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1.
Medicine (Baltimore) ; 100(5): e23976, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592852

RESUMO

ABSTRACT: This pilot study retrospectively assessed the feasible efficacy of TurboHawk plaque rotation system (THPRS) for treatment of arteriosclerosis occlusion in lower extremities (AOLE).A total of 36 eligible patients with AOLE were included in this pilot retrospective study. We divided all those patients into a treatment group and a control group, each group 18 patients. All patients in both groups administered conventional therapy. Additionally, all patients in the treatment group received THPRS, while all patients in the control group received percutaneous transluminal angioplasty (PTA) and percutaneous transluminal stenting (PTS). All outcomes were evaluated and analyzed at 3-month after surgery.At 3-month postsurgery, there were not significant statistical differences in clinical manifestations (intermittent claudication, P = .49; resting pain, P = .28), ankle brachial index change (P = .07), 6-minute walk distance (P = .43), and complications between 2 groups.This pilot study did not show better outcome improvement of THPRS for patients with AOLE. We cautiously draw the present conclusion, because it suffers from several major restrictions. Thus, further studies with larger sample size and longer term follow-up are still needed to warrant the current conclusion.


Assuntos
Técnicas de Ablação/instrumentação , Extremidade Inferior/cirurgia , Doença Arterial Periférica/cirurgia , Placa Aterosclerótica/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Idoso , Angioplastia/métodos , Estudos de Viabilidade , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Rotação , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(35): e21975, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871947

RESUMO

To investigate the efficiency of high ligation, great saphenous vein stripping and subfascial perforator vein surgery for treating great saphenous vein varicosis under the assistance of sterilized electric pneumatic tourniquet and Esmarchs bandage.In total, 274 patients confirmed with primary varicosis between January 2014 and November 2017 were included in this study. Patients were divided intoAfter surgery, the affected limbs in both groups were wrapped up using the elastic bandage for 2 weeks, followed by wearing elastic stocking for 6 months. Then we analyzed the intraoperative bleeding, surgery time, subcutaneous hemorrhage after surgery and postoperative pains.The surgical time in the treatment group was significantly lower than that of control group (58.62 ±â€Š7.47 minutes vs 76.35 ±â€Š9.24 minutes, P < .01). The intraoperative bleeding in the treatment group was significantly lower than that of the control group (17.56 ±â€Š3.52 ml vs 49.87 ±â€Š8.78 ml, P < .01).High ligation, great saphenous vein stripping, and subfascial perforator vein surgery under the assistance of sterilized electric pneumatic tourniquet and Esmarch's bandage was effective for the treatment of varicosis in lower limbs featured by reduced surgery time and less bleeding.


Assuntos
Veia Safena/cirurgia , Torniquetes , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade
6.
Vasc Endovascular Surg ; 54(4): 378-381, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32270756

RESUMO

Extracranial internal carotid artery (ICA) aneurysms account for <1.0% all aneurysms and a rare indication for carotid intervention. Causes include atherosclerotic degeneration, trauma, dissection, previous carotid surgery, connective tissue disorders, and infection. Authors report a case of a middle-aged male found to have a large aneurysm of the left ICA who underwent repair by resection and reconstruction with end-to-end anastomosis under neuroprotection with flow reversal. Our discussion includes a recommendation for this particular surgical repair. The patient in this case report has granted the authors consent for review of records and subsequent publication submission.


