arterial spin-labeling may predict the presence and amount of arteriovenous shunting in venous-predominant AVMs, and using arterial spin-labeling enables confirmation of typical venous-predominant AVMs without DSA. However, lesions with an intermediate amount of shunting suggest a spectrum of vascular malformations ranging from purely vein-draining developmental venous anomalies to venous-predominant AVMs with overt arteriovenous shunting.


Subject(s)
Intracranial Arteriovenous Malformations , Humans , Spin Labels , Intracranial Arteriovenous Malformations/diagnostic imaging , Intracranial Arteriovenous Malformations/pathology , Magnetic Resonance Angiography/methods , Retrospective Studies , Diagnosis, Differential , Magnetic Resonance Imaging , Arteries/pathology
7.
Endoscopy ; 44(9): 819-24, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22791587

ABSTRACT

BACKGROUND AND STUDY AIMS: The incidence of residual stones after mechanical lithotripsy for retained common bile duct (CBD) stones is relatively high. Peroral cholangioscopy using a mother-baby system may be useful for confirming complete extraction of stones, but has several limitations regarding routine use. We evaluated the role of direct peroral cholangioscopy (DPOC) using an ultraslim upper endoscope for the evaluation and removal of residual CBD stones after mechanical lithotripsy. PATIENTS AND METHODS: From August 2006 to November 2010, 48 patients who had undergone mechanical lithotripsy for retained CBD stones with no evidence of filling defects in balloon cholangiography were recruited. The bile duct was inspected by DPOC after balloon cholangiography. Detected residual CBD stones were directly retrieved with a basket or balloon catheter under DPOC. The incidence of residual stones detected by DPOC, and the success rate of residual stone retrieval under DPOC were investigated. RESULTS: DPOC was successfully performed in 46 of the 48 patients (95.8%). Of these, 13 patients (28.3%) had residual CBD stones (mean number 1.4, range 1-3; mean diameter 4.5 mm, range 2.3-9.6). The residual stones were removed directly under DPOC in 11 of these patients (84.6%). There were no complications associated with DPOC or stone removal. CONCLUSION: DPOC using an ultraslim upper endoscope is a useful endoscopic procedure for the evaluation and extraction of residual stones after mechanical lithotripsy for retained CBD stones.


Subject(s)
Endoscopy, Digestive System/methods , Gallstones/therapy , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Endoscopy, Digestive System/instrumentation , Female , Follow-Up Studies , Gallstones/diagnosis , Humans , Lithotripsy , Male , Middle Aged
8.
Clin Radiol ; 66(8): 726-31, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21529794

ABSTRACT

PURPOSE: To investigate the anatomic causes of false-positive unruptured aneurysms (FPUIAs) and the added value of source images (SIs) in magnetic resonance angiography (MRA)-based UIA diagnosis. METHODS: The MRA images of 59 patients with 63 FPUIAs and 113 patients with 127 aneurysms were retrospectively reviewed. Two neurointerventionists reviewed MRA- maximum intensity projection (MIP) and conventional angiographic images of patients with FPUIAs, and determined the anatomical causes of FPUIAs by location. They also reviewed both MIP images alone (MIP mode) and additional SI together with MIP (MIP+SI mode) and rated aneurysm probability separately. Receiver operating characteristic (ROC) analysis was performed to compare diagnostic performance of both image modes. RESULTS: FPUIAs were most commonly found at the internal carotid artery (ICA)-posterior communicating artery (Pcom) (36%). False-positive results at the ICA-Pcom and ICA-anterior choroidal artery resulted from the presence of infundibuli in 28 (97%) and six (100%), respectively. An arterial loop was the leading cause of FPUIAs throughout all locations of the anterior cerebral artery and middle cerebral artery except the anterior communicating artery, where fenestration was found in six (60%) cases. The areas under the ROC curves of the two image modes were not significantly different (0.887 versus 0.925; p=0.103). Addition of the SIs did not cause a significant change in sensitivity (88.2 versus 83.5%; p=0.21), whereas it led to a significant increase in specificity (74.6 versus 95.2%; p=0.0002). CONCLUSIONS: MRA-based FPUIAs are mostly attributable to infundibuli and arterial loops. Although the addition of the SIs appears not to significantly increase the sensitivity of UIA diagnosis, it may significantly improve the specificity.


