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1.
Neuroradiology ; 66(6): 1013-1020, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38563963

ABSTRACT

PURPOSE: The aim of this registry was to assess technical success, procedural safety and mid- to long-term follow-up results of the Silk Vista "Mama" (SVM) flow diverter (BALT, Montmorency, France) for the treatment of proximal intracranial aneurysms. METHODS: Between August 2020 and March 2022, data from nine Italian neurovascular centres were collected. Data included patients' clinical presentation, aneurysms' size, location and status, technical details, overall complications and mid- to long-term angiographic follow-up. RESULTS: Forty-eight aneurysms in 48 patients were treated using the SVM. Most aneurysms were small (≤ 10 mm: no. 29, 60%) and unruptured (no. 31, 65%); 13 aneurysms were recurrent after coiling or clipping. 37/48 aneurysms involved the internal carotid artery (77%). Optimal opening and complete wall apposition of the device were achieved in 46 out of 48 cases (96%). Four intra- or periprocedural complications occurred (two thrombotic complications successfully resolved, one cerebellar ischemia, one perirenal hematoma), without new neurological deficit. No significant intra-stent stenosis or stent displacement was observed during follow-up. No FD-related morbidity nor mortality was reported. At midterm (6-12 months) to long-term (> 12 months) follow-up, complete aneurysm occlusion (OKM D) was achieved in 76% of cases. Eighty-eight percent of patients had complete aneurysm occlusion or entry remnant (OKM D + C). CONCLUSIONS: Our experience suggests that the new generation of low-profile SVM flow diverter for the treatment of proximal intracranial aneurysms is safe and effective, with low rates of intraprocedural complications and acceptable mid- to long-term occlusion rate.


Subject(s)
Embolization, Therapeutic , Intracranial Aneurysm , Registries , Stents , Humans , Intracranial Aneurysm/therapy , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Male , Female , Embolization, Therapeutic/methods , Embolization, Therapeutic/instrumentation , Middle Aged , Aged , Follow-Up Studies , Circle of Willis/diagnostic imaging , Adult , Cerebral Angiography , Italy , Treatment Outcome
2.
J Neuroradiol ; 51(2): 220-223, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37652262

ABSTRACT

BACKGROUND: The Contour Embolization Device (CED) is typically assessed using coiling angiographic outcomes. However, these scales do not address device-specific problematics. We evaluated the usability of the Bicêtre occlusion scale (BOS) with the CED. RESULTS: BOS scores can be analyzed as BOSS 0 = no residual flow, BOSS 1 = residual flow inside the CED but with complete neck-sealing, BOSS 2 = neck-remnant, BOSS 3 = aneurysm-remnant, BOSS 1 + 3 = contrast filling inside the device and aneurysmal sac without complete neck-sealing. CONCLUSION: BOS usage should be encouraged as it provides a more comprehensive assessment of the mechanism of CED occlusion, especially considering the potential prognostic value of the neck sealing assessment.


Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Cerebral Angiography , Treatment Outcome , Retrospective Studies , Stents
3.
Clin Neuroradiol ; 2023 Dec 08.
Article in English | MEDLINE | ID: mdl-38066106

ABSTRACT

PURPOSE: This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using a nonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP). METHODS: We conducted a review of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals. RESULTS: A total of 25 cases of HNPs in 24 patients underwent direct puncture embolization (12 males, 12 females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm3. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with a homogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type. CONCLUSION: Preoperative embolization of HNPs using a direct puncture technique and EVOHs is a safe, efficient, and feasible treatment option with a low risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.