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Dispositivos de Proteção Embólica , Procedimentos Cirúrgicos Vasculares/instrumentação , Anastomose Cirúrgica , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Vascular ; 28(4): 342-347, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32241240

RESUMO

BACKGROUND AND AIM: Recognition of structured training in endovascular aortic repair (EVAR) for vascular trainees is increasing. Nevertheless, how trainees can achieve sufficient skills in EVAR sizing and graft selection is sparsely described. The aim of this study was to investigate the effect of systematic training in basic EVAR sizing and graft selection on vascular surgery trainees using a validated assessment tool. METHODS: Sixteen vascular surgery trainees were included in an intensive 6-h hands-on workshop in aortic sizing and stent graft selection for EVAR with a trainer-to-trainee ratio of 1:2. After 1-h lecture, participants did 5 h of supervised training on increasingly complex cases. Finally, the participants were tested using a validated assessment tool. RESULTS: All participants were able to size the test-case and select a stent graft combination in 24:35 (13:30-48:20) min (median and range). The participants' overall test scores (lower is better) were in median 17.9 (11.9-28.4). This did not differ from the scores of experienced EVAR operators 14.7 (11.7-25.2) (<200 EVAR's) (p = .32) but was inferior to the score of EVAR experts 11.2 (9.8 -18.7) (≥200 EVAR's) (p = .01). The sub-score for anatomical measurements was 10.6 (3.9-18.8) and comparable with the experienced group 9.7 (8.1-12.8) (p = .83) but inferior to the expert operators 6.5 (5.2-10.2) (p = .04). The sub-score for stent graft selection was 7.5 (4.9-14.1) and comparable with experienced operators scoring 4.5 (3.6-12.3) (p = .09) but inferior to the expert operators score of 5.0 (3.6-8.4) (p = .01). CONCLUSION: This study presents the results of a standardised one-day basic EVAR sizing and graft selection workshop. Vascular surgery trainees with no prior EVAR experience learned to size and select stent grafts for a simple infra-renal AAA on par with experienced EVAR operators.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Educação de Pós-Graduação em Medicina , Aprendizagem , Stents , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/instrumentação , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Competência Clínica , Congressos como Assunto , Currículo , Avaliação Educacional , Escolaridade , Humanos , Desenho de Prótese , Análise e Desempenho de Tarefas
10.
Vet Surg ; 49 Suppl 1: O120-O130, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32053219

RESUMO

OBJECTIVE: To evaluate the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device (EBVS) intended for single use after multiple use-and-resterilization cycles. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Eight 3-mm EBVS handpieces. METHODS: Handpieces were subjected to a maximum of 15 cycles of testing, including simulated surgery, sealing and burst pressure testing of porcine carotid arteries, reprocessing, and hydrogen peroxide plasma resterilization. Failure was defined as two sequential vascular seal leakage events occurring at <250 mm Hg. Histological evaluation, maximum external temperature of the jaws, sealing time, tissue adherence, jaw surface characterization, and mechanical deterioration were studied. Failure rate was analyzed by using a Kaplan-Meier curve. Linear and ordinal logistic mixed models were used to analyze sealing time, handpiece jaw temperature, and adherence score. RESULTS: Mean ± SD diameter of arteries was 3.22 ± 0.35 mm. Failure was observed starting at cycle 10 and going up to cycle 13 in 37.5% (3/8) of the handpieces. Tissue adherence increased after each cycle (P < .001). Maximum external temperature (79.8°C ± 13.9°C) and sealing time (1.8 ± 0.5 seconds) were not significantly different throughout cycles up to failure. A flatter surface and large scratches were observed microscopically throughout the jaw surface after repeated use and resterilization. CONCLUSION: The 3-mm EBVS handpiece evaluated in this study can be considered safe to use for up to nine reuse-and-resterilization cycles. CLINICAL SIGNIFICANCE: These data provide the basis for establishing preliminary guidelines for the reuse and hydrogen peroxide plasma resterilization of an endoscopic 3-mm EBVS handpiece.


Assuntos
Eletrocoagulação/veterinária , Esterilização , Instrumentos Cirúrgicos/veterinária , Procedimentos Cirúrgicos Vasculares/instrumentação , Animais , Artérias Carótidas , Eletrocoagulação/instrumentação , Suínos
11.
World Neurosurg ; 138: e82-e94, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32045725

RESUMO

BACKGROUND: Native vessel patency and residual lesion are primary sources of morbidity in cerebrovascular surgery (CVS) that require real-time visualization to inform surgical judgment, as is available in endovascular procedures. Micro Doppler and microscopy-based indocyanine green (ICG) fluorescence are promising evolutions compared with intraoperative angiography (IA), and digital subtraction angiography (DSA) remains the gold standard. Exoscopic visualization in CVS is emerging; however, the feasibility of exoscopic-based ICG (ICG-E) for CVS has not yet been reported. To objective of the study was to provide initial experience with ICG-E video angiography in CVS. METHODS: Retrospective study in which 2 ICG-E form-factors (exoscopic-coupled or self-contained handheld imager) were used to determine native vessel patency and residual and compared with DSA. RESULTS: Eleven patients (8 aneurysms, 3 arteriovenous malformations [AVMs]) were included. ICG-E was feasible in all, providing real-time information leading to operative decisions affecting surgical judgment. For aneurysms, discordance of IA with ICG-E and DSA was 12%. In 1 patient, IA showed non-flow-restrictive branch stenosis; however, both ICG and DSA showed patency. All AVMs were fully obliterated, with 100% concordance among all modalities. ICG averaged 4.2 mg dose/run (1-4 doses/case); 1.25 mg was the lowest dose allowing visualization with no advantage with escalating dosages. There were no intraoperative/perioperative complications. CONCLUSIONS: In this preliminary study, ICG-E was safe and feasible, providing real-time visualization informing surgical decision making. The last 4 cases (2 aneurysms and 2 AVMs) evolved toward a portable handheld device, a readily accessible real-time modality providing contextual anatomic and flow visualization. Larger studies are needed to assess broader safety, dose escalation, and efficacy.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiofluoresceinografia/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Angiografia Cerebral/instrumentação , Corantes , Estudos de Viabilidade , Angiofluoresceinografia/instrumentação , Humanos , Verde de Indocianina , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/métodos
12.
Cardiology ; 145(3): 126-129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32007999

RESUMO

A 38-year-old female with anomalous left coronary artery from the pulmonary artery presented with refractory angina (Canadian Cardiovascular Society [CCS] class 4). Having failed two previous internal mammary artery grafts to the left anterior descending artery and with no percutaneous revascularization options, she underwent coronary sinus reducer implantation, which improved her symptoms (CCS 0), quality of life, and corresponded to an improvement in ischemia on myocardial perfusion scanning. This case report describes an unusual case of refractory angina in the context of congenital heart disease, illustrates the benefit of this novel hourglass-shaped stent in improving ischemia, quality of life, depression and anxiety, and highlights the importance of managing these patients in multidisciplinary teams.


Assuntos
Angina Pectoris/cirurgia , Artéria Coronária Esquerda Anormal/cirurgia , Seio Coronário/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/fisiopatologia , Artéria Coronária Esquerda Anormal/diagnóstico por imagem , Artéria Coronária Esquerda Anormal/fisiopatologia , Angiografia Coronária , Seio Coronário/diagnóstico por imagem , Seio Coronário/fisiopatologia , Feminino , Humanos , Qualidade de Vida , Stents , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
13.
J Neurol Surg A Cent Eur Neurosurg ; 81(3): 261-263, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32107756

RESUMO

We describe a new method for preventing galvanic corrosion induced by contact between old and new clips of different materials during clipping for recurrent intracranial aneurysms. After applying a new clip to the aneurysm neck close to the old clip, a Gore-Tex (GORE PRECLUDE; W.L. Gore & Associates, Inc., Newark, Delaware, United States) sheet is interposed to prevent contact between the old and new clip. The procedure was used successfully in three cases. The present technique is beneficial for the treatment of recurrent intracranial aneurysms to prevent galvanic corrosion when encountering difficulty in removing a previously placed clip.


