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1.
Medicine (Baltimore) ; 99(2): e18665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914055

RESUMO

We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ±â€Š1.53 vs 3.49 ±â€Š1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117-0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061-0.468; P = .001).Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.


Assuntos
Revascularização Cerebral/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Imagem de Difusão por Ressonância Magnética , Procedimentos Endovasculares/métodos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico
2.
J Trauma Acute Care Surg ; 88(2): 298-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31996655

RESUMO

BACKGROUND: Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) and intermittent REBOA (iREBOA) are techniques to extend the therapeutic duration of REBOA by balloon titration for distal flow or cyclical balloon inflation/deflation to allow transient distal flow, respectively. We hypothesized that manually titrated pREBOA would reduce blood losses and ischemic burden when compared with iREBOA. METHODS: Following 20% blood volume controlled hemorrhage, 10 anesthetized pigs underwent uncontrolled hemorrhage from the right iliac artery and vein. Once in hemorrhagic shock, animals underwent 15 minutes of complete zone 1 REBOA followed by 75 minutes of either pREBOA or iREBOA (n = 5/group). After 90 minutes, definitive hemorrhage control was obtained, animals were resuscitated with the remaining collected blood, and then received 2 hours of critical care. RESULTS: There were no differences in mortality. Animals randomized to iREBOA spent a larger portion of the time at full occlusion when compared with pREBOA (median, 70 minutes; interquartile range [IQR], 70-80 vs. median, 20 minutes; IQR, 20-40, respectively; p = 0.008). While the average blood pressure during the intervention period was equivalent between groups, this was offset by large fluctuations in blood pressure and significantly more rescue occlusions for hypotension with iREBOA. Despite lower maximum aortic flow rates, the pREBOA group tolerated a greater total amount of distal aortic flow during the intervention period (median, 20.9 L; IQR, 20.1-23.0 vs. median, 9.8 L; IQR, 6.8-10.3; p = 0.03) with equivalent abdominal blood losses. Final plasma lactate and creatinine concentrations were equivalent, although iREBOA animals had increased duodenal edema on histology. CONCLUSION: Compared with iREBOA, pREBOA reduced the time spent at full occlusion and the number of precipitous drops in proximal mean arterial pressure while delivering more distal aortic flow but not increasing total blood loss in this highly lethal injury model. Neither technique demonstrated a survival benefit. Further refinement of these techniques is necessary before clinical guidelines are issued.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Animais , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Modelos Animais de Doenças , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Análise de Sobrevida , Sus scrofa , Fatores de Tempo , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
3.
World Neurosurg ; 133: e796-e803, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605852

RESUMO

BACKGROUND: Techniques for endovascular management of carotid-cavernous fistulas (CCFs) have evolved over the years. Current strategies include transarterial or transvenous approaches and direct puncture or exposure of the cavernous sinus. Rarely, complex CCFs may require multiple approaches or procedures. We describe our experience managing CCFs, reporting on outcomes and technical nuances. METHODS: A retrospective review of institutional records was conducted to identify consecutive cases of CCF treated between July 2005 and July 2016. Pertinent technical details and outcomes were recorded. RESULTS: In 44 patients, 51 procedures were performed. There were 13 direct CCFs and 31 indirect CCFs: 13 (30%) type A, 3 (7%) type B, 5 (11%) type C, and 23 (52%) type D. A transarterial approach was selected in 39% of cases (n = 20), resulting in a long-term successful embolization rate of 60% (n = 12). Transvenous methods via the inferior petrosal sinus or superior ophthalmic vein were used in 49% of cases (n = 25), resulting in a long-term obliteration rate of 88% (n = 22). Multimodal management was required in 5 patients, including 1 patient in whom a craniotomy was performed to facilitate coil embolization of the cavernous sinus under direct vision. A 7% complication rate (n = 3) was observed, with significant morbidity in 1 patient. CONCLUSIONS: CCFs are complex vascular lesions that require facility with various endovascular and surgical approaches. High-flow, direct-type fistulas may harbor a significant risk of recurrence after transarterial embolization. Partial or unsuccessful embolization may necessitate an open surgical approach to the superior ophthalmic vein or cavernous sinus.