Subject(s)
Anterior Cerebral Artery , Cerebral Angiography/methods , Intracranial Aneurysm/diagnosis , Magnetic Resonance Angiography , Adult , Aged , Area Under Curve , Cerebral Angiography/standards , False Positive Reactions , Female , Humans , Image Interpretation, Computer-Assisted , Intracranial Aneurysm/etiology , Magnetic Resonance Angiography/methods , Magnetic Resonance Angiography/standards , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Retrospective Studies
9.
J Dent Res ; 100(4): 423-431, 2021 04.
Article in English | MEDLINE | ID: mdl-33143523

ABSTRACT

Patients with cleidocranial dysplasia (CCD) caused by mutations in RUNX2 have severe dental anomalies, including delayed or absent eruption of permanent teeth. This requires painful and expensive surgical/orthodontic intervention because of the absence of medicine for this condition. Here, we demonstrate that nicotinamide, a vitamin B3 and class III histone deacetylase inhibitor, significantly improves delayed tooth eruption in Runx2+/- mice, a well-known CCD animal model, through the restoration of decreased osteoclastogenesis. We also found that Csf1 mRNA and protein levels were significantly reduced in Runx2+/- osteoblasts as compared with wild type whereas RANKL and OPG levels had no significant difference between wild type and Runx2+/- osteoblasts. The nicotinamide-induced restoration of osteoclastogenesis of bone marrow-derived macrophages in Runx2+/- mice was due to the increased expression of RUNX2 and CSF1 and increased RANKL/OPG ratio. RUNX2 directly regulated Csf1 mRNA expression via binding to the promoter region of the Csf1 gene. In addition, nicotinamide enhanced the RUNX2 protein level and transacting activity posttranslationally with Sirt2 inhibition. Taken together, our study shows the potential and underlying molecular mechanism of nicotinamide for the treatment of delayed tooth eruption by using the Runx2+/- murine model, suggesting nicotinamide as a candidate therapeutic drug for dental abnormalities in patients with CCD.


Subject(s)
Cleidocranial Dysplasia , Core Binding Factor Alpha 1 Subunit , Animals , Mice , Niacinamide/pharmacology , Osteoclasts , Tooth Eruption
10.
Endoscopy ; 42(2): 169-72, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19998219

ABSTRACT

Laser lithotripsy is an effective and safe method for difficult common bile duct (CBD) stones. However, radiolucent laser fibers make accurate fragmentation difficult and require continuous visual control or an accessory for effective targeting. The newly developed double-lumen basket may promote effective laser lithotripsy after stone capture. We performed laser lithotripsy using a double-lumen basket in 14 patients with CBD stones refractive to conventional endoscopic treatment, and evaluated the feasibility and efficacy of this procedure. Stones were successfully fragmented in 13 of 14 patients, and 13 patients eventually became stone-free. Mechanical lithotripsy was applied in two patients with biliary strictures. Minor complications were noted in three patients, including transient hemobilia in one patient. For a selected group of patients with difficult CBD stones, laser lithotripsy using a double-lumen basket appears to be an effective and safe method. However, continuous development of basket protocols to increase the success rate of lithotripsy is needed.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Endoscopes , Gallstones/therapy , Lithotripsy, Laser/methods , Aged , Aged, 80 and over , Equipment Design , Female , Follow-Up Studies , Gallstones/diagnosis , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
11.
AJNR Am J Neuroradiol ; 41(4): 619-623, 2020 04.
Article in English | MEDLINE | ID: mdl-32273325

