Long-term clinical and angiographic follow-up results of the dual-layer flow diverter device (FRED) for the treatment of intracranial aneurysms in a multicenter study

Purpose Our aim was to determine the long-term safety and efficacy of the Flow Re-Direction Endoluminal Device (FRED) in this multicenter study with prospective design. Materials-method This study included 136 consecutive patients with 155 aneurysms treated between March 2013 and June 2016 in 10 centers. Twenty-two (16.2%) patients presented with rupture of the index aneurysm. Large/giant aneurysms comprised 1/3 of the cohort. Adjuvant coil use during the treatment was 15.5%. The effectiveness measure in the study was the percentage of aneurysms with stable occlusion at follow-up. Results Vascular imaging follow-up was performed at least once in 131/136 (96.3%) patients with 148/155 (95.5%) aneurysms up to 75 months (mean: 37.3 months; median: 36 months according to latest follow-up), and 102/155(65.8%) aneurysms in 90/136 (66.2%) patients had >= 24-month control. According to the latest controls, the overall stable occlusion rate was 91.9% (95% CI, 87.5 to 96.3%). Three out of 148 aneurysms with follow-up were retreated (2%, 95% CI 0.0 to 4.3%). Adverse events were noted in 19/136 (14%, 95% CI, 9 to 21%) patients with a morbidity of 1.5% (95% CI, 0.0 to 3.5%). Mortality was 1/136 (0.7%, 95% CI, 0.02 to 2.2%) and was unrelated to aneurysm treatment. In-stent stenosis (ISS) was detected in 10/131 of the patients with follow-up (7.6%, 95% CI; 3.1 to 12.2%), only one being symptomatic. No adverse events have occurred in any of the patients with follow-up after 24 months, except the one resulting from ISS. Conclusion In the treatment of cerebral aneurysms which were candidates for flow diversion technique, this study showed long-term efficacy of FRED with good safety and occlusion rates

A rare cause of hyperprolactinemia: persistent trigeminal artery with stalk-section effect

The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are fetal anastomoses between the carotid and vertebrobasilar systems, Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the vertebrobasilar and carotid systems in adults. We report a case of PTA compressing the left side of the pituitary gland and stark, in a patient with elevated blood prolactin level

Tuberculous abdominal aortic aneurysm in a 14-year-old child

Abdominal aortic aneurysms are rare in childhood, We present a case of aneurysm of the abdominal aorta in a child with tuberculous para-aortic lymphadenitis

Inguinoscrotal bladder herniation: is CT a useful tool in diagnosis?

Urinary bladder herniation into the inguinal canal is a rare occurrence. The condition is often diagnosed during inguinal hernia surgery. We present a rare case of inguinoscrotal bladder herniation with its computed tomography findings

Management of Massive Hemorrhage after Percutaneous Nephrolithotomy: Angioembolization or Renorrhaphy

Objective We present two treatment modalities, selective renal angioembolization and renorraphy, in massive renal hemorrage after percutaneous nephrolithotomy (PCNL) that could not be controlled by conservative methods. Materials and Methods One thousand two-hundred patients, who had undergone PCNL between January 2003 and February 2014, were retrospectively reviewed. From these cases, we selected patients with massive post procedural bleeding that could not be taken under control by conservative methods and we reviewed their clinical course and treatment results. Results Bleeding could not controlled by conservative methods in 6 patients and, angioembolization was done succesfully. In 3 patients, angioembolization was not available. Renorraphy was performed in 2 patients and nephrectomy in 1 patient at first attempt. Renorraphy could not solve the problem of massive hemorrage and these 2 patients eventually underwent nephrectomy. Conclusion Renal angiography and embolization is an effective and safe method and renorraphy should not be the first option in massive bleeding after PCNL that can not be taken under control by conservative methods

Intraarterial thrombolysis with r-tPA for treatment of anterior circulation acute ischemic stroke - Technical and clinical results

