Vascular Causes of Dysphonia: A Case Series with Different Etiologies

Pierino Spadafora,1 Andrea Esposito,2 Caterina Giannitto,3 Letizia Di Meglio,1 Nunzio Paolo Nuzzi,3 Gianpaolo Carrafiello2 1Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, 20122, Italy; 2Foundation IRCCS Ca' Granda Maggiore Policlinico Hospital, Radiology Department, Milan, Italy; 3Humanitas Research Hospital, Radiology Department, Milan, 20013, ItalyCorrespondence: Pierino SpadaforaPostgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, Milan, 20122, ItalyEmail [email protected] EspositoFoundation IRCCS Ca' Granda Maggiore Policlinico Hospital, Radiology Department, Via F. Sforza 35, Milan, 20122, ItalyEmail [email protected]: Dysphonia is a frequent and often disabling condition that can be caused by a multitude of circumstances. Differential diagnosis of dysphonia comprehends many different etiologies and many causative agents (neoplasms, inflammations, traumatic injuries) that can occur in a large anatomical space (from the encephalic trunk to the upper mediastinum). It is fundamental to remember that vascular etiologies are responsible for some rare cases of dysphonia. In the radiological database of two urban academic hospitals, from 2012 to 2020, we sought patients who underwent CT or MRI for dysphonia, selecting only the ones with an underlying clinically confirmed vascular etiology. We present three emblematic cases with different vascular etiologies: a ductus arteriosus aneurysm, a left internal carotid artery dilatation, a laryngeal arteriovenous malformation (AVM). Vascular causes of dysphonia are rare, but especially in these cases an accurate and prompt diagnosis is fundamental, in particular considering that the underlying cardiovascular anomaly can often pose a higher risk for the patient than the hoarseness itself. Diagnostic imaging plays a fundamental role in detecting the most common causes of dysphonia but it is very important that radiologists take the vascular causes into account so as not to miss them and to obtain a correct diagnosis.Keywords: dysphonia, thoracic aorta, arteriovenous malformation, carotid artery, patent ductus arteriosu

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

Diversion-p64: results from an international, prospective, multicenter, single-arm post-market study to assess the safety and effectiveness of the p64 flow modulation device

International audienceBackground: The use of flow diversion to treat intracranial aneurysms has increased in recent years.Objective: To assess the safety and angiographic efficacy of the p64 flow modulation device.Methods: Diversion-p64 is an international, prospective, multicenter, single-arm, study conducted at 26 centers. The p64 flow modulation device was used to treat anterior circulation aneurysms between December 2015 and January 2019. The primary safety endpoint was the incidence of major stroke or neurologic death at 3-6 months, with the primary efficacy endpoint being complete aneurysm occlusion (Raymond-Roy Occlusion Classification 1) on follow-up angiography.Results: A total of 420 patients met the eligibility criteria and underwent treatment with the p64 flow modulation device (mean age 55±12.0 years, 86.2% female). Mean aneurysm dome width was 6.99±5.28 mm and neck width 4.47±2.28 mm. Mean number of devices implanted per patient was 1.06±0.47, with adjunctive coiling performed in 14.0% of the cases. At the second angiographic follow-up (mean 375±73 days), available for 343 patients (81.7%), complete aneurysm occlusion was seen in 287 (83.7%) patients. Safety data were available for 413 patients (98.3%) at the first follow-up (mean 145±43 days) with a composite morbidity/mortality rate of 2.42% (n=10).Conclusions: Diversion-p64 is the largest prospective study using the p64 flow modulation device. The results of this study demonstrate that the device has a high efficacy and carries a low rate of mortality and permanent morbidity

Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis

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General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke

As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA)

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There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes