The Advocate - July 19, 1962

Original title (1951-1987)--The Advocate: official publication of the Archdiocese of Newark (N.J.)

Endovascular treatment of cranial aneurysms with the pipeline flow-diverting stent: preliminary mid-term results

WOS: 000315753000013PubMed ID: 23233405PURPOSE We aimed to present our initial experience with a new self-expanding flow diverter device designed for wide-neck aneurysm treatment, assess its safety for intracranial deployment and efficacy of occlusion at mid-term follow-up. MATERIALS AND METHODS Forty-five consecutive patients with difficult aneurysmal anatomy underwent an endovascular treatment. Fifty-five intracranial aneurysms were clipped using the Pipeline flow-diverting stent (ev3 Inc., Plymouth, Minnesota, USA) between November 2009 and December 2011. Data including antiplatelet therapy, technical issues, complications, and imaging findings were recorded during the follow-up period. RESULTS Twenty-seven aneurysms were asymptomatic, 13 were symptomatic due to mass effect, seven were recurrent, six had subarachnoid hemorrhage, and two subjects presented with ischemia. There were 45 saccular, six fusiform-dissecting, and four blister aneurysms. The six-month control angiography was available in 34 subjects with an 85.3% (29/34 patients) complete occlusion rate. The overall occlusion rate according to the last angiography was 91.9% (34/37 patients). The following three major technical complications without clinical consequences were encountered: one distal wire fracture of the stent delivery system and two insufficient stent expansion. There was one fatal nonaneurysmal cerebellar hemorrhage. The overall mortality rate was 2.2% with no permanent morbidity. CONCLUSION The Pipeline flow-diverting stent represents an important advancement in endovascular therapy for cerebral aneurysms. Standard endovascular techniques are typically not suitable for these types of aneurysms. The device targets primary parent vessel reconstruction rather than endosaccular occlusion to achieve exclusion of the aneurysm and maintain a relatively high occlusion rate at six months

Radiological Findings and Endovascular Management of Three Cases with Segmental Arterial Mediolysis

WOS: 000277594900021PubMed ID: 19629590Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions

Tailoring platelet inhibition according to multiple electrode aggregometry decreases the rate of thrombotic complications after intracranial flow-diverting stent implantation

WOS: 000353421400014PubMed ID: 24721755Background and purpose Pretreatment with dual antiaggregant drugs is accepted as a standard step in intracranial stent implantation. The aim of this study was to determine whether tailored antiaggregant medication based on platelet reactivity testing with multiple electrode aggregometry (Multiplate) yields superior outcomes after intracranial flow-diverting stent (FDS) implantation compared with standard clopidogrel treatment. Methods We retrospectively analyzed the following data from 100 consecutive patients: endovascular procedure characteristics, antiaggregant medications, procedural variables, and perioperative complications after FDS implantation for intracranial aneurysm. Patients were divided into two groups: uniform treatment with clopidogrel (untailored, early phase) and tailored treatment based on the results of aggregometry (late phase). Statistical comparisons included the Fisher exact test to compare categorical variables between the standard and aggregometry groups and the Mann-Whitney U test to compare ADP test values within the aggregometry group between groups receiving tailored or untailored treatment. Results In the aggregometry group (68 patients, 71 procedures) there were 17 (25%) clopidogrel-resistant patients, according to a cut-off value of 468 area under the aggregation curve; 12 underwent FDS implantation under tailored antiaggregant medication. In the standard treatment group (32 patients, 33 procedures) there were 3 (9.1%) spontaneous thrombotic events and 1 (3.3%) technical hemorrhagic complication. In the aggregometry group there were 2 (2.8%) spontaneous hemorrhagic events and 1 (1.4%) technical ischemic complication. In the aggregometry group, thrombotic complications and morbidity were lower than in the standard (no test) group (p<0.03). Conclusions Tailoring platelet reactivity according to multiple electrode aggregometry decreases the rate of thrombotic complications after intracranial FDS implantation

Coil embolization of iatrogenic coronary-pulmonary arterial fistula after heart transplantation

WOS: 000357329900014PubMed ID: 2613917

Aggregometry Response to Half-dose Prasugrel in Flow-diverting Stent Implantation

Gok, Mustafa/0000-0001-7021-0984WOS: 000566420700006PubMed: 31165176Purpose the aim of this study was to determine whether half-dose loading (30/mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10/mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation. Methods Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented. Results A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). the 6-month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate. Conclusion Half-dose (30/mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm

Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy

WOS: 000318045000008PubMed ID: 23322455The current literature describing surgical and endovascular interventions in blister-like aneurysms (BAs) offers no clear consensus on the optimal treatment modality. The aim of this study was to assess the clinical and angiographic features of ruptured BAs treated endovascularly using predominantly flow-diversion strategy. The initial clinical and radiological findings, endovascular treatment results, clinical outcomes, and follow-up angiographic findings of seven BAs (one man and six women; mean age, 44.5 years; range, 33-50 years) were retrospectively evaluated. All seven BAs were located in the supraclinoid internal carotid artery. Two patients were managed initially by other endovascular treatment options, after that flow-diverting strategy became intention to treat in these two and the remaining five patients. Flow-diverting treatment with pipeline stent (Covidien/Ev3) could be accomplished in all but one patient who was treated by parent artery occlusion due to an access problem. Dual antiaggregant loading was performed 6-8 h before treatment in all patients. No re-bleeding or thrombotic complication occurred periprocedurally. Long-term control angiography was available in all patients revealing occluded aneurysm. The clinical outcome (mRS) was good in five and moderate in two patients. Endovascular reconstructive treatment of a ruptured BA using a flow-diverting device is a promising strategy that can be performed with acceptable clinical and good radiological results

Brain infarction in a young patient with Buerger's disease - a case of cerebral thromboangiitis obliterans

WOS: 000399195200013Buerger's disease (BD) or thromboangiitis obliterans is a vasculitis that most commonly affects the small and medium-sized arteries and veins in the extremities. 1 It is most frequently seen in the young men who smoke and is associated with low socioeconomic status. BD is diagnosed on the basis of the clinical findings; the pathogenesis is not completely be understood. 1-4 In this report, we aim to present the clinical, magnetic resonance imaging (MRI) and angiographic findings of a 30-year-old man with ischemic stroke as a rare complication of BD

Intracranial Saccular Aneurysm in a Child With Only Persistent Headache

WOS: 000354546700013PubMed ID: 25156664Headache is one of the common symptoms of intracranial aneursym. A 5-year-old child lately presented to our pediatric emergency department with persistent headache. Brain magnetic resonance imaging revealed a 7x8 mm rounded lesion with slowly heterogeneous low signal in T2 sequence consistent with a partial occluded aneurysm, in the right medial frontal lobe that close to anterior cerebral artery. Intracranial aneurysms are rare in children and they are noncommon without complications as our case

Decompressive Craniectomy Saves Life When Performed in Time. A Member of Our Own Team, From Herniation to Independent Life; Case Report

WOS: 000300363200021Stroke remains to be the leading cause of morbidity and mortality all over the world among the aging population. Despite the ultimate developments in vascular neurosurgery and interventional endovascular methods, none have succeeded to be performed widely yet. Decompressive craniectomy is probably one of the basic practices of neurosurgery, which is simple but neglected time to time. It must be considered in all patients suffering from ischemic stroke with findings of mass effect but especially young patients with a non-dominant hemisphere affected. We would like to remind once more the useful and life-saving method by reporting the dramatic benefit of the patient who is also a member of our medical team