Embolizarea endovasculară a anevrismelor cerebrale: Studiu. Serie de cazuri

Background. Nontraumatic subarahnoid hemorrhage (SAH) of aneurysmal etiology is a neurosurgical emergency. Aneurysm rupture accounts for 80% of nontraumatic SAH and has a high rate of complications and death. Endovascular coiling embolization of the aneurysm is a basic method for aneurysm exclusion. Objective of the study. The objective of this study is to share the results of a series of cases that underwent aneurysm coiling for aneurysmal SAH. Material and Methods. The study represents a series of patients who underwent aneurysm coiling for the treatment of SAH. Before intervention the patients were assessed based on mFisher, Hunt-Hess and WFNS scales. Coiling embolization was performed under general anesthesia. Outcome criteria were assessed at 3 and 6 months. Results. All the patients were initially evaluated with an angiographic study (CT angio or angiography) for planning the intervention. The patients were operated under general anesthesia. Coiling and baloon-assisted coiling were procedures used in the majority of cases. One case were complicated by intraprocedural rupture of the aneurysm and later the patient passed away. All other cases were successfully and the patients were discharged in a mRS score below 3. Conclusion. Considering minimal invasiveness of endovascular coiling of an brain aneurysm for a patient than neurosurgical clipping, we conclude that implementation of this technique will improve the quality of patient care and improve clinical results. Introducere. Hemoragia subarahnoidiană (HSA) anevrismală este o urgență neurochirurgicală. Anevrismele erupte sunt responsabile de 80% din HAS nontraumatică. Embolizarea endovasculară este o metodă de bază pentru a exclude anevrismul din circulație. Scopul lucrării. Scopul lucrării este prezentarea rezultatelor unei serii de cazuri de embolizare endovasculară a anevrismelor cerebrale. Material și Metode. Studiul reprezintă o serie de cazuri de embolizare endovasculara a anevrismelor cerebrale. Preoperator, pacienții au fost evaluați conform scalelor uzuale: Hunt-Hess, WFNS, mFisher. Procedurile au fost efectuate în anestezie generală. Evaluarea pacienților a avut loc la 3 și 6 luni, postoperator. Rezultate. Preoperator, pacienții au fost evaluați printr-o metodă angiografică (CT angio sau angiografie clasică) în vederea planificării intervenției chirurgicale. Toate procedurile au avut loc în anestezie generală. Embolizarea și embolizarea balon-asistată au fost tehnicile folosite cel mai des. Un caz s-a complicat cu o erupție repetată intraoperatorie a anevrismului și ulterior, decesul pacientului. Restul cazurilor s-au finisat cu succes, pacienții fiind externați într-un scor Rankin mai mic ca 3. Concluzii. Având în vedere caracterul minimal invaziv al procedurii de embolizare, comparativ cu clipping-ul, implimentarea pe larg a acestei metode de tratament va ameliora outcome-ul și calitatea vieții pacienților cu anevrisme cerebrale

Endovascular coiling embolization of cerebral aneurysms: a case series study

State University of Medicine and Pharmacy ”Nicolae Testemitanu”, Institute of Neurology and Neurosurgery ”Diomid Gherman”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction Cerebral aneurysm rupture accounts for 80% of nontraumatic SAH and has a high rate of complications and death. Endovascular coiling embolization of the aneurysm is a basic method for aneurysm exclusion from circulation to prevent a repeated rupture. Purpose The main purpose of this presentation is to share the results of a series of cases that underwent aneurysm coiling for aneurysmal SAH. Material and methods The study represents a series of patients who underwent aneurysm coiling for the treatment of SAH. Before intervention the patients were assessed based on different scales. Outcome criteria were assessed at 3 and 6 months. Results All the patients were initially evaluated with an angiographic study (CT angio or angiography) for planning the intervention. Coiling and baloon-assisted coiling were procedures used in the majority of cases. The majority of cases were successfully and the patients were discharged in a mRS score below 3. Conclusions Considering minimal invasiveness of endovascular coiling of an brain aneurysm for a patient, than neurosurgical clipping, we conclude that implementation of this technique will improve the quality of patient care and improve clinical results

Stentarea arterei carotide interne la pacienții simptomatici cu stenoze critice de carotidă: Studiu-serie de cazuri

