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1.
J Vasc Interv Radiol ; 31(1): 82-92, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31627908

RESUMO

PURPOSE: To prove that covered stents are more efficacious than uncovered stents regarding patency, safety, enabling of chemotherapy, and survival in percutaneous palliation of malignant infrahilar biliary obstruction. MATERIALS AND METHODS: After failed endoscopic treatment, 154 patients with obstructive jaundice caused by unresectable infrahilar malignancy were randomly allocated to receive an expanded polytetrafluoroethylene and fluorinated ethylene propylene-covered or an uncovered nitinol stent. Occlusion rate, patency, and survival were assessed. Safety and clinical success in terms of chemotherapy were compared. RESULTS: Three patients were excluded post hoc. Fifteen patients died within 7 d and were excluded from patency analysis. Occlusion rates were 32% (21 of 66) for covered and 29% (20 of 70) for uncovered stents (P = .7). Estimated median patency durations were 308 d (95% confidence interval [CI], 178-438 d) for covered and 442 d (95% CI, 172-712 d) for uncovered stents (P = .1). Serious adverse events (P = 1.0) and 30-day mortality (P = .5) were equivalent between groups. At hospital discharge, median bilirubin reduction of 8 mg/dL was found in both groups (P < .001). In the covered stent group, 35 patients (48%) received palliative chemotherapy, vs 29 (37%) in the uncovered stent group (P = .2). Estimated median survival times were 96 days (95% CI, 68-124 d) with covered stents and 75 days (95% CI, 42-108 d) with uncovered stents (P = .6). CONCLUSIONS: In malignant infrahilar biliary obstruction not amenable to endoscopy, no improvement in patency or survival with percutaneously placed covered stents could be confirmed. Covered and uncovered stent types exhibit similar safety profiles and clinical success rates.

2.
Eur Radiol ; 30(1): 175-185, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385047

RESUMO

OBJECTIVE: To investigate whether covered stents show a higher efficacy than uncovered stents in percutaneous treatment of malignant hilar biliary obstruction. METHODS: Patients with obstructive jaundice caused by an unresectable hilar malignancy were included after failed endoscopic intervention in a prospective randomized trial comparing expanded polytetrafluoroethylene and fluorinated ethylene propylene (ePTFE-FEP)-covered nitinol stents with uncovered nitinol stents. Exclusion criteria were as follows: primary tumors existing more than 3 months, a biliodigestive anastomosis, previous stenting, and a Karnofsky score of less than 50. Safety, clinical success, and adjuvant chemotherapy were compared as well as occlusion rate, patency, and survival. RESULTS: A total of 120 patients were included. One patient was post hoc excluded. Fourteen patients who died within 7 days and one patient without patency data were excluded from patency analysis. Serious adverse events (p = 0.4), 30-day mortality (p = 0.5), and clinical success (p = 0.8) were equivalent for both stent groups. Twenty-one out of 61 (34%) patients in the covered and 24/58 (41%) in the uncovered stent groups received adjuvant chemotherapy (p = 0.5). Occlusion rate was 54% (27/50) in the covered stent group and 57% (31/54) in the uncovered stent group (p = 0.8). Median patency was 229 days (95% CI 113-345) for covered stents and 130 days (95% CI 75-185) for uncovered stents (p = 0.1). Median survival in patients with covered stents was 79 days (95% CI 52-106) and with uncovered stents 92 days (95% CI 60-124) (p = 0.3). CONCLUSION: In malignant hilar biliary obstruction, there is no evidence that ePTFE-FEP-covered stents are superior to uncovered stents in terms of safety, clinical success, adjuvant chemotherapy, patency, or survival. KEY POINTS: • Percutaneous palliation of hilar biliary obstruction is feasible with both uncovered and covered stents. • Clinical success in terms of bilirubin decrease and adjuvant chemotherapy is achievable with both stents. • Thirty-day mortality is considerable when stenting is also offered to patients with a low performance status.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Colestase/cirurgia , Icterícia Obstrutiva/cirurgia , Neoplasias Hepáticas/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/etiologia , Colestase/mortalidade , Materiais Revestidos Biocompatíveis/uso terapêutico , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Politetrafluoretileno/análogos & derivados , Estudos Prospectivos , Stents/efeitos adversos
3.
Eur Radiol ; 29(2): 636-644, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29980926

