Endovascular treatment of acute type B dissection complicating graft-bypass repair for aortic coarctation

AbstractObjectivesThe early dissection of the descending aorta after the repair of aortic coarctation is very rare. Herein, we present a special endovascular technique used for acute type B dissection complicating graft bypass for aortic coarctation.MethodsThe 48 year-old male patient with the diagnosis of adult type aortic coarctation had bypass procedure between the aortic arch and the descending aorta. Six weeks after the first operation, the patient was readmitted with severe back pain and had the diagnosis of acute type B dissection which involved the descending aorta at the distal part of the graft anastomosis.ResultsTwo separate stent-grafts were deployed respectively 31 × 150 mm and 34 × 200 mm (C-TAG™ WL Gore&Asc., Flagstaff, AZ, USA). The previous Dacron bypass graft was used as a proximal landing zone for the first stent-graft. The distal landing zone for the second stent was the area between the celiac trunk and superior mesenteric artery. Therefore, the covered stent-graft was implanted to the celiac trunk (Viabahn™ 7 × 50 mm WL Gore&Asc, AZ, USA) to maintain its patency before the deployment of the second graft. The segment of coarctation was closed with a vascular plug (Amplatzer™ vascular plug II) to prevent persistent perfusion of aneurysmal false lumen.ConclusionThe endovascular approach offers multiple less invasive options based on a patient-specific problem

The Advocate - July 19, 1962

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

Are perioperative near-infrared spectroscopy values correlated with clinical and biochemical parameters in cyanotic and acyanotic infants following corrective cardiac surgery?

WOS: 000371172200007PubMed ID: 26034194Background: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. Methods: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. Results: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. Conclusion: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction

Necrotizing Liver Granuloma/Abscess and Constrictive Aspergillosis Pericarditis with Central Nervous System Involvement: Different Remarkable Phenotypes in Different Chronic Granulomatous Disease Genotypes

Chronic granulomatous disease (CGD) is a primary immune deficiency causing predisposition to infections with specific microorganisms, Aspergillus species and Staphylococcus aureus being the most common ones. A 16-year-old boy with a mutation in CYBB gene coding gp91phox protein (X-linked disease) developed a liver abscess due to Staphylococcus aureus. In addition to medical therapy, surgical treatment was necessary for the management of the disease. A 30-month-old girl with an autosomal recessive form of chronic granulomatous disease (CYBA gene mutation affecting p22phox protein) had invasive aspergillosis causing pericarditis, pulmonary abscess, and central nervous system involvement. The devastating course of disease regardless of the mutation emphasizes the importance of early diagnosis and intervention of hematopoietic stem cell transplantation as soon as possible in children with CGD

Pediyatrik beyin hastalıklarının tanısında difüzyon MRG'nin yararı ve konvansiyonel MRG sekanslarına katkısı

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.[Abstarct Not Available

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

Multi dedektör bilgisayarlı tomografi ile karotid arter plaklarında kontrastlanma miktarlarının saptanması

Aim: The purpose of the study is to determine the accuracy of carotid artery plaque density measurements using multi detector computed tomography (MDCT) with contrast administration to differentiate symptomatic from asymptomatic plaques. Materials and Methods: Seventy-two patients who did not have calcified plaques were identified retrospectively among patients undergoing neck and brain MDCT due to atherosclerotic carotid artery disease diagnosis or prediagnosis. The plaque density measurements were made on the same axial unenhanced and contrast-enhanced sections in large window, using a circular ROI in 1-4 mm;sup2; in size. The symptom differentiation of patients was based on neurological examination and radiological findings. The measured density values were compared according to the clinical and laboratory findings and medical histories of the patients. Student t-test was used for statistical analyses. Results: Significant differences (p;lt;0.001) were found between the unenhanced and contrast-enhanced plaque densities, but the same density difference was not observed among symptomatic patients. A significant relationship was shown between the plaque density and localization (p;lt;0.003). In addition, the comparison between the degree of stenosis and symptoms was statistically significant (p;lt;0.001). There was no significant association between the plaque density and symptoms, gender, stenosis side, infarct type, hyperlipidemia, hypertension, diabetes, coronary artery disease and cigarette use. Conclusion: An increased density with MDCT was determined depending on the contrast agent uptake in carotid plaques. However, it was not statistically significant between the symptomatic and the asymptomatic patients groups.Amaç: Multi dedektör bilgisayarlı tomografi (MDBT) ile karotid arter plaklarının kontrastsız ve kontrastlı görüntüleri üzerindeki dansite artışının saptanması ve bu dansite artışının semptomatik hastalardaki miktarının belirlenmesi amaçlandı. Gereç ve Yöntem: Aterosklerotik karotid arter hastalığı tanı ya da ön tanısıyla supraaortik damarların incelenmesine yönelik MDBT tetkiki yapılmış ve kalsifik plak içermeyen 72 hasta retrospektif olarak tespit edildi. Plak dansite ölçümleri, kontrastlı ve kontrastsız olmak üzere aynı aksiyel kesitlerde, geniş pencerede, 1-4 mm² büyüklüğündeki dairesel ROI kullanılarak yapıldı. Hastaların semptom ayrımında nörolojik muayene bulguları ve radyolojik görüntüleme bulguları kullanıldı. Ölçülen dansite değerleri hastaların özgeçmiş, klinik ve laboratuvar bulguları ile karşılaştırıldı. İstatistik hesaplamaları student-t testi ile yapıldı. Bulgular: Tüm hastaların kontrastsız ve kontrastlı plak dansiteleri arasındaki fark anlamlı (p0.001) bulundu, fakat semptomlu hastalarda aynı dansite farkı tespit edilmedi. Plak dansitesi ile lokalizasyon arasında anlamlı (p0.003) bir ilişki saptandı. Ayrıca stenoz derecesi ile semptom arasındaki karşılaştırma (p0.001) anlamlı idi. Plak dansitesi ile semptom, cinsiyet, stenoz tarafı, infarkt tipi, hiper lipidemi, hipertansiyon, diabet, koroner arter hastalığı varlığı ve sigara kullanımı arasında anlamlı ilişki bulunmadı. Sonuç: MDBT ile karotid plaklarında kontrast madde tutuluşuna bağlı dansite artışı, semptomatik ve asemptomatik hasta grupları arasında anlamlı bulunmadı

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

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