Assuntos
Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Cirúrgicos Vasculares/instrumentação , Idoso , Corrosão , Feminino , Humanos , Procedimentos Neurocirúrgicos/métodos , Politetrafluoretileno , Recidiva , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/métodos
14.
Biomed Res Int ; 2020: 9289321, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32051830

RESUMO

Objective: It is sometimes difficult to obtain complete/partial response of large hepatocellular carcinoma (HCC) nodules by trans-arterial chemoembolization/embolization (TACE/TAE). The aim is retrospective investigation of tumor response of large HCC nodules (>7 cm) treated by the new TACE technique, repeated alternate infusion of cisplatin solution, and sparse gelatin slurry under balloon occlusion (RAIB-TACE). Materials and Methods. A microballoon catheter was placed at a proximal portion of the hepatic artery (subsegmental to the lobar level hepatic artery), and alternate infusion of cisplatin solution and sparse gelatin slurry were repeated under balloon occlusion until stasis of gelatin slurry beyond the catheter was seen. RAIB-TACE of multiple proximal hepatic and extrahepatic collateral arteries were performed to treat hemi-lobe or more of the liver while avoiding infusion into gastric and cystic arteries for 19 large nodules (>7 cm) in 19 patients without portal venous invasion. All patients underwent dynamic CT/MRI 1-3 months after RAIB-TACE, and tumor response of each large nodule was evaluated based on modified RECIST criteria. Results: CR, PR, SD, and PD were achieved in 11, 8, 0, and 0 nodules, respectively. CR and PR were considered as success, and the ratio of success was 100%. Major complications were abscess formation in the necrotic nodule (n = 1) which was treated by drainage tube placement, and subsegmental level liver infarction (n = 1) which was treated by drainage tube placement, and subsegmental level liver infarction (. Conclusion: New TACE technique, RAIB-TACE, was useful to achieve successful response of large HCC nodules.


Assuntos
Oclusão com Balão/métodos , Carcinoma Hepatocelular/cirurgia , Cisplatino/administração & dosagem , Gelatina/administração & dosagem , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Feminino , Artéria Hepática , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/instrumentação
15.
In Vivo ; 34(1): 433-439, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882510

RESUMO

BACKGROUND/AIM: Restenosis and stent fractures are well-characterised treatment failures following femoropopliteal (FP) stent-based interventions. We aimed to determine patterns of restenosis and fracture rates following focal stenting of FP arteries. PATIENTS AND METHODS: This retrospective study investigated angiographic patterns of restenosis and the occurrence of stent fractures following focal FP stenting with the multiple stent delivery system VascuFlex® Multi-LOC. RESULTS: We identified 10 patients with 10 (of 129) FP lesions (mean length 11.7±4.6 cm) and a total of 51 (of 646) Multi-LOC stents that underwent clinically driven target lesion revascularizations (TLR) after 11.5±9.2 months, due to symptomatic recurrence of stenosis. None of the Multi-LOC stents had fractured. No isolated in-stent restenosis (>50%) was observed. Median diameter lumen loss was significantly more pronounced at the inter-stent segments (27.0%) compared to in-stent segments (7.8%, p=0.023). CONCLUSION: No evidence of fracture or susceptibility to stent-related restenosis using Multi-LOC stents was observed. Focal FP stenting may be more effective when combined with strategies known to reduce restenosis in non-stented artery segments.


Assuntos
Constrição Patológica/terapia , Reestenose Coronária/terapia , Artéria Femoral/fisiopatologia , Artéria Poplítea/fisiopatologia , Stents/efeitos adversos , Procedimentos Cirúrgicos Vasculares/instrumentação , Idoso , Constrição Patológica/patologia , Reestenose Coronária/etiologia , Reestenose Coronária/patologia , Feminino , Artéria Femoral/cirurgia , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/métodos
16.
Gen Thorac Cardiovasc Surg ; 68(4): 411-413, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31531836

RESUMO

We describe a unique technique for pulmonary artery reconstruction using a bovine pericardial conduit after long-segment sleeve resection of the pulmonary artery. In this technique, the conduit tube was not created in advance but was sewn in situ from a bovine pericardial "sheet" step-by-step to form a desirable diameter, length and curve to fit the vascular defect. This is a safe and secure method to create desirable conduit for long and complex pulmonary artery replacement.


