ABSTRACT
BACKGROUND: Ehlers-Danlos type IV or vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited disorder characterized by profound vascular fragility resulting from defective production of type III procollagen. Cerebrovascular diseases including spontaneous dissections, cerebral aneurysms, and cavernous carotid fistulae are common. Endovascular therapies in this patient population are known to be higher risk, although many studies (before 2000) involved older techniques and equipment. The purpose of this study is to investigate the safety and efficacy of modern neuroendovascular techniques in the treatment of cerebrovascular diseases in patients with vEDS. METHODS: We combined a multi-institutional retrospective case series at 3 quaternary-care centers with a systematic literature review of individual case reports and case series spanning 2000-2021 to evaluate the safety and efficacy of neuroendovascular procedure in patients with vEDS with cerebrovascular diseases. RESULTS: Fifty-nine patients who underwent 66 neuroendovascular procedures were evaluated. Most of the patients had direct cavernous carotid fistulas (DCCF). Neuroendovascular procedures had a 94% success rate, with a complication rate of 30% and a mortality of 7.5%. CONCLUSIONS: Neuroendovascular procedures can be performed with a high rate of success in the treatment of cerebrovascular diseases in patients with vEDS, although special care is required because complication rates and mortality are high. Access site and procedure-related vascular injuries remain a significant hurdle in treating vEDS with cerebrovascular diseases, even with modern techniques.
Subject(s)
Cavernous Sinus , Ehlers-Danlos Syndrome, Type IV , Ehlers-Danlos Syndrome , Intracranial Aneurysm , Humans , Retrospective Studies , Ehlers-Danlos Syndrome/complications , Ehlers-Danlos Syndrome/surgery , Intracranial Aneurysm/surgery , Intracranial Aneurysm/complications , Multicenter Studies as TopicABSTRACT
Because of advances in the treatment of cancer, the average rate of patient survival is increasing. As patients with cancer live longer, the incidence of spinal metastasis also likely will increase. To help control pain and maintain function, some of these metastases will require surgical intervention. Because >60% of spinal metastases are hypervascular, preoperative embolization may be considered in order to decrease hemorrhage risk and improve outcomes. Embolization for spinal metastasis can be performed through the angiogram catheter. When such embolization is performed carefully, the complication rate is low.
Subject(s)
Blood Loss, Surgical/prevention & control , Embolization, Therapeutic , Spinal Neoplasms/surgery , Spinal Neoplasms/therapy , Blood Loss, Surgical/statistics & numerical data , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/methods , Humans , Preoperative Care , Radiology, Interventional , Spinal Neoplasms/blood supply , Spine/blood supplyABSTRACT
We report the successful treatment of bilateral postendarterectomy restenosis using simultaneously placed, bilateral carotid SMART stents and balloon angioplasty. Technical aspects and the results of 29-month follow-up are presented. The benefits derived from single-setting bilateral carotid stenting versus staged bilateral stenting are discussed.