ABSTRACT

BACKGROUND AND PURPOSE: After endovascular coiling of intracranial aneurysms, round dark parenchymal lesions believed to be particulate metal are sometimes encountered in MR imaging studies of the brain. We used SWI to assess the frequency of such occurrences, in addition to exploring likely causes and clinical implications. MATERIALS AND METHODS: We reviewed 700 MR imaging studies performed between September 2018 and March 2019 at our institution as follow-up monitoring of coiled intracranial aneurysms. Any sizeable (>5 mm) rounded dark-signal lesions encountered were presumed to be metallic. The magnitudes and locations of such lesions were recorded. In patients with these lesions, pertinent procedural documentation was screened for devices used, including coils, microcatheters, microguidewires, and stents. Medical records were also examined to determine whether any related symptoms ensued. RESULTS: Twenty patients (2.8%) exhibited a total of 25 lesions on SWI. Diameters ranged from 5 to 11 mm (median, 8 mm). All except 2 lesions were located in brain regions downstream from aneurysms, but all lesions occupied vascular territories of vessels used to place guiding catheters. Other than the Synchro 14, which was routinely deployed, no device was regularly used in patients with SWI-detectable lesions; and none of the affected patients developed focal neurologic symptoms as a consequence. CONCLUSIONS: Although the origins remain unclear, distal embolization of particulate metal distal to coiled cerebral aneurysms is occasionally observed on follow-up MR imaging studies. Such lesions, however, seem to have no apparent clinical impact.


Subject(s)
Blood Vessel Prosthesis/adverse effects , Intracranial Aneurysm/surgery , Intracranial Embolism/diagnostic imaging , Intracranial Embolism/etiology , Magnetic Resonance Imaging/methods , Adolescent , Adult , Aged , Aged, 80 and over , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Female , Follow-Up Studies , Humans , Male , Metals , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
12.
Acta Radiol ; 49(8): 902-11, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18651252

ABSTRACT

BACKGROUND: Iodinated X-ray contrast media (CM) are recognized worldwide to be among the safest and most widely used injectable drugs. However, adverse drug reactions (ADRs) may still occur, ranging in severity from minor disturbances to severe and potentially fatal complications. PURPOSE: To prospectively determine the incidence and characteristics of acute ADRs during clinical utilization of a single nonionic monomeric contrast agent, iopromide, in routine radiological practice in a large number of nonselected patients. MATERIAL AND METHODS: 74,717 patients were enrolled in a prospective international postmarketing surveillance registry with iopromide (Ultravist; Bayer Schering Pharma AG, Berlin, Germany). A standardized questionnaire was used to collect the following patient information from 762 centers in 27 countries: baseline demographics, risk factors, premedication regimen, type of examination, route of injection, volume and selected concentration of iopromide, and overall tolerance to CM (utilizing specific criteria and descriptors). RESULTS: The overall rate of ADRs, including tolerance indicators (TI) (i.e., heat sensation and pain at the injection site), was 2%; when TIs were excluded, the rate was 1.5%. Fourteen serious adverse reactions were reported (rate 0.02%), of which none were fatal. There was a higher incidence of ADRs among women and for the age group ranging between 18 and 30 years. Patients with established risk factors, such as a history of previous CM reaction or allergic diathesis (7.4% and 4.1%, respectively), were at an increased risk for developing an ADR when compared to patients without risk factors (1.2%). The incidence of ADRs was not altered by the use of premedication. CONCLUSION: The safety of iopromide in routine clinical practice was shown to be comparable to the published safety profiles of other nonionic iodinated contrast agents. Adverse drug reaction rates were affected by age, gender, and risk factors (especially previous CM reactions or allergies), but not by premedication.