RESUMO

OBJECTIVE: To evaluate long-term patency rates of a novel percutaneous threefold balloon dilatation protocol in benign anastomotic biliary strictures. METHODS: Patients with a benign biliary stricture after hepatobiliary surgery or liver transplantation, untreatable with endoscopy, underwent a percutaneous treatment cycle consisting of a 20-min balloon dilatation session on day one, repeated on days three and five. No catheters were left behind after the last dilatation session. Technical and clinical success as well as complications were analysed. Mean primary and secondary patency times were assessed. Cumulative primary and secondary patency rates at 6 months and 1, 2 and 3 years were determined. RESULTS: Seventy patients underwent 135 dilatation treatment cycles (mean 1.9) with a technical success rate of 99%. Clinical success was achieved in 87% of the patients. Fifty-eight of 135 (43%) patients had minor and 15/135 (11%) had major complications. Mean primary and secondary patency times were 26 months and 46 months, respectively, with a median follow-up of 69 months. Cumulative primary patency rate at 6 months was 67%, at 1 year 56%, at 2 years 41% and at 3 years 36%. The cumulative secondary patency rate at 6 months was 83%, at 1 year 79%, at 2 years 70% and at 3 years 64%. CONCLUSION: In benign anastomotic biliary strictures, a percutaneous threefold balloon dilatation treatment is effective. As long indwelling catheters are avoided, patient comfort improves. KEY POINTS: • Percutaneous threefold balloon dilatation treatment is effective in benign anastomotic biliary strictures. • As indwelling catheters after dilatation are avoided, patient comfort improves. • The dilatation protocol can be repeated efficiently in case of recurrent stricture.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Colestase/terapia , Dilatação/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/métodos , Criança , Pré-Escolar , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colestase/diagnóstico por imagem , Colestase/etiologia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/terapia , Dilatação/efeitos adversos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Eur J Gastroenterol Hepatol ; 30(12): 1441-1446, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30048333

RESUMO

OBJECTIVE: To evaluate the outcome of early transjugular portosystemic shunt (TIPS) treatment in patients with a trial-compatible high-risk variceal bleeding and secondly to disclose other predictors of early mortality. MATERIALS AND METHODS: A cohort study was conducted on patients referred for a TIPS procedure with or without combined variceal embolization to control acute esophageal variceal bleeding. A total of 32 patients with Child-Pugh C score less than 14 or Child-Pugh B plus active bleeding at endoscopy, admitted for early-TIPS treatment (<72 h), were included. RESULTS: We noted one (3.7%) failure to control bleeding and no rebleeding during 1-year follow-up. Ten (31.3%) patients died within 6 weeks after TIPS placement. Early mortality was associated with model for end-stage liver disease (MELD) score (P=0.025), MELD score of at least 19 (P=0.008) and hemodynamic instability at time of admission (P=0.001). If hemodynamic instability is associated with a high MELD score, the 6-week mortality peaks at 77.8% (P=0.000). CONCLUSION: This study confirms the excellent survival results of early-TIPS treatment for acute variceal bleeding in a selected patient group with a low MELD score. Poor survival in hemodynamically unstable patients with high MELD scores (≥19) contests the guidelines that patients with Child-Pugh class C cirrhosis or Child-Pugh class B with active bleeding on endoscopy should deliberately receive preemptive TIPS treatment after endoscopic haemostasis.