Assuntos
Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Técnicas de Sutura , Transplante Heterólogo/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adenocarcinoma/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Animais , Bioprótese , Bovinos , Humanos , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Pericárdio/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Suturas , Transplante Heterólogo/instrumentação , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/instrumentação
17.
World Neurosurg ; 134: 518-531, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31542444

RESUMO

Aneurysm clips are indispensable tools in the armamentarium of vascular neurosurgeons. The history of the development of aneurysm clips is witness to ingenuity and tenacity in treating a potentially devastating disease. Few know the stories of their innovators and the inspiration behind their designs. Hence, we present this historical vignette in an attempt to shed more light on the pioneers who shaped the evolution of aneurysm clips as we know them. A comprehensive literature search was performed using PubMed, Google Scholar, Google Books, and library historical archives, as well as personal communications with relatives, colleagues, and institutions of the surgeon-designers. We present the following aneurysm clip innovators and chronicle their biographies and contributions: Herbert Olivecrona (1891-1980), Frank Mayfield (1908-1991), Charles Drake (1920-1998), Joseph McFadden (1920-present), Thoralf Sundt Jr. (1930-1992), William M. Lougheed (1923-2004), William B. Scoville (1906-1984), Milton D. Heifetz (1921-2015), Gazi Yasargil (1925-present), Kenichiro Sugita (1932-1994), and Robert Spetzler (1944-present). Although this compilation of eponymous clips is by no means complete, we hope that it provides an informative historical perspective and an inspiration for aspiring neurosurgeons. The history of aneurysm surgery, an entity once deemed inoperable, teaches us the importance of innovation in medicine.


Assuntos
Aneurisma/cirurgia , Instrumentos Cirúrgicos/história , Procedimentos Cirúrgicos Vasculares/história , Procedimentos Cirúrgicos Vasculares/instrumentação , História do Século XX , História do Século XXI , Humanos
18.
Neurosurgery ; 86(2): 309-314, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30993336

RESUMO

BACKGROUND: Despite advances in robotic-assisted technology for cardiac and peripheral vascular interventions, a robotic-assisted platform for neurovascular intervention is not yet available. OBJECTIVE: To evaluate the feasibility of the CorPath® GRX robotic-assisted platform (Corindus Inc, Waltham, Massachusetts) for neurovascular interventions through preclinical study. METHODS: The robotic system was tested for its ability to accurately navigate a variety of common neurovascular devices in an in Vitro flow model and in a live, anesthetized pig, under conditions and following procedures appropriate for clinical intervention. An access catheter was introduced manually at the equivalent of the common carotid artery in both models. Endovascular wires and catheters were navigated through the external and internal carotid artery and posterior cerebral vasculature under robotic assistance, using 0.014 in guidewires, 2.4F/1.7F microcatheters, bare-metal stents, and embolic coils. RESULTS: All procedures in both the flow and porcine models, including navigation, wiring, and deployment of the stent and coils, were performed successfully with no technical complications. There was no evidence of extravasation, dissection, thrombosis, or other vascular injury when angiography was compared before and after the live-animal procedure. CONCLUSION: This is the first study to demonstrate that use of a robotic-assisted platform is feasible for intracranial neurovascular intervention. The robotic system was successful at navigating and deploying the small-gauge devices specific to neurovascular procedures. Given the potential benefits of robotic-assisted surgery for the patient and the surgeon, further investigation is warranted for this indication.


