The contemporary endovascular treatment of intracranial aneurysms

The first endovascular treatment of intracranial aneurysms began with simple coiling in 1991. Ever since, it has developed significantly, and endovascular treatment is now the first choice for most intracranial aneurysms. However, some intracranial aneurysms such as wide-necked, blood-blister-like, fusiform and dissecting intracranial aneurysms are not suitable for simple coiling. In 2008, intraluminal flow diversion was introduced for uncoilable saccular intracranial aneurysms of the internal carotid artery, and since then, the indications of intraluminal flow diversion have expanded to complex aneurysms like blister-like, dissecting, and fusiform intracranial aneurysms. In 2010, intrasaccular flow disruption was introduced with the Woven EndoBridge (WEB) for the treatment of naïve wide-necked bifurcation aneurysms. Several studies have shown the safety and efficacy of flow diverters and WEB in the treatment of intracranial aneurysms. In our study the safety and efficacy of the WEB and flow diverters were assessed in Finnish population. Furthermore, we identified and analysed the factors influencing radiological outcomes after the contemporary endovascular treatments. A rate of 90% adequate radiological outcomes can be achieved in the treatment of naïve and recurrent wide-necked intracranial aneurysms with the WEB. No rupture or re-rupture observed after the WEB treatment. The flow diverters can provide a high occlusion rate for elective and acutely ruptured intracranial aneurysms. However, a 45% rate of complications was observed in flow diversion for acutely ruptured intracranial aneurysms. The WEB for wide-necked intracranial aneurysms including wide-necked recurrent intracranial aneurysms appears to be safe and efficient, and is a valuable alternative when the conventional methods are not amenable. The aneurysm morphology and size seem to influence the radiological outcomes after the WEB treatment. Flow diverters provides high occlusion rates. However, the flow diversion of acutely ruptured intracranial aneurysms carries a high rate of complications. Flow diversion can be justified as a last-resort option when other endovascular methods are not suitable for acutely ruptured intracranial aneurysms.Aivovaltimoaneurysmien nykyaikainen suonensisäinen hoito Aivovaltimoaneurysma hoidettiin koiliembolisaatiolla onnistuneesti ensimmäisen kerran vuonna 1991, ja siitä lähtien endovaskulaariset tekniikat ovat kehittyneet merkittävästi. Endovaskulaarinen menetelmä onkin nykyään ensisijainen valinta useimpien aneurysmien hoitoon. Koska rakkulamaiset, dissekoivat ja fusiformiset aneurysmat ovat vaikeita hoitaa tavanomaisilla endovaskulaarisilla menetelmillä, vaikeahoitoisia aneurysmia varten otettiin vuonna 2008 käyttöön flow diverter -stentit. Niiden alkuperäinen käyttöaihe oli sisemmän kaulavaltimon jättianeurysmien hoito; nyt käyttöaiheet ovat laajentuneet niin rakkulamaisten kuin dissekoivien aneurysmien hoitoon. Intrasakkulaarinen laite Woven Endobridge (WEB) kehitettiin vuonna 2010 leveäkaulaisten aivovaltimoaneurysmien hoitoon. Useat tutkimukset ovat osoittaneet sekä flow diverter -stentin sekä WEB:in turvallisuuden ja tehokkuuden aivoaneurysmien hoidossa. Tutkimuksessa arvioitiin WEB ja flow diverter -hoidon turvallisuutta ja tehokkuutta Suomessa. Erityistä huomiota kiinnitettiin tekijöihin, jotka ennustavat radiologisia tuloksia nykyaikaisen hoidon jälkeen. Tutkimuksella todettiin, että WEB-hoidolla voidaan saavuttaa 90%:sti lähes täydellinen radiologinen hoitotulos. WEB-hoidon jälkeen aneurysmien puhkeamista ei havaittu. Flow diverter -hoidolla saavutetaan 90%:sti täydellinen tai lähes täydellinen radiologinen tulos, mutta 45%:lla potilaista esiintyy jokin flow diverter -hoitoon liittyvä komplikaatio akuutisti puhjenneiden aneurymien hoidossa. WEB on tehokas menetelmä sekä uusien että uusiutuneiden leveäkaulaisten aneurysmien hoidossa. Se on käyttökelpoinen silloin, kun perinteiset menetelmät eivät riitä. Aneurysman muoto ja koko vaikuttavat WEB:in hoitotuloksiin. Flow diverterit mahdollistavat hyvän radiologisen hoitotuloksen akuutisti repeytyneissä aivoaneurysmissa. Niiden flow diverter -hoitoon liittyy kuitenkin huomattavan korkea komplikaatioriski, mutta mikäli muu menetelmä ei potilaan akuutisti puhjenneen aneurysman hoitoon sovellu, sitä voidaan viimeisenä hoitomuotona perustellusti käyttää

