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1.
Interv Neuroradiol ; 26(5): 557-565, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1455862

ABSTRACT

BACKGROUND: The Low-profile Visualized Intraluminal Support device (LVIS) has been successfully used to treat cerebral aneurysm, and the push-pull technique has been used clinically to compact the stent across aneurysm orifice. Our aim was to exhibit the hemodynamic effect of the compacted LVIS stent. METHODS: Two patient-specific aneurysm models were constructed from three-dimensional angiographic images. The uniform LVIS stent, compacted LVIS and Pipeline Embolization Device (PED) with or without coil embolization were virtually deployed into aneurysm models to perform hemodynamic analysis. Intra-aneurysmal flow parameters were calculated to assess hemodynamic differences among different models. RESULTS: The compacted LVIS had the highest metal coverage across the aneurysm orifice (case 1, 46.37%; case 2, 67.01%). However, the PED achieved the highest pore density (case 1, 19.56 pores/mm2; case 2, 18.07 pores/mm2). The compacted LVIS produced a much higher intra-aneurysmal flow reduction than the uniform LVIS. The PED showed a higher intra-aneurysmal flow reduction than the compacted LVIS in case 1, but the results were comparable in case 2. After stent placement, the intra-aneurysmal flow was further reduced as subsequent coil embolization. The compacted LVIS stent with coils produced a similar reduction in intra-aneurysmal flow to that of the PED. CONCLUSIONS: The combined characteristics of stent metal coverage and pore density should be considered when assessing the flow diversion effects of stents. More intra-aneurysmal flow reductions could be introduced by compacted LVIS stent than the uniform one. Compared with PED, compacted LVIS stent may exhibit a flow-diverting effect comparable to that of the PED.


Subject(s)
Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Stents , Subarachnoid Hemorrhage/therapy , Angiography, Digital Subtraction , Cerebral Angiography , Computer Simulation , Hemodynamics , Humans , Hydrodynamics , Imaging, Three-Dimensional , Intracranial Aneurysm/diagnostic imaging , Magnetic Resonance Angiography , Prosthesis Design , Subarachnoid Hemorrhage/diagnostic imaging
2.
BMJ Case Rep ; 14(7)2021 Jul 12.
Article in English | MEDLINE | ID: covidwho-1307884

ABSTRACT

A rare case of a hypoplastic internal carotid artery (ICA) terminating in the ophthalmic artery with multiple intracranial saccular aneurysms in the contralateral ICA, anterior communicating artery fenestration and triple A2 was identified. The aetiology and pathogenesis of ICA hypoplasia are subjected to certain hypotheses. Developing several collaterals to preserve the blood supply of the ipsilateral cerebral hemisphere could result in aneurysm formation due to flow overload on the contralateral vasculature, but it could also result in hemicranial hypoplasia, cerebral atrophy and deep watershed infarcts, as in our case.


Subject(s)
Intracranial Aneurysm , Ophthalmic Artery , Anterior Cerebral Artery , Carotid Artery, Internal/diagnostic imaging , Cerebral Angiography , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/etiology , Ophthalmic Artery/diagnostic imaging
5.
J Neurointerv Surg ; 13(11): 1022-1026, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-991864

ABSTRACT

BACKGROUND: Existing travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures. METHODS: International teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner. RESULTS: All three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution. CONCLUSIONS: International teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.


Subject(s)
COVID-19 , Endovascular Procedures , Intracranial Aneurysm , Canada , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , SARS-CoV-2
6.
Clin Neurol Neurosurg ; 201: 106425, 2021 02.
Article in English | MEDLINE | ID: covidwho-965057

ABSTRACT

BACKGROUND/OBJECTIVES: The present study aimed at evaluating the impact on the early outcome of patients with ruptured intracranial aneurysms. METHODS: Our study prospectively included 26 consecutive patients with ruptured intracranial aneurysm managed at our institution in context of COVID-19 pandemic between March 1st, 2020 and April, 26th, 2020 (2020 group). A group control included other 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group). On admission, poor neurological status was defined as WFNS score >3. Severe radiological status was defined by the presence of intracerebral hematoma, or/and acute hydrocephalus requiring further EVD or/and the presence of vasospasm on presentation. Statistical analysis was performed to compare the 2 distinct groups. RESULTS: Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher in the 2020 group (p = 0.01 and p = 0.02, respectively). The delayed hospital admission was 2.7 days in 2020 group and 0.75 days in 2019 group (p = 0.005). Therefore, vasospasm's rate on presentation was also higher in the 2020 group (p = 0.04). CONCLUSION: To our knowledge, this is one of the first studies demonstrating influence of the COVID-19 pandemic on patients with urgent and severe intracranial aneurysmal disease. In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized.


Subject(s)
Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/epidemiology , COVID-19/diagnostic imaging , COVID-19/epidemiology , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/epidemiology , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , France/epidemiology , Humans , Male , Middle Aged , Pandemics , Prospective Studies
7.
BMJ Case Rep ; 13(10)2020 Oct 04.
Article in English | MEDLINE | ID: covidwho-814252

ABSTRACT

This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Endovascular Procedures/methods , Intracranial Aneurysm/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/methods , Angiography, Digital Subtraction/methods , COVID-19 , Humans , Intracranial Aneurysm/diagnostic imaging , SARS-CoV-2
8.
World Neurosurg ; 138: e955-e960, 2020 06.
Article in English | MEDLINE | ID: covidwho-274866

ABSTRACT

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Subject(s)
Aneurysm, Ruptured/surgery , Coronavirus Infections/diagnosis , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Pneumonia, Viral/diagnosis , Subarachnoid Hemorrhage/surgery , Air Filters , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Betacoronavirus , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Computed Tomography Angiography , Coronavirus Infections/complications , Craniotomy/methods , Drainage , Emergencies , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/surgery , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Pressure , Intraoperative Care , Lung/diagnostic imaging , Monitoring, Physiologic , Operating Rooms , Pandemics , Perioperative Care , Personal Protective Equipment , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2 , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed , United States
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