En respuesta a «Trombectomía mecánica en el ictus isquémico agudo, conociendo nuestros resultados» / In reply to "Mechanical thrombectomy in acute ischemic stroke, knowing our results"

No disponible

Tratamiento combinado, mediante embolización y cirugía, de los aneurismas cerebrales rotos con hematoma cerebral e hipertensión intracraneal: Análisis retrospectivo y revisión de la bibliografía / Combined surgery and embolization to treat ruptured cerebral aneurysms with cerebral hematoma and intracranial hypertension: a retrospective analysis and review of the literature

Objetivo: Valorar si la técnica de embolización urgente del aneurisma cerebral y posterior cirugía del hematoma es segura y eficaz en pacientes con hematoma y signos de hipertensión intracraneal por rotura de aneurisma cerebral. Métodos: Se incluyeron 23 pacientes consecutivos con aneurisma cerebral roto y mal estado clínico debido a un hematoma intracraneal, ambos tratamientos completados en las primeras 4 horas del inicio de la clínica. Todos los pacientes presentaban signos clínicos de hipertensión intracraneal y/o alteración del nivel conciencia, incluido coma por deterioro rostrocaudal. Se valoró la eficacia de la técnica mediante el grado de cierre de los aneurismas y el pronóstico de los pacientes un mes después, y la seguridad, mediante el análisis de las complicaciones de los tratamientos. Resultados: El 91,3% de los pacientes tenía un aneurisma localizado en la arteria cerebral media (ACM). Todos los pacientes presentaban un valor de 4 en la escala de Fisher y de IV-V en la escala de Hunt y Hess. El tiempo medio desde la identificación del aneurisma en la tomografía computarizada hasta la embolización del aneurisma fue de 115 minutos. Se usó balón de remodeling en el 78% de los casos, con el que se logró un cierre adecuado en el 82,6% de los pacientes. Durante la cirugía se colocó un drenaje ventricular en 9 (39,1%) pacientes. Al mes, 13 (56,5%) pacientes eran independientes, con una mortalidad del 13%. No existieron resangrados. Conclusión: En nuestra experiencia, el tratamiento combinado mediante embolización del aneurisma y descompresión quirúrgica con evacuación del hematoma es segura y efectiva, y es una alternativa al tratamiento quirúrgico aislado

Objective: To determine whether the urgent embolization of a cerebral aneurysms and posterior surgery on cerebral hematomas is safe and efficacious in patients with hematomas and signs of intracranial hypertension due to the rupture of cerebral aneurysms. Methods: We included 23 consecutive patients in poor clinical condition due to an intracranial hematoma caused by a ruptured cerebral aneurysm who were treated with both embolization and surgery within 4 hours of the onset of symptoms. All patients had clinical signs of intracranial hypertension and / or altered levels of consciousness, including coma due to rostrocaudal deterioration. We evaluated the efficacy of the combined technique by determining the degree of closure of the aneurysms and the patients' prognosis one month after the procedures; we evaluated safety by analyzing the complications of the treatments. Results: All but two of the patients (21/23; 91.3%) had an aneurysm of the middle cerebral artery. All patients scored 4 on the Fisher scale and were classified as Hunt and Hess IV or V. The mean time from the identification of the aneurysm on computed tomography to embolization was 115minutes. A balloon remodeling technique was used in 18 (78%) patients; embolization achieved adequate closure in 19 (82.6%) patients. During surgery, a ventricular drain was placed in 9 (39.1%) patients. One month after treatment, 13 (56.5%) patients were functionally independent and 3 (13%) had died. No episodes of rebleeding were observed. Conclusion: In our experience, combined treatment including embolization of the aneurysm and surgical decompression with evacuation of the hematoma is a safe and effective alternative to surgical treatment alone

Combined surgery and embolization to treat ruptured cerebral aneurysms with cerebral hematoma and intracranial hypertension: a retrospective analysis and review of the literature. / Tratamiento combinado, mediante embolización y cirugía, de los aneurismas cerebrales rotos con hematoma cerebral e hipertensión intracraneal: Análisis retrospectivo y revisión de la bibliografía.

