Single-Center Case Series of Temporary Stent Assistance for Coiling of Acutely Ruptured Aneurysms.

BACKGROUND: Wide-necked intracranial aneurysms continue to pose a challenge for endovascular surgeons. Flow diversion and stent-assisted coiling are 2 techniques that have improved the ability to manage these lesions, but these require the use of dual antiplatelet therapy. In patients with aneurysmal subarachnoid hemorrhage, dual antiplatelet therapy is relatively contraindicated, and many surgeons prefer to use open techniques or balloon assistance for coiling, although at times the latter is not feasible. We describe temporary stent assistance using retrievable stents for coiling of ruptured intracranial aneurysms as an endovascular management option. METHODS: Surgeon case logs were retrospectively reviewed for cases of temporary stent assistance for aneurysm coiling. Cases were identified and compiled into a case series. RESULTS: Seven cases were identified, including 6 using the Solitaire FR device in an off-label manner as a temporary stent for assistance with coiling of wide-necked aneurysms. One patient experienced intraoperative aneurysm rupture (planned stent coiling; stent placement aborted after rupture), but otherwise no hemorrhagic complications were noted. Two patients experienced radiographic thromboembolic complications, with 1 patient requiring intervention during the index operation, but neither patient experienced demonstrable neurologic deficits postoperatively. After mean follow-up of 9 months, the average Glasgow Coma Scale score was 14, and the average modified Rankin Scale score was 1.2. CONCLUSIONS: Stents and stent retrievers can be temporarily used for technically challenging aneurysms as an alternative to balloon assistance for treatment of ruptured intracranial aneurysms without needing to use dual antiplatelet therapy.

Unexpected syncope and death during intense physical training: evolving role of molecular genetics.

Special operations forces (SOF) undergo an unparalleled degree of physical training. The medical officer responsible for these personnel must often deal with episodes of syncope that cannot be readily explained. In the past, loss of consciousness during heavy physical exertion was attributed to inadequate fluid intake resulting in dehydration or abnormalities in temperature regulation. However, many of those diagnoses, in retrospect were probably incorrect. The occurrence of exercise-related syncope in multiple members of the same family suggested that there could be a genetic basis for the unexpected loss of consciousness during exercise. Intensive clinical examinations of these patients, coupled with current advances in molecular genetics, have shown this to be the case. We review some of the more common genetic abnormalities associated with exertion-related syncope. These syndromes should be considered by the medical officer presented with a patient having syncope of indeterminate cause.