4.
Diagnostics (Basel) ; 13(3)2023 Jan 25.
Article in English | MEDLINE | ID: mdl-36766536

ABSTRACT

PURPOSE: Thrombus permeability has been related to clot composition and treatment outcomes in stroke patients undergoing reperfusion therapies. The aim of this study was to evaluate whether thrombus perviousness, evaluated by multiphase computed tomography angiography (mCTA), is associated with distal embolization risk. METHODS: We interrogated our dataset of acute ischemic stroke (AIS) patients involving the M1 segment of the middle cerebral artery (MCA) who had undergone mechanical thrombectomy, and we calculated thrombus average attenuation measurement (dHU) on non-contrast CT (NCCT) and clot perviousness on mCTA. dHU was calculated as the difference between the thrombus HU average value (tHU) and the HU average value on the contralateral side (cHU), while perviousness was calculated as the difference in mean clot density on mCTA and NCCT both in arterial (Perviousness pre-post-1) and delayed (Perviousness pre-post 2) phases. RESULTS: A total of 100 patients (53 females (53%), mean age 72.74 [± 2.31]) with M1 occlusion were available for analysis. Perviousness, calculated between baseline and arterial phase of mCTA (Perviousness pre-post1), was lower in patients with distal embolization (p = 0.05), revealing an association between reduced perviousness and distal embolization risk. Logistic regression showed that thrombus perviousness calculated on the arterial phase of mCTA (OR, 0.66; 95% CI, 0.44-0.99] (p = 0.04)) and the contact aspiration technique (OR, 0.39; 95% CI, 0.15-1.02] (p = 0.05)) were protecting factors against distal embolization. CONCLUSION: Our study showed an association between reduced perviousness and distal embolization, suggesting that perviousness evaluation may be a useful neuroimaging biomarker in predicting distal embolization risk during mechanical thrombectomy.

5.
J Pers Med ; 12(11)2022 Nov 01.
Article in English | MEDLINE | ID: mdl-36579533

ABSTRACT

Degenerative disc disease is a common manifestation in routine imaging of the spine; this finding is partly attributable to physiological aging and partly to a pathological condition, and sometimes this distinction is simply not clear. In this review, we start focusing on disc anatomy and pathophysiology and try to correlate them with radiological aspects. Furthermore, there is a special focus on degenerative disc disease terminology, and, finally, some considerations regarding disc morphology and its specific function, as well as the way in which these aspects change in degenerative disease. Radiologists, clinicians and spine surgeons should be familiar with these aspects since they have an impact on everyday clinical practice.

6.
Clin Neuroradiol ; 32(3): 761-771, 2022 Sep.
Article in English | MEDLINE | ID: mdl-34910224

ABSTRACT

PURPOSE: Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. In this study we performed a comprehensive meta-analysis to investigate clinical and radiological outcomes after endovascular treatment of CS-dAVFs. METHODS: PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened for a comprehensive literature review from 1990 to 2020 regarding series of patients treated for CS-dAVF with endovascular approaches. We performed a proportion meta-analysis estimating the pooled rates of each outcome also including data of patients treated in our center. RESULTS: A total of 22 studies reporting 1043 patients and 1066 procedures were included. Chemosis was reported in 559 out of 1043 patients (45.9%), proptosis in 498 (41.5%), and ophthalmoplegia in 344 (23.5%). A transvenous embolization was preferred in 753 cases (63.2%) and coils were used in 712 out of 1066 procedures (57.8%). Overall, 85% (95% confidence interval, CI 69.5-96.1%) of patients had a complete resolution of symptoms, while complications occurred in 7.75% (95% CI 3.82-12.7%) with minimal permanent deficits (0.15%). The mortality rate was 1 out of 1043 patients (< 0.001). CONCLUSION: A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. Transvenous approaches show less complications than transarterial ones, and coils appear safer than liquid embolic agents.


Subject(s)
Cavernous Sinus , Central Nervous System Vascular Malformations , Embolization, Therapeutic , Endovascular Procedures , Exophthalmos , Humans , Radiography , Retrospective Studies , Treatment Outcome
7.
J Integr Neurosci ; 20(3): 645-650, 2021 Sep 30.
Article in English | MEDLINE | ID: mdl-34645097

ABSTRACT

We sought to verify the benefit of mechanical thrombectomy in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation and low National Institute of Health stroke scale score at presentation. The prospective database of our stroke center was screened for patients with acute ischemic stroke due to large vessel occlusion and a baseline National Institute of Health stroke scale score ≤5 that had undergone mechanical thrombectomy. Outcome measures were the modified Rankin Scale (mRS) score at 90 days, brain bleeding events and death at 90 days. Out of 459 patients, 17 (12 females, mean age 70 ± 14 years) with occlusion of M1 or M2 segment of middle cerebral artery and baseline National Institute of Health stroke scale score ≤5 underwent mechanical thrombectomy. Eight patients (47%) were treated within 6 hours from the onset, 5 (29%) were treated beyond 6 hours, and 4 (24%) were wake-up strokes. Effective mechanical thrombectomy was achieved in 16 patients (94%) and associated with excellent functional outcomes at 3 months (mRS 0-1) in 13 (76%). The asymptomatic brain-bleeding event was observed in one patient 4 days after effective mechanical thrombectomy concerning safety issues. One patient died 1 month after mechanical thrombectomy of a cause unrelated to stroke. Our findings favor a potential benefit of mechanical thrombectomy in patients with stroke due to large vessel occlusion and low National Institute of Health stroke scale score at presentation. These patients may also benefit from a prolonged time window for treatment.


