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BACKGROUND/AIM: Lung percutaneous needle biopsy (PNB) under CT guidance can be performed with a single-needle or with a coaxial (CX) technique. This study evaluated the CX technique in a large cohort of patients who underwent to CT-guided lung PNB in our Institute over a period of 7 years. PATIENTS AND METHODS: We retrospectively collected and analyzed data relative to 700 CT-guided lung PNBs performed from August 2012 to August 2019 in 700 patients (M:F=436:264; mean age=69 years, range=6-93 years) with normal coagulation and pulmonary function. PNB was considered diagnostic if at least one of the collected tissue specimens allowed for histological diagnosis. Pulmonary hemorrhage (PH) and pneumothorax (PNX) were evaluated as present or absent. Statistical analysis was made by Chi-square test of Pearson, Fisher's exact test and Wilcoxon test. RESULTS: The CX technique showed a high diagnostic accuracy (93.0%) and allowed the collection of a great number of appropriate tissue specimens with a single pleural puncture (≥3 specimens in 77.4% of cases). PH was the complication more frequent (55.4%), without significant clinical impact. Global PNXs incidence was high (42.9%), but the introducer allowed to aspirate the PNX with a lower percentage of chest tube placement vs. PNXs not aspirated (6.3% and 13.3%, respectively). CONCLUSION: This large retrospective study confirmed the high diagnostic accuracy of lung PNB with the CX technique and allowed identification of significant factors to achieve a greater diagnostic power and decrease complication rates.

Asunto(s)

Enfermedades Pulmonares , Neumotórax , Humanos , Anciano , Biopsia con Aguja Gruesa , Estudios Retrospectivos , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/patología , Neumotórax/diagnóstico , Neumotórax/etiología , Neumotórax/epidemiología , Tomografía Computarizada por Rayos X , Hemorragia/diagnóstico , Hemorragia/etiología , Medición de Riesgo

RESUMEN

Introduction: Mechanical thrombectomy (MT) is the first line treatment in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Approximately half of patients treated with MT does not have a favorable outcome 3 months after stroke. The aim of this study was to identify predictors of futile recanalization (FR) in patients with LVO treated with MT. Methods: A retrospective analysis of consecutive patients with acute ischemic stroke due to anterior circulation LVO who underwent MT. Patients with a TICI score of 2b or 3 were included. We distinguished two groups, FR and meaningful recanalization (MR), according to patients' disability three months after stroke (FR: mRS score > 2; MR: mRS score < 2). Results: We enrolled 238 patients (FR, n = 129, 54.2%; MR, n = 109, 45.8%). Age (OR 1.05, 95% CI 1.01-1.09, p = 0.012), female sex (OR 2.43, 95% CI 1.12-5.30, p = 0.025), stress hyperglycemia, as measured by the GAR index, (OR 1.17, 95% CI 1.06-1.29, p = 0.002), NIHSS at admission (OR 1.15, 95% CI 1.07-1.25, p = 0.001) and time from symptoms onset to MT (OR 1.01, 95% CI 1.00-1.01, p = 0.020) were independent predictors of FR. The AUC for the model combining age, female sex, GAR index, NIHSS at admission and time from symptoms onset to MT was 0.81 (95% CI 0.76-0.87; p < 0.001). The optimal GAR index cut-off score to predict FR was 17.9. Discussion: FR is common after MT. We recognized older age, female sex and baseline NIHSS as non-modifiable predictors of FR. On the other hand, time from symptoms onset to MT and stress hyperglycemia were modifiable pre- and post-MT factors, respectively. Any effort should be encouraged to reduce the impact of these modifiable predictors.

RESUMEN

Background and Purpose: Flow diverting stents are designed to divert blood flow from the aneurysm sac, allowing for eventual occlusion following endovascular therapy. This case series reports clinical experience using the Silk Vista Baby (SVB, Balt Extrusion, Montmorency, France), a flow diverter (FD) designed to treat intracranial aneurysms in small, distal vessels. Methods: All patients who underwent treatment with SVB at the University Hospital "Santa Maria della Misericordia" of Udine between July 2018 and September 2020 were retrospectively identified. Baseline patient and aneurysm characteristics, intraprocedural technical outcomes, periprocedural complications, modified Rankin Scale (mRS) at discharge, magnetic resonance imaging (MRI) results at 3-month follow-up, and angiographic results at 6-month follow-up were collected. Results: A total of 18 patients (55.6% [10/18] male; mean age 62.6 years, range: 42-77 years) were retrospectively identified, receiving treatment for 22 aneurysms. Most patients were symptomatic (14/18, 77.8%) and approximately half had subarachnoid hemorrhage (10/18, 55.6%). Sufficient aneurysm coverage was achieved in 88.9% (16/18) of patients with a single device. Mortality did not occur (0/18, 0%); adverse device-related events included side branch occlusion (1/18, 5.6%) and in-stent thrombosis (1/18, 5.6%). At discharge, 77.8% (14/18) had an mRS of 0. In most cases, patients showed complete occlusion (10/15, 66.7%) or a small aneurysmal remnant (3/15, 20.0%) upon MRI; upon angiography, most showed complete occlusion (10/13, 76.9%) or only a small aneurysmal remnant (2/13, 15.4%). Conclusion: This case series showed that the SVB FD is safe and feasible to use in patients with aneurysms in small, distal vessels. Additional randomized, prospective studies with larger cohorts are needed for the SVB.