Assuntos
Doença Hepática Terminal/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Doença Aguda , Idoso , Terapia Combinada , Embolização Terapêutica , Doença Hepática Terminal/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do Tratamento
6.
Stroke ; 48(12): 3393-3396, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29114088

RESUMO

BACKGROUND AND PURPOSE: In light of evidence from ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations), neurovascular specialists had to reconsider deliberate treatment of unruptured brain arteriovenous malformations (uBAVMs). Our objective was to determine the outcomes of uBAVM treated with primary embolization using ethylene vinyl alcohol (ONYX). METHODS: Patients with uBAVM who met the inclusion criteria of ARUBA and were treated with primary Onyx embolization were assigned to this retrospective study. The primary outcome was the modified Rankin Scale score. Secondary outcomes were stroke or death because of uBAVM or intervention and uBAVM obliteration. RESULTS: Sixty-one patients (mean age, 38 years) were included. The median observation period was 60 months. Patients were treated by embolization alone (41.0%), embolization and radiosurgery (57.4%), or embolization and excision (1.6%). Occlusion was achieved in 44 of 57 patients with completed treatment (77.2%). Forty-seven patients (77.1%) had no clinical impairment at the end of observation (modified Rankin Scale score of <2). Twelve patients (19.7%) reached the outcome of stroke or death because of uBAVM or intervention. Treatment-related mortality was 6.6% (4 patients). CONCLUSIONS: In uBAVM, Onyx embolization alone or combined with stereotactic radiosurgery achieves a high occlusion rate. Morbidity remains a challenge, even if it seems lower than in the ARUBA trial.


Assuntos
Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil , Tantálio , Adulto , Terapia Combinada , Combinação de Medicamentos , Embolização Terapêutica/mortalidade , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/mortalidade , Masculino , Complicações Pós-Operatórias , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos Retrospectivos , Ruptura , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
7.
J Neurointerv Surg ; 9(4): 394-398, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27036980

RESUMO

BACKGROUND: Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment. METHODS: We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days. RESULTS: PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities <40 HU (for ruling hemorrhage out) and ≥140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%. CONCLUSIONS: There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.


Assuntos
Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/terapia , Hemorragia Cerebral/diagnóstico por imagem , Meios de Contraste , Procedimentos Endovasculares , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/métodos , Trombectomia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
8.
Acta Gastroenterol Belg ; 80(2): 249-255, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29560690

RESUMO

BACKGROUND AND STUDY AIMS: Obstructive jaundice caused by metastatic disease leads to deterioration of general condition and short survival time. Successful decompression can offer symptom control and enable further treatment with chemotherapy, which can improve survival. PATIENTS AND METHODS: Ninety-nine percutaneous transhepatic cholangiography (PTC) procedures with metallic stent placement were performed in 93 patients between 2007 and 2013. Files were retrospectively studied and a review of patients' demographics, clinical and laboratory parameters, treatment and survival was performed. Kaplan-Meier survival analysis with log-rank test was done in function of bilirubin level, tumor type and treatment with chemotherapy. RESULTS: Hyperbilirubinemia resolved in 73% of procedures. Median survival time after the procedure was 48 (95%CI 34.8 - 61.1) days. If additional chemotherapy was possible, a median survival of 170 (95%CI 88.5 - 251.4) days was noted versus 32 (95%CI 22.4 - 41.5) days without chemotherapy (p < 0.01). Survival rates greatly differed between primary tumor type, with the largest benefit of PTC in colorectal cancer. In 35 % of the procedures minor or more severe complications were noted. The 30-day mortality was 33%, with 3 procedure related deaths. CONCLUSION: PTC with metallic stenting can bring symptom relief and enable further treatment with chemotherapy, which can lead to a longer survival time, especially in colorectal cancer. However, in patients in whom palliative stenting failed to resolve the hyperbilirubinemia survival is short.


Assuntos
Colangiografia , Neoplasias Colorretais , Icterícia Obstrutiva , Metástase Neoplásica , Idoso , Bélgica/epidemiologia , Bilirrubina/análise , Colangiografia/instrumentação , Colangiografia/métodos , Colestase Extra-Hepática/etiologia , Colestase Extra-Hepática/cirurgia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/mortalidade , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/fisiopatologia , Metástase Neoplásica/terapia , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Estudos Retrospectivos , Stents , Análise de Sobrevida
9.
Interv Neurol ; 5(1-2): 89-99, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27610126

RESUMO

BACKGROUND AND OBJECTIVE: Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. MATERIALS AND METHODS: We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. RESULTS: One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). CONCLUSIONS: Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months.