Subject(s)
Arterial Occlusive Diseases/therapy , Ischemic Stroke/therapy , Mechanical Thrombolysis , Outcome and Process Assessment, Health Care , Aged , Aged, 80 and over , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/physiopathology , Female , Humans , Ischemic Stroke/etiology , Ischemic Stroke/physiopathology , Male , Prospective Studies , Retrospective Studies , Severity of Illness Index , Time Factors
8.
Cerebrovasc Dis Extra ; 11(1): 1-8, 2021.
Article in English | MEDLINE | ID: mdl-33454704

ABSTRACT

INTRODUCTION: We sought to verify the predicting role of a favorable profile on computed tomography perfusion (CTP) in the outcome of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing effective mechanical thrombectomy (MT). METHODS: We retrospectively enrolled 25 patients with AIS due to LVO and with a CTP study showing the presence of ischemic penumbra who underwent effective MT, regardless of the time of onset. The controls were 25 AIS patients with overlapping demographics and clinical and computed tomography angiography features at admission who had undergone successful MT within 6 h from onset and without a previous CTP study. The outcome measure was the modified Rankin Scale (mRS) score at 90 days. RESULTS: Sixty-four percent of the study patients had an mRS score of 0-1 at 90 days versus 12% of the control patients (p < 0.001). Patients of the study group had a more favorable distribution of disability scores (median mRS [IQR] score of 0 [0-2] vs. 2 [2-3]). Multivariate analysis showed that the selection of patients based on a favorable CTP study was strongly associated (p < 0.001) with a better neurological outcome. CONCLUSIONS: In our small-sized and retrospective study, the presence of ischemic penumbra was associated with a better clinical outcome in patients with AIS due to LVO after MT. In the future, a larger and controlled study with similar criteria of enrollment is needed to further validate the role of CTP in patient selection for MT, regardless of the time from the onset of symptoms.


Subject(s)
Cerebral Angiography , Computed Tomography Angiography , Ischemic Stroke/therapy , Perfusion Imaging , Thrombectomy , Aged , Aged, 80 and over , Cerebrovascular Circulation , Disability Evaluation , Female , Humans , Ischemic Stroke/diagnostic imaging , Ischemic Stroke/physiopathology , Male , Predictive Value of Tests , Recovery of Function , Retrospective Studies , Thrombectomy/adverse effects , Time Factors , Treatment Outcome
9.
Remote Sens (Basel) ; 13(12): 2404, 2021 Jun 19.
Article in English | MEDLINE | ID: mdl-36082363

ABSTRACT

Nitrogen (N) is one of the key nutrients supplied in agricultural production worldwide. Over-fertilization can have negative influences on the field and the regional level (e.g., agro-ecosystems). Remote sensing of the plant N of field crops presents a valuable tool for the monitoring of N flows in agro-ecosystems. Available data for validation of satellite-based remote sensing of N is scarce. Therefore, in this study, field spectrometer measurements were used to simulate data of the Sentinel-2 (S2) satellites developed for vegetation monitoring by the ESA. The prediction performance of normalized ratio indices (NRIs), random forest regression (RFR) and Gaussian processes regression (GPR) for plant-N-related traits was assessed on a diverse real-world dataset including multiple crops, field sites and years. The plant N traits included the mass-based N measure, N concentration in the biomass (Nconc), and an area-based N measure approximating the plant N uptake (NUP). Spectral indices such as normalized ratio indices (NRIs) performed well, but the RFR and GPR methods outperformed the NRIs. Key spectral bands for each trait were identified using the RFR variable importance measure and the Gaussian processes regression band analysis tool (GPR-BAT), highlighting the importance of the short-wave infrared (SWIR) region for estimation of plant Nconc-and to a lesser extent the NUP. The red edge (RE) region was also important. The GPR-BAT showed that five bands were sufficient for plant N trait and leaf area index (LAI) estimation and that a surplus of bands effectively reduced prediction performance. A global sensitivity analysis (GSA) was performed on all traits simultaneously, showing the dominance of the LAI in the mixed remote sensing signal. To delineate the plant-N-related traits from this signal, regional and/or national data collection campaigns producing large crop spectral libraries (CSL) are needed. An improved database will likely enable the mapping of N at the agro-ecosystem level or for use in precision farming by farmers in the future.