Treatment of intracranial aneurysms using the new Surpass Evolve flow diverter : Safety outcomes and six-month imaging follow-up

Background and purpose. - Several studies have reported good long-term results in the occlusion of intracranial aneurysms with flow diverter treatment. The aim of this study was to report the safety and six-month follow-up outcomes using the new Surpass Evolve flow diverter in the treatment of intracranial aneurysms. Materials and methods. - Consecutive patients with intracranial aneurysm treated with Surpass Evolve flow diverter in two high-volume neurovascular centers between May 2019 and January 2020 were retrospectively reviewed. Procedure-related complications, aneurysm occlusion (O'Kelly-Marotta grading scale), and clinical outcomes were assessed. Results. - Twenty-nine patients with 30 aneurysms were included in the study. Favorable aneurysm occlusion (O'Kelly Marotta grading scale C-D) at six-month follow-up was achieved in 21/27 (78%) aneurysms. No clinical procedure related thromboembolic complications were encountered. Twenty-three out of 24 patients with unruptured aneurysms treated with Surpass Evolve remained clinically intact at clinical follow-up. There was one fatal hemorrhagic procedure-related complication (3%). In five patients with ruptured aneurysms, no early or late rebleeds occurred from the aneurysms. Conclusions. - Surpass Evolve FD worked technically well with no intraprocedural thromboembolic complications and occlusion rates comparable to other FDs. (c) 2021 L'Auteur(s). Publie par Elsevier Masson SAS. Cet article est publie en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Synthesis, characterization and cyclization reactions of some new bisthiosemicarbazones

The reaction of trans-1, 4-dichloro-2-butene 1 with selected phenols affords (E)-1, 4-bis(aryloxy)-2-butenes 2a-d which are converted into bis-thiosemicarbazones 3a-h via the reactions with thiosemicarbazide and 4-methyl thiosemicarbazide, respectively. Similarly, 4-methyl-5-ethoxycarbonyl- 2, 3-dihydro-1, 3-thiazoles 4a-h are synthesized via the reaction of bis-thiosemicarbazones 3a-h with ethyl 2-chloroacetoacetate. trans-1, 4-Dithiocyanato-2-butene 5 is obtained from the reaction of KSCN and trans-1, 4-dichloro-2-butene 1. Furthermore, the bis-2-amino-1, 3, 4-thiadiazoles 6k and l are obtained from the reaction of trans-1, 4-dithiocyanato-2-butene 5 with thiosemicarbazide and 4-methyl thiosemicarbazide, respectively. These compounds are characterized by elemental analyses, infrared, 1H-, 13C-NMR and mass spectrometry. Finally, the microbial features of all compounds are determined. Some of them exhibited microbial activities at low level, and the electronic absorption spectra of the compounds 3b, d, f and h are measured in organic solvents (MeOH, DMF, DMSO and 1, 4-dioxane) with various polarities

Treatment of intracranial aneurysms using the new Surpass Evolve flow diverter: Safety outcomes and six-month imaging follow-up

Background and purpose: Several studies have reported good long-term results in the occlusion of intracranial aneurysms with flow diverter treatment. The aim of this study was to report the safety and six-month follow-up outcomes using the new Surpass Evolve flow diverter in the treatment of intracranial aneurysms.Materials and methods: Consecutive patients with intracranial aneurysm treated with Surpass Evolve flow diverter in two high-volume neurovascular centers between May 2019 and January 2020 were retrospectively reviewed. Procedure-related complications, aneurysm occlusion (O'Kelly-Marotta grading scale), and clinical outcomes were assessed.Results: Twenty-nine patients with 30 aneurysms were included in the study. Favorable aneurysm occlusion (O'Kelly Marotta grading scale C-D) at six-month follow-up was achieved in 21/27 (78%) aneurysms. No clinical procedure related thromboembolic complications were encountered. Twenty-three out of 24 patients with unruptured aneurysms treated with Surpass Evolve remained clinically intact at clinical follow-up. There was one fatal hemorrhagic procedure-related complication (3%). In five patients with ruptured aneurysms, no early or late rebleeds occurred from the aneurysms.Conclusions: Surpass Evolve FD worked technically well with no intraprocedural thromboembolic complications and occlusion rates comparable to other FDs.</p

The Woven EndoBridge for intracranial aneurysms: Radiological outcomes and factors influencing occlusions at 6 and 24 months

Purpose: To identify factors influencing short- and mid-term radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB).Methods: A total of 112 patients were treated for IAs with the WEB in at our institution between 2013 and 2020. Patients with 6- and/or 24-months follow-up data were included in the study. Aneurysm occlusion was evaluated using the Raymond-Roy occlusion classification (RR). RR 1 and RR 2 were considered as adequate outcomes, while RR 3 inadequate.Results: Data were available for 91 patients (56 females, 62%) at 6 months and 62 of those patients (39 females, 58%) at 24 months. The adequate occlusion (RR 1/RR 2) rate was 89% (n = 81/91) at the 6-months follow-up and 91% (n = 56/62) at the 24-months follow-up. The treatment-related morbidity rate was 4% (n = 4/91), and mortality rate was 1% (n = 1/91). The predictor for inadequate occlusion at the 6-months follow-up was the lobular shape of an aneurysm (p = .01). The aneurysm's height (p = .02), maximal diameter (p = .001), width (p = .002), aspect ratio (p = .03), dome-to-neck ratio (p = .04), and lobular shape (p= .03) were predictive factors for inadequate occlusion at 24 months. All the thrombosed aneurysms (n = 3) showed unfavorable radiological outcomes and required re-treatment within 24 months. None of the patient-related factors were significant.Conclusions: The WEB provides favorable occlusion rates and low complications for both ruptured and unruptured wide-necked IAs. Unfavorable radiological outcomes after WEB treatment may be related to aneurysm morphology and size.</p

The outcomes of recurrent wide-necked intracranial aneurysms treated with the Woven EndoBridge (WEB): A retrospective bicenter study

Background: The Woven EndoBridge (WEB) is a device for the treatment of intracranial wide-necked bifurcation aneurysms. The safety and effectiveness of WEB for intracranial aneurysms have both been evaluated in previous trials. Our aim was to study the outcomes of recurrent intracranial aneurysms (IAs) treated with WEB.Methods: Clinical and radiological outcomes of patients with a wide-necked aneurysm recurrence, which was treated with WEB device, were assessed. Imaging follow-up was performed with digital subtraction angiography and/or magnetic resonance angiography. Aneurysm occlusion was determined using by the Raymond-Roy Occlusion Classification (RROC). RROC 1 and RROC 2 were considered as adequate radiological outcome.Results: Twenty-two patients with 23 recurrent IAs were treated with WEB. Of which, 17 of recurrent IAs (74%) previously treated by coiling, three (13%) by clipping and three (13%) by WEB. The most common location of the recurrent IA was the middle cerebral artery (n = 10, 43%). Endovascular treatment with WEB alone was suitable for 20 recurrent IAs (87%). Ancillary devices were also used: coils in two (9%), and a stent in one (4%). Radiological follow-up results available for all patients (range: 3-60 months; median 24 months). Adequate occlusion (RROC I and II) was achieved in 20 recurrent IAs (87%). A hemorrhagic complication occurred 2 weeks post treatment in one patient (5%).Conclusions: WEB could be an effective treatment with low rates of complications for challenging cases of recurrent wide-necked IAs.</p

Finnish flow diverter study : 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.Peer reviewe

Finnish flow diverter study : 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Background Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date. Methods This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate. Results 110 patients (64 females; mean age 55.7 years; range 12-82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0-2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102). Conclusions FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.Peer reviewe

The Antibiotic Usage Before and After a Nationwide Antibiotic Restriction Policy at a University Hospital