OBJECTIVE: To determine whether the urgent embolization of a cerebral aneurysms and posterior surgery on cerebral hematomas is safe and efficacious in patients with hematomas and signs of intracranial hypertension due to the rupture of cerebral aneurysms. METHODS: We included 23 consecutive patients in poor clinical condition due to an intracranial hematoma caused by a ruptured cerebral aneurysm who were treated with both embolization and surgery within 4hours of the onset of symptoms. All patients had clinical signs of intracranial hypertension and / or altered levels of consciousness, including coma due to rostrocaudal deterioration. We evaluated the efficacy of the combined technique by determining the degree of closure of the aneurysms and the patients' prognosis one month after the procedures; we evaluated safety by analyzing the complications of the treatments. RESULTS: All but two of the patients (21/23; 91.3%) had an aneurysm of the middle cerebral artery. All patients scored 4 on the Fisher scale and were classified as Hunt and Hess IV or V. The mean time from the identification of the aneurysm on computed tomography to embolization was 115minutes. A balloon remodeling technique was used in 18 (78%) patients; embolization achieved adequate closure in 19 (82.6%) patients. During surgery, a ventricular drain was placed in 9 (39.1%) patients. One month after treatment, 13 (56.5%) patients were functionally independent and 3 (13%) had died. No episodes of rebleeding were observed. CONCLUSION: In our experience, combined treatment including embolization of the aneurysm and surgical decompression with evacuation of the hematoma is a safe and effective alternative to surgical treatment alone.

Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica / Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

OBJETIVO: Estudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquémico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrían influir en la mortalidad y en el grado de discapacidad al alta y un año después del ictus. DISEÑO: Estudio prospectivo observacional. Ámbito: UCI polivalente. Hospital de tercer nivel. PACIENTES: Sesenta pacientes adultos. Muestra consecutiva. INTERVENCIONES: Ninguna. Variables de interés: Datos epidemiológicos, tiempo desde la clínica inicial hasta el TEV, resultado angiográfico, tiempo de estancia en UCI, días de ventilación mecánica, complicaciones neurológicas, National Institutes of Health Stroke Scale (NIHSS) al ingreso y al alta de UCI, escala de Rankin modificada (mRS) al año de evolución. RESULTADOS: Edad media 68,90±8,84años. Mediana de tiempo hasta el TEV: 180min. Mediana NIHSS al ingreso: 17,5; al alta: 3. Flujo distal en el 90% de los casos. Mediana estancia en UCI: 3días. Ventilación mecánica: 81,7%. Independencia funcional (mRS≤2) 50% al año del ictus. Fallecimientos: 22 (36,6%); 8 (13,3%) en la UCI y el resto durante el primer año. CONCLUSIONES: Las variables asociadas a un peor estado funcional fueron la transformación hemorrágica sintomática, la ausencia de recanalización y las complicaciones durante el procedimiento. La transformación hemorrágica y la hidrocefalia se asociaron a mayor mortalidad. Se consiguió flujo distal en la mayoría de los casos, con una baja tasa de complicaciones. La mitad de los pacientes alcanza independencia funcional al año del ictus

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. Variables of interest: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit. / Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica.

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. VARIABLES OF INTEREST: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

[Analysis of the direct costs associated with mechanical thrombectomy and intravenous fibrinolysis in the Hospital Universitario Central de Asturias]. / Analisis de los costes directos asociados a la trombectomia mecanica y a la fibrinolisis intravenosa en el Hospital Universitario Central de Asturias.

INTRODUCTION: The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. AIMS: To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias. PATIENTS AND METHODS: A retrospective analysis was performed that included 44 patients who received intravenous fibrinolysis and 61 patients treated with mechanical thrombectomy, in whom a series of clinical and economic variables were analysed. RESULTS: The mean final total cost per patient was 16,059 euros in treatments with thrombectomy and 8,169 euros in those in which intravenous fibrinolysis was administered. The percentage of patients with a good functional prognosis at 90 days was 63.93% in those treated by endovascular means and 56.82% in those who received intravenous fibrinolysis. Mortality rates were 18.03 and 11.36%, respectively. CONCLUSIONS: The mean cost of treatment with mechanical thrombectomy, as well as the total mean cost per patient during the acute phase of the disease associated with this technique, is higher than in the case of intravenous fibrinolysis. In our setting, both intravenous fibrinolysis and mechanical thrombectomy are considered to be effective and safe.

