Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms.

BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. MATERIALS AND METHODS: A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well. RESULTS: A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16). CONCLUSIONS: There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.

[Bronchial and nonbronchial systemic artery embolization in managing haemoptysis: 31 years of experience]. / Embolizzaione delle arterie bronchiali e/o sistemiche non bronchiali nel controllo dell'emottisi: 31 anni d'esperienza.

PURPOSE: The authors report on 31 years of experience with bronchial (BAE) and/or nonbronchial (NBAE) systemic artery embolisation for managing haemoptysis. MATERIALS AND METHODS: A total of 534 patients who underwent bronchial artery angiography for haemoptysis between 1979 and 2010 were retrospectively evaluated. Of these patients, 477 (89%) had active bleeding and underwent BAE and/or NBAE (295 males and 182 females, aged between 12 and 71 years). Embolisation techniques, materials, major and minor complications and relapses were recorded. RESULTS: Complete resolution of haemoptysis was achieved within 24 h in 458/477 (96%) cases and within 48 h in 2% of cases. The aetiology of haemoptysis was as follows: cystic fibrosis (23%), bronchiectasis (13%), tuberculosis sequelae (8%), chronic obstructive pulmonary disease (COPD) (6%) and no apparent cause (21%). Major complications were recorded in 3/477 (0.6%): stroke (n=1), transient ischaemic attack (TIA) (n=1) and transient quadriplegia (n=1). Minor complications were recorded in 143/477 (30%): chest pain 86/143 (60%) and dysphagia 29/143 (20%). During a mean follow-up period of 14 (8-36) months, haemoptysis recurrence was observed in 42/110 cases (38%) of cystic fibrosis and in 77/367 cases of other diseases (21%). CONCLUSIONS: BAE and NBAE are effective and safe for acute treatment of haemoptysis, with low recurrence and complication rates. Interventional radiologist experience is crucial to the successful haemoptysis control and preventing complications.

Natural contraceptive methods.

PIP: This is a brief review of the available natural family planning methods, the rhythm, basal body temperature, cervical mucus, and symptothermal methods, for use by Italian adolescents and young women who choose to avoid artificial contraception. Data from the last AIED Report show that 50% of Italian adolescent girls aged 16-18 have had coitus, while only 3-7.3% are using contraception, and a high proportion of women having abortions are under 20. The majority of adolescents using natural family planning state that they use the rhythm method, which has a Pearl Index ranging from 14.4-47%. Consistent use of the basal body temperature method can be improved with electronic or digital thermometers which take seconds rather than minutes to use. The cervical mucus method is notoriously unreliable in the post-menarchic period, when anovulatory cycles are common. An electronic instrument is also available to facilitate its use. The symptothermal method, combining cervical mucus, basal body temperature, and other clinical signs, is more difficult to integrate for new users, and no data are available in the literature on its use by adolescents. When the wide variation in menstrual cycle lengths, ovulatory and anovulatory cycles, and the myriad psychosocial barriers to regulated sexuality, a 3-6 month training period, and a committed relationship rarely found in adolescents are considered, it is highly unlikely that any natural family planning method can be recommended to this group of women.^ieng