Vertebroplasty - minimally invasive treatment for vertebral fractures

Interventional Radiology Department, University Hospital, Bucharest, Romania, “Carol Davila” University, Neurosurgery Clinic, University Hospital, Bucharest, Romania, “Carol Davila” University, Radiology and Medical Imaging Clinic, University Hospital, Bucharest, Romania, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Background and purpose: Vertebral fracture is the most common complication of osteoporosis and sometimes also in osteolytic methastasis, active hemangiomas or multiple myelomas. We present the indications, technique, complications, etc. Methods: Vertebroplasty is the percutaneous placement of polymethylmethacrylate (PMMA) into vertebral compression fractures for relief of pain, performed under fluoroscopic guidance while the exact mechanism of pain relief is unknown, it is believed that the delivery of the ciment into the fracture stabilizes the vertebral body, obtaining an analgesic effect. Results: We present our experience of 14 years in percutaneous vertebroplasty (and kyphoplasty) with common indications, results, complications, new indications, tips and tricks, etc. Conclusions: Vertebroplasty is an alternative to spinal surgery. In experienced centers, percuta-neous vertebroplasty is safe and effective in the treatment of patients with painful vertebral com-pression fractures

Minimally invasive treatments for disk hernia

Interventional Radiology Department, University Hospital, Bucharest, Romania, “Carol Davila” University, Neurosurgery Clinic, University Hospital, Bucharest, Romania, Neurosurgery Clinic, University Hospital, Bucharest, Romania, “Carol Davila” University, Radiology and Medical Imaging Clinic, University Hospital, Bucharest, Romania, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Background and purpose: Low back pain (LBP) is one of the common reasons for people to seek treatment from a physician, especially in modern society. We present the indications, technique, complications, etc. of the different minimally invasive interventions. Methods: A multitude of therapies are available to treat disc herniation, ranging from conserva-tive methods (medication and physical therapy) to minimally invasive (chemonucleolysis, O₂-O₃ therapy, mechanical nucleoplasty, intradiscal electrothermal therapy, etc) and surgery. Results: We present our experience of 10 years in minimally invasive interventions with common indications, results, complications, tips and tricks, etc. Conclusions: Percutaneous disk interventions are an alternative therapy situated between medical treatment and spinal surgery. Patients selection is very important and lead to the successful of the intervention

Uterine Artery Embolization for Uncontrollable Hemorrhage after Vaginal Hysterectomy

Hysterectomy is the most common gynecologic procedure performed all over the world and various complications may appear depending on the surgical route. Delayed postoperative hemorrhage is a rare, life threatening complication. It requires timely management and recently the surgical reinterventions tend to be replaced by minimally invasive techniques. Transcatheter arterial embolization shows good results as a treatment strategy for massive vaginal bleeding post hysterectomy, when vaginal vault suturing fails to achieve hemostasis. We report a case of right uterine artery bleeding occurring 30 days after vaginal hysterectomy that was successfully treated by transcatheter arterial embolization

Percutaneous transluminal angioplasty and stenting for innominate artery pre-occlusive stenosis with subclavian steal syndrome – case report and current challenges

Introduction. Atherosclerotic occlusive disease of the innominate artery (IA) represents a rare entity, comprising less than 2% of all extracranial causes of altered cerebral blood flow. This type of lesion is associated with adaptative hemodynamic changes increasing the risk of developing both cerebral and upper extremity ischaemia. Subclavian steal syndrome is a serious complication that may occur with occlusive lesions of the innominate artery and may represent an indication for revascularization. Case presentation. In the current paper we present the case of a patient who was admitted in our clinic for further investigations regarding episodes of dizziness and a difference of 30mmHg in the systolic blood pressure between his arms. On duplex ultrasonography scanning, an IA stenosis suspicion was raised, with associated retrograde flow through the right vertebral artery (VA) at light efforts of the right upper extremity. An angiographic evaluation confirmed the sub-occlusive lesion and reversed flow through the right VA. A decision was reached to undertake percutaneous transluminal angioplasty and stenting. There was no report of periprocedural complications, the intervention has been considered successful with no restenosis and no neurologic symptoms at 9 months follow-up. Discussion. Until recently, surgical treatment was the only option in the management of atherosclerotic disease of the IA, a procedure with high complication, morbidity and mortality rate. Therefore, endovascular treatment gained more ground and is considered today as the first line of treatment for this type of lesion. Conclusion. PTA and stenting of the IA still remains challenging mainly due to complex anatomy and the rarity of this pathology and we must keep in mind that the decision for the revascularization technique is personalized. This present case brings new evidence that percutaneous transluminal angioplasty is a safe and efficient method to manage an atherosclerotic lesion of the brachiocephalic artery

Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy

Objective: The aim of this study is to propose a standardized management of care for patients diagnosed with cesarean scar pregnancy (CSP). There are two types of CSP: Type 1 (on the scar) vs. type 2 (in the niche). To date there is no international standard to predict the extent of invasion or the optimal management of CSP. Materials and methods: We used intramuscular methotrexate injection followed by uterine artery embolization combined with suction evacuation as a conservative approach for the treatment of seven patients diagnosed with CSP. Our inclusion criteria, to be satisfied simultaneously, were established as follows: (1) patients with CSP; (2) early gestational age ≤ 9 weeks, and (3) written consent of the proposed treatment of the patient. Results: This course of treatment produced a positive outcome in all cases. We did not have any complications (e.g., emergency hysterectomy, perforation of the uterine cavity, severe hemorrhage, or endometritis) during the procedures or in the follow-up. The most important predictors of successful management are early diagnosis of CSP and orientation of the invasive trophoblast opposite to the scar. Conclusions: The main finding from this series of cases is that associating systemic methotrexate and uterine artery embolization provides efficient and low-risk management of CSP. This treatment regime is adequate for both types of CSPs. We consider that early localization diagnosis of pregnancy following a cesarean delivery is mandatory for CSP morbidity prevention

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.

BACKGROUND AND OBJECTIVES COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry

BACKGROUND AND OBJECTIVES: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS: Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis