Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers.

BACKGROUND AND PURPOSE: Aspiration thrombectomy of large vessel occlusions has made a comeback among recanalization techniques thanks to recent advances in catheter technology resulting in faster recanalization and promising clinical results when used either alone or as an adjunct to stent retriever. This multicenter retrospective study reports angiographic data, complications, and clinical outcome in patients treated with aspiration thrombectomy as the first-line option. MATERIALS AND METHODS: We analysed the clinical and procedural data of patients treated from January 2014 to March 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months. RESULTS: Overall, 152 patients (mean age 68 years) were treated. Sites of occlusion were 90.8% anterior circulation (including 16.4% tandem extracranial/intracranial occlusions) and 9.2% basilar artery. In 79 patients administration of intravenous tissue plasminogen activator was attempted. Recanalization of the target vessel was obtained in 115/152 cases (75.6%) whereas direct aspiration alone was successful in 83/152 cases (54.6%) with an average puncture to revascularization time of 44.67 min. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 1.9%. 77 patients (50.6%) had a good outcome at 90-day follow-up: 55/96 in the direct aspiration alone group and 22/56 in the aspiration-stent retriever group. CONCLUSIONS: Direct aspiration thrombectomy appears a feasible technique with good revascularization results achieved in more than half the patients. In light of the self-reported data, inhomogeneous patient selection, absence of a core imaging laboratory, and a non-standardized approach, the results should be validated in a larger trial.

Benefits and shortcomings of superselective transarterial embolization of renal tumors before zero ischemia laparoscopic partial nephrectomy.

AIMS: To report feasibility, safety and effectiveness of "zero-ischemia" laparoscopic partial nephrectomy (LPN) following preoperative superselective transarterial embolization (STE) for clinical T1 renal tumors. METHODS: We retrospectively reviewed perioperative data of 23 consecutive patients, who underwent STE prior LPN between March 2010 and November 2012 for incidental clinical T1 renal mass. STE was performed by two experienced radiologists the day before surgery. Surgical procedures were performed in extended flank position, transperitoneally, by a single surgeon. RESULTS: Mean patients age was 68 years (range 56-74), mean tumor size was 3.5 cm (range 2.2-6.3 cm). STE was successfully completed in 16 patients 12-15 h before surgery. In 4 cases STE failed to provide a complete occlusion of all feeding arteries, while in 3 cases the ischemic area was larger than expected. LPN was successfully completed in all patients but one where open conversion was necessary; a "zero-ischemia" approach was performed in 19/23 patients (82.6%) while hilar clamp was necessary in 4 cases, with a mean warm-ischemia time of 14.8 min (range 5-22). Mean operative time was 123 min (range 115-130) and mean intraoperative blood loss was 250 mL (range 20-450). No patient experienced postoperative acute renal failure and no patient developed new onset IV stage chronic kidney disease at 1-yr follow-up. CONCLUSIONS: STE is a viable option to perform "zero-ischemia" LPN at beginning of learning curve; however, hilar clamp was necessary to achieve a relatively blood-less field in 17.4% of cases.

Compliance of geriatric patients subjected to antiplatelet agents with Triflusal in peripheral arteriopathy. Preliminary data.

BACKGROUND: Triflusal is an irreversible inhibitor of platelet cyclooxygenase. Triflusal significantly reduced the incidence of nonfatal myocardial infarction in patients with unstable angina. Antithrombotic properties have also been demonstrated in patients with aortocoronary vein grafting, coronary angioplasty, peripheral arteriopathy and cerebrovascular disease. Moreover, in diabetic patients it has a protective effect against retinal microangiopathy, improves renal flow and reduces proteinuria. The drug has a high tolerability and has low incidence of side effects, with prevalence of gastrointestinal and skin disorders. Because of its demonstrated effectiveness and its good handling, we decided to use Triflusal in treatment of geriatric patients with peripheral arteriopathy. Often these patients have a diffused arteriopathic disease which can be associated with chronic diseases. For this reason there are severe problems of compliance due to contemporary administration of several drugs; so the utilization of effective drugs, without side effects, promotes a safer clinical management of patients. METHODS: Between April 2000 and March 2001, we treated with Triflusal 70 patients, over 65 years old, with peripheral arteriopathy. The group comprises patients who had undergone traditional vascular surgery, or endovascular surgery and patients treated exclusively with drug therapy. During the follow-up we obser-ved the possible clinical development of side effects of the drug reported in the literature (nausea, vomiting, etc.). RESULTS: One patient, already affected by gastroduodenal disease, suspended the therapy because of severe epigastric burning. CONCLUSIONS: The follow-up of the patients goes on in order to evaluate the tolerability and handling of Triflusal, observing a larger number of patients.

[Retroperitoneal fibrosis associated with neuritis symptomatology due to external iliac artery stent subadventitial migration]. / Fibrosi retroperitoneale associata a sintomatologia nevritica dovuta alla migrazione sottoavventiziale di stent dell'arteria iliaca esterna.

The occurrence of a neuritis of the ischiatic nerve and the genito-femoral nerve due to the implant of three stents in the iliac artery, is an extremely rare complication, especially if associated with retroperitoneal fibrosis which caused a nevritis symptomatology. A case of stent migration in the subadventitial space which caused 4 years from angioplasty and stents implant, a nevritis symptomatology. Retroperitoneal fibrosis has been considered as a consequence of the stents presence and of their chronic irritational activity, especially for what concerns the stent migrated in the subadventitial space; the procedure personally performed in this case is reported.

[Dynamic ultrasonic hysteroscopy]. / L'ecoisteroscopia dinamica.

An attempt was made to establish Dynamic Echohysteroscopy (DEHS) diagnostic criteria for the study of female genital apparatus, as recently proposed. DEHS consists of a pelvic ultrasonography during and following an injection of physiological solution in the uterine cavity. Since this technique does not use X-rays, it has been proven useful to study female infertility. The authors have studied the normal and pathological aspects of 33 patients who underwent both DEHS and hysterosalpingography (HSG) (comparison diagnostic test). The results lead to the following conclusions: 1) DEHS can be considered a useful alternative to HSG, in the evaluation of uterine pathology; 2) in the evaluation of tubal pathology, DEHS has fewer diagnostic possibilities than HSG. Nevertheless, DEHS indirectly allows the patency of at least one tube.

[Unilateral alveolar effusions (author's transl)]. / Versamenti alveolari monolaterali.

The unilateral alveolar effusions can be divided into two groups: those which take place in an already diseased lung (ipsilateral), and those which take place in the healthy one (contralateral). Starting from the most recent literature, the causes of the two different radiological features are discussed. Some cases of alveolar effusions, both ipsilateral and contralateral, are reported.

Selective arterial embolization in renal tumors.

Selective arterial embolization with Gelfoam was performed in 45 cases of hypernephroma. In 33 cases this technique has been utilized as preoperative procedure and almost always (97%) nephrectomy was facilitated: 97% of the cases had slight or moderate operative bleeding; in 82% of the cases separation of the tumor-containing kidney from adjacent tissues was easy. Embolization has been employed in 12 inoperable patients and was effective mainly in management of bleeding. Angiographic controls after embolization (from 13 to 162 days) were performed 8 times and it was assessed that the efficacy of the procedure on primary tumor growth is limited in time by renal artery revascularization. The embolized patients never presented severe complications, except several episodes of transitory renal failure.