RapidpulseTM cyclic aspiration system for acute ischemic stroke due to large vessel occlusions.

BACKGROUND: The best strategy to achieve optimal reperfusion outcomes during mechanical thrombectomy remains to be defined. The RapidPulseTM Cyclic Aspiration System is a novel technology, delivering high-frequency pulsed vacuum forces to increase the efficiency of aspiration thrombectomy. METHODS: Prospective, multicenter, open-label, core lab-adjudicated, two-arm study comparing safety and efficacy of a feasibility version of the RapidPulseTM system compared with contemporary controls. Primary endpoint was the rate of mTICI ≥ 2c after first-pass effect (FPE). Additional efficacy endpoints were the rates of mTICI ≥ 2b after first pass (modified FPE (mFPE)), last pass with study device defined as frontline technical success, and after all passes including rescue therapy. The primary safety endpoints included symptomatic ICH (sICH) within 24 h post-procedure. RESULTS: Between February 2022 to December 2022, 80 subjects were consented and enrolled in the study (n = 40 treatment arm, n = 40 control arm). In the intent to treat (ITT) population, mean age was 67.8 ± 11.5 years; 19 (47.5%) were male. Median NIHSS score was 16 (IQR: 13-22). Median ASPECTS score was 9 (IQR: 8-10). The rate of mTICI ≥ 2c after first pass was 53.9% in ITT population (60.0% in per-protocol population) versus 38.5% in the corresponding control population. Functional independence (mRS 0-2) at 90 days was achieved in 61.1% (22/36) in the RapidPulseTM arm and 52.8% (19/36) in the control arm. In the RapidPulseTM arm, no sICH within 24 h and no device-related morbidity or mortality occurred. CONCLUSION: Preliminary data suggests RapidPulseTM Aspiration System is highly effective and safe for recanalization of large vessel occlusions.

Morphological investigation of deep femoral artery variations using multidetector computed tomography angiography.

PURPOSE: The deep femoral artery (DFA) is the largest and thickest branch of the femoral artery (FA), separated from the posterior lateral surface of the FA. This study aimed to analyze the anatomy of DFA using multidetector computed tomography (MDCT) angiography images to improve its clinical applications. MATERIALS AND METHODS: Eight hundred right and left DFA MDCT angiography images from 400 individuals, 302 males (75.5%) and 98 females (24.5%), were included. RESULTS: It was determined that the DFA originates from six different aspects of the FA. The DFA was found to most commonly originate from the posterolateral aspect of the FA, with an incidence of 53%. The DFA originated from the posterior, lateral, medial, anterolateral, and posteromedial aspects at an incidence of 35.3%, 9.8%, 1%, %0.5, and 0.37%, respectively. The average distance between the DFA's origin and the midpoint of the inguinal ligament (IL) was 43.07 mm across both genders. The average distance between the DFA's origin and the midpoint of the IL was 43.07 mm. The average diameters of the DFA, medial circumflex femoral artery (MCFA), and lateral circumflex femoral artery (LCFA) were 5.62 mm, 3.01 mm, and 3.44 mm, respectively. The average distance between the DFA and MCFA was 14.64 mm, while between the DFA and LCFA, it was 19.05 mm. CONCLUSION: Knowledge regarding the anatomical variants and morphology of the DFA will enhance the accuracy of decision-making during interventional procedures and operations in the femoral region, as well as aid in the prevention of iatrogenic injuries.

First pass results of mechanical thrombectomy with two-drop zone NeVaTM device.

BACKGROUND: Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy. The NeVaTM (Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTM device for mechanical thrombectomy. METHODS: Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria. The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post-intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded. RESULTS: There was female pre-dominance (54.5%). Median presenting national institutes of health stroke scale (NIHSS) was 16 (IQR, 3-32). 88 MCA-m1 (60,6%), 43 ICA-tip (29,6%), 11 MCA-m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7-136). First-pass reperfusion scores were mTICI 0-2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% and mTICI 3 35.9%. Mean number of pass was 1,84 ± 1,14. Final mTICI 2b-3 score was 97.9% and TICI2c-3 score was 87.6%. No device related adverse event occurred. The mean 24-h NIHSS score was 6 (IQR 0-33). CONCLUSION: In conclusion, the NeVa thrombectomy device offers a high rate of first-pass success along with favorable safety profile. Larger series and multi-center studies are needed for further investigation.

Investigation of proper hepatic artery and gastroduodenal artery variations by multidetector computed tomography angiography method.

Purpose: The purpose of this study is to evaluate the clinical anatomic variations of the proper hepatic artery (PHA) and the gastroduodenal artery (GDA). For this purpose, angiographic images of patients were evaluated.Materials and methods: We retrospectively reviewed the multiple-detector computed tomography angiography images of 671 patients.Results: In this retrospective study, 35 different types were identified as associated with PHA and GDA. There were 292 patients (43.52%; 175 females and 117 males) included in normal anatomical classification. Different anatomic variations were detected in 300 patients (44.71%; 129 females and 171 males). In 79 patients, arterial branch follow-up failed. These patients were evaluated as an unidentified group.Conclusion: We described different vascular variations in the PHAs and GDAs of our patients.

Balo's concentric sclerosis in a patient with spontaneous remission based on magnetic resonance imaging: A case report and review of literature.