Subject(s)
Contrast Media/adverse effects , Drug Hypersensitivity/epidemiology , Iohexol/analogs & derivatives , Product Surveillance, Postmarketing/statistics & numerical data , Acute Disease/epidemiology , Age Distribution , Aged , Aged, 80 and over , Contrast Media/administration & dosage , Drug Hypersensitivity/diagnosis , Female , Germany/epidemiology , Humans , Incidence , Injections, Intra-Arterial/adverse effects , Injections, Intravenous/adverse effects , Iohexol/administration & dosage , Iohexol/adverse effects , Korea/epidemiology , Male , Middle Aged , Prevalence , Prospective Studies , Risk Factors , Severity of Illness Index , Sex Distribution , United States/epidemiology
13.
AJNR Am J Neuroradiol ; 39(12): 2297-2300, 2018 12.
Article in English | MEDLINE | ID: mdl-30442700

ABSTRACT

BACKGROUND AND PURPOSE: Aneurysms arising from the proximal A1 segment of the anterior cerebral artery are rare, and their distinctive configurations often pose technical challenges during endovascular embolization. Herein, we present 11 patients with proximal A1 aneurysms requiring a contralateral approach (via the anterior communicating artery) to coil embolization. MATERIALS AND METHODS: From a prospectively collected data repository, we retrieved records of 11 patients consecutively treated for proximal A1 aneurysms between January 2011 and March 2018. In each instance, coil embolization was performed by the contralateral route. Outcomes were analyzed in terms of morphologic features and clinical status. RESULTS: Aneurysms in all 11 patients were directed posteriorly and were small (<5 mm). A contralateral approach (via the anterior communicating artery) was used after ipsilateral attempts at aneurysm selection failed in each instance, despite using a variety of microcatheters. Single punctures and single guiding catheters sufficed in 9 patients, but 2 patients required dual punctures and 2 guiding catheters. All endovascular treatments ultimately yielded excellent outcomes. Although 1 symptomatic infarct was manifested in the course of ipsilateral treatment, no morbidity or mortality resulted from the contralateral access. CONCLUSIONS: Due to angio-anatomic constraints, a contralateral strategy for coil embolization of proximal A1 aneurysms is acceptable if ipsilateral access is technically prohibitive and the vessels (contralateral A1 and anterior communicating artery) are amenable to the passage of microdevices.


Subject(s)
Embolization, Therapeutic/methods , Endovascular Procedures/methods , Intracranial Aneurysm/therapy , Anterior Cerebral Artery/surgery , Embolization, Therapeutic/instrumentation , Endovascular Procedures/instrumentation , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
14.
Clin Neuroradiol ; 27(2): 205-211, 2017 Jun.
Article in English | MEDLINE | ID: mdl-26608741

ABSTRACT

PURPOSE: It is generally accepted that filling of a saccular aneurysm with contrast immediately after coil embolization predisposes to later recanalization. However, not all such scenarios evolve similarly over time. We investigated outcomes of small (≤ 7 mm) aneurysms with contrast-filled sacs immediately after coil embolization, evaluating the impact of pattern and degree of filling on subsequent recanalization. METHODS: Between January, 2008 and December, 2010, 186 small (≤ 7 mm) saccular aneurysms that retained contrast after coil embolization accrued for this study. Lesions were categorized by pattern (eccentric vs. concentric) and degree of filling on working projections. Clinical and morphologic factors were also analyzed to assess impact on subsequent recanalization. Morphologic outcomes at 6 months or more were assessed. RESULTS: In 93.5 % (174/186) of aneurysms with visible contrast retention, complete occlusion was evident on follow-up imaging studies at 6 months. Multiple logistic regression analysis indicated that eccentric (vs. concentric) contrast filling carried greater risk of subsequent recanalization (p = 0.020). Stent placement and progressive occlusion were also linked, falling short of statistical significance (p = 0.089). Of 166 progressively occluded aneurysms followed for more than 12 months (mean, 30.8 ± 7.3 months), 158 (95.2 %) exhibited stable occlusion. CONCLUSION: Small (≤ 7 mm) aneurysms that retain contrast immediately after coil embolization are more likely to become completely occluded over time through progressive thrombosis. However, an eccentric fill pattern may predispose to recanalization.


Subject(s)
Cerebral Angiography/methods , Cerebral Arteries/diagnostic imaging , Embolization, Therapeutic/methods , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Mechanical Thrombolysis/methods , Contrast Media , Embolization, Therapeutic/instrumentation , Female , Humans , Longitudinal Studies , Male , Mechanical Thrombolysis/instrumentation , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome
15.
AJNR Am J Neuroradiol ; 38(9): 1765-1770, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28619836

ABSTRACT

BACKGROUND AND PURPOSE: Long-term documentation of anatomic and angiographic characteristics pertaining to the timing of recanalization in coiled aneurysms has been insufficient. Our intent was to analyze and compare early and late-phase recanalization after coiling, identifying respective risk factors. MATERIALS AND METHODS: A total of 870 coiled saccular aneurysms were monitored for extended periods (mean, 30.8 ± 8.3 months). Medical records and radiologic data were also reviewed, stratifying patients as either early (n = 128) or late (n = 52) recanalization or as complete occlusion (n = 690). Early recanalization was equated with confirmed recanalization within 6 months after the procedure, whereas late recanalization was defined as verifiable recanalization after imaging confirmation of complete occlusion at 6 months. A multinomial regression model served to assess potential risk factors, the reference point being early recanalization. RESULTS: Posterior circulation (P = .009), subarachnoid hemorrhage at presentation (P = .011), second attempt for recanalized aneurysm (P < .001), and aneurysm size >7 mm (P < .001) emerged as variables significantly linked with early recanalization (versus complete occlusion). Late (versus early) recanalization corresponded with aneurysms ≤7 mm (P = .013), and in a separate subanalysis of lesions ≤7 mm, aneurysms 4-7 mm showed a significant predilection for late recanalization (P = .008). However, the propensity for complete occlusion in smaller lesions (≤7 mm) increased as the size diminished. CONCLUSIONS: Although long-term complete occlusion after coiling was more likely in aneurysms ≤7 mm, such lesions were more prone to late (versus early) recanalization, particularly those of 4-7 mm in size. Long-term follow-up imaging is thus appropriate in aneurysms >4 mm to detect late recanalization of those formerly demonstrating complete occlusion.


Subject(s)
Embolization, Therapeutic/methods , Endovascular Procedures/methods , Intracranial Aneurysm/pathology , Intracranial Aneurysm/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Factors , Treatment Outcome
16.
AJNR Am J Neuroradiol ; 38(11): 2126-2130, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28860217

ABSTRACT

BACKGROUND AND PURPOSE: Procedural rupture of an intracranial aneurysm is a devastating complication in endovascular treatment. The purpose of this study was to evaluate the clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms compared with those with spontaneously ruptured aneurysms. MATERIALS AND METHODS: A retrospective review was performed for 1340 patients with 1595 unruptured saccular intracranial aneurysms that underwent endovascular coil embolization between February 2010 and December 2014. The clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms were compared with those of 198 patients presenting with spontaneously ruptured aneurysms. RESULTS: In this series, procedural rupture developed in 19 patients (1.4% per patient and 1.2% per aneurysm), and the morbidity related to procedural rupture was 26.3% (95% confidence interval, 8.5%-61.4%) with no mortality. Hunt and Hess scale grades and hospitalization days of patients with procedural rupture were equivalent to those of patients presenting with spontaneous aneurysm rupture. Subsequent treatment procedures after hemorrhage (including lumbar drainage, extraventricular drainage, decompressive craniectomy, and permanent shunt) showed no difference between the 2 groups. The hemorrhage volumes were smaller in the procedural-rupture group (P = .03), and the endovascular vasospasm therapies tended to be more frequently required in the spontaneous aneurysm-rupture group (P = .08). At postictus 6 months, the proportion of modified Rankin Scale scores of ≥2 were lower in the procedural-rupture group (5.3% versus 26.8%, P = .049). In multivariate analysis, spontaneous aneurysm rupture was a significant risk factor for worse clinical outcome (OR = 14.9; 95% CI, 1.2-193.1; P = .039). CONCLUSIONS: This study showed better clinical outcomes in the procedural-rupture group. Even though there is a potential chance of aneurysm rupture during treatment, the clinical outcomes after procedural bleeds seem to be more favorable than those of spontaneous rupture.