TITLE: Analisis de los costes directos asociados a la trombectomia mecanica y a la fibrinolisis intravenosa en el Hospital Universitario Central de Asturias.Introduccion. La ampliacion de las indicaciones de la trombectomia mecanica y su implementacion en los hospitales españoles hacen necesario conocer los costes relacionados con este tratamiento para racionalizar los recursos economicos y permitir una adecuada distribucion de estos. Objetivos. Analizar los costes directos asociados a los pacientes con ictus isquemico agudo tratados con fibrinolisis intravenosa y con trombectomia mecanica, y valorar la efectividad y seguridad de ambos tratamientos durante los primeros 90 dias de evolucion en el Hospital Universitario Central de Asturias. Pacientes y metodos. Se realizo un analisis retrospectivo en el que se incluyo a 44 pacientes que recibieron fibrinolisis intravenosa y a 61 pacientes tratados con trombectomia mecanica, en los que se analizaron una serie de variables clinicas y economicas. Resultados. El coste total final medio por paciente fue de 16.059 euros en los tratados con trombectomia y de 8.169 euros en los que se administro fibrinolisis intravenosa. El porcentaje de pacientes con buen pronostico funcional a los 90 dias fue del 63,93% en los tratados de forma endovascular y del 56,82% en los que recibieron fibrinolisis intravenosa. Las tasas de mortalidad fueron del 18,03% y 11,36%, respectivamente. Conclusiones. El coste medio del tratamiento con trombectomia mecanica, asi como el coste medio total por paciente durante la fase aguda de la enfermedad asociado a esta tecnica, es mayor que en el caso de la fibrinolisis intravenosa. Tanto la fibrinolisis intravenosa como la trombectomia mecanica se configuran en nuestro medio como tratamientos efectivos y seguros.

[Description of a series of hospital patients with a spinal fistula]. / Descripcion de una serie hospitalaria de pacientes con fistula espinal.

INTRODUCTION: Although spinal fistulas account for 70% of all spinal arteriovenous malformations, they are an underdiagnosed condition. The arteriovenous shunt produces vascular congestion that gives rise to a progressive myelopathy, sometimes irreversible if it is not treated in the early stages. AIM: To describe the clinicoradiological characteristics of a series of patients with spinal fistulas. PATIENTS AND METHODS: A retrospective search was conducted for patients diagnosed with a spinal fistula who were hospitalised in the neuroscience area of a tertiary care hospital. RESULTS: A total of 19 patients (7 females and 12 males) were identified, with a mean age of 56 years. The spinal fistula was type I in 79% of patients, and a dorsal location was the most frequent. Most of the cases (90%) presented a progressive course. Magnetic resonance imaging was used in the diagnosis in 74% of the patients. In four cases angiography was required to reach a diagnosis, and in one of them it was necessary to perform an intraoperative biopsy. Three lumbar punctures were performed, two of which revealed lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The average diagnostic delay was nine months. Seventy-nine per cent of the patients were treated and only 10% of them improved. CONCLUSIONS: When faced with a clinical picture suggestive of a spinal fistula, a diagnostic spinal angiography must be carried out, although the patient under study may present atypical cerebrospinal fluid characteristics and normal results in magnetic resonance imaging of the spinal cord.

TITLE: Descripcion de una serie hospitalaria de pacientes con fistula espinal.Introduccion. Aunque las fistulas espinales suponen el 70% de las malformaciones arteriovenosas espinales, son una entidad infradiagnosticada. El shunt arteriovenoso produce una congestion vascular que da lugar a una mielopatia progresiva, en ocasiones irreversible si no se trata de forma precoz. Objetivo. Describir las caracteristicas clinicorradiologicas de una serie de pacientes con fistula espinal. Pacientes y metodos. Se realizo una busqueda retrospectiva de pacientes con diagnostico de fistula espinal ingresados en el area de neurociencias de un hospital de tercer nivel asistencial. Resultados. Se identificaron 19 pacientes (7 mujeres y 12 varones) con una edad media de 56 años. La fistula espinal fue de tipo I en un 79% de los pacientes y la localizacion dorsal fue la mas frecuente. La mayoria de los casos presento un curso progresivo (90%). Un 74% de los pacientes se diagnostico mediante resonancia magnetica. En cuatro casos fue necesaria la realizacion de una angiografia para llegar al diagnostico, y en uno de ellos se preciso una biopsia intraoperatoria. Se realizaron tres punciones lumbares, en dos de las cuales se objetivo pleocitosis linfocitaria e hiperproteinorraquia. El retraso diagnostico medio fue de nueve meses. Se trato a un 79% de los pacientes, y de ellos solo mejoro el 10%. Conclusiones. Ante una clinica sugestiva de fistula espinal, debe realizarse una angiografia espinal diagnostica aunque el paciente estudiado pueda presentar caracteristicas licuorales atipicas y normalidad en la resonancia magnetica medular.

