RESUMEN
BACKGROUND: The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. METHODS: A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. RESULTS: In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. CONCLUSION: The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.
Asunto(s)
Procedimientos Endovasculares , Aneurisma Intracraneal , Arteria Radial , Humanos , Embolización Terapéutica/métodos , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/terapia , Aneurisma Intracraneal/diagnóstico por imagen , Arteria Radial/cirugía , StentsRESUMEN
The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.
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Arterias Carótidas , Embolización Terapéutica , Procedimientos Endovasculares , Fístula Esofágica/terapia , Estenosis Esofágica/terapia , Implantación de Prótesis/instrumentación , Stents , Fístula Vascular/terapia , Arterias Carótidas/diagnóstico por imagen , Preescolar , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/instrumentación , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/etiología , Estenosis Esofágica/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Implantación de Prótesis/efectos adversos , Recurrencia , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiologíaRESUMEN
Abstract This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.
Resumo Trata-se de uma revisão sistemática conduzida de acordo com o PRISMA 2009 (Principais Itens para Relatar Revisões Sistemáticas e Metanálises) que incluiu estudos em que a melhora dos parâmetros seminais tenha sido um dos desfechos. Esta revisão foi realizada com o objetivo de avaliar as evidências sobre o papel da embolização com uso apenas de molas na melhora de parâmetros seminais em homens com varicocele, uma vez que a embolização apenas com molas é o método com melhor custo-benefício para o reparo de varicoceles. A qualidade dos estudos foi analisada com o índice MINORS. Em seis estudos clínicos retrospectivos e em outros dois prospectivos observacionais ou comparativos, a concentração seminal melhorou significativamente em todos os cinco estudos que avaliaram esse parâmetro. A motilidade seminal melhorou significativamente em sete estudos. Não foi possível analisar o impacto da embolização com molas na densidade seminal.
Asunto(s)
Humanos , Masculino , Adulto , Adulto Joven , Varicocele/terapia , Embolización Terapéutica/instrumentación , Valores de Referencia , Embolización Terapéutica/métodos , Análisis de SemenRESUMEN
Background and Purpose- Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods- BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective, interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results- Between December 2016 and October 2018, 146 patients harboring 183 intracranial aneurysms were treated in 151 interventions at 7 centers. Derivo Embolization Device placement was technically successful in all patients. Most aneurysms (86.9%) were located at the internal carotid artery, and the mean diameter was 6.7 mm. At 6 months, 113 of 140 (80.7%) aneurysms met the study's primary end point, and 74 of 83 (89.2%) met the study's primary end point at 12 months. Saccular morphology of the aneurysm (odds ratio, 5.66; 95% CI, 1.01-31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11-22.36) predicted persistence. A long duration of follow-up (odds ratio, 0.86; 95% CI, 0.78-0.95) predicted total occlusion. Of the 146 enrolled patients, 138 (94.5%) were treated without serious adverse events during follow-up. In the multivariable analysis, aneurysms located at a sidewall were less likely to experience these events than those located at bifurcations (odds ratio, 0.07; 95% CI, 0.01-0.51). Conclusions- The Derivo Embolization Device is a safe and effective treatment for intracranial aneurysms. Clinical Trial Registration- URL: http://plataformabrasil.saude.gov.br/login.jsf. Unique identifier: CAAE 77089717.7.1001.5125.
Asunto(s)
Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Stents Metálicos Autoexpandibles , Adulto , Anciano , Brasil/epidemiología , Embolización Terapéutica/métodos , Femenino , Humanos , Aneurisma Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Resultado del TratamientoRESUMEN
Treatment with a pipeline embolization device (PED) is widely accepted as an excellent option for patients harboring giant, wide neck, saccular intracranial aneurysms. It has been shown to be safe and very effective. We describe a previously unreported case of a large middle cerebral artery aneurysm, related to the carotid tip, that was treated with a PED and coils. The 6 month follow-up angiogram demonstrated complete occlusion of the aneurysm. However, the 9 month angiogram revealed recurrent filling of the aneurysm sac. To our knowledge, this is the first report to describe recanalization of an aneurysm totally occluded on the control angiography after treatment with a PED. Unanswered questions include the mechanism of recanalization and the need for additional control angiograms and MRI following a previous examination revealing total aneurysm occlusion.