10.
Am J Otolaryngol ; 37(6): 544-551, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27650391

RESUMO

PURPOSE: The purpose of this study was to evaluate the effectiveness on function preservation and tumor control of the treatment of glomus tympanicum tumors with pre-operative embolization followed by total surgical resection. MATERIAL AND METHODS: We describe a series of 6 patients with a glomus tympanicum tumor who were treated in our hospital using the same technique: the day before surgery selective tumor embolization due to denaturation with 96% ethanol. Following parameters were considered: tumor classification, tumor control, clinical and audiological outcome, effectiveness of embolization, percentage of tumor necrosis and treatment complications. RESULTS: There were no severe complications due to embolization or surgery. Tumor blush disappeared completely in 5 patients on DSA post embolization and histologic evaluation of the resected tissue showed a median of 69.2% of tumor necrosis. Pulsatile tinnitus disappeared in all patients and 3 patients had no symptoms at all. Hearing ameliorated in 4 patients, 1 patient without hearing loss pre- treatment still had normal hearing after treatment and 1 patient's hearing was worse after treatment. Average follow-up was 21.3months. CONCLUSIONS: Treatment of glomus tympanicum tumors by pre-operative embolization with ethanol and surgical resection has not been described before. Our results show that it is a safe procedure with a good long term tumor control, good clinical and audiological outcome.


Assuntos
Embolização Terapêutica , Tumor de Glomo Timpânico/cirurgia , Idoso , Terapia Combinada , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
11.
Acta Neurol Belg ; 116(1): 7-14, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26445955

RESUMO

Clinical trials have shown a beneficial effect of mechanical thrombectomy in acute ischemic stroke patients treated within six up to even 12 h after symptom onset. This treatment was already performed in selected hospitals in Belgium before completion of the randomized controlled trials. Outcome data on these procedures in Belgium have not been published. We performed a retrospective multicenter study of all patients with acute ischemic stroke treated with mechanical endovascular therapy in four hospitals in Belgium. Clinical outcomes, as measured by the modified Rankin Scale (mRS), site of arterial occlusion, reperfusion and the association between these variables were studied. The study included 80 patients: 65 patients with an occlusion in the anterior circulation and 15 with an occlusion in the posterior circulation. Good functional outcome (GFO) rates, defined as mRS 0-2 at 90 days, were 42 % in all patients, 44 % in anterior circulation stroke and 34 % in posterior circulation stroke. Reperfusion was achieved in 78 % of patients; more (100 %) in patients with posterior compared to patients with anterior circulation stroke (72 %; p = 0.02). The rate of GFO was greater in patients with reperfusion versus patients in whom reperfusion was not achieved (adjusted OR 8.2, 95 % CI 2.0-34.2). Symptomatic intracerebral hemorrhage was documented in 5 % of all patients. Endovascular treatment with mechanical devices for acute ischemic stroke in Belgium results in GFO and reperfusion rates similar to recently published results in the endovascular-treated arms of randomized clinical trials. Rates of symptomatic intracranial hemorrhage are low and comparable to other cohort studies and clinical trials.


Assuntos
Isquemia Encefálica/complicações , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Reperfusão/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
AJR Am J Roentgenol ; 205(3): 667-75, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26295656

RESUMO

OBJECTIVE: The purpose of this study was to determine whether phlebographic features can be used to discriminate adult from adolescent varicocele. MATERIALS AND METHODS: Left and right internal spermatic venograms of 191 adolescents (< 17 years) and 224 adults (≥ 25 years) were anonymized and evaluated. Phlebographic radioanatomic features (valves, duplications, collaterals, and classifications) were compared and analyzed with univariate tests. RESULTS: Insufficiency of the left internal spermatic vein (ISV) was confirmed in 409 of the 415 (99%) patients. Adults had no spontaneous opacification of the ISV during venography twice as frequently as adolescents (p = 0.001), a complex outflow into the renal vein 2.2 times as often (p = 0.021), and significantly more collaterals (p = 0.030). Adolescents had a significantly lower number of competent valves and significantly more instances of nutcracker phenomenon (p = 0.001). According to the Bähren classification, the distribution of the types of ISVs was significantly different between adults and adolescents (p = 0.009). Insufficiency of the right ISV was encountered 2.4 times as frequently in adults as in adolescents (p < 0.001). In adults the maximum diameter of the ISV was significantly larger (p = 0.023). Bilateral ISV insufficiency was 2.2 times as frequent in adults (p < 0.001) as in adolescents. CONCLUSION: Left-sided varicoceles in adults are distinct from those in adolescents. In adults, reflux is likely to be induced via collateral pathways, whereas in adolescents congenital venous abnormalities are predominantly present. The higher prevalence and the greater diameter of a right insufficient ISV in adults, combined with the absence of venous anatomic differences, supports the hypothesis that right-sided varicocele is an evolutive disease.