Background. Internal carotid artery atherosclerosis account for an estimate of 15-25% of ischemic strokes. Carotid revascularization techniques have proven useful in reducing the incidence of ischemic stroke. Nowadays, carotid artery stenting is a basic treatment for carotid stenosis. Objective of the study. The objective of this publication is to present a series of cases of patients who had a high degree stenosis of ICA and underwent carotid stenting, as secondary stroke prevention. Material and Methods. The study represents a series of symptomatic patients who underwent carotid stenting for critical carotid stenosis. All the procedures were performed in Institute of Neurology and Neurosurgery. Main outcomes like: morbidity and mortality rates at 30 days post procedure; repeated ischemic stroke in the territory of stented artery; and common complications were registered. Results. All the patients were initially evaluated with an angiographic study (CT angio or angiography) for planning the intervention. The patients were operated under conscious sedation and with distal embolic protection. The design of the stents was chosen according to the vascular anatomy of carotid bifurcation. In our case series of patients we didn’t register major complications during, or in first 30 days after the procedure. One patient had a hyperperfusion syndrome which was resolved with careful arterial tension monitoring. Conclusion. Carotid stenting is a safe and efficient procedure, with low periprocedural complications and good outcomes in correctly selected patients. Due to its minimal invasiveness in the future it may become first choice procedure in the treatment of carotid artery stenosis. Introducere. Stenoza de arteră carotidă internă este responsabilă de 15-25% din ictusurile ischemice. Tehnicile de revascularizare carotidiană și-au demonstrat eficacitatea în a micșora incidența ictusului ischemic. Stentarea arterei carotide reprezintă un tratament de bază stenozei carotidiene. Scopul lucrării. Scopul lucrării este prezentarea unei serii de cazuri de pacienți simptomatici cu stenoze critice de arteră carotidă, care au fost stentați în vederea prevenției secundare a ictusului ischemic. Material și Metode. Studiul reprezintă analiza unei serii de cazuri de pacienți. Toate procedurile au fost efectuate în Institutul de Neurologie și Neurochirugie „Diomid Gherman”. Criteriile de bază ale outcome-ului precum: ratele de morbiditate și mortalitate la 30 de zile postprocedură, ictus ischemic repetat în teritoriul arterei stentate și complicațiile apărute au fost înregistrate și analizate. Rezultate. Preoperator, pacienții au fost evaluați printr-o metodă angiografică (CT angio sau angiografie clasică), în vederea depistării gradului stenozei și planificării intervenției chirurgicale. Toți pacienții au fost operați cu anestezie locală și sedare intravenoasă. Procedura de stentare a fost efectuată cu respectarea protecției distale. Design-ul stentului a fost ales în dependență de configurația vasculară a bifurcației carotidiene. Datele înregistrate denotă absența în seria de cazuri prezentată a complicațiilor majore raportate în literatură. Un singur pacient a prezentat un sindrom de hiperperfuzie cerebrală, care a fost rezolvat prin corijarea tensiunii arteriale. Concluzii. Stentarea arterei carotide este o procedură eficentă cu rate mici ale complicațiilor periprocedurale și rezultate bune în cazuri atent selectate. Având în vedere caracterul minim-invaziv, în viitor ar putea deveni procedura de primă intenție în tratamentul stenozei carotidiene

Trombectomia mecanică la pacineții cu avc ischemic supraacut. Cazuri speciale

Neurosurgery Department, Nicolae Testemitanu SUMPh, Diomid Gherman Institute of Neurology and Neurosurgery, Department of Radiology and Imaging, Nicolae Testemitanu SUMPhBackground. Mechanical thrombectomy is the standard treatment for large vessel occlusion in acute ischemic stroke up to 6 hours after onset. Objective of the study. The objective of this study is to share the results of a series of cases that underwent mechanical thrombectomy Material and Methods. The study represents a series of patients who underwent mechanical thrombectomy for the treatment of acute ischemic stroke. Before intervention, the patients were assessed based on NIHSS scale. Mechanical thrombectomy using aspiration, stent-retriever and special techniques were used. Outcome criteria were assessed at 6 months. Results. All the patients were initially evaluated with CT and CT angio for planning the intervention. The patients were operated mainly under general anesthesia. Aspiration and thrombectomy using a stent-retriever were procedures used in the majority of cases. Special cases are also described. Majority of the patients were in a mRS score below 3 at 6 months follow-up. Conclusion. Our data confirm the data that endovascular management is superior to standard medical management alone for the treatment of acute ischemic stroke due to large vessel occlusion.Introducere. Trombectomia mecanică rămâne stantartul de aur în tratamentul de revascularizare în ictusul ischemic supraacut cauzat de o ocluzie de vas major intracranian. Scopul lucrării. Scopul lucrarii este prezentarea rezultatelor unei serii de cazuri de trombectomie mecanică. Material și Metode. Studiul reprezintă o serie de cazuri de trombectomie mecanică la pacienții cu ictus cerebral ischemic acut. Pacienții au fost evaluați preoperator conform scalei NIHSS. Procedurile efecutate au fost: trombespirația, trombectomia prin stent-retriever și trombectomia prin utilizarea tehnicilor speciale. Evaluarea pacienților a avut loc la 6 luni postoperator. Rezultate. Pacienții au fost evaluați preoperator prin CT și CT angio în vederea planificării intervenției chirurgicale. Majoritatea procedurilor au fost efectuate sub anestezie generală. Trombaspirația și trombectomia, utilizând un stent-retriver, au fost procedurile de baza. În lucrare mai sunt descrise și cazurile speciale de trombectomie. Majoritatea pacienților externați au avut la 6 luni un scor Rankin mai mic ca 3. Concluzii. Studiul dat confirmă datele prezentate în literatura de specialitate că tratamentul endovascular al ictusului ischemic acut este superior tratamentului conservativ/ medicamentos cauzat de ocluzii de vase majore intracraniene

Arteriovenous malformations embolization in the modern era: case series report

Background: Cerebral arteriovenous malformations are complex high-flow lesions that can result in devastating neurological injury when they hemorrhage. Embolization for cerebral arteriovenous malformations has evolved in the last decade with evolution in both equipment and material. Endovascular interventions within arteriovenous malformations may include curative exclusion of arteriovenous malformations from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Fortunately, care by a multidisciplinary team experienced in the comprehensive management of arteriovenous malformations can offer excellent results in most cases. Material and methods: We report the technical and management outcomes of our first cases of cerebral arteriovenous malformations treated with embolization. The clinical, angiographic, treatment, and outcome variables of consecutive cerebral arteriovenous malformation cases, treated with curative embolization between September 2019 and April 2021 in our center were retrospectively analyzed. Results: In 12 patients, 12 arteriovenous malformations were identified. Fourteen embolization sessions were done. No cases of early hemorrhage after embolization occurred. All the patients were discharged at grade below 2 mRS. Angiographic cure was achieved in 2 patients (17%). The average size reduction was 80 %. Conclusions: Embolization is a critical component of the multimodality treatment of cerebral arteriovenous malformations. It is clear that many arteriovenous malformations cannot be safely cured without the judicious use of this modality. In addition, embolization could serve as a curative option for arteriovenous malformations treatment with accepted morbidity and mortality