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1.
Vasc Endovascular Surg ; 54(3): 240-246, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31928203

RESUMO

PURPOSE: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. METHODS: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients' demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients' electronic medical records. RESULTS: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. CONCLUSION: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.


Assuntos
Angiomiolipoma/terapia , Embolização Terapêutica/instrumentação , Doença Iatrogênica , Neoplasias Renais/terapia , Artéria Renal , Lesões do Sistema Vascular/terapia , Adulto , Angiomiolipoma/diagnóstico por imagem , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Artéria Renal/diagnóstico por imagem , Artéria Renal/lesões , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto Jovem
2.
World Neurosurg ; 133: 201-204, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605851

RESUMO

OBJECTIVE: Traumatic pseudoaneurysms of the proximal middle cerebral artery (MCA) segments are challenging to treat. We describe the management of traumatic internal carotid artery and MCA pseudoaneurysms with flow diversion. CASE DESCRIPTION: A 19-year-old man had sustained a gunshot wound to the head. Delayed digital subtraction angiography showed de novo formation of the left internal carotid artery ophthalmic segment and left MCA M2 segment pseudoaneurysms. We had initially performed coil embolization of the left MCA pseudoaneurysm. However, it had recurred 2 weeks later. We treated both pseudoaneurysms with flow diversion using the Pipeline Flex embolization device. The patient has continued with dual antiplatelet therapy of aspirin and ticagrelor. Follow-up digital subtraction angiography at 6 months showed complete obliteration of both pseudoaneurysms with patent parent vessels. The patient remained neurologically intact. CONCLUSIONS: Flow diversion can be an efficacious treatment of traumatic MCA pseudoaneurysms in appropriately selected cases. The risks versus benefits of dual antiplatelet therapy must be weighed in trauma settings.


Assuntos
Falso Aneurisma/terapia , Embolização Terapêutica/instrumentação , Artéria Cerebral Média/diagnóstico por imagem , Ferimentos por Arma de Fogo/terapia , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Angiografia Cerebral , Humanos , Masculino , Resultado do Tratamento , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto Jovem
3.
World Neurosurg ; 133: e434-e442, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31525478

RESUMO

OBJECTIVE: To assess the association of degree of contrast stasis in intracranial aneurysms (IAs) immediately after Pipeline embolization device (PED; Medtronic, Dublin, Ireland) deployment with 6- and 12-month angiographic occlusion rates. METHODS: This retrospective cohort study included consecutive patients undergoing PED deployment for saccular IA treatment at a large-volume cerebrovascular center over a 4-year 9-month period. Angiographic images obtained immediately after PED deployment were graded according to amount of intra-aneurysmal contrast flow during the late venous phase: 0 = no stasis; 1 = <50% contrast stasis; 2 = 50%-75% stasis; and 3 = >75%-99% stasis. Follow-up occlusion rates were determined by digital subtraction angiography, computed tomographic angiography, or magnetic resonance angiography. RESULTS: The study included 119 patients in whom 182 PEDs were deployed to treat 141 aneurysms. A single PED was deployed in 105 (74.5%) aneurysms. The internal carotid artery was the commonest aneurysm site (119 [85%]). Fifty-two (36.9%) aneurysms were grade 0; 33 (23.4%) were grade 1; 46 (32.6%) were grade 2; and 10 (7.1%) were grade 3 immediately post-treatment. A 6-month follow-up angiogram available for 101 aneurysms showed complete occlusion (no flow into the aneurysm) in 74 (73.3%) aneurysms. A 12-month follow-up study available for 132 aneurysms showed complete occlusion in 79.5%. At last follow-up, occlusion rates were not significantly different for different contrast stasis grades (P = 0.60). Mean angiographic follow up for all IAs was 23v±v17.7 months. IA size, sex, age, and smoking were not significant predictors of occlusion. CONCLUSIONS: The degree of aneurysm contrast stasis immediately after PED deployment is not statistically associated with 6- and 12-month angiographic occlusion rates.


Assuntos
Embolização Terapêutica/instrumentação , Hemorreologia , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Angiografia Digital , Angiografia Cerebral , Meios de Contraste/farmacocinética , Embolização Terapêutica/métodos , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Método Simples-Cego , Trombose/etiologia , Resultado do Tratamento
4.
Radiol Med ; 125(3): 288-295, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823294

RESUMO

PURPOSE: High-flow priapism is an incomplete and painless persistent erection caused by trauma. Its diagnosis is performed thanks to clinic and imaging evaluation with detection of fistula/pseudoaneurysm in the cavernous tissue. This paper aims to retrospectively assess the efficacy and safety of superselective arterial embolization in patients with high-flow priapism. MATERIALS AND METHODS: From January 2008 to March 2017, nine patients with high-flow priapism have been treated in a single center with embolization. The main etiology was trauma in eight subjects. The patients were evaluated with laboratory examinations and clinical and imaging findings (color Doppler ultrasonography and angiography). The mean follow-up time after embolization was 24 months. RESULTS: Eleven procedures were performed in nine patients: two of them required a second treatment session because of recurrence after 1-2 weeks. Embolic agents were microcoils, microparticles (300-500 µm) and Spongostan. Restoration of erectile function was monitored by clinical and color Doppler evaluation during follow-up. CONCLUSIONS: Superselective embolization should be the procedure of choice in patients affected by high-flow priapism; this technique appears to be successful in preserving erectile function. The choice of the embolic agent is crucial, and it should be tailored for each patient.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adolescente , Adulto , Angiografia , Criança , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/lesões , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Recidiva , Fluxo Sanguíneo Regional , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
6.
World Neurosurg ; 135: e710-e715, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887464

RESUMO

BACKGROUND: Coil protrusion occasionally occurs during embolization and can lead to thromboembolic complications. We aimed to evaluate the efficacy of rescue stenting procedures with a low-profile stent system (LVIS Jr.) for treating ruptured intracranial aneurysms during complicated coil embolization. METHODS: We performed a retrospective review to identify patients who had subarachnoid hemorrhage and were treated with LVIS Jr. stent rescue therapy. We enrolled 15 patients with intracranial aneurysms and evaluated the technical success and immediate postprocedural clinical and angiographic outcomes. RESULTS: All 15 patients underwent successful rescue-stent treatment, and no thrombotic or hemorrhagic complications occurred. Immediate postprocedural angiography revealed complete aneurysm occlusion in 40% (6/15) of the patients, whereas 60% (9) of the patients had a residual neck. Among the 12 patients who underwent follow-up angiography, 10 (83.3%) patients had complete aneurysm occlusion, 1 (8.3%) had a residual neck, and 1 (8.3%) showed an increase in the filling status of the aneurysm. There were no thrombotic complications during the follow-up period. CONCLUSIONS: Our findings indicate that LVIS Jr. stent rescue therapy is clinically useful for handling coil protrusion during the embolization of ruptured intracranial aneurysms.


Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/patologia , Prótese Vascular , Embolização Terapêutica/métodos , Feminino , Humanos , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Terapia de Salvação/instrumentação , Terapia de Salvação/métodos
7.
Ann Vasc Surg ; 62: 35-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31201971