Técnicas asistidas para el tratamiento endovascular de aneurismas cerebrales complejos o atípicos / Assisted techniques for the endovascular treatment of complex or atypical cerebral aneurysms

A lo largo de los últimos 10 años, el abordaje endovascular de los aneurismas cerebrales ha pasado de ser una alternativa a la cirugía a convertirse en la terapia de elección en la inmensa mayoría de los casos. El constante desarrollo de técnicas asistidas y de nuevos materiales de embolización ha multiplicado sus posibilidades terapéuticas, de modo que en la actualidad es posible tratar con eficacia y seguridad aneurismas que hace tan solo unos años hubiesen sido considerados quirúrgicos. Este continuo avance tecnológico exige a los profesionales implicados en el tratamiento de pacientes con aneurismas cerebrales un alto grado de especialización y una actualización formativa permanente. En el presente trabajo repasamos algunas de las técnicas asistidas más empleadas en la actualidad para el tratamiento endovascular de los aneurismas cerebrales, mostramos sus principales indicaciones, las mejoras que suponen respecto a las técnicas de embolización convencional y sus posibles limitaciones(AU)

In the last ten years, the endovascular approach to the management of cerebral aneurysms has gone from being an alternative to surgery to being the first-choice technique in the vast majority of cases. The continuous development of new assisted techniques and of new materials for embolization have multiplied its therapeutic possibilities, so that safe and efficacious endovascular treatment is now possible for aneurysms that would have required surgery only a few years ago. These continuous technological advances require the professionals that treat patients with cerebral aneurysms to achieve a high degree of specialization and to keep up to date through continuous training. In this article, we review some of the most widely used assisted techniques in the endovascular treatment of cerebral aneurysms, discussing their main indications, their advantages over conventional embolization techniques, and their possible limitations(AU)

[Assisted techniques for the endovascular treatment of complex or atypical cerebral aneurysms]. / Técnicas asistidas para el tratamiento endovascular de aneurismas cerebrales complejos o atípicos.

In the last ten years, the endovascular approach to the management of cerebral aneurysms has gone from being an alternative to surgery to being the first-choice technique in the vast majority of cases. The continuous development of new assisted techniques and of new materials for embolization have multiplied its therapeutic possibilities, so that safe and efficacious endovascular treatment is now possible for aneurysms that would have required surgery only a few years ago. These continuous technological advances require the professionals that treat patients with cerebral aneurysms to achieve a high degree of specialization and to keep up to date through continuous training. In this article, we review some of the most widely used assisted techniques in the endovascular treatment of cerebral aneurysms, discussing their main indications, their advantages over conventional embolization techniques, and their possible limitations.

Nuestra experiencia en el diagnóstico y tratamiento de los seudoaneurismas cerebrales / Our experience in the diagnosis and treatment of cerebral pseudoaneurysms

Objetivo. Presentar nuestra experiencia en el diagnóstico y tratamiento intravascular de los seudoaneurismas cerebrales. Material y métodos. Presentamos 11 casos de seudoaneurismas (2 traumáticos, 2 micóticos, 3 iatrogénicos y 4 asociados a otras causas) en otros tantos pacientes y analizamos los métodos y criterios diagnósticos, la evolución radiológica y clínica, los criterios tomados en cuenta para la decisión terapéutica, el método de tratamiento y las complicaciones. Resultados. El método de referencia para el diagnóstico es la angiografía por sustracción digital y los criterios diagnósticos en la literatura médica incluyen: aneurismas con cambios morfológicos precoces, aneurismas distales o aneurismas proximales asociados a otro distal, en el contexto clínico adecuado. En los 9 pacientes tratados mediante técnica intravascular se consiguió el objetivo del tratamiento, evitar el resangrado. Conclusiones. Ante la sospecha clínica de un seudoaneurisma todo paciente debe ser valorado mediante arteriografía, principalmente aquellos que presentan hemorragias cerebrales inexplicables y los pacientes con septicemia. La angiografía mediante TC o mediante RM puede sustituir a la arteriografía con una buena rentabilidad diagnóstica. El tratamiento de elección debe ser el intravascular de primera intención y no demorarse excepto que exista una razón que impida el acceso al seudoaneurisma, normalmente un vasoespasmo cerebral grave (AU)

