17 research outputs found
Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism
The aim of the present study was to analyze possible relationships between pulmonary
vessel obstruction and clinically relevant parameters and scores in patients with pulmonary embolism
(PE). Overall, 246 patients (48.8% women and 51.2% men) with a mean age of 64.0 17.1 years were
involved in the retrospective study. The following clinical scores were calculated in the patients:
Wells score, Geneva score, and pulmonary embolism severity index (PESI) score. Levels of D-dimer
(g/mL), lactate, pH, troponin, and N-terminal natriuretic peptide (BNP, pg/mL) were acquired.
Thrombotic obstruction of the pulmonary arteries was quantified according to Mastora score. The data
collected were evaluated by means of descriptive statistics. Spearman’s correlation coeffcient was
used to analyze associations between the investigated parameters. P values < 0.05 were taken
to indicate statistical significance. Mastora score correlated weakly with lactate level and tended
to correlate with D-dimer and BNP levels. No other clinical or serological parameters correlated
significantly with clot burden. Thrombotic obstruction of pulmonary vessels did not correlate with
clinical severity of PE
Image-Guided High-Intensity Focused Ultrasound, A Novel Application for Interventional Nuclear Medicine?
Image-guided high-intensity focused ultrasound (HIFU) has been increasingly used in medicine over the past few decades, and several systems for such have become commercially available. HIFU has passed regulatory approval around the world for the ablation of various solid tumors, the treatment of neurologic diseases, and the palliative management of bone metastases. The mechanical and thermal effects of focused ultrasound provide a possibility for histotripsy, supportive radiation therapy, and targeted drug delivery. The integration of imaging modalities into HIFU systems allows for precise temperature monitoring and accurate treatment planning, increasing the safety and efficiency of treatment. Preclinical and clinical results have demonstrated the potential of image-guided HIFU to reduce adverse effects and increase the quality of life postoperatively. Interventional nuclear image–guided HIFU is an attractive noninvasive option for the future
Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments—Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter
Background and Purpose: Low-profile flow diverter stents (FDS) quite recently
amended peripheral segments as targets for hemodynamic aneurysm treatment;
however, reports on outcomes, especially later than 3 months, are scarce. This study
therefore reports our experience with the novel silk vista baby (SVB) FDS and respective
outcomes after 8 and 11 months with special respect to specific adverse events.
Materials and Methods: Forty-four patients (mean age, 53 years) harboring 47
aneurysms treated with the SVB between June 2018 and December 2019 were included
in our study. Clinical, procedural, and angiographic data were collected. Follow-ups were
performed on average after 3, 8, and 11 months, respectively. Treatment effect was
assessed using the O’Kelly Marotta (OKM) grading system.
Results: Overall, angiographic follow-ups were available for 41 patients/45 aneurysms.
Occlusion or significant reduction in aneurysmal perfusion (OKM: D1, B1–B3 and
A2–A3) was observed in 98% of all aneurysms after 8 months. Only 2% of the treated
aneurysms remained morphologically unaltered and without an apparent change in
perfusion (OKM A1). Adverse events in the early post-interventional course occurred
in seven patients; out of them, mRS-relevant morbidity at 90 days related to FDS
treatment was observable in two patients. One death occurred in the context of
severe SAH related to an acutely ruptured dissecting aneurysm of the vertebral artery.
Conclusion: The SVB achieves sufficient occlusion rates of intracranial aneurysms
originating from peripheral segments, which are comparable to prior established
conventional FDS with acceptably low complication rates. However, alteration of a
hemodynamic equilibrium in distal localizations requires special attention to prevent
ischemic events
First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating
Background: In the last decade, flow diversion (FD) has been established as
hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral
arteries. However, two significant limitations remain—the need for 0.027” microcatheters
required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet
therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost
of increasing the risk for hemorrhage. This study reports the experience of three
neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that
is implantable via a 0.021” microcatheter.
Materials and methods: Three neurovascular centers contributed to this retrospective
analysis of patients that had been treated with the p64MW-HPC between March 2020
and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including
procedural and post-procedural complications, were recorded. The hemodynamic effect
was assessed using the O’Kelly–Marotta Scale (OKM).
Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms
(27 anterior circulation and six posterior circulation) were successfully treated with
the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly
reduced immediately post implantation. Follow-up imaging was available for 23
aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size
(OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and
D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9
months. In two cases, device thrombosis after early discontinuation of DAPT occurred.
One delayed rupture caused a caroticocavernous fistula. The complications were
treated sufficiently and all patients recovered without permanent significant morbidity.
Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves
good early aneurysm occlusion rates in the proximal intracranial circulation, which are
comparable to those of well-established FDS. Sudden interruption of DAPT in the
early post-interventional phase can cause in-stent thrombosis despite the HPC surface
modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging
vascular anatomies
Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism
The aim of the present study was to analyze possible relationships between pulmonary
vessel obstruction and clinically relevant parameters and scores in patients with pulmonary embolism
(PE). Overall, 246 patients (48.8% women and 51.2% men) with a mean age of 64.0 17.1 years were
involved in the retrospective study. The following clinical scores were calculated in the patients:
Wells score, Geneva score, and pulmonary embolism severity index (PESI) score. Levels of D-dimer
(g/mL), lactate, pH, troponin, and N-terminal natriuretic peptide (BNP, pg/mL) were acquired.
Thrombotic obstruction of the pulmonary arteries was quantified according to Mastora score. The data
collected were evaluated by means of descriptive statistics. Spearman’s correlation coeffcient was
used to analyze associations between the investigated parameters. P values < 0.05 were taken
to indicate statistical significance. Mastora score correlated weakly with lactate level and tended
to correlate with D-dimer and BNP levels. No other clinical or serological parameters correlated
significantly with clot burden. Thrombotic obstruction of pulmonary vessels did not correlate with
clinical severity of PE
Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism
The aim of the present study was to analyze possible relationships between pulmonary vessel obstruction and clinically relevant parameters and scores in patients with pulmonary embolism (PE). Overall, 246 patients (48.8% women and 51.2% men) with a mean age of 64.0 ± 17.1 years were involved in the retrospective study. The following clinical scores were calculated in the patients: Wells score, Geneva score, and pulmonary embolism severity index (PESI) score. Levels of D-dimer (µg/mL), lactate, pH, troponin, and N-terminal natriuretic peptide (BNP, pg/mL) were acquired. Thrombotic obstruction of the pulmonary arteries was quantified according to Mastora score. The data collected were evaluated by means of descriptive statistics. Spearman’s correlation coefficient was used to analyze associations between the investigated parameters. P values < 0.05 were taken to indicate statistical significance. Mastora score correlated weakly with lactate level and tended to correlate with D-dimer and BNP levels. No other clinical or serological parameters correlated significantly with clot burden. Thrombotic obstruction of pulmonary vessels did not correlate with clinical severity of PE
Pulmonary Vessel Obstruction Does Not Correlate with Severity of Pulmonary Embolism
The aim of the present study was to analyze possible relationships between pulmonary
vessel obstruction and clinically relevant parameters and scores in patients with pulmonary embolism
(PE). Overall, 246 patients (48.8% women and 51.2% men) with a mean age of 64.0 17.1 years were
involved in the retrospective study. The following clinical scores were calculated in the patients:
Wells score, Geneva score, and pulmonary embolism severity index (PESI) score. Levels of D-dimer
(g/mL), lactate, pH, troponin, and N-terminal natriuretic peptide (BNP, pg/mL) were acquired.
Thrombotic obstruction of the pulmonary arteries was quantified according to Mastora score. The data
collected were evaluated by means of descriptive statistics. Spearman’s correlation coeffcient was
used to analyze associations between the investigated parameters. P values < 0.05 were taken
to indicate statistical significance. Mastora score correlated weakly with lactate level and tended
to correlate with D-dimer and BNP levels. No other clinical or serological parameters correlated
significantly with clot burden. Thrombotic obstruction of pulmonary vessels did not correlate with
clinical severity of PE