RESUMO

BACKGROUND: Iliac branch devices (IBDs) can treat iliac and aortoiliac aneurysms (AIAs) less invasively than open surgery (OS) and preserve pelvic perfusion. Our hypothesis was that the rates of perioperative complications after treatment for AIAs are similar between IBDs and hypogastric occlusion with coil and cover (C&C), and lower than OS. METHODS: We identified patients undergoing elective AIA repair by IBD, C&C, and OS (all with infrarenal clamps) within the National Surgical Quality Improvement Program (NSQIP) vascular aneurysm specific Participant User Files (2012-2016). Baseline characteristics, procedural variables, and 30-day outcomes were compared. The primary outcomes were any major complication or death. Secondary outcomes included minor complications, total operative time, total and intensive care unit length of stay (LOS), and reinterventions. Multivariable logistic regression assessed differences in major complications between IBD and C&C/OS after adjusting for patient and procedural variables. RESULTS: We identified 593 patients (83% men, mean age 71.6 ± 9 years) undergoing elective AIA repair (IBD = 283, C&C = 118, and OS = 192). Patient age and American Society of Anesthesiology (ASA) classification varied significantly between groups. Mean aneurysm diameter was higher for OS and similar between IBD and C&C (5.9 cm vs. 5.5 cm and 5.2 cm, respectively, P < 0.001). OS was associated with higher rate of major complications (65.5% vs. IBD: 8.8% and C&C: 13.6%, P=<0.001) and higher mortality (3.6% vs. IBD: 0.7% and C&C: 0%, P = 0.017). Minor complications and reinterventions were similar. IBD patients had significantly shorter total operative time and total and intensive care unit LOS. After adjustment, OS was associated with higher major complications compared with IBD (Odds ratio [OR]: 11.3, 95% confidence interval [CI]: 5.8-21.9, P < 0.001), primarily because of the use of transfusions (major complications excluding transfusions OR: 1.3, 95% CI: 0.6-2.8, P = 0.52). Major complications between IBD and C&C were similar (OR: 1.6, 95% CI: 0.8-3.4, P = 0.23). CONCLUSIONS: The use of IBDs for elective treatment of AIAs is associated with favorable perioperative outcomes and a lower rate of major complications compared with OS, primarily because of fewer transfusions. IBDs use has perioperative outcomes similar to C&C with the associated benefit of preserving pelvic perfusion. Pending long-term durability results for this technique, IBDs appear to be associated with several perioperative advantages in patients with AIAs compared with OS and C&C.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Pelve/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/mortalidade , Aneurisma Ilíaco/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(47): e18092, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764846

RESUMO

RATIONALE: Pipeline embolization device pipeline embolization device (PLED) is one of the most preferred flow-diverting devices used in treating giant and complex intercranial aneurysms. The occurrence of in-stent stenosis (ISS), which is a partially reversible complication, has been associated with PLED. Trauma around the neck of the aneurysm during our attempts to implant the PLED across the aneurysm resulted into inflammatory reactions, endotheliazation, granular tissue formation, and subsequent ISS. PATIENT CONCERNS: We present an 11-year-old girl with dizziness of 6 days duration on account of which she was admitted at our institution. Physical as well as neurological examinations did not yield much. DIAGNOSES: Cerebral angiography revealed a right cavernous segment giant aneurysm. INTERVENTIONS: We initially implanted Pipeline embolization devices (PLEDs) (ev3, Irvine, California, USA) across the neck of the aneurysm which resulted into ISS 6 months after the operation. OUTCOMES: We also attempted balloon angioplasty which failed during our second operation. She was finally treated with Neuroform stent (Stryker Neurovascular, USA) with no further complication and two years follow-up revealed no ISS. LESSONS SUBSECTIONS AS PER STYLE: A combination of multiple kinds of flow diverting devices could reduce the incidence of ISS in selected patients with complex aneurysms. Minimal trauma caused by PLED at aneurysm site could also reduce incidence of ISS.


Assuntos
Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Criança , Constrição Patológica/etiologia , Feminino , Humanos
10.
Medicine (Baltimore) ; 98(39): e17151, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574820

RESUMO

RATIONALE: Persistent primitive hypoglossal artery (PPHA) is often associated with intracranial anomalies such as aneurysms. Surgical treatment of aneurysms on the PPHA is challenging due to that the posterior circulation depends solely on PPHA. PATIENT CONCERNS: A case of an 83-year-old woman with a large aneurysm on PPHA presented with vertigo was reported. DIAGNOSIS: Three-dimensional angiogram revealed a wide-neck aneurysm on the PPHA. INTERVENTIONS: The aneurysm was successfully treated using a novel low-profile visualized intraluminal support stent-assisted coiling technique. OUTCOMES: No complications occurred during the procedure. The final angiogram confirmed the patency of the posterior inferior cerebellar artery and the parent artery and its distal branches. LESSONS: Our case suggests that stent-assisted coil embolization is safe and effective for the treatment of aneurysms on the PPHA.


Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Posterior/cirurgia , Stents , Idoso de 80 Anos ou mais , Embolização Terapêutica/instrumentação , Feminino , Humanos , Resultado do Tratamento
11.
J Stroke Cerebrovasc Dis ; 28(11): 104374, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530480

RESUMO

Traumatic cerebral aneurysms are histologically dissecting aneurysms or pseudoaneurysms, thus requiring parent artery occlusion for cure. Combination of endovascular parent artery occlusion and extracranial-intracranial bypass is considered optimal to obtain complete obliteration of the aneurysm and to avoid hemodynamic hypoperfusion. However, endovascular parent artery occlusion of the supraclinoid internal carotid artery (ICA) is at risk of ischemic complications due to distal coil protrusion to adjacent perforating arteries or distal embolism of the thrombi generated in the coil mass. A 20-year-old man presented with progressive left optic neuropathy following motor vehicle accident. Radiological examination revealed left supraclinoid ICA aneurysmal formation with dissecting change. We treated this traumatic supraclinoid ICA aneurysm by combination of endovascular parent artery occlusion and high-flow bypass in the hybrid operating room. An aneurysmal clip was applied on the ICA just distal to the aneurysm prior to coil embolization, and worked as a scaffold for subsequent filling coils and as a blockade for the distal emboli. This "clip anchor-assisted coil embolization" technique resulted in optimal parent artery occlusion for the traumatic aneurysm of the supraclinoid ICA with minimal risks of residual blood flow, intraoperative rupture, and thromboembolic complications.


Assuntos
Acidentes de Trânsito , Aneurisma Dissecante/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Artéria Radial/transplante , Enxerto Vascular , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Velocidade do Fluxo Sanguíneo , Circulação Cerebrovascular , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 132: 106-112, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491581

RESUMO

BACKGROUND: Dissecting pseudoaneurysms of the craniocervical circulation are uncommon, accounting for only 3% of all cerebral aneurysms. These aneurysms pose a challenge due to their location and anatomic configuration. The Pipeline Embolization Device (PED) is a flow diversion technique that successfully treats aneurysms by diverting blood flow away from the aneurysm and reconstructing the diseased parent artery by altering its hemodynamics. CASE DESCRIPTION: We report 3 cases in which the PED was used to treat craniocervical carotid artery dissection with associated pseudoaneurysms. A single PED was used in the first case, 4 PEDs were used in the second case, and 3 PEDs and a PRECISE PRO RX carotid stent were placed in the third case. All 3 patients achieved full neurologic recovery postoperatively. Cerebral angiography performed postoperatively demonstrated revascularization, good laminar flow, and no in-stent or adjacent stenosis. CONCLUSIONS: PED placement offers a safe and effective method of treating spontaneous or traumatic craniocervical carotid artery dissections with excellent neurologic outcomes postoperatively and complete long-term aneurysmal occlusion.


Assuntos
Falso Aneurisma/terapia , Dissecação da Artéria Carótida Interna/terapia , Embolização Terapêutica/instrumentação , Adulto , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/terapia , Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino
13.
BMJ Case Rep ; 12(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488452

RESUMO

Embolisation of neonatal arteriovenous shunts poses several challenges: tortuous and fragile vessels, limited contrast volume and few specialised paediatric endovascular devices. In a 9-day-old patient with a choroidal type vein of Galen malformation we encountered an extremely tortuous posterior choroidal artery pedicle during endovascular treatment. After attempted selection using a traditional over-the-wire technique, we advanced a platinum coil through the micro-catheter. High flow within the feeder directed the soft and malleable coil anterograde. We then advanced the catheter over the coil's pusher wire in a facile manner to an ideal position for embolisation. This approach may be especially useful in cases requiring coil/vinyl-based liquid embolics, given that the only flow-directed micro-catheter available to most operators is compatible with n-Butyl cyanoacrylate alone. Moreover, the soft distal portion of coil may impart a safety benefit over traditional guidewires in easily perforated neonatal vasculature.


Assuntos
Cateterismo/métodos , Embolização Terapêutica/instrumentação , Malformações Arteriovenosas Intracranianas/terapia , Angiografia Digital , Veias Cerebrais/anormalidades , Veias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Malformações Arteriovenosas Intracranianas/diagnóstico
14.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
15.
J Stroke Cerebrovasc Dis ; 28(11): 104306, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31439523

RESUMO

Carotid-Cavernous sinus fistula (CCF) caused by a ruptured aneurysm of persistent primitive trigeminal artery (PPTA) is exceptionally rare. Herein, we reported the case of a 64-year-old female who presented with headache, pulsatile tinnitus, and diplopia. Angiography showed a PPTA and CCF. Three-dimensional digital subtraction angiograms revealed a direct shunt between the PPTA aneurysm and the left cavernous sinus. The trigeminal carotid fistula was successfully treated with detachable coils and Onyx, and the PPTA was preserved. Hence, coil and Onyx occlusion of the cavernous sinus is a safe and effective treatment for trigeminal carotid fistula.


Assuntos
Aneurisma Roto/etiologia , Artéria Basilar/anormalidades , Artéria Carótida Interna/anormalidades , Fístula Carotidocavernosa/etiologia , Malformações Vasculares do Sistema Nervoso Central/complicações , Aneurisma Intracraniano/etiologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Artéria Basilar/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Combinação de Medicamentos , Embolização Terapêutica/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Pessoa de Meia-Idade , Polivinil/administração & dosagem , Tantálio/administração & dosagem , Resultado do Tratamento
16.
World Neurosurg ; 129: 164-169, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426250

RESUMO

BACKGROUND: Fusiform aneurysms are challenging lesions to manage given their poorly understood natural history and lack of a distinct neck. Historically, they have been treated surgically but endovascular management has recently evolved as a viable alternative. In this case, we describe a novel flow diversion technique for treatment of a fusiform anterior cerebral artery (ACA) aneurysm by jailing the compromised parent vessel obtaining endovascular aneurysm trapping. METHODS: A 25-year-old man underwent brain magnetic resonance imaging and magnetic resonance angiography for workup of a headache, which revealed a fusiform right ACA A1 segment aneurysm. The patient subsequently underwent catheter digital subtraction angiography, which confirmed a 9 × 5.5 mm fusiform right ACA A1 segment aneurysm. The patient elected to undergo endovascular treatment. A Pipeline Embolization Device (Medtronic, Dublin, Ireland) was placed from the right anterior cerebral artery to the right middle cerebral artery, thereby jailing the right ACA A1 segment. RESULTS: At 6-month follow-up, the patient was asymptomatic and his headache had resolved. An angiogram was obtained, showing patency of the Pipeline Embolization Device and near complete occlusion of the right ACA A1 segment. The right ACA A2 segment remained patent via collateral flow through the anterior communicating artery. These findings were confirmed on magnetic resonance imaging. The patient remained asymptomatic for the duration of the follow-up. CONCLUSIONS: This case illustrates the efficacy of the Pipeline Embolization Device for treatment of a fusiform anterior circulation aneurysm via remodeling the circle of Willis.