Asunto(s)
Prótesis Vascular , Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Anciano , Prótesis Vascular/tendencias , Angiografía Cerebral/métodos , Embolización Terapéutica/tendencias , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/tendencias , Femenino , Humanos , Imagen por Resonancia Magnética/tendencias , Recurrencia , Resultado del TratamientoRESUMEN
PURPOSE: Endovascular therapy for the treatment of cerebral aneurysms has a higher incidence of rebleeding and a lower occlusion rate than microsurgical clipping. This study investigated whether first coil volume packing density (1st VPD) and first loop diameter of the first coil (1st LD) are associated with recanalization after endovascular coiling. METHODS: The study included 174 initial saccular aneurysm cases from 2010 to 2015. Between the recanalization and non-recanalization groups, we compared age, sex, aneurysm location, rupture occurrence, shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, coil volume, VPD, 1st VPD, 1st LD, relation of the first loop diameter of the first coil and the maximum aneurysm size (RLAS), types of assistance techniques, and the Raymond scale score at initial and follow-up angiography. RESULTS: Recanalization occurred in 41 cases (23.6%). The factors associated with recanalization were irregular shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, VPD, 1st VPD and 1st LD smaller than the maximum aneurysm size. The cut-off values for aneurysmal recanalization were 92%, 11% and 37% for RLAS, 1st VPD and VPD, respectively. CONCLUSION: The 1st VPD and 1st LD were associated with aneurysmal recanalization after embolization. These factors provide a helpful index for coil programming.
Asunto(s)
Embolización Terapéutica/métodos , Aneurisma Intracraneal/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Roto/terapia , Estudios de Casos y Controles , Angiografía Cerebral , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/métodos , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/patología , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Curva ROC , Recurrencia , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
A significant prosthetic paravalvular leak is an uncommon and severe postsurgical complication correlated to the occurrence of congestive heart failure and hemolytic anemia. Percutaneous treatment has become an attractive and effective proposal to relieve symptoms and reduce complications in patients whose high rate of morbidity/mortality precludes a new surgery. This is the case of an 81-year-old patient with a history of biological aortic valve replacement seeking medical help due to heart failure and hemolytic anemia, with a prosthetic paravalvular regurgitation jet and high surgical mortality according to EuroSCORE II.
Asunto(s)
Bioprótesis/efectos adversos , Embolización Terapéutica/instrumentación , Insuficiencia Cardíaca/terapia , Prótesis Valvulares Cardíacas/efectos adversos , Dispositivo Oclusor Septal , Anciano de 80 o más Años , Ecocardiografía Transesofágica , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , MasculinoRESUMEN
Abstract A significant prosthetic paravalvular leak is an uncommon and severe postsurgical complication correlated to the occurrence of congestive heart failure and hemolytic anemia. Percutaneous treatment has become an attractive and effective proposal to relieve symptoms and reduce complications in patients whose high rate of morbidity/mortality precludes a new surgery. This is the case of an 81-year-old patient with a history of biological aortic valve replacement seeking medical help due to heart failure and hemolytic anemia, with a prosthetic paravalvular regurgitation jet and high surgical mortality according to EuroSCORE II.
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Bioprótesis/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Embolización Terapéutica/instrumentación , Dispositivo Oclusor Septal , Insuficiencia Cardíaca/terapia , Ecocardiografía Transesofágica , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiologíaRESUMEN
OBJECTIVE: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. METHODS: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. RESULTS: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). CONCLUSIONS: Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol.
Asunto(s)
Embolización Terapéutica , Hemorragia/etiología , Aneurisma Intracraneal/terapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Premedicación , Trombosis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Roto/complicaciones , Aneurisma Roto/terapia , Niño , Estudios Transversales , Embolización Terapéutica/instrumentación , Femenino , Hemorragia/inducido químicamente , Humanos , Aneurisma Intracraneal/complicaciones , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Trombofilia/tratamiento farmacológico , Trombofilia/etiología , Trombosis/prevención & control , Adulto JovenRESUMEN
BACKGROUND: Aspirin is a promising medical therapy for the prevention of intracranial aneurysm (IA) rupture. Recently, we found that men have a better response to aspirin than women. The purpose of this study was to determine whether a sex differential exists in the level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in the lumen of human IAs. METHODS AND RESULTS: Consecutive patients undergoing coiling or stent-assisted coiling for a saccular IA at our institution were enrolled. Two samples (A and B) were collected from IA lumens, and the plasma level of 15-PGDH was measured using an ELISA-based method. The study included 38 patients, with 20 women and 18 men. Women and men were comparable on baseline characteristics. The mean plasma concentration of 15-PGDH did not differ statistically between sample A (62.8±16.2 ng/mL) and sample B (61.8±17.9 ng/mL; 95% confidence interval -6.6 to 9.4). The mean plasma concentration of 15-PGDH in IA lumens of samples A and B was significantly higher in men (73.8±13.5 ng/mL) than women (49.6±7.8 ng/mL; P<0.0001). CONCLUSIONS: Higher enzyme levels of 15-PGDH exist in the lumen of IAs of men compared with women. This observation could explain why aspirin confers better protection against IA rupture in men than in women. The susceptibility of an individual to aspirin may differ according to the level of 15-PGDH.