Assuntos
Flebografia , Varicocele/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Adolescente , Adulto , Criança , Humanos , Masculino , Veias Renais/anormalidades , Testículo/irrigação sanguínea , Veias/anormalidades
16.
Acta Neurol Belg ; 114(2): 113-5, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24399198

RESUMO

The current time-based approach for patient selection for intravenous (IV) thrombolysis in an acute stroke setting neglects the individual variation of cerebral blood flow impairment. This approach restricts the eligible patient population. In the last decade, advanced imaging and especially MRI diffusion- and perfusion-weighted imaging (DWI-PWI) techniques have been used to select patients for IV thrombolysis outside the current 4.5 h time window. Most of these studies focus on the anterior (carotid artery) cerebral circulation only. We report the case of an acute ischemic stroke due to a dissection of the right vertebral artery and occlusion of the posterior inferior cerebellar artery with good clinical outcome. The patient received IV thrombolysis far beyond the current established time window. This decision was based upon a marked MRI DWI-PWI mismatch zone in the posterior circulation territory.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Imagem de Difusão por Ressonância Magnética , Humanos , Angiografia por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
17.
Eur J Radiol ; 83(3): 559-63, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24374263

RESUMO

PURPOSE: To find out whether in varicocele embolization the copolymer cyanoacrylate glue (NBCA-MS) has a better patient tolerance compared to the monomer n-butyl-2-cyanoacrylate (NBCA). MATERIALS AND METHODS: N=112 insufficient spermatic veins (left sided N=84, right sided N=28) diagnosed in N=83 adult males were prospectively randomized for blinded embolization with either NBCA N=54 (Histoacryl) or with NBCA-MS N=58 (Glubran2). Before, during and up to one week after embolization, patient discomfort was assessed by a standardized pain scale. Type, location and side of discomfort were noted. Statistical analysis was performed with the Mann-Whitney U-test, the McNemar test and the Fisher's exact test. RESULTS: Embolization caused discomfort in N=48/112 (43%) spermatic veins, comprising N=26/54 (48%) in the NBCA group and N=22/58 (38%) in the NBCA-MS group. During the week after embolization, the overall number of discomfort reports rose to N=62/106 (59%), with an increase to N=30/53 (57%) in the NBCA group and to N=32/53 (60%) in the NBCA-MS group. The number of immediate grade 2 to 4 pain reactions was N=22/112 (20%), and rose to N=37/106 (35%) after one week. No difference in discomfort during embolization and at 1 week after treatment was noted. Characteristics, severity grading, and location of discomfort were similar in both NBCA groups, regardless the time point of observation. CONCLUSION: Discomfort after glue embolization of varicocele is a common side effect, which might evolve to pain. The assumed lower inflammatory reaction on NBCA-MS was not translated in an improved tolerance.