Assuntos
Círculo Arterial do Cérebro/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Implante de Prótese Vascular/métodos , Embolização Terapêutica/instrumentação , Humanos , Masculino
17.
J Neurointerv Surg ; 11(11): 1129-1134, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31266856

RESUMO

BACKGROUND: Direct carotid-cavernous sinus fistulas (dCCFs) are high flow arteriovenous shunts between the internal carotid artery and the cavernous sinus. Recently, we have used the pipeline embolization device (PED) to treat dCCFs. METHODS: We describe our experience treating patients with dCCFs in whom the PED was placed as the primary treatment modality. RESULTS: Five patients with dCCFs were treated with PEDs deployed in the ipsilateral internal carotid artery spanning the fistula. All patients also underwent either adjunctive transvenous or transarterial embolization. The PED served both as the primary treatment modality and as a scaffold that facilitated safe and efficacious transvenous embolysate administration by altering the flow dynamics through the fistula and providing a physical barrier that protected the internal carotid artery. No intraoperative or perioperative complications occurred. One of the five patients exhibited complete angiographic resolution of the fistula immediately after the procedure. The remaining four patients experienced complete obliteration of the fistula without additional treatment, which suggests that the PED induced alteration promoted thrombosis of the fistula. Therefore, 100% of patients in this series exhibited complete and durable obliteration of the fistula and complete resolution of symptoms following treatment. CONCLUSIONS: We believe that use of the PED to treat dCCFs may be a safe and efficacious strategy that facilitates parent vessel protection during transvenous embolization. Furthermore, the flow alterations induced by the PED may promote thrombosis of incompletely occluded fistulas. This is the largest reported series of non-iatrogenic dCCFs treated with use of the PED as the primary initial treatment strategy.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Medicine (Baltimore) ; 98(27): e16184, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277124

RESUMO

RATIONALE: Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied. PATIENT CONCERNS: A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure. DIAGNOSIS: A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery. INTERVENTIONS: The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality. OUTCOMES: During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction. LESSONS: Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.


Assuntos
Embolização Terapêutica/instrumentação , Hemorragia/etiologia , Doenças Uretrais/etiologia , Cateteres de Demora/efeitos adversos , Humanos , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/lesões , Ruptura/etiologia
19.
Neuroradiol J ; 32(5): 353-365, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271334

RESUMO

INTRODUCTION: Blister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging. PURPOSE: The purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms. METHODS: We retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004-2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed. RESULTS: Thirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy (n = 9), stent-assisted coiling (n = 7), flow diverting stents (n = 13) and coiling + Onyx embolization (n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%. CONCLUSION: Treatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.


Assuntos
Aneurisma Dissecante/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Vesícula/cirurgia , Embolização Terapêutica/instrumentação , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
World J Surg Oncol ; 17(1): 124, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315628

RESUMO

BACKGROUND: The exact contribution of preoperative coil embolization in distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for the prevention of ischemic liver complication is not fully elucidated. METHODS: From January 2004 to July 2015, 31 patients underwent DP-CAR for the pancreatic body-tail cancer. Twenty-three patients received preoperative coil embolization. The characteristics and operative outcomes were analyzed retrospectively. RESULTS: The median survival time and 1- and 3-year overall survival rates were 23.7 months and 74.2% and 34.4%, respectively. No 30-day mortality occurred in any of the patients. Postoperative liver infarction developed only in 8 patients (25.8%) even though 7 of 8 patients had undergone preoperative coil embolization. Tumor contact with the gastroduodenal artery (GDA)/proper hepatic artery (PHA) on preoperative multi-detector computed tomography (MDCT), tumor size, operative time, portal vein resection, and stenosis of the GDA/PHA after DP-CAR are related to liver infarction. Among them, postoperative stenosis of the GDA/PHA on MDCT, which was observed in all 8 patients with liver infarction, was the most closely related factor to postoperative liver infarction. Tumor contact with the GDA/PHA did not worsen the R0 resection rate or overall survival rate. CONCLUSION: Our data indicate that preoperative coil embolization of the common hepatic artery is not useful in DP-CAR as long as GDA is completely preserved during surgery.


Assuntos
Artéria Celíaca/cirurgia , Embolização Terapêutica/métodos , Artéria Hepática/cirurgia , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Celíaca/patologia , Embolização Terapêutica/instrumentação , Feminino , Seguimentos , Artéria Hepática/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
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