Assuntos
Fístula Carotidocavernosa/terapia , Seio Cavernoso/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
World Neurosurg ; 133: e600-e608, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568912

RESUMO

BACKGROUND: Evidence is lacking regarding the role of radiologic surveillance for asymptomatic intracranial aneurysms (AIAs) in the elderly (≥65 years). We sought to establish if long-term clinical and radiologic observation is warranted for older patients with AIAs. METHODS: A retrospective cohort of 193 consecutive patients with 255 AIAs were clinically and radiologically observed between January 2011 and January 2019. The primary end points were documented aneurysm growth, subarachnoid hemorrhage, or definitive treatment with microsurgical clipping or endovascular coiling. Baseline patient and aneurysm characteristics were obtained. Univariate and multivariate comparisons were performed. RESULTS: Aneurysm growth was observed in 8 patients (4.2%) at a median follow-up of 58.2 months (interquartile range, 38.4-78.5 months). The median aneurysm size at initial diagnosis was 3.5 mm (interquartile range, 2.2-5 mm). Aneurysms larger than 7 mm selected for surveillance were noted in 37 patients (19.2%). The growth rate was estimated at 0.2 mm per person-year. At the end of the study period, 175 patients (90.7%) were alive, 6 (3.1%) were lost to follow-up, and 12 (6.2%) died of unrelated causes. During the 1025.2 person-years follow-up, no patient had experienced subarachnoid hemorrhage, and none required definitive treatment. The presence of aneurysmal bleb (odds ratio, 6.02; 95% confidence interval, 1.15-31.43; P = 0.033) and multiple intracranial aneurysms (odds ratio, 10.98; 95% confidence interval, 1.27-94.91; P = 0.029) were associated with growth. CONCLUSIONS: AIAs in older patients deemed suitable for conservative management do not require robust follow-up. The current study suggests a potential role for closer surveillance for patients with multiple intracranial aneurysms or aneurysms with bleb morphology.


Assuntos
Aneurisma Intracraniano/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Tratamento Conservador , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Masculino , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologia , Tempo
5.
World Neurosurg ; 133: e487-e491, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31542440

RESUMO

BACKGROUND: Stenting may be a safer alternative to endarterectomy for treating carotid artery stenosis (CAS), but its long-term efficacy is uncertain. There is a lack of long-term and noncontrolled clinical trial data that reflects "real-world" CAS. This study aimed to analyze the long-term efficacy and safety of our center's CAS procedure. METHODS: We retrospectively analyzed our database of patients who underwent CAS. Patient demographic data, previous risk factors, diagnostic and procedural information, and clinical and image follow-up data were collected from up to 1 year after treatment. RESULTS: Overall, 187 patients were analyzed. Our patient population largely comprised higher-risk patients compared with the patient populations of randomized controlled trials. We had more symptomatic (n = 145, 77.5%) than asymptomatic patients (n = 42, 22.5%), and 49% of patients had >90% stenosis. By the 30-day follow-up, there were 10 major adverse events (5.3%) observed in 8 patients (4.2%), including 7 strokes (3 ischemic and 4 hemorrhagic) and 3 deaths. By the 1-year follow-up, 6 strokes and 5 deaths occurred in 9 patients (4.8%), and color Doppler control showed that 87.6% of patients had stenosis-free stents. CONCLUSIONS: Despite our high-risk population group, there were high rates of successful stent placement, low complication rates, good clinical outcomes, and low rates of stenting restenosis.


Assuntos
Estenose das Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Resultado do Tratamento
6.
World Neurosurg ; 133: e576-e582, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31561042

RESUMO

OBJECTIVE: To investigate the factors associated with futile recanalization after stent retriever thrombectomy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We retrospectively analyzed the medical records of 56 patients with an acute anterior circulation macrovascular occlusion who underwent successful stent retriever thrombectomy. Patients were classified as successful recanalization or futile recanalization at the follow-up. Univariate analysis and binary logic regression analysis were used to explore the association between patients' demographic and clinical characteristics and futile recanalization. RESULTS: The rate of futile recanalization was significantly higher after stent retrieval thrombectomy in patients with an Alberta Stroke Program Early CT (ASPECT) score ≤7 points versus >7 points (P < 0.001), ≥5 passes with the stent retriever versus <5 passes with the stent retriever (P = 0.036), or a longer recanalization time (P = 0.008). The influence of number of stent retriever pass is foremost, followed by ASPECT and occurrence to recanalization. CONCLUSIONS: Improving technical expertise with mechanical thrombectomy and shortening the therapeutic time window may improve the prognosis of patients with acute ischemic stroke due to large vessel occlusion.