Subject(s)
Aneurysm, Ruptured/pathology , Endovascular Procedures/adverse effects , Intracranial Aneurysm/surgery , Adult , Aged , Blood Vessel Prosthesis/adverse effects , Embolization, Therapeutic/adverse effects , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Rupture, Spontaneous/pathology , Treatment Outcome
18.
Clin Neuroradiol ; 26(1): 57-64, 2016 Mar.
Article in English | MEDLINE | ID: mdl-25159038

ABSTRACT

PURPOSE: Considerable inter-observer variability in the visual assessment of aneurysm recurrences limits its use as an outcome parameter evaluating new coil generations. The purpose of this study was to compare visual assessment of aneurysm recurrences and aneurysm recurrence volumetry with an example dataset of HydroSoft coils (HSC) versus bare platinum coils (BPC). METHODS: For this retrospective study, 3-dimensional time-of-flight magnetic resonance angiography datasets acquired 6 and 12 months after endovascular therapy using BPC only or mainly HSC were analyzed. Aneurysm recurrence volumes were visually rated by two observersas well as quantified by subtraction of the datasets after intensity-based rigid registration. RESULTS: A total of 297 aneurysms were analyzed (BPC: 169, HSC: 128). Recurrences were detected by aneurysm recurrence volumetry in 9 of 128 (7.0 %) treated with HSC and in 24 of 169 (14.2 %) treated with BPC (odds ratio: 2.39, 95 % confidence interval: 1.05-5.48; P = 0.039). Aneurysm recurrence volumetry revealed an excellent correlation between observers (Cronbach's alpha = 0.93). In contrast, no significant difference in aneurysm recurrence was found for visual assessment (3.9 % in HSC cases and 4.7 % in BPC cases). Recurrences were observed in aneurysms smaller than the sample median in 10 of 33 (30.3 %) by aneurysm recurrence volumetry and in 1 of 13 (7.7 %) by visual assessment. CONCLUSIONS: Aneurysm recurrences were detected more frequently by aneurysm recurrence volumetry when compared with visual assessment. By using aneurysm recurrence volumetry, differences between treatment groups were detected with higher sensitivity and inter-observer validity probably because of the higher detection rate of recurrences in small aneurysms.


Subject(s)
Imaging, Three-Dimensional/methods , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Magnetic Resonance Angiography/statistics & numerical data , Pattern Recognition, Automated/methods , Stents/statistics & numerical data , Clinical Competence/statistics & numerical data , Female , Humans , Imaging, Three-Dimensional/statistics & numerical data , Intracranial Aneurysm/epidemiology , Korea/epidemiology , Male , Middle Aged , Models, Statistical , Observer Variation , Pattern Recognition, Automated/statistics & numerical data , Prevalence , Recurrence , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome
19.
AJNR Am J Neuroradiol ; 37(8): 1490-5, 2016 Aug.
Article in English | MEDLINE | ID: mdl-26965468

ABSTRACT

BACKGROUND AND PURPOSE: Minor recanalization in coiled aneurysms may remain stable with time or may progress to major recanalization. Our aim was to monitor the aneurysms displaying minor recanalization in imaging studies at 6 months, gauging major recanalization rates and related risk factors through extended follow-up. MATERIALS AND METHODS: Sixty-five aneurysms (in 65 patients) showing minor recanalization in follow-up imaging at 6 months were reviewed retrospectively. Medical records and radiologic data accruing during extended monitoring (mean, 24.8 ± 8.2 months) were assessed. Univariate and multivariate analyses were conducted to identify risk factors for progression from minor-to-major recanalization. RESULTS: Progression to major recanalization was observed in 24 (36.9%) of the initially qualifying aneurysms during a follow-up of 112.5 aneurysm-years, for an annual rate of 17.84% per aneurysm-year. Progression was determined chronologically as follows: 14 (58.3%) at 6 months, 8 (33.3%) at 18 months, and 2 (8.4%) at 30 months. Stent deployment significantly decreased the occurrence of major recanalization (OR = 0.22, P = .03), whereas antiplatelet therapy (OR = 0.82, P = .75), posterior location (OR = 0.24, P = .20), and second coiling for recanalized aneurysms (OR = 0.96, P = .96) were unrelated. CONCLUSIONS: Our analysis determined a 36.9% rate of major recanalization during a follow-up of 112.5 aneurysm-years in coiled aneurysms showing minor recanalization at 6 months. Stent deployment alone conferred a protective effect, preventing further recanalization without additional treatment. Given the fair probability of late major recanalization, aneurysms showing minor recanalization at 6 months should be monitored diligently, particularly in the absence of stent placement.


Subject(s)
Embolization, Therapeutic , Intracranial Aneurysm/pathology , Disease Progression , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Female , Humans , Intracranial Aneurysm/therapy , Male , Multivariate Analysis , Recurrence , Retrospective Studies , Risk Factors , Stents , Treatment Outcome
20.
Clin Neuroradiol ; 26(3): 285-90, 2016 Sep.
Article in English | MEDLINE | ID: mdl-25516149

ABSTRACT

PURPOSE: Not infrequently, intracranial aneurysms may be multifocal. However, strategies conferring open surgical access to opposite sides of the brain are limited. Given the recent advances in protection devices and coiling technique, a study of single-stage coil embolization in patients with multiple intracranial aneurysms was undertaken, assessing procedural safety and efficacy. METHODS: Data prospectively accrued between January 2010 and September 2013 were systematically reviewed, assessing clinical and morphologic outcomes of single-stage coil embolization in 172 patients with multiple aneurysms (≥ 2 aneurysms each; total, 371 aneurysms). RESULTS: Internal carotid artery (n = 132) was the most common site, with progressively fewer aneurysms found elsewhere (middle cerebral artery, 103; anterior communicating artery, 41; posterior communicating artery, 38). In 26 patients, one-stage embolization of three or more aneurysms took place (25 patients with three each; 1 patient with four). Stents were applied in 109 aneurysms, and in 33 lesions, balloons were used. Occlusion was achieved in 326 aneurysms (87.9 %) through coil embolization, and attempted coiling rarely failed (3 of 371, 0.8 %). Mean procedural time was 111.5 ± 37.8 min. Although procedure-related adverse events included three instances of treatment failure, asymptomatic thrombi in four patients, and aneurysmal leakage in one patient, procedural morbidity was low (1 of 172, 0.6 %), and no procedure-related deaths occurred. Postembolization follow-up of 303 aneurysms at > 6 months (mean, 15.4 ± 9.8 months) showed complete occlusion in the vast majority (275 of 303, 90.8 %), with comparatively fewer instances of minor (19 of 303, 6.3 %) and major (9 of 303, 3.0 %) recanalization. Four patients experienced delayed cerebral infarction, but only one suffered permanent neurologic deficit (Glasgow outcome scale 4). CONCLUSION: Single-stage coil embolization of multiple unruptured intracranial aneurysms is technically feasible. The time required for such procedures and the rate of complications observed seem acceptable.


Subject(s)
Embolization, Therapeutic/mortality , Embolization, Therapeutic/methods , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Postoperative Complications/mortality , Postoperative Complications/prevention & control , Adult , Embolization, Therapeutic/instrumentation , Feasibility Studies , Female , Humans , Intracranial Aneurysm/pathology , Male , Operative Time , Postoperative Complications/diagnosis , Prevalence , Republic of Korea/epidemiology , Risk Factors , Treatment Outcome
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