To investigate factors effecting the safety and recanalization efficacy of local intraarterial (IA) recombinant tissue plasminogen activator (r-tPA) delivery in patients with acute ischemic stroke. Eleven patients with anterior circulation acute ischemic stroke were treated. The neurological status of the patients were graded with the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS). All patients underwent a computed tomography (CT) examination at admission. In addition four patients had diffusion-weighted and one patient had a perfusion magnetic resonance (MR) examinations. Patients were treated within six hours from stroke onset. Immediate, six hours, and 24 hours follow-up CT examinations were performed in order to evaluate the haemorrhagic complications and the extent of the ischemic area. The Rankin Scale (RS) was used as an outcome measure. Two of the 11 patients had carotid T occlusion (CTO), nine had middle cerebral artery (MCA) main trunk occlusion. Four patients had symptomatic haemorrhage with a large haematoma rupturing into the ventricles and subarachnoid space. Of these, three patients died within 24 hours. The remaining seven patients had asymptomatic haematomas that were smaller compared to symptomatic ones, and showed regression in size and density on follow-up CTs. At third month five patients had a good outcome and three patients had a poor outcome. In acute ischemic stroke, local IA thrombolysis is a feasible treatment when you select the right patient. Haemorrhage rate does not seem to exceed that occuring in the natural history of the disease and in other treatment modalities

Flow Redirection Endoluminal Device (FRED) with or without Adjunctive Coiling in Treatment of Very Large and Giant Cerebral Aneurysms

Purpose Flow diverter stents are gaining wider use in the treatment of complex intracranial aneurysms; however, there are limited data on occlusion and complication rates of flow diverters in very large and giant aneurysms. This study assessed the safety and efficacy of flow redirection endoluminal device (FRED) and FRED Jr. stents in aneurysms >= 20 mm. Methods We retrospectively analyzed all aneurysms >= 20 mm treated with FRED/FRED Jr. between January 2010 and June 2020 from three centers. Endpoints for clinical safety were absence of major stroke, aneurysmal rupture, or death and complete or near-complete occlusion for efficacy. Results A total of 45 patients with very large (28 cases) and giant aneurysms (17 cases) were treated with FRED (41 cases), and FRED Jr. (4 cases) stents. The majority of the aneurysms (40/45, 88.9%) were in the anterior circulation. Adjunctive aneurysm coiling was performed in 21 aneurysms (46.7%). Technical complications were encountered in 4 procedures (8.9%). Ischemic and hemorrhagic complication rates were 6.7% and 8.9%, respectively. There was no case with major stroke. The mortality rate was 8.9%, and all cases were due to hemorrhagic complications from aneurysmal rupture. Median angiographic follow-up was 21.5 months (range 3-60 months). Complete occlusion was achieved in 32 aneurysms (71.1%), and near-complete occlusion in 5 cases (11.1%). Conclusion The use of FRED/FRED Jr. for the treatment of aneurysms >= 20 mm achieved a long-term aneurysm occlusion rate and a safety profile comparable to the large series reported with other flow diverter stents

MR imaging, CT, and angiography features of endolymphatic sac tumors: report of two cases

Low-grade adenocarcinoma of endolymphatic sac origin is a rare tumor of the temporal bone. There are some difficulties in its differential diagnosis from other vascular and non-vascular tumors of the temporal bone. However its radiological differentiation from other tumors of the temporal bone is important for surgical planning. We present a report on two endolymphatic sac tumors with some specific radiological findings which can support a correct diagnosis

Temporal bone measurements on high-resolution computed tomography

The distances between the important neural and vascular structures in normal temporal bones were measured by using high-resolution computed tomography (HRCT). We examined 100 normal ears in 50 subjects ranging in age from 15 to 72 years (mean age 39 years). We measured the distances from the medial lip of the posterior wall of the internal auditory canal to the medial wall of the vestibule (mean 9.7 mm), from the cochlea to the tympanic segment of the facial canal (mean 1.76 mm), from the medial wall of the vestibule to the lateral aspect of the lateral semicircular canal (mean 8.03 mm), and from the external auditory canal to the lateral sinus (mean 13.2 mm). HRCT examination is the best method for defining the morphology of temporal bone