10.
J Stroke Cerebrovasc Dis ; 30(3): 105566, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33360517

ABSTRACT

OBJECTIVES: 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"). MATERIALS AND METHODS: it is an observational retrospective multicenter study conducted in three Italian high-volume tertiary stroke centers between January 2017 and May 2019. The study population included all consecutive patients with an ischemic stroke due to middle cerebral artery occlusion (M1 segment only) that underwent intra-arterial mechanical thrombectomy with contact aspiration as first-line strategy within 24 hours from symptoms onset. RESULTS: Three hundred twenty-one patients were included in the study. Multivariable logistic regression analysis comparing the three catheters revealed no differences in terms of successful recanalization. Sofia 6 Plus catheter was associated with better first-passage successful recanalization [OR, 9.09; 95% CI, 2.66-31.03] (p<0.001) and first-passage complete recanalization [OR: 3.73; 95% CI: 1.43-9.72] (p=0.007) whereas rt-PA was associated with worse first-passage recanalization [OR: 0.52; 95% CI: 0.29-0.93] (p=0.028). CONCLUSIONS: No differences between the three catheters were reported in terms of successful recanalization. Sofia 6 Plus has proven to be superior in achieving both successful and complete first-passage recanalization. Conversely, rt-PA was found to be a negative predicting factor of first-passage effect.


Subject(s)
Endovascular Procedures/instrumentation , Infarction, Middle Cerebral Artery/therapy , Ischemic Stroke/therapy , Thrombectomy/instrumentation , Vascular Access Devices , Aged , Aged, 80 and over , Endovascular Procedures/adverse effects , Equipment Design , Female , Humans , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/physiopathology , Ischemic Stroke/diagnostic imaging , Ischemic Stroke/physiopathology , Italy , Male , Middle Aged , Retrospective Studies , Thrombectomy/adverse effects , Treatment Outcome
11.
Clin Neuroradiol ; 31(1): 21-29, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33301052

ABSTRACT

PURPOSE: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. METHODS: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3­month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. RESULTS: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. CONCLUSION: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3­month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.


Subject(s)
Brain Ischemia , Endovascular Procedures , Stroke , Thrombectomy , Aged , Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , Carotid Arteries , Humans , Italy , Registries , Retrospective Studies , Stroke/diagnostic imaging , Stroke/surgery , Treatment Outcome
12.
Clin Neurol Neurosurg ; 198: 106207, 2020 11.
Article in English | MEDLINE | ID: mdl-32950754

ABSTRACT

BACKGROUND: DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion. The aim of our study is to evaluate results of endovascular thrombectomy in large intracranial vessel occlusion without perfusion CT patient selection. METHODS: we reviewed our prospectively collected endovascular databases for patients with an acute stroke from March 2016 to October 2018, treated after 6 h from stroke onset, without perfusion CT selection. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0-2. The association between clinical and procedural parameters and functional outcome was assessed. RESULTS: out of 212 patients 55 were treated after 6 h from stroke onset, 49 of which for an anterior circulation occlusion. 18/49 were functional independent at 90 days (mRS 0-2), Successful recanalization (mTICI 2b to 3) was achieved in 38/49 patients (77 %). Multivariate logistic regression indicated that a low baseline NIHSS was associated with favorable outcome (OR 0.66, 95 % CI 0.52-0.83, p-value 0.001). CONCLUSIONS: in our retrospective analysis, baseline NIHSS is the only parameter that can predict good outcome (90-days mRS 0-2). We confirm data from recent papers assessing that perfusion CT can provide a better patients' selection compared to mCTA for large vessels occlusion treated beyond six hours from symptom onset.


