Evaluation of Onyx HD-500 embolic system in the treatment of 84 wide-neck intracranial aneurysms.

OBJECTIVE: We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils. METHODS: Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck >4 mm and/or dome-to-neck ratio <1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to <25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months. RESULTS: Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%. CONCLUSION: Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.

Diagnostic performance of stress perfusion and delayed-enhancement MR imaging in patients with coronary artery disease.

PURPOSE: To prospectively determine the accuracy of a combined magnetic resonance (MR) imaging approach (stress first-pass perfusion imaging followed by delayed-enhancement imaging) for depicting clinically significant coronary artery stenosis (> or = 70% stenosis) in patients suspected of having or known to have coronary artery disease (CAD), with coronary angiography serving as the reference standard. MATERIALS AND METHODS: The committee on human research approved the study protocol, and all participants gave written informed consent. This study was HIPAA compliant. Forty-seven patients (38 men and nine women; mean age, 63 years +/- 5.3 [standard deviation]) scheduled for coronary angiography were prospectively enrolled: 33 were suspected of having CAD (group A) and 14 had experienced a previous myocardial infarction and were suspected of having new lesions (group B). The MR imaging protocol included cine function, gadolinium-enhanced stress and rest first-pass perfusion MR imaging, and delayed-enhancement MR imaging. Myocardial ischemia was defined as a segment with perfusion deficit at stress first-pass perfusion MR imaging and no hyperenhancement at delayed-enhancement imaging. Myocardial infarction was defined as an area with hyperenhancement at delayed-enhancement imaging. RESULTS: One patient was excluded from analysis because of poor-quality MR images. Coronary angiography depicted significant stenosis in 30 of 46 patients (65%). In a per-vessel analysis (n = 138), stress first-pass perfusion MR imaging and delayed-enhancement imaging yielded sensitivity of 0.87, specificity of 0.89, and accuracy of 0.88, when compared with coronary angiography. The diagnostic accuracy of stress first-pass perfusion MR imaging and delayed-enhancement imaging was slightly better than that of stress and rest first-pass perfusion MR imaging in the entire population (0.88 vs 0.85), in group A (0.86 vs 0.82), and in group B (0.93 vs 0.90). CONCLUSION: Stress first-pass perfusion MR imaging followed by delayed-enhancement imaging is an accurate method to depict significant coronary stenosis in patients suspected of having or known to have CAD.

Embolizaçäo das artérias hipogástricas no tratamento de sangramento dos órgäos pélvicos / Embolization of the hypogastric arteries in the treatment of pelvic bleeding

O método de embolizaçäo arterial transcateter que foi inicialmente utilizado para o tratamento de hemorragia maciça secundária a trauma pélvico é hoje usado para controle de hemorragia pélvica de diversas causas, sendo neoplasia de bexiga/neoplasias ginecológicas e seqüelas pós-radioterapia de órgäos pélvicos as mais freqüentes. Em muitas ocasiöes torna-se a única opçäo para pacientes que näo têm condiçöes cirúrgicas e que apresentam hemorragia pélvica incontrolável clinicamente. O presente estudo baseia-se na revisäo dos casos de hemorragia pélvica tratados no serviço, através de embolizaçäo arterial transcateter, no período de março de 1977 a abril de 1985. Foram levantados 30 casos, sendo que a causa mais freqüente de hemorragia pélvica foi neoplasia de bexica em 19 pacientes. Desde 19, 11 apresentavam cistite actínica. Quatro tiveram hemorragia pós-prostatectomia, quatro pacientes sangraram por tumores uterinos e um por tumor de próstata. Houve um sangramento pós-histerctomia via vaginal e outro caso de sangramento puerperal. Obteve-se controle imediato da hemorragia em 28 dos 30 pacientes. Um paciente voltou a sangrar, porém näo foi possível sua reembolizaçäo devido à oclusäo proximal das artérias hipogástricas com molas de Gianturco no primeiro procedimento. Em outro paciente optou-se pela näo embolizaçäo, uma vez que foram identificadas artérias radículo-medulares conectadas à circulaçäo das hipogástricas, o que poderia eventualmente levar a complicaçöes neurológicas se realizada a embolizaçäo; este paciente continuou sangrando. Näo houve complicaçöes sérias ou permanentes em nenhum dos casos, embora tenham ocorrido complicaçöes menores em três casos