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Hidroxiprostaglandina Deshidrogenasas/sangre , Aneurisma Intracraneal/enzimología , Adulto , Anciano , Aspirina/uso terapéutico , Biomarcadores/sangre , Fármacos Cardiovasculares/uso terapéutico , Embolización Terapéutica/instrumentación , Femenino , Humanos , Aneurisma Intracraneal/sangre , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/terapia , Masculino , Persona de Mediana Edad , Factores Sexuales , Stents , Regulación hacia ArribaRESUMEN
PURPOSE: To describe a novel configuration of pipeline embolization device for internal carotid bifurcation region aneurysm, named horizontal stenting. CLINICAL PRESENTATION: A 64-year-old woman, with visual deficit, harboring a large wide-necked aneurysm located at the junction between left internal carotid artery and left A1 segment of anterior cerebral artery, was submitted to endovascular treatment. As she had pre-existing occlusion of left internal carotid, approach from the contralateral internal carotid was used to advance the pipeline embolization device through the anterior communicating artery and place the flow diverter horizontally across the neck (from M1 to A1). Coil embolization was also performed through a microcatheter navigated via posterior communicating artery. The intervention was uneventful, with total aneurysm occlusion. Patient presented with visual improvement on follow-up. CONCLUSION: Horizontal deployment of pipeline embolization device appears to be an acceptable and feasible alternative to treat internal carotid bifurcation aneurysms. Long-term follow-up and a greater number of cases are mandatory to establish the safety of this strategy.
Asunto(s)
Enfermedades de las Arterias Carótidas/cirugía , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Aneurisma Intracraneal/cirugía , Implantación de Prótesis/métodos , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Análisis de Falla de Equipo , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana Edad , Diseño de Prótesis , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: Stent-assisted coil embolization is an established endovascular technique for wide-necked intracranial aneurysms. Although recanalization after coil embolization is reduced with the use of a stent, the impact of aneurysm packing density is less clear in stent-coiled aneurysms. The purpose of the present study was to assess packing density in stent-coiled aneurysms and evaluate its effect on recanalization and retreatment. METHODS: A retrospective analysis of consecutive aneurysms treated with stent-assisted coiling was performed at 2 academic institutions between 2007 and 2015. Aneurysm occlusion was assessed using digital subtraction angiography. Packing density was calculated using the AngioCalc app. RESULTS: Two hundred fifty-three aneurysms were identified (median age, 59 years). The median packing density was 35.3%. At last follow-up, 72.7% of aneurysms were completely obliterated and 19.4% had a neck remnant. Complete occlusion was associated with smaller aneurysms and coiling through stent interstices. A higher packing density was associated with increased rate of complete occlusion when analyzed as continuous variable. After adjustment for confounding variables, packing density was no longer predictive of complete occlusion (odds ratio = 1.018, P = 0.122). Similarly, there was no significant association between aneurysm occlusion, retreatment, and packing density when assessed by categories of high (>22%), moderate (12%-22%), and low (<12%) packing density. CONCLUSIONS: Aneurysm size remains the most important predictor of aneurysm recanalization and retreatment after stent-assisted coiling. Although higher packing densities were associated with increased rates of aneurysm occlusion in unadjusted statistical comparisons, this finding was no longer significant after adjusting for confounders.