Assuntos
Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents
8.
World Neurosurg ; 133: 392-397, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476475

RESUMO

BACKGROUND: Up to 3.2% of the adult population has an unruptured intracranial aneurysm (IA). Flow diversion is a relatively new treatment technique that is especially useful for large and morphologically unfavorable IAs. METHODS: A previously healthy woman aged 32 years presented with a 6-month history of ptosis and ophthalmoplegia of the left eye. A magnetic resonance imaging scan revealed a giant left internal carotid artery aneurysm. She was admitted for treatment using flow diversion. After delivery of the flow diverter (FD), prolapse of the proximal end of the stent into the aneurysmal sac was observed. FD stabilization was achieved by deploying multiple coils through a previously placed microcatheter to push the prolapsed end away from the aneurysmal lumen. RESULTS: The patient had a favorable outcome, with reduction of preoperative mass effect symptoms and complete obliteration of the aneurysm persisting at the 3-month follow-up. CONCLUSIONS: Giant IAs remain one of the most daunting clinical problems to treat. FD displacement is a rare (0.5%-0.75%) and possibly fatal complication. Currently, no clinical guidelines exist for its management. Adjunctive coiling is a possible rescue strategy for stabilizing an FD that foreshortened and prolapsed into the aneurysmal sac. Further studies are needed to identify the best approach to this complication.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Resultado do Tratamento
9.
Vasc Endovascular Surg ; 54(1): 89-92, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31551026

RESUMO

Endovascular stent placement (ESP) for patient with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a widely accepted treatment option. However, failed percutaneous ESP is not uncommon and is one of the leading causes for laparotomy. We report a case of 63-year-old man with SIDSMA encountered failed antegrade recanalization via conventional transfemoral approach. We achieved recanalization in a retrograde fashion through middle colic artery using rendezvous technique and successfully placed self-expandable stents inside the dissected superior mesenteric artery. The patient recovered well after percutaneous ESP. We herein describe the transcollateral retrograde approach of percutaneous ESP for SIDSMA as an alternative option when conventional antegrade recanalization fails.


Assuntos
Aneurisma Dissecante/terapia , Circulação Colateral , Procedimentos Endovasculares/métodos , Artéria Mesentérica Superior , Circulação Esplâncnica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
10.
Tech Vasc Interv Radiol ; 22(4): 100633, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864530

RESUMO

Arteriovenous malformations (AVMs) are fast flow malformations characterized by the presence of arteriovenous shunting. These congenital lesions can be evolutive, leading to serious complications such as bleeding, skin ulceration, and cardiac failure. The interventional radiologist plays an important role in the management of these patients. He should be involved in the clinical evaluation to make the proper diagnosis, evaluate the symptoms and potential indication for endovascular treatment. This evaluation should be done in a multidisciplinary clinic with access to plastic surgeons, internal medicine and dermatologist, as well as specific specialists that might need to be implicated (ENT surgeon in the face and neck area, for example). The Schobinger clinical classification is important to assess patient evolution and indicate intervention. We recommend to treat symptomatic or evolutive AVMs. Doppler ultrasound is the first imaging examination that should be performed. Then, MR angiography or computed tomography angiography (CTA) can be proposed depending on the anatomic area involved. Embolization is currently the first line of treatment for these patients. There is currently promising research in the identification of genetic markers and molecular target(s) but there is no recognized pharmacologic treatment for AVM available yet. Digital substraction angiography (DSA) is usually performed for guidance during the embolization session but is also essential to properly classify a specific lesion, according to its anatomy. The anatomic classifications proposed by Cho and Yakes are both useful to choose the best therapeutic approach: Endovascular, direct puncture, retrograde venous approach or a combination of these techniques. Ethanol is the most efficient agent but is at higher risk of skin necrosis and nerve injury and should therefore be used with caution in dangerous territories. Glue and Onyx are liquid agents that are also well suited to occlude the nidus; they can be used in association with ethanol. On the venous side, mechanical occlusion with coils or Amplatzer plugs is mostly used. Again, they can be used in association with a liquid agent (Ethanol, glue or Onyx) to reflux in the nidus. Surgery can be indicated to resect residual AVM following embolization if residual symptoms are present and the planned surgery is feasible, with relative safety.


Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Angiografia Digital , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Radiografia Intervencionista/métodos , Resultado do Tratamento
11.
Angiol Sosud Khir ; 25(4): 76-82, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855203

RESUMO

An abdominal aortic aneurysm is one of frequently encountered cardiovascular diseases, which is often accompanied by an aneurysm of the common and/or internal iliac arteries. Recent trends are towards increased use of endovascular methods of treatment, associated with a certain risk for the development of type IIa endoleaks. This raises the question as to the necessity of embolization of the internal iliac artery while covering it with a stent graft. Our study included a total of 20 patients operated on for abdominal aortic aneurysms combined with aneurysms of the common and/or internal iliac arteries. In order to evaluate the obtained outcomes, the patients were divided into 4 groups depending on the intervention performed. The scope of the performed operations varied from endoprosthetic repair of an abdominal aortic aneurysm with coverage of one internal iliac artery without embolization to endoprosthetic repair of an abdominal aortic aneurysm with coverage of both internal iliac arteries with embolization. In the latter event, two-stage interventions were performed. The duration of follow up amounted to more than 3 years. We assessed the short- and long-term outcomes, with zero lethality and the absence of either specific or non-specific complications observed. Embolization increases the duration of the operation and X-ray exposure, as well as the amount of the contrast medium, thus casting doubt upon the necessity of carrying it out, since the immediate and remote results do not differ as compared with mere coverage of the internal iliac artery.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Embolização Terapêutica , Procedimentos Endovasculares/métodos , Artéria Ilíaca/cirurgia , Humanos , Estudos Retrospectivos , Stents , Resultado do Tratamento
12.
Angiol Sosud Khir ; 25(4): 173-180, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855215

RESUMO

Described herein is a clinical case report regarding treatment of a 70-year-old male patient presenting with a late complication following endoprosthetic repair for a Stanford type B dissecting thoracic aortic aneurysm. The man was admitted to our hospital for persistent type IIb endoleak and an increased diameter of the aorta in its thoracic and thoracoabdominal portions. Two years previously, he had endured endoprosthetic repair of the thoracic aorta. The findings of computed tomography revealed negative dynamics manifesting as an increase in the diameter of the false channel of the arch and descending thoracic aorta with persistent type IIb endoleak. He was subjected to elimination of abdominal aortic dissection and type IIb endoleak with partial prosthetic repair of the descending thoracic portion of the aorta by means of prosthetic repair of the lower thoracic portion of the aorta between the stent graft and linear vascular Dacron prosthesis. The postoperative period was complicated by transient acute renal failure and paraparesis of the lower limbs. The patient was discharged on POD 14, with no endoleaks revealed on control computed tomography 3 months thereafter.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Lesão Renal Aguda/etiologia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/métodos , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/métodos , Humanos , Masculino , Paraparesia/etiologia , Stents , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(50): e18241, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852089

RESUMO

T helper 17 (Th17) cells are related to the progression of aortic dissection. This study aimed to determine whether circulating Th17 levels are associated with the prognosis of acute Stanford type B aortic dissection (STBAD) after thoracic endovascular aortic repair (TEVAR).A cohort study was performed and STBAD patients (n = 140) received TEVAR were enrolled, the circulating Th17 levels were measured and the patients were divided into low and high Th17 groups, and 36 months of follow-up was performed. The data for mortality, survival outcomes, heart structure and function changes, aortic regurgitation prevalence, and aortic remodeling outcomes were recorded.Lower mortality and fewer complications were observed in the low Th17 group than in the high Th17 group in the third year of follow-up. In addition, the low Th17 group exhibited better cardiac remodeling and cardiac function when compared with that in the high Th17 group in the second to third year after TEVAR. Aortic reflux was improved in both groups but was more pronounced in the low Th17 group. During follow-up, the true lumen of the proximal thoracic aorta at the level of the celiac trunk in both the low and high Th17 groups continuously enlarged and was more pronounced in the low Th17 group.Circulating Th17 cells were related to cardiac and aortic remodeling and prognosis during STBAD after TEVAR. Anti-inflammatory therapy may be useful for STBAD patients who have undergone TEVAR.


Assuntos
Aneurisma Dissecante/sangue , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/sangue , Procedimentos Endovasculares/métodos , Células Th17/patologia , Remodelação Vascular , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
14.
J Comput Assist Tomogr ; 43(6): 948-952, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31688249

RESUMO

PURPOSE: This study aimed to evaluate the image quality and degree of metal artifact reduction using the new-generation gemstone spectral imaging (GSI) and metal artifact reduction software (MARs) and to demonstrate the optimal monochromatic energy level for dual-energy cerebral computed tomography angiography (CTA) in patients with intracranial aneurysm after endovascular treatment. MATERIAL AND METHODS: A total of 20 patients with cerebral aneurysms treated with coils or clips underwent CTA using gemstone spectral computed tomography. Artifact index was calculated at each energy level with and without MARs. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated on all axial images with MARs; subjective evaluation was done by using a 4-point scale and a 3-point scale for assessing noise and vessel contrast, respectively, and compared between the monochromatic energy levels. RESULTS: The artifact index value of group GSI-MARs was significantly lower than that of group GSI at each monochromatic energy level (all, P < 0.01). Contrast-to-noise ratio and SNR of the parent arteries decreased as the energy increased from 40 to 140 keV in group GSI-MARs (all, P < 0.01). Signal-to-noise ratio and CNR between each 2 adjacent monochromatic energy level showed significant difference (all, P < 0.01). Subjective evaluation showed that a monochromatic energy level between 40 and 70 keV provided the optimal image quality. CONCLUSION: Gemstone spectral imaging with MARs could reduce metal artifacts and improve the image quality of cerebral CTA after coil or clip treatment. The new generation of GSI could provide better CNR and SNR at lower energy level, and the best image quality was obtained at energy level 40 to 70 keV for GSI-MARs.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Intensificação de Imagem Radiográfica/métodos , Adulto , Idoso , Artefatos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , Razão Sinal-Ruído , Software
15.
Tex Heart Inst J ; 46(3): 183-188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708700

RESUMO

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11-18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Endoleak/prevenção & controle , Procedimentos Endovasculares/métodos , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia , Seguimentos , Humanos , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
J Cardiovasc Surg (Torino) ; 60(5): 567-571, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31778065

RESUMO

Chronic total occlusion (CTO) is a common finding during endovascular treatment of peripheral arterial disease. The treatment of CTOs is a challenging task, which requires good knowledge of the devices and their specific characteristics and skills to different techniques for crossing. As a matter of fact, any dedicated center treating patients with peripheral arterial disease requires an adequate consignment stock regarding wires, catheters, balloons and some specific devices for challenging anatomic scenarios. Herein, the most important steps of a successful recanalization of a femoropopliteal CTO are summarized together with a number of tips regarding utilization of different techniques and specific devices.


Assuntos
Procedimentos Endovasculares/métodos , Artéria Femoral , Doença Arterial Periférica/terapia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
17.
Medicine (Baltimore) ; 98(48): e18203, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770276

RESUMO

The aim of this study was to evaluate the safety and clinical effectiveness of endovascular stent repair of celiac arterial aneurysm (CAA).From January 2015 to December 2018, 11 patients (7 males, 4 females with a mean age of 52.2 ±â€Š7.9 years) underwent endovascular stent repair of CAA in our center. A covered stent was used to occlude the CAA neck. Follow-up was performed 2 weeks and 1, 3, 6, and 12 months following surgery and yearly thereafter. Rates of technical success, treatment-related complications, and long-term outcome were analyzed.Each patient was placed with 1 stent for repair of CAA. Stent was placed in the celiac and common hepatic arteries for 10 patients and was placed in the celiac artery for 1 patient. The duration of the procedure ranged from 50 to 75 minutes (mean 63.2 ±â€Š7.2 minutes). The rate of technical success of the endovascular stent repair was 100%. No patient experienced CAA rupture or instant endoleak during or after stent insertion. Abdominal pain was relieved progressively after stent insertion. All patients were followed-up for 6 to 48 months (mean 22.4 ±â€Š10.8 months). All patients were alive during the follow-up. No endoleaks were experienced during follow-up with 100% stent patency rate. No patient suffered splenic, hepatic, or bowel infarction during follow-up.Endovascular stent repair is a safe, simple, and effective treatment for patients with CAA.


Assuntos
Aneurisma , Implante de Prótese Vascular , Artéria Celíaca , Procedimentos Endovasculares , Complicações Pós-Operatórias/epidemiologia , Stents , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Aneurisma/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/patologia , Artéria Celíaca/cirurgia , China/epidemiologia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Efeitos Adversos de Longa Duração/epidemiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
18.
BMC Neurol ; 19(1): 245, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640586