Assuntos
Embolização Terapêutica/métodos , Embucrilato/efeitos adversos , Embucrilato/uso terapêutico , Dor/etiologia , Adesivos Teciduais/efeitos adversos , Adesivos Teciduais/uso terapêutico , Varicocele/terapia , Adulto , Anestésicos Locais/uso terapêutico , Método Duplo-Cego , Embolização Terapêutica/efeitos adversos , Embucrilato/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/prevenção & controle , Medição da Dor/efeitos dos fármacos , Resultado do Tratamento , Varicocele/diagnóstico , Adulto Jovem
18.
Trials ; 13: 144, 2012 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-22913492

RESUMO

BACKGROUND: Hepatocellular carcinoma is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10 to 15% of hepatocellular carcinoma patients are suitable candidates for treatment with curative intent, such as hepatic resection and liver transplantation. A majority of patients have locally advanced, liver restricted disease (Barcelona Clinic Liver Cancer (BCLC) staging system intermediate stage). Transarterial loco regional treatment modalities offer palliative treatment options for these patients; transarterial chemoembolization (TACE) is the current standard treatment. During TACE, a catheter is advanced into the branches of the hepatic artery supplying the tumor, and a combination of embolic material and chemotherapeutics is delivered through the catheter directly into the tumor. Yttrium-90 radioembolization ((90)Y-RE) involves the transarterial administration of minimally embolic microspheres loaded with Yttrium-90, a ß-emitting isotope, delivering selective internal radiation to the tumor. (90)Y-RE is increasingly used in clinical practice for treatment of intermediate stage hepatocellular carcinoma, but its efficacy has never been prospectively compared to that of the standard treatment (TACE). In this study, we describe the protocol of a multicenter randomized controlled trial aimed at comparing the effectiveness of TACE and (90)Y-RE for treatment of patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma. METHODS/DESIGN: In this pragmatic randomized controlled trial, 140 patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma, with Eastern Cooperative Oncology Group performance status 0 to 1 and Child-Pugh A to B will be randomly assigned to either (90)Y-RE or TACE with drug eluting beads. Patients assigned to (90)Y-RE will first receive a diagnostic angiography, followed by the actual transarterial treatment, which can be divided into two sessions in case of bilobar disease. Patients assigned to TACE will receive a maximum of three consecutive transarterial treatment sessions. Patients will undergo structural follow-up for a timeframe of two years post treatment. Post procedural magnetic resonance imaging (MRI) will be performed at one and three months post trial entry and at three-monthly intervals thereafter for two years to assess tumor response. Primary outcome will be time to progression. Secondary outcomes will be overall survival, tumor response according to the modified RECIST criteria, toxicities/adverse events, treatment related effect on total liver function, quality of life, treatment-related costs and cost-effectiveness. TRIAL REGISTRATION: NCT01381211.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Embolização Terapêutica/métodos , Artéria Hepática , Neoplasias Hepáticas/terapia , Compostos Radiofarmacêuticos/administração & dosagem , Projetos de Pesquisa , Radioisótopos de Ítrio/administração & dosagem , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Análise Custo-Benefício , Progressão da Doença , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Custos de Cuidados de Saúde , Artéria Hepática/diagnóstico por imagem , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética , Microesferas , Países Baixos , Qualidade de Vida , Radiografia , Compostos Radiofarmacêuticos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Radioisótopos de Ítrio/efeitos adversos
19.
Lancet ; 380(9840): 469-70; author reply 470-1, 2012 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-22863044
20.
Acta Neurol Belg ; 112(1): 101-4, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22427301

RESUMO

Radiotherapy is extensively used in the treatment of malignant tumors of the central nervous system, but may also cause considerable morbidity and mortality, probably through damage to the remarkably vulnerable vascular system. We present two cases of infarction in the posterior cerebral vasculature related to earlier irradiation for a pineal gland tumor. Two patients were irradiated for a pineal gland tumor in young adulthood. Respectively 20 and 35 years later, they presented with a progressive neurological decline, related to early progressive atherosclerosis in the posterior cerebral vasculature. In conclusion, irradiation of the posterior cerebral territory may produce precocious atherosclerosis of posterior circulation vasculature, even decades later. When a progressive clinical decline with accumulating ischemic events is observed, together with signs of atherosclerosis, radiotherapy-related vasculopathy may be considered.


Assuntos
Transtornos Cerebrovasculares/etiologia , Lesões por Radiação/complicações , Adulto , Artérias/patologia , Encéfalo/patologia , Neoplasias Encefálicas/radioterapia , Angiografia Cerebral , Transtornos Cerebrovasculares/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Pineal/patologia , Pinealoma/radioterapia
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