Subject(s)
Brain Ischemia/surgery , Computed Tomography Angiography/methods , Endovascular Procedures/methods , Ischemic Stroke/surgery , Thrombectomy/methods , Adult , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Computed Tomography Angiography/trends , Endovascular Procedures/trends , Female , Humans , Ischemic Stroke/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Thrombectomy/trends , Treatment Outcome
13.
Interv Neuroradiol ; 26(5): 651-657, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32842833

ABSTRACT

BACKGROUND: Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. METHODS: Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. RESULTS: 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2-82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5-6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. CONCLUSIONS: The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.


Subject(s)
Central Nervous System Vascular Malformations/therapy , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Polyvinyls/therapeutic use , Adult , Aged , Aged, 80 and over , Central Nervous System Vascular Malformations/diagnostic imaging , Cerebral Angiography , Female , Humans , Male , Middle Aged , Retrospective Studies
14.
Eur Radiol ; 30(12): 6940-6949, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32607633

ABSTRACT

OBJECTIVES: To retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity. METHODS: All IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March-8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis. RESULTS: A total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered. CONCLUSIONS: Coronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients. KEY POINTS: • Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year. • Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures. • Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pandemics , Pneumonia, Viral/diagnosis , Radiography/methods , Tertiary Care Centers/statistics & numerical data , Aged , COVID-19 , Coronavirus Infections/epidemiology , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/trends , Humans , Italy/epidemiology , Longitudinal Studies , Male , Middle Aged , Pneumonia, Viral/epidemiology , Radiology, Interventional/methods , Retrospective Studies , SARS-CoV-2
15.
World Neurosurg ; 140: 213-218, 2020 08.
Article in English | MEDLINE | ID: mdl-32434020

ABSTRACT

BACKGROUND: Postinfectious Moyamoya syndrome (MMS) is a rare vasculopathy that can follow meningitis. Only 9 cases of MMS after meningitis have been reported in the literature. We present a unique case of MMS after meningitis caused by Aspergillus fumigatus and Escherichia coli and review all cases of MMS postmeningitis in the literature. CASE DESCRIPTION: A 41-year-old man was admitted to our emergency department for sudden hypoesthesia in the left arm and an intense headache not responsive to drugs. Computed tomography scan and magnetic resonance imaging showed acute ischemic lesions in the right centrum semiovale associated with bilateral chronic watershed cerebral ischemic lesions. The cerebral digital subtraction angiography documented a typical Moyamoya pattern. In anamnesis, the patient suffered from meningitis caused by A. fumigatus and E. coli infection after neurosurgery for subependymoma of the fourth ventricle 2 years before. Laboratory tests, clinical investigation, and imaging ruled out any other cause of vasculopathy and led to the final diagnosis of postinfectious MMS. The patient started medical therapy with oral acetyl salicylic acid, verapamil, and prednisone while surgical approach was excluded in the first instance. CONCLUSIONS: Physicians should be aware of an uncommon but severe complication of meningitis such as MMS, even several years after the infection. Neuroimaging is essential for the diagnosis and to exclude other causes of neurologic symptoms in these patients.


Subject(s)
Brain/diagnostic imaging , Meningitis, Bacterial/complications , Moyamoya Disease/etiology , Adult , Angiography, Digital Subtraction , Cerebral Angiography , Humans , Magnetic Resonance Imaging , Male , Moyamoya Disease/diagnostic imaging , Tomography, X-Ray Computed
16.
Interv Neuroradiol ; 26(3): 346-353, 2020 Jun.
Article in English | MEDLINE | ID: mdl-31856645

ABSTRACT

OBJECTIVE: The authors have evaluated their experience in pre-operative direct puncture embolization of hypervascular tumors of the head and neck using SQUID 12, an embolic liquid agent. METHODS: Between July 2016 and March 2019, the authors retrospectively reviewed clinical, embolization and surgical data of 11 consecutive patients with 12 hypervascular head and neck tumors who had undergone pre-operative embolization using SQUID 12. Percutaneous embolizations were performed by inserting a 19-22 Gauge needle directly into the tumor under ultrasound, fluoroscopic and/or endoscopic guidance. The hub of the needle was connected to a 15-cm DMSO-compatible extension tube, and the SQUID 12 was injected. RESULTS: Total or near-total devascularization was achieved in 11 over 12 cases. Complete en-bloc tumor removal by surgery was achieved in all cases. Only one patient required blood transfusion. No major periprocedural adverse events were recorded. CONCLUSIONS: Direct puncture embolization of hypervascular tumors of the head and neck using SQUID 12 seems to be safe and effective. It may offer almost complete devascularization due to homogenous, deep penetration in the tumor, with optimal visibility of the agent throughout the percutaneous procedure. It may reduce intraoperative blood loss and the need for transfusion, thus facilitating complete surgical resection.