Objective. To present our experience in the diagnosis and intravascular treatment of cerebral pseudoaneurysms. Material and methods. We present 11 pseudoaneurysms (2 traumatic, 2 mycotic, 3 iatrogenic, and 4 with other causes). We analyze the methods and diagnostic criteria, radiological and clinical outcome, the criteria used in making decisions about treatment, the method of treatment, and the complications. Results. Digital subtraction angiography is the gold standard for the diagnosis of cerebral pseudoaneurysms; the diagnostic criteria in the literature include: aneurysms with early morphological changes and distal aneurysms or proximal aneurysms associated with another distal one, in the context of the right symptoms and signs. In the nine patients treated with endovascular techniques, the treatment objective was achieved and rebleeding did not occur. Conclusions. In cases with clinical suspicion of a pseudoaneurysm, the patient should undergo angiography. This is especially important in patients with inexplicable cerebral hemorrhage and in those with septicemia. CT angiography and MR angiography have good diagnostic accuracy and can replace conventional angiography. However, the treatment of choice is endovascular and treatment should not be delayed unless access to the pseudoaneurysm is impeded, usually due to severe cerebral vasospasm (AU)

Tratamiento endovascular de la estenosis carotídea: experiencia en el Hospital Universitario Central de Asturias / Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias

Introducción. La estenosis carotídea es responsable de aproximadamente el 25% de los eventos cerebrovasculares isquémicos. La angioplastia-stent carotídeo (ASC) constituye un procedimiento mínimamente invasivo utilizado como alternativa a la endarterectomía carotídea, especialmente en pacientes de alto riesgo quirúrgico. Objetivo. Analizar la eficacia y seguridad del tratamiento endovascular de la estenosis carotídea en el Hospital Universitario Central de Asturias. Pacientes y métodos. Análisis retrospectivo de las estenosis carotídeas tratadas mediante ASC entre febrero de 2005 y abril de 2010, con registro de datos demográficos, diagnóstico clínico, indicación de tratamiento, tiempo entre el inicio de los síntomas y la realización del tratamiento, resultados angiográficos, complicaciones y seguimiento a largo plazo (incluyendo la tasa de reestenosis). Resultados. Se trataron 121 pacientes (77,8% varones y 22,2% mujeres), con una edad media de 70,8 ± 10,7 años. Los principales factores de riesgo vascular fueron hipertensión arterial (65,3%), tabaquismo (61,2%) y dislipidemia (42,1%). En el 86% de los casos se trataba de estenosis sintomáticas y en el 14% de asintomáticas. En un 60,3% de los casos se trataba de estenosis > 70%; en un 30,6%, de estenosis preoclusivas, y en un 9,1%, de recanalizaciones de oclusiones carotídeas inestables. El tiempo medio de tratamiento fue de 17,0 ± 8,3 días tras el evento isquémico. La estenosis residual fue inferior al 30% en todos los casos. La tasa de morbimortalidad a 30 días fue del 4,1% y la tasa de reestenosis a lo largo de un seguimiento medio de 31,2 ± 10,8 meses fue del 2,4%. Conclusiones. La ASC en nuestro hospital se configura como una técnica eficaz y segura, con una tasa de complicaciones dentro de los parámetros que justifican su indicación (AU)