Balo's concentric sclerosis (BCS) is a rare monophasic demyelinating disease known as multiple sclerosis subtype and seen as a round lesion with variable hyper and hypo-detoxification layers. Characteristic appearance can be seen as "bulb eye" or "onion bulb". The initial terminology for this neurological disorder was leukoencephalitis periaxialis concentrica; this is defined as a disease in which the white matter of the brain is destroyed in concentric layers in such a way as to leave the axial cylinders intact. This report presents a case of BCS with spontaneous healing of the patient and a mass lesion with concentric rings adjacent to the left lateral ventricle and the posterior portion of the corpus callosum with peripheral vasogenic edema. The neurological lesion of the patient was similar to the magnetic resonance imaging and clinical findings of the BCS.

Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study.

PURPOSE: Vascular structures of the liver and the bile ducts are crucial during liver transplantation or liver resection surgery. Here, we report on variations in the vascular structures and bile ducts of 200 patients. MATERIALS AND METHODS: We reviewed magnetic resonance cholangiopancreatographic and multiple-detector computed tomographic data. RESULTS: Michels type 1 was detected in 54% of the patients. The other most common variations were, respectively, Michels type 5 (13%) and type 2 (11%). Unclassified variations were defined as Michels type 11; 5% of patients were in this group. Type 1 variations in the hepatic portal vein were detected in 76% of our study group. Other common variations were type 2 (9%) and type 3 (8.5%). The left and intermediate hepatic veins united to become a single vein and then joined the inferior vena cava in 64% of the patients. The right, intermediate, and left hepatic veins joined the inferior vena cava separately in 36% of the patients. Type A, which represents the classic anatomy of the bile duct, was observed in 51.5% of our patients. Type C1 and type B were detected in 15% and 12% of patients, respectively. CONCLUSIONS: We describe vascular and biliary variations in the livers of our patients.

Epicardial adipose tissue thickness predicts descending thoracic aorta atherosclerosis shown by multidetector computed tomography.

Human epicardial adipose tissue (EAT) is a type of visceral adipose tissue functioning as an endocrine organ by secreting hormones and adipocytokines which have an important role in the atherosclerotic process. In this study, we aimed to assess the relationship between EAT measured by dual source multidetector computed tomography (MDCT) and descending thoracic aorta (DTA) atherosclerosis. A total of 148 patients who underwent MDCT for the evaluation of coronary artery disease were enrolled in this study. Thickness of the EAT was measured on contrast enhanced multiplanar reformat images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view. The atherosclerotic plaque was scored from 0 to 4 points by the percentage of the luminal surface at the cross sectional area of proximal, mid and distal segments of descending aorta. Among the study population, 84 (56.8%) were male and age was (mean ± standart deviation) 56.9 ± 11.7 years. In patients with critical coronary atherosclerosis, DTA atherosclerosis had a significant relationship with EAT (P = 0.012). Multivariate linear regression analysis revealed that in addition to critical coronary stenosis, age and total epicardial fat thickness were associated with aortic atherosclerosis (ß value, 0.058 and 0.035; t value, 4.74 and 2.28, respectively; P < 0.05) after adjustment for traditional cardiovascular risk factors. In this study we demonstrated that atherosclerotic plaque burden of DTA was associated with the amount of EAT thickness among patients with suspected CAD shown by MDCT. Further large scale prospective studies are needed to address the interaction of EAT as well as the mediators of inflammation and adipocytokines with the development of atherosclerotic plaques in aorta and effects on cardiovascular outcomes.

Aortic atherosclerosis predicts the extent and severity of coronary atherosclerosis detected by multidetector computed tomography coronary angiography.

We investigated the association between atherosclerosis of the thoracic aorta and the severity and extent of coronary atherosclerosis detected by multidetector computed tomography (MDCT) coronary angiography. In 122 patients, atherosclerotic plaque was scored from 0 to 4 points by the percentage of the luminal surface at the cross-sectional area of proximal, mid, and distal segments of the descending aorta. Critical coronary atherosclerosis was defined as lesions causing >50% luminal narrowing. Atherosclerotic plaque score of the descending aorta was associated with the severity (noncritical: 2.95 +/- 1.45 vs critical: 4.09 +/- 2.25, P < .001) and extent of coronary atherosclerosis (Kruskal-Wallis test, P < .005). Logistic regression revealed that aortic plaque score was as an independent risk factor associated with the severity of coronary artery disease (OR 1.32, 95% CI 1.01-1.73, P <.05). Atherosclerotic plaque burden of the descending aorta was associated with the extent and severity of coronary atherosclerosis.

Comparison of bioactive coils and bare platinum coils for treatment of intracranial aneurysms: a matched-pair analysis.

OBJECT: The primary goal of this matched-pair analysis was to evaluate the durability of the treatment results with Cerecyte coils in comparison with that of bare platinum coils in terms of angiographic occlusion rates at follow-up. METHODS: Eighty aneurysms treated with Cerecyte coils were included in this study to carry out a matched-pair analysis. Every aneurysm treated with Cerecyte coils was matched with an aneurysm treated with bare platinum coils. Matching of the aneurysms was done according to the aneurysm size, location, neck size, initial occlusion grade, and clinical presentation. RESULTS: The initial treatment results were similar in both groups as part of a matching protocol. Subgroup analysis revealed a significant difference in the durability of occlusion in aneurysms that showed Raymond Class I obliteration on follow-up angiograms (69 [86.2%] in the Cerecyte group vs 51 [63.8%] in the control group, p = 0.002). Further thrombosis to Raymond Class I occlusions was higher in the Cerecyte group (17 [77.3%] of 22 vs 8 [36.4%] of 22 aneurysms). CONCLUSIONS: Cerecyte coils provide further thrombosis and more durable results than bare platinum coils following coil embolization of cerebral aneurysms.