Subject(s)
Embolization, Therapeutic/methods , Head and Neck Neoplasms/therapy , Neovascularization, Pathologic/therapy , Polyvinyls/therapeutic use , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Head and Neck Neoplasms/surgery , Humans , Male , Middle Aged , Preoperative Care , Punctures , Radiography, Interventional , Retrospective Studies
18.
Interv Neuroradiol ; 25(1): 27-30, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30235957

ABSTRACT

BACKGROUND: The Barrel vascular reconstruction device is an electrolytically detachable laser-cut closed-cell stent used for neck reconstruction in wide-necked bifurcation aneurysms to support coiling without necessitating dual stent implantation. The purpose is to lower the metal-to-artery ratio and its inherent risk of thromboembolic complications of multiple stents. CASE DESCRIPTION: A 53-year-old woman presenting with subarachnoid hemorrhage due to acutely ruptured basilar tip aneurysm underwent emergency endovascular embolization with the Barrel vascular reconstruction device. Since the stent did not cover the entire neck of the aneurysm, an Atlas stent was released in a Y configuration through the Barrel. The Neuroform Atlas correctly opened through the Barrel and allowed the complete exclusion of the aneurysm. CONCLUSION: If necessary, releasing a Neuroform Atlas through a Barrel vascular reconstruction device is a feasible technique.


Subject(s)
Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/therapy , Basilar Artery , Endovascular Procedures/instrumentation , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Stents , Angiography, Digital Subtraction , Anticoagulants/administration & dosage , Cerebral Angiography , Female , Humans , Middle Aged , Tomography, X-Ray Computed
19.
Neuroradiology ; 61(2): 137-145, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30310942

ABSTRACT

PURPOSE: Brain death (BD) is defined as the irreversible destruction of all brain functions. It is usually diagnosed through a clinical examination, but in certain circumstances, ancillary examinations (such as digital subtraction angiography (DSA), transcranial color Doppler (TCD), computed tomography angiography (CTA), magnetic resonance angiography (MRA), or radionuclide scanning) are required as confirmatory tests. In many countries, cervical color Doppler sonography (CCD) is not recognized as a valid test. The aim of our study is to assess its accuracy as a non-invasive, inexpensive, and easily available examination to determine cerebral circulatory arrest (CCA). METHODS: We performed a retrospective study in which 123 patients with clinical diagnosis of BD underwent bedside cervical color Doppler as an additional examination for CCA assessment. We compared these cervical color Doppler findings with the results of validated ancillary tests such as CTA, TCD, and DSA. RESULTS: Cervical color Doppler exams showed a sensitivity of 78% (96/123 patients) in detecting CCA compared to standard ancillary tests. Twenty-seven patients showed a persistent diastolic flow in one or two of the four arterial vessels examined and thus considered as false negatives. CONCLUSION: Our results show that cervical color Doppler may become a reliable and safe technique in detecting CCA, which can shorten the time for declaring brain death. In particular, in patients lacking good bone windows at transcranial color Doppler, cervical color Doppler of the cervical internal carotids and vertebral arteries could be recommended to increase the sensitivity of transcranial color Doppler, or as an alternative bedside examination.


Subject(s)
Brain Death/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Ultrasonography, Doppler, Transcranial/methods , Adolescent , Adult , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity
20.
Neurosurgery ; 81(2): 315-330, 2017 Aug 01.
Article in English | MEDLINE | ID: mdl-28204584

ABSTRACT

BACKGROUND: High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. OBJECTIVES: To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). METHODS: The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). RESULTS: Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. CONCLUSIONS: Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk.


Subject(s)
Central Nervous System Vascular Malformations , Angiography , Central Nervous System Vascular Malformations/diagnostic imaging , Central Nervous System Vascular Malformations/epidemiology , Central Nervous System Vascular Malformations/pathology , Central Nervous System Vascular Malformations/physiopathology , Hemorrhage , Humans , Retrospective Studies , Risk
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