Introduction. Carotid stenosis accounts for about 25% of all ischaemic cerebrovascular events. Carotid angioplasty and stenting (CAS) is a minimally invasive procedure used as an alternative to carotid endarterectomy, especially in high surgical risk patients. Aim. To analyse the effectiveness and safety of the endovascular treatment of carotid stenosis in the Hospital Universitario Central de Asturias. Patients and methods. The study consisted in a retrospective analysis of the carotid stenoses treated by means of CAS between February 2005 and April 2010, and the following information was recorded: demographic data, clinical diagnosis, indication of treatment, time between the onset of symptoms and beginning of treatment, angiographic findings, complications and long-term follow-up (including the rate of restenosis). Results. Altogether 121 patients were treated (77.8% males and 22.2% females), with a mean age of 70.8 ± 10.7 years. The main vascular risk factors were arterial hypertension (65.3%), smoking (61.2%) and dyslipidaemia (42.1%). In 86% of cases the stenoses were symptomatic and in the remaining 14% they were asymptomatic. In 60.3% of cases they were stenoses > 70%, in 30.6% they were preocclusive stenoses and in 9.1% they were recanalisations of unstable carotid occlusions. The mean treatment time was 17.0 ± 8.3 days after the ischaemic event. The residual stenosis was less than 30% in all cases. The morbidity and mortality rate at 30 days was 4.1% and the rate of restenosis throughout a mean follow-up of 31.2 ± 10.8 months was 2.4%. Conclusions. In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication (AU)

[Our experience in the diagnosis and treatment of cerebral pseudoaneurysms]. / Nuestra experiencia en el diagnóstico y tratamiento de los seudoaneurismas cerebrales.

OBJECTIVE: To present our experience in the diagnosis and intravascular treatment of cerebral pseudoaneurysms. MATERIAL AND METHODS: We present 11 pseudoaneurysms (2 traumatic, 2 mycotic, 3 iatrogenic, and 4 with other causes). We analyze the methods and diagnostic criteria, radiological and clinical outcome, the criteria used in making decisions about treatment, the method of treatment, and the complications. RESULTS: Digital subtraction angiography is the gold standard for the diagnosis of cerebral pseudoaneurysms; the diagnostic criteria in the literature include: aneurysms with early morphological changes and distal aneurysms or proximal aneurysms associated with another distal one, in the context of the right symptoms and signs. In the nine patients treated with endovascular techniques, the treatment objective was achieved and rebleeding did not occur. CONCLUSIONS: In cases with clinical suspicion of a pseudoaneurysm, the patient should undergo angiography. This is especially important in patients with inexplicable cerebral hemorrhage and in those with septicemia. CT angiography and MR angiography have good diagnostic accuracy and can replace conventional angiography. However, the treatment of choice is endovascular and treatment should not be delayed unless access to the pseudoaneurysm is impeded, usually due to severe cerebral vasospasm.

Cavernoma intraventricular del foramen de Monro: particularidades derivadas de su localización atípica / Intraventricular cavernoma in the foramen of Monro: particularities due to its atypical location

A pesar de que los cavernomas son malformaciones vasculares relativamente frecuentes en el sistema nervioso central, su localización intraventricular, especialmente en la región del foramen de Monro, es muy poco común. Esta localización atípica les confiere una serie de rasgos diferenciales, tanto clínicos como radiológicos, que pueden dificultar en extremo su diagnóstico preoperatorio y conducir a procedimientos ineficaces, como la radioterapia o el abordaje quirúrgico neuroendoscópico, e incluso peligrosos para el paciente, como la biopsia estereotáxica.Dado lo infrecuente de la patología y con el fin de ilustrar estas dificultades diagnósticas, se presenta a continuación un caso de cavernoma intraventricular de la región del foramen de Monro (AU)

Although cavernomas are relatively common vascular malformations in the central nervous system, they are rarely located in the ventricles and are even more rarely located in the region of the foramen of Monro. This atypical location results in a series of differential clinical and radiological characteristics that can make the diagnosis of these lesions extremely difficult and lead to inefficacious procedures like radiotherapy or a neuroendoscopic surgical approach or even to procedures that endanger the patient like stereotactic biopsy.We present a case of intraventricular cavernoma in the region of the foramen of Monro with the aim of illustrating the difficulties involved in the diagnosis of this rare lesion (AU)

[Intraventricular cavernoma in the foramen of Monro: particularities due to its atypical location]. / Cavernoma intraventricular del foramen de Monro: particularidades derivadas de su localización atípica.

Although cavernomas are relatively common vascular malformations in the central nervous system, they are rarely located in the ventricles and are even more rarely located in the region of the foramen of Monro. This atypical location results in a series of differential clinical and radiological characteristics that can make the diagnosis of these lesions extremely difficult and lead to inefficacious procedures like radiotherapy or a neuroendoscopic surgical approach or even to procedures that endanger the patient like stereotactic biopsy. We present a case of intraventricular cavernoma in the region of the foramen of Monro with the aim of illustrating the difficulties involved in the diagnosis of this rare lesion.