The use of dual-lumen balloon for embolization of peripheral arteriovenous malformations

PURPOSEWe aimed to evaluate the safety and feasibility of the embolization of peripheral arteriovenous malformation (AVM) with non-adhesive liquid agents (NALA) injected by dual-lumen balloons (DLB).METHODSWe conducted a multicenter retrospective study between January 2017 and June 2019, including patients with peripheral AVM embolized with NALA by DLB. Fourteen patients were included. The AVM classification, technical and clinical success were evaluated, as were nidus size, liquid agent used, volume and time of injection in DLB, complications, follow-up and need of surgical intervention.RESULTSThe mean age of the patients was 37±22.5 years (range, 6–82 years). The mean nidus size was 5.2±2.4 cm (range, 3.0–12.0 cm). By Schobinger classification, 11 AVMs were classified in stage 3 and 3 AVMs were classified in stage 2. By Cho’s classification, 2 AVMs were in stage II, 4 AVMs were in stage I, 4 AVMs were in stage IIIa and 4 AVMs were in stage IIIb. Onyx was used in 11 patients (78.6%), while Squid, PHIL, and both Onyx and Squid were used in one patient each (7.1%). Seven patients (50%) required one session of embolization, 4 patients (28.6%) required two, 2 patients (14.3%) required three and 1 patient (7.1%) required four sessions. Complete nidus exclusion was achieved in 11 patients (78.6%), optimal clinical response in 12 patients (85.7%). Four patients (28.6%) exhibited minor complications, all controlled. No major complications were seen. Four patients underwent surgical intervention (28.6%). CONCLUSIONThe embolization of peripheral AVM with NALA in DLB appears to be safe and feasible, achieving high rates of technical and clinical success

Randomized clinical trial of carotid angioplasty with distal brain protection filter comparing closed cell stent with Casper stent

Objetivo deste estudo: comparar a eficácia do stent de célula fechada com o stent Casper durante angioplastia de carótida com implante de stent (ACS) e dispositivo de proteção cerebral (DPC) distal. Material e Métodos: estudo prospectivo de superioridade randomizado no qual 88 pacientes foram incluídos. Os desfechos primários foram a incidência, número e tamanho de novas lesões cerebrais isquêmicas após ACS sob DPC distal. Os desfechos secundários incluíram acidente vascular cerebral (AVC), ataque isquêmico transitório (AIT) e infarto agudo do miocárdio (IAM). As lesões cerebrais isquêmicas foram avaliadas por uma imagem de ressonância magnética na sequência de difusão (DWI-MR). Os resultados neurológicos foram avaliados por meio do NIHSS e da escala Rankin modificada (mRS). Resultados: Comparado com o stent de célula fechada (n = 47), o stent Casper (n = 41) não resultou em redução significativa na incidência (44,7% versus 39%, p = 0,592), número (1,3 ± 1,8 versus 0,9 ± 1,5; p = 0,444) e tamanho (3,9 ± 5,8 versus 2,8 ± 4,2 mm; p = 0,353) de novas lesões cerebrais isquêmicas na DWI-MR. A taxa global de AVC / AIT / IAM foi (2/88 - 2,3%). Dois AITs ocorreram no período hospitalar, um em cada grupo (1/41 - 2,4% versus 1/47 - 2,1%). Um paciente do grupo-Casper apresentou trombose intra-stent assintomática. Um paciente do grupo-controle apresentou IAM (1/47 - 2,1%) após a alta. Conclusão: O stent Casper não mostrou superioridade na taxa de incidência, número e tamanho de novas lesões cerebrais isquêmicas silenciosas detectadas por DWI-RM quando comparado ao stent célula fechada durante ACS sob DPC distal.Objective: The aim of this trial was to compare the efficacy of closed-cell stents with Casper stents during carotid angioplasty stenting (CAS). Methods: This was a randomized superiority trial in which 88 patients were enrolled. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS under distal embolic protection devices (EPD). The secondary end points included stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Ischemic brain lesions were assessed by a diffusion-weighted magnetic resonance image (DWI-MR). Neurological outcomes were evaluated by means of the National Institutes of Health scale score (NIHSS) and the modified Rankin scale (mRS). Results: Compared with closed-cell stents (n= 47), Casper stents (n= 41), resulted in no significant reduction in the incidence (44.7% versus 39%, p = 0.592), number (1.3± 1.8 versus 0.9± 1.5, p = 0.444), and size (3.9± 5.8 mm versus 2.8± 4.1mm, p = 0.353) of new ischemic brain lesions. The global rate of stroke/TIA/MI was (2/88, 2.3%). Two TIA occurred during the hospitalization period, one in each group (1/41, 2.4% versus 1/47, 2.1%). One patient of the Casper group had an asymptomatic in-stent thrombosis. One patient of the control group had a MI (1/47, 2.1%) after discharge. Conclusion: The Casper stents did not show superiority in the rate of incidence, number and size of new silent ischemic brain lesions detect by DW-MRI when compared to close cell stents during CAS under distal EPD

Number of coils necessary to treat cerebral aneurysms according to each size group: a study based on a series of 952 embolized aneurysms

OBJECTIVE: The Brazilian public health system determines a quantity of coils allowed to treat a cerebral aneurysm. The goal of this paper was to determine the number of coils necessary to treat an aneurysm based on size. METHODS: All patients harboring an aneurysm treated by endovascular approach between 1999 and 2003 were reviewed. RESULTS: There were 952 aneurysms included. Mean diameter sac was 8.2 mm with 7.9 coils per aneurysm. Out of 462 small aneurysms, mean size was 4.8 mm, with 4.6 coils/aneurysm used. A total of 315 medium aneurysms were treated, mean size was 8.6 mm, with 8.2 coils. Out of 135 large, mean size was 17 mm, with 16.1 coils. Forty giant aneurysms were treated with a mean size of 32 mm and 28.7 coils. CONCLUSIONS: We propose size as a reference to predict the number of coils necessary to treat each aneurysm: one coil for each millimeter of diameter