Assuntos
Circulação Cerebrovascular/fisiologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/métodos , Animais , Cateteres , Desenho de Equipamento/métodos , Estudos de Viabilidade , Feminino , Modelos Animais , Projetos Piloto , Stents , Suínos , Resultado do Tratamento
19.
Eur Radiol ; 30(4): 2152-2160, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31844961

RESUMO

OBJECTIVE: To assess the diagnostic accuracy of 256-row multislice computed tomographic angiography (CTA) compared with three-dimensional rotational angiography (3DRA) in the postoperative evaluation of cerebral aneurysms treated with titanium clips. METHODS: A total of 128 patients (42 men, 86 women; mean age, 57.6 years) with 143 cerebral aneurysms treated using titanium clips underwent both CTA and 3DRA. Two reviewers retrospectively evaluated the following parameters on CTA and 3DRA: (1) residual/recurrent aneurysm (absent or present), (2) patency of parent artery (patent or occluded/severe stenotic (> 70%)), and (3) patency of adjacent branch (patent or occluded/absent). RESULTS: A total of 24 residual/recurrent aneurysms were detected by 3DRA. The sensitivity, specificity, and accuracy of CTA for the detection of residual/recurrent aneurysms were 83.3%, 100%, and 97.2% for reviewer 1 and 79.2%, 100%, and 96.5% for reviewer 2, respectively. The sensitivity, specificity, and accuracy of CTA for the evaluation of patency of parent artery were 100%, 100%, and 100%, respectively, for both reviewers. The sensitivity, specificity, and accuracy of CTA for evaluation of the patency of adjacent branch were 85.1%, 100%, and 92.3% for reviewer 1 and 82.4%, 100%, and 90.9% for reviewer 2, respectively. CONCLUSION: A 256-row multislice CTA is a valuable non-invasive tool for assessment of cerebral aneurysms treated with titanium clips. KEY POINTS: • A 256-row multislice CTA is an accurate imaging technique for the postoperative assessment of cerebral aneurysms treated with titanium clips. • Sensitivity of CTA for the detection of residual/recurrent aneurysms was 79-83% compared with 3DRA. • CTA is still limited in detecting residual/recurrent aneurysms of < 2 mm and small adjacent branches.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Imagem de Difusão por Ressonância Magnética/métodos , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico , Tomografia Computadorizada Multidetectores/métodos , Titânio , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Angiografia Cerebral/métodos , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Instrumentos Cirúrgicos
20.
Neurol India ; 67(5): 1305-1309, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31744964

RESUMO

Background: Most of the neurointerventional procedures use various anticoagulants, antiplatelets, and fibrinolytic drugs, and it can predispose arterial access site complications. Safe and efficient closure arteriotomy site has extreme importance in reducing the morbidity. Percutaneous vascular closure devices (VCDs) enable us to close the arteriotomy sites. In this prospective study, we evaluated the factors affecting the safety and efficacy of Perclose ProGlide VCD in neurovascular interventions. Materials and Methods: In this prospective study, we have evaluated the safety and efficacy of 327 Perclose ProGlide devices deployed in 217 patients who underwent various neurointerventions in our institute from October 2014 to October 2016. Time to achieve hemostasis (TAH) was calculated for various groups and the statistical significance of mean values between groups was estimated. Results: Out of the 327 Perclose ProGlide deployed, complication rate was 0.91% and the mean TAH was 77.14 s. Assessment of TAH mean value showed statistically significant prolongation of TAH in obesity and those with larger arterial sheaths. Age, sex, post-heparin ACT, peri-procedure medications, and type of diseases had no significant role in increasing TAH. The evaluation also showed the presence of a learning curve in using this device. Conclusion: Perclose ProGlide VCD is safe and effective in closing the arteriotomy after neurointerventions. Obesity and larger arterial sheaths are independent factors prolonging the TAH. Learning curve associated with this device mildly increases the hemostatic time and device-related complications.


Assuntos
Artéria Femoral/cirurgia , Dispositivos de Oclusão Vascular , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos
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