Asunto(s)
Aneurisma Roto/epidemiología , Aneurisma Roto/terapia , Embolización Terapéutica/estadística & datos numéricos , Aneurisma Intracraneal/epidemiología , Aneurisma Intracraneal/terapia , Stents/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital/estadística & datos numéricos , Prótesis Vascular/estadística & datos numéricos , Terapia Combinada/estadística & datos numéricos , Embolización Terapéutica/instrumentación , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Prevalencia , Estudios Retrospectivos , América del Sur/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To report of experience of intrauterine hydrostatic condom to control obstetric hemorrhage. MATERIAL AND METHOD: Descriptive, retro-prospective study. The method was use in patients who had obstetric hemorrhage and do not responded to medical management during the period from March 1st to August27, 2015 in a rural facility. RESULTS: 955 patients that had a vaginal delivery were identified, 40 (4.1%) of which needed the application of the method. The method was unsuccessful in 2 of 40 patients (5%), one requiring emergency obstetric hysterectomy and other exploratory laparotomy with conservative measures. 11 of 40 patients (2 7.5%) required at least 1-3 globular packs transfusion. None of the 38 patients (95%) who responded to the method presented endometritis in the postpartum follow up or complications associated with the use of hydrostatic condom. CONCLUSION: The use of intrauterine hydrostatic condom is an effective method to control postpartum obstetric hemorrhage secondary to uterine atony unresponsive to medical management.
Asunto(s)
Embolización Terapéutica/métodos , Hemorragia Posparto/terapia , Adolescente , Adulto , Condones , Embolización Terapéutica/instrumentación , Femenino , Humanos , Estudios Prospectivos , Estudios Retrospectivos , Útero , Adulto JovenRESUMEN
BACKGROUND: Choroid plexus papilloma is a rare intracranial neoplasm derived from choroid plexus epithelium accounting for less than 1 % of all brain tumors. These tumors are highly vascularized, and tumor resection is difficult, especially in small children, due to severe intraoperative bleeding. Preoperative embolization is helpful to reduce intraoperative bleeding, but it may not be possible in small children or if the tumor has no suitable feeding vessels for embolization. METHODS: We present the case of a 2-year-old girl with a giant choroid plexus papilloma. An attempt of tumor resection was previously performed in another clinic, but the surgery was aborted due to massive intraoperative bleeding and only a biopsy was done. Angiography showed no suitable vessels for embolization. A new attempt of tumor removal was carried out, but again, severe intraoperative bleeding occurred and only a partial resection was possible. Intratumoral embolization with onyx through direct percutaneous puncture was performed. RESULTS: Radical tumor removal was possible after two additional surgeries. Intraoperative blood loss was 345 ml (first surgery = only partial removal), 250 ml (second procedure = 1/3 of tumor volume resected), and 250 ml (third surgery = total removal). The patient presented no additional deficits. CONCLUSIONS: Intratumoral percutaneous embolization with onyx was very helpful in reducing intraoperative bleeding in this case. Safe radical tumor resection was possible. This technique may be useful for those surgeons dealing with highly vascularized tumors, especially in small children. No report of intratumoral embolization with onyx in cases of intracerebral tumors could be found in the literature.
Asunto(s)
Dimetilsulfóxido/uso terapéutico , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Papiloma del Plexo Coroideo/cirugía , Polivinilos/uso terapéutico , Angiografía de Substracción Digital , Preescolar , Femenino , Gadolinio DTPA/metabolismo , Humanos , Imagen por Resonancia Magnética , Papiloma del Plexo Coroideo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: Endovascular treatment of broad-neck, complex cerebral aneurysms is a challenging issue. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows dense packing of the coils. Another challenge is represented by distal aneurysms situated in small vessels. In these cases, the use of little stents, which we are going call ministents, could be a good decision. These low-profile intracranial ministents can be deployed into arteries with diameters between 1.5 and 3.10 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels. We present six cases of wide-neck aneurysms, with small parental arteries less than 2.5 mm using a low-profile ministent system (LEO Baby and LVIS Jr) plus coil embolization. MATERIALS AND METHODS: We retrospectively reviewed patients in whom LEO Baby or LVIS Jr stent was used for the treatment of intracranial aneurysms. Five aneurysms were treated during 2013-2014 in our service using the LEO Baby stent and one aneurysm using LVIS Jr. Stent-assisted coil embolization was performed using the jailing technique in all cases. Clinical and angiographic findings, procedural data, and follow-up are reported. RESULTS: Six consecutive patients were included in this study. Four patients presented with subarachnoid hemorrhage in the subacute-chronic phase and two patients had unruptured aneurysms. Two of the six aneurysms were located at branches of the sylvian artery, one at the basilar artery, two at the anterior communicating artery, and one at the P1-P2 artery. The procedures were successful. Six-month control digital subtraction angiograms were obtained in all cases; they demonstrated complete occlusion of the aneurysms in all instances. All patients had good clinical outcomes on follow-up, as measured with the Glasgow Outcome Scale and Modified Rankin Scale. CONCLUSIONS: The results of this small study show that the LEO Baby and LVIS Jr ministents could be safe and efficient for endovascular treatment of intracranial broad-neck aneurysms situated in small arteries.
Asunto(s)
Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/terapia , Stents , Adulto , Anciano , Angiografía de Substracción Digital , Angiografía Cerebral , Femenino , Escala de Coma de Glasgow , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Flow diverter stents represent a new endovascular tool to treat complex aneurysms, such as giant, large, wide-necked and fusiform. The highly dense mash of these stents reduces inflow and outflow inside the aneurysm, resulting in intra aneurysmal thrombosis and stent endothelialization. OBJECTIVES: To present the results of treatment of intracranial aneurysms with flow diverter stents in a single center. METHODS: Retrospective review of 77 patients with 87 aneurysms treated using two different types of flow diverter stent, the Pipeline Embolization Device and SILK stent, between October 2010 and September 2013 in an interventional neuroradiology center. RESULTS: Flow diverter stent placement was successful in 98% of the lesions and resulted in an immediate major stasis within most of the treated aneurysms. The overall aneurysm occlusion rate at six months and 18 months was 80% and 84% respectively. Symptomatic complications occurred in 11 patients (14.3%) with morbidity in eight (10.4%) and mortality in three patients (3.9%). CONCLUSION: Flow diversion is a promising technique for treatment of challenging intracranial aneurysms with acceptable morbidity. A high rate of complete occlusion for small large necked aneurysms, a low morbidity and mortality rate and no recanalization encourage their use in these aneurysms. Further studies accessing long-term aneurysm occlusion and recanalization are required.
Asunto(s)
Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Stents , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The fenestration of the basilar artery is an uncommon anatomical variant that may be associated with saccular aneurysms; however this association is rare. We report the case of a patient who presented with subarachnoid hemorrhage that was successfully treated by coil embolization and review the literature.
Asunto(s)
Aneurisma Roto/terapia , Arteria Basilar , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/terapia , Stents , Adulto , Aneurisma Roto/complicaciones , Embolización Terapéutica/métodos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Rotura Espontánea/terapia , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/terapiaRESUMEN
BACKGROUND: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. AIM: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. METHODS: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam(r) powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. RESULTS: An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. CONCLUSIONS: The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective.
Asunto(s)
Embolización Terapéutica/instrumentación , Hepatectomía , Vena Porta , Catéteres , Embolización Terapéutica/métodos , Diseño de Equipo , Humanos , Histerosalpingografía/instrumentaciónRESUMEN
BACKGROUND: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. AIM: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. METHODS: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam(r) powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. RESULTS: An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. CONCLUSIONS: The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective. .
RACIONAL: Embolização da veia porta é procedimento consagrado para estimular a hipertrofia do fígado remanescente, a fim de reduzir as complicações pós-hepatectomia. OBJETIVO: Apresentar série de casos submetidos à embolização da veia porta usando cateter adaptado de histerossalpingografia, por via transileocólica. MÉTODOS: Foi realizada embolização do ramo portal direito em 19 pacientes utilizando cateter de histerossalpingografia. Foi usado Gelfoam(r) em pó com solução de álcool absoluto, como material embolizante. As indicações para hepatectomia foram metástases hepáticas colorretais em todos os casos. RESULTADOS: Hipertrofia adequada do fígado remanescente foi alcançada em 15 pacientes (78,9%) e a hepatectomia foi realizada em 14 (73,7 %). Em um (5,2 %), a progressão do tumor impediu a realização da operação. Um paciente apresentou insuficiência renal aguda após embolização portal. CONCLUSÕES: O cateter de histerossalpingografia é fácil de ser manuseado e pode ser introduzido na veia porta com um fio guia. Não houve complicação grave pós-embolização. Seu uso é seguro, barato e eficaz. .
Asunto(s)
Humanos , Embolización Terapéutica/instrumentación , Hepatectomía , Vena Porta , Catéteres , Embolización Terapéutica/métodos , Diseño de Equipo , Histerosalpingografía/instrumentaciónRESUMEN
The recent generation of AMPLATZER Vascular Plug (AVP; ie, the AVP IV) was used for the occlusion of eight pulmonary arteriovenous malformations (PAVMs) in five patients. A treatment was considered successful when there was a reduction or disappearance of the aneurysmal sac. At a mean follow-up of 20.1 months, no recanalization of PAVMs was observed on multidetector computed tomographic angiography. This shows the AVP IV to be safe and effective as an embolic device to occlude PAVMs.