RESUMO

BACKGROUND: The purpose of this study was to report our preliminary experience of stent-assisted coiling (SAC) of wide-necked intracranial aneurysms with a single microcatheter in patients with parent arteries that were small-caliber, with stenosis, or a very tortuous course. METHODS: Between March 2018 and December 2018, we treated 394 aneurysms in 359 patients with endovascular treatment. Among 197 aneurysms treated by SAC, there were 16 cases (all wide-necked unruptured aneurysms) treated by SAC with a single microcatheter and a Neuroform Atlas stent. Follow-up angiography was performed at 6 to 12 months after SAC, and clinical follow-up was performed from 6 to 12 months in all patients. RESULTS: The reasons for SAC with a single 0.0165-in. microcatheter were small-caliber (n = 4), stenosis (n = 2), and very tortuous course (n = 10) of the parent arteries. There was no complication related to delivering or deploying the Neuroform Atlas stent as well as no failure of selecting aneurysm by cell-through technique. All patients had a modified Rankin score of 0 at discharge and at follow-up. Initial angiographic results showed six cases (37.5%) of complete occlusion. In follow-up angiographies, 12 cases (75.0%) achieved compete occlusion. CONCLUSION: When performing SAC of wide-necked intracranial aneurysms in parent arteries with small-caliber, stenosis, or a very tortuous course, cell-through SAC using a single microcatheter and a Neuroform Atlas stent within a 5 Fr- (or smaller) guiding or intermediate catheter might be a useful option.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Idoso , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
19.
Heart Surg Forum ; 22(5): E380-E384, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31596716

RESUMO

OBJECTIVE: To explore the feasibility of endovascular reconstruction of aortic root including aortic valve, sinus of valsalva and ascending aorta by a single stent-graft, a novel valved stent-graft with two fenestrae for preserving the coronary arteries was designed and performed in-vitro on a pig heart based circulation simulating system. METHODS: Pig hearts were harvested from 30 healthy adult female pigs weighing between 60-65 kilograms. Before sacrifice, all the pigs received aortic computed tomography angiography (CTA) examinations and morphologic parameters of aortic root were measured. Then we customized the valved stent-grafts according to the CTA measurements. After the pig heart was fixed on the special platform according to the original orientation and connected to the circulation system, the stent graft was delivered through transapical access and covered the segment from aortic annulus to proximal part of aortic arch under DSA (digital subtraction angiography) guidance. Then changes of coronary flow before and after the procedure and fenestration alignment with coronary ostia were analyzed. RESULTS: The overall technical success rate was 100%. The valve functions tested by ultrasound were in good condition under 120 mmHg circulation pressure. The flow of left coronary artery (LCA) did not decrease, but increased after the stent-graft implantation (340 ± 2.06 mL/min versus 288 ± 5.29 mL/min, P < .05). Similarly, the flow of right coronary artery (RCA) also increased (392 ± 9.17 mL/min versus 348 ± 8.01 mL/min; P < .05). The final angiography confirmed that both coronary arteries were patent. When generally observed from outer wall of valsalva sinus, both RCA and LCA orifices were aligned with the fenestrae. In 4 cases, the autologous valve leaflets blocked nearly 20% of the LCA fenestra's area, but the flow did not significantly decrease in these cases. CONCLUSION: Stimulated on a pig heart-based circulation simulation system, the one-piece valved-fenestrated stent graft with a branch could be delivered via the transapical access and deployed accurately, which achieved endovascular reconstruction of aortic valve, sinus of valsalva and ascending aorta while preserving the coronary artery perfusion by fenestrations. More in-vivo experiments on animal models are mandatory to further verify its efficacy and safety.


Assuntos
Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Stents , Angiografia Digital , Animais , Angiografia por Tomografia Computadorizada , Circulação Coronária , Vasos Coronários/cirurgia , Estudos de Viabilidade , Feminino , Técnicas In Vitro , Tratamentos com Preservação do Órgão/métodos , Estudo de Prova de Conceito , Procedimentos Cirúrgicos Reconstrutivos/métodos , Seio Aórtico/cirurgia , Técnicas de Sutura , Suínos
20.
West Afr J Med ; 36(3): 286-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622495

RESUMO

Stroke is a leading cause of disability and mortality globally. In the first few hours after ischaemic stroke, the severity and irreversibility of brain injury increase as time passes. The primary goal of the emergent management of acute ischaemic stroke is stabilization and reperfusion of the ischaemic penumbra if eligibility criteria are met and contraindications are ruled out. The primary reperfusion strategies are administration of intravenous tissue plasminogen activator (IV tPA) and endovascular thrombectomy (EVT). Close monitoring is warranted prior to, during, and after these reperfusion procedures to detect early neurologic deterioration that may signify complications from treatment.


Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Fibrinolíticos/administração & dosagem , Reperfusão/métodos , Acidente Vascular Cerebral/cirurgia , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Administração Intravenosa , Isquemia Encefálica/diagnóstico , Humanos , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
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