There is a growing concern on wisely use of antimicrobial agents. Some nationwide restrictions on antibiotic usage have been settled via a regulation released by Turkish government in February 2003. We conducted a study to assess the impact of this nationwide antibiotic restriction policy (NARP) at a university hospital. All hospitalized patients were visited on 18th February 2003 (before the regulation) and on 15th September 2003 (after the regulation). For each patient receiving antibiotic treatment, demographic data, diagnosis, results from microbiological specimens, details of antibiotic administration, indication for treatment or prophylaxis, dosage, dose frequency and administration route were recorded on individual forms. The appropriateness of antimicrobial treatments were assessed by two infectious disease specialists and infectious disease proffessors according to the local and international guidelines. On the first prevalence day and on the second prevalence day 20.8% of patients were receiving antimicrobial treatment. Before and after NARP, 36% and 29% of antimicrobial treatments were judged inappropriate, respectively (p= 0.131). There was not any difference between surgical and medical wards. The rate of antibiotic usage without any clinical indication was significantly decreased after NARP (p= 0.03). After NARP, 42% of the empirical treatments was begun after infectious disease consultation, while it was 14% (p< 0.001) before NARP. Fourty-four percent and 36% of antimicrobial regimens used for surgical prophylaxis was inappropriate before and after NARP, respectively (p= 0.39). The daily cost of inappropriate antibiotic usage was 2661 and 2187 dollars in February and September, respectively (p= 0.77). We conclude that, NARP has a good but unsatisfactory impact on antibiotic usage and cost. Other interventions should be implemented for an optimal outcome

Career Choices of University Students in Terms of Demographic Characteristics: The Sample of Pınarhisar Vocational College

İçinde bulunduğumuz bilgi toplumunda meslek yaşamı kavramı, değişiklik göstermekte ve kariyer kavramı ön plana çıkmaktadır. Kişilerin bir meslek alanında dikey bir biçimde yükselmeleri geleneği, bilgi toplumunda değişmekte; kişiler ömürleri boyunca birden çok alanda kendilerini geliştirmek durumunda kalmakta ve diğer yandan mesleki alanlarında yatay ilerlemeleri de mesleki gelişme içinde düşünülmektedir. Bilgi işçisi ve yaşam boyu öğrenme gibi bilgi toplumuna özgü kavramlarla birlikte, kariyer kavramının içeriği de kişilerin ömürleri boyunca kendi gelişimlerinin inisiyatifini kendilerinin ellerine aldığı ve bir işyerinden çok, farklı işyerlerinde kendilerini gerçekleştirme gereksinimlerini tatmin ettikleri bir bağlama kavuşmaktadır. Bu çalışmanın amacı Pınarhisar Meslek Yüksekokulu’nda öğrenim gören öğrencilerin kariyer tercihlerini belirlemek ve bu tercihlerin öğrencilere ait demografik özelliklere göre anlamlı farklılıklar gösterip göstermediğini tespit etmektir. Bu amaç doğrultusunda öğrencilerden anket tekniği ile veri toplanmış ve toplanılan veriler analiz edilmiştir. Yapılan faktör analizi sonucunda kariyer tercihi altı alt boyutta incelenmiştir. Bu boyutlar Sosyal, Araştırmacı, Sanatçı, Geleneksel, Gerçekçi ve Girişimci kariyer boyutlarıdır. Bu boyutların, öğrencilerin demografik özelliklerine göre istatistiksel olarak anlamlı farklılık gösterdikleri tespit edilmiştir. Çalışma ile öğrencilerin kariyer tercihi boyutları üzerinde etkili olan demografik özelliklerin tespit edilmesiyle kariyer tercihlerine ilişkin bir profil elde edilmiştir.The professional life concept has been changing and the concept of career has been important. The vertically improvement along the hierarchy becomes less significant and the individuals have to improve themselves on many fields. Also, the horizontal improvement is thought to be a part of the professional development. Together with the concepts of knowledge work and lifelong learning, the content of the career concept becomes to be involved with the individuals’ initiatives to take the control of their career processes and the context of the career concept turns into what the employees satisfy their selfactualization need by working in different organizations. The aim of this study is determine the career choices of the students at Pınarhisar Vocational College and to reveal whether these choices have significant relations with the demographic characteristics of the students. Data were collected from the students by means of a questionnaire and the collected data were analyzed. As a result of the factor analysis, six factors (Social, Investigative, Artistic, Conventional, Realistic and Enterprising) were extracted from the career choice items. These factors were found to be statistically in relation with the demographic characteristics. As a result of the study, a profile of the demographic characteristics, which influence the career choices arouse