Flow-diverter treatment for renal artery aneurysms: One-year follow-up of a multicentric preliminary experience

PURPOSERenal artery aneurysms (RAAs) are rare in the general population, although the true incidence and natural history remain elusive. Conventional endovascular therapies such as coil embolization or covered stent graft may cause sidebranches occlusion, leading to organ infarction. Flow-diverters (FD) have been firstly designed to treat cerebrovascular aneurysms, but their use may be useful to treat complex RAAs presenting sidebraches arising from aneurysmal sac. To evaluate mid-term follow-up (FUP) safety and efficacy of FD during treatment of complex RAAs.METHODSBetween November 2019 and April 2020, 7 RAAs were identified in 7 patients (4 men, 3 women; age range 55-82 years; median 67 years) and treated by FD. Procedural details, complications, morbidity and mortality, aneurysm occlusion and segmental artery patency were retrospectively reviewed. Twelve months computed tomography angiography (CTA) FUP was evaluated for all cases.RESULTDeployment of FD was successful in all cases. One intraprocedural technical complication was encountered with one FD felt down into aneurism sac which requiring additional telescopic stenting. One case at 3 months CTA FUP presented same complication, requiring same rescue technique. At 12 months CTA FUP 5 cases of size shrinkage and 2 cases of stable size were documented. No rescue surgery or major intraprocedural or mid-term FUP complication was seen.CONCLUSIONComplex RAAs with two or more sidebranches can be safely treated by FD. FD efficacy for RAA needs a further validation at long term FUP by additional large prospective studies

Bilanciamento tra liberta e diritto alla sicurezza: chimera o obiettivo raggiungibile?

Il tema della sicurezza è molto complesso ed è stato più volte al centro della riflessione giuridica e, in particolare, di quella costituzionale. Tutta la materia presenta, sia per quanto riguarda gli aspetti peculiari, sia normative e dottrinali, una serie di rischi che mirano e, in un certo senso, deviano l’attenzione dall’oggetto dell’indagine. In particolare, il tema della sicurezza è un argomento alquanto delicato, perché coinvolge sotto molti aspetti tutti i diritti e libertà della persona. Lo studio muove da un’analisi dei concetti giuridici di sicurezza e di libertà, funzionali alla ricostruzione della natura giuridica della stessa sicurezza. In questo testo, chi scrive, cerca di sviluppare la sua tesi orientando lo studio verso un’analisi della sicurezza che riguardi sia l’interesse della collettività che il diritto dell’individuo, soffermandosi sulle principali problematiche connesse al tema della sicurezza nel contesto dei principi e diritti sanciti dalla Carta costituzionale e su come la stessa sicurezza influenzi diritti riconosciuti quali quello alla vita, quello all’incolumità personale, quello alla libertà e alla sicurezza personale, quello alla libertà della manifestazione del pensiero, ma anche quello alla libertà di circolazione e di iniziativa economica privata. Nel proseguo dello studio, verrà descritta un’analisi sia del “nuovo equilibrio” all’indomani degli attentati dell’11 settembre, i quali hanno portato ad un momento di rottura della tutela costituzionale dei diritti e delle libertà in nome della sicurezza e sia un’analisi del bilanciamento tra sicurezza e libertà affrontato dai Paesi europei ed extra-europei. Al termine di questo studio, si tenterà di stimolare una rivisitazione del paradigma costituzionale del rapporto tra sicurezza e libertà, non derogando dall’imprescindibile necessità di trovare un punto di equilibrio tra gli stessi. Delineando tra questi due termini – sicurezza e altri diritti – un forte rapporto derivante dall’essere il primo strumento di protezione delle libertà piuttosto che oppressione delle libertà stesse. Da ciò ne consegue che eventuali interventi limitativi dei diritti inviolabili trovano giustificazione fino a quando sono diretti alla loro conservazione e sempre nel rispetto del principio di proporzionalità degli strumenti rispetto al fine che si vuole perseguire. Solo in questo modo la sicurezza può mantenere la sua duplice immagine di interesse della collettività e di diritto dell’individuo

Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms

Basilar trunk perforator (BTP) aneurysms are rare. Treatment options traditionally considered for these uncommon lesions have included direct surgery, endovascular therapy, or conservative management. Flow diverters represent a newer therapeutic option for BTP aneurysms but pitfalls and complications are unknown. We describe three patients with BTP aneurysms treated with flow diverter stents

Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience

Experience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device

Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)

Background Clinical trials and observational studies have demonstrated the benefit of thrombectomy up to 16 or 24 hours after the patient was last known to be well. This study aimed to evaluate the outcome of stroke patients treated beyond 24 hours from onset. Methods We analyzed the outcome of 34 stroke patients (mean age 70.7 +/- 12.3 years; median National Institutes of Health Stroke Scale (NIHSS) score 13) treated with endovascular thrombectomy beyond 24 hours from onset who were recruited in the Italian Registry of Endovascular Thrombectomy in Acute Stroke. Selection criteria for patients were: pre-stroke modified Rankin scale (mRS) score of <= 2, non-contrast CT Alberta Stroke Program Early CT score of >= 6, good collaterals on single phase CT angiography (CTA) or multiphase CTA, and CT perfusion mismatch with an infarct core size <= 50% of the total hypoperfusion extent or involving less than one-third of the extent of the middle cerebral artery territory evaluated by visual inspection. The primary outcome measure was functional independence assessed by the mRS at 90 days after onset. Safety outcomes were 90 day mortality and the occurrence of symptomatic intracranial hemorrhage (sICH). Results Successful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was present in 76.5% of patients. Three month functional independence (mRS score 0-2) was observed in 41.1% of patients. The case fatality rate was 26.5%. and the incidence of sICH was 8.8%. Conclusions These findings suggest that, in a real world setting, very late endovascular therapy is feasible in appropriately selected patients

Comparison Between Three Commonly Used Large-Bore Aspiration Catheters in Terms of Successful Recanalization and First-Passage Effect

To compare three commonly used large-bore aspiration catheters in terms of final successful recanalization rate and first-passage successful and complete recanalization rates (the so called "first-passage effect")

Mechanical thrombectomy in minor stroke due to isolated M2 occlusion: a multicenter retrospective matched analysis

Background The purpose of this study was to evaluate the effectiveness of mechanical thrombectomy (MT) in patients with isolated M2 occlusion and minor symptoms and identify possible baseline predictors of clinical outcome. Methods The databases of 16 high-volume stroke centers were retrospectively screened for consecutive patients with isolated M2 occlusion and a baseline National Institutes of Health Stroke Scale (NIHSS) score <= 5 who received either early MT (eMT) or best medical management (BMM) with the possibility of rescue MT (rMT) on early neurological worsening. Because our patients were not randomized, we used propensity score matching (PSM) to estimate the treatment effect of eMT compared with the BMM/rMT. The primary clinical outcome measure was a 90-day modified Rankin Scale score of 0-1. Results 388 patients were initially selected and, after PSM, 100 pairs of patients receiving eMT or BMM/rMT were available for analysis. We found no significant differences in clinical outcome and in safety measures between patients receiving eMT or BMM/rMT. Similar results were also observed after comparison between eMT and rMT. Concerning baseline predicting factors of outcome, the involvement of the M2 inferior branch was associated with a favorable outcome. Conclusion Our multicenter retrospective analysis has shown no benefit of eMT in minor stroke patients with isolated M2 occlusion over a more conservative therapeutic approach. Although our results must be viewed with caution, in these patients it appears reasonable to consider BMM as the first option and rMT in the presence of early neurological deterioration