Therapeutic internal carotid or vertebral artery occlusion using the WEB device.

The WEB device was used to occlude the internal carotid artery or vertebral artery as treatment for large aneurysms. The WEB could be placed accurately at the desired position inside the vessel. Two WEBs were sufficient to occlude the parent artery.

Endovascular treatment of a ruptured flow aneurysm of the heubner artery as part of a moyamoya collateral network in a young patient with an occluded middle cerebral artery.

A young woman with an occluded middle cerebral artery presented with a ruptured flow aneurysm distal on a Heubner artery as part of a moyamoya collateral network. Leptomeningeal collateral supply was tested by occlusion of the A1 origin of the Heubner artery. This test occlusion demonstrated ample collateral leptomeningeal supply over the hemispheres to the M2. Subsequently, the Heubner artery harbouring the aneurysm could be safely proximally occluded with coils.

Endovascular treatment of intracranial aneurysms in the flow diverter era: frequency of use and results in a consecutive series of 550 treatments in a single centre.

Flow diverter devices became available in our department in 2009. We considered treatment with flow diverters only in patients with aneurysms not suitable for surgery or conventional endovascular techniques. This paper presents our preliminary experience with flow diverters in a consecutive series of 550 endovascular aneurysm treatments. Between January 2009 and July 2013, 550 endovascular treatments for intracranial aneurysms were performed. Of these, 490 were first-time aneurysm treatments in 464 patients and 61 were additional treatments of previously coiled aneurysms in 51 patients. Endovascular treatments consisted of selective coiling in 445 (80.8%), stent-assisted coiling in 68 (12.4%), balloon-assisted coiling in 13 (2.4%), parent vessel occlusion in 12 (2.2%) and flow diverter treatment in 12 (2.2%). Eleven patients with 12 aneurysms were treated with flow diverters. Two patients had ruptured dissecting aneurysms. One patient with a basilar trunk aneurysm died of acute in stent thrombosis and another patient died of brain stem ischaemia at 32 months follow-up. One patient had ischaemia with permanent neurological deficit. Two aneurysms are still open at up to 30 months follow-up. Flow diversion was used in 2% of all endovascular treatments. Both our own poor results and the high complication rates reported in the literature have converted our initial enthusiasm to apprehension and hesitancy. The safety and efficacy profile of flow diversion should discourage the use of these devices in aneurysms that can be treated with other techniques.

The donut sign: a new angiographic sign for partially thrombosed aneurysms with flow-induced intraluminal thrombus.

Three patients are described with unruptured large partially thrombosed aneurysms with a peculiar donut-shaped remaining lumen. Observations suggest that the flow geometry of the aneurysm and parent vessels induces a preferential circular laminar flow inside the aneurysm followed by partial intraluminal thrombosis leaving a donut-shaped lumen to accommodate the circular flow. This flow mechanism of thrombus formation inside aneurysms is different from the more common repeated intramural dissections and hemorrhages that cause growth in most large and giant partially thrombosed aneurysms.

Prosthetic valve endocarditis due to Brucella: successful outcome with a combined strategy.

Infective endocarditis is a serious heart disease that can affect native and prosthetic valves. Staphylococci and Streptococci are the etiological agents in almost 80% of cases. Human brucellosis is a multiple organ disease often transmitted via contaminated, unpasteurized goat milk and cheese. Brucella endocarditis is a rare complication associated with elevated morbidity and mortality rates; it can affect native or, even more rarely, prosthetic valves. In this report, we present the successful management of an infected aortic biological prosthesis in a man of 68 years.

Early administration of abciximab in patients with acute myocardial infarction improves angiographic and clinical outcome after primary angioplasty.

Adjunctive use of abciximab during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) improves clinical outcome. This study addresses the outcome of patients with AMI treated with abciximab, initiated either before transport to a PCI center (early group) or immediately upon arrival at the catheterization laboratory (late group) for primary PCI. Of 446 consecutive patients with AMI, angiographic data and clinical complications were evaluated up to 6 months after primary PCI. Patients received abciximab before transport (early group; n = 138) or just before the intervention (late group; n = 308). Baseline data, including transport time (45 +/- 15 min; range, 15-60 min), were comparable in both groups. Early reperfusion was more prevalent in the early group (35% vs. late 19%; P < 0.001). Furthermore, a better final TIMI 3 flow was noted in the early group (91% vs. late 83%; P = 0.05). Although mortality reduction attributable to early abciximab treatment could not be demonstrated, major adverse cardiac events (MACE) occurred in 27% in the early group and 36% in the late group (P = 0.05). Revascularization rates were similar, but repeat acute coronary syndromes were less frequent in the early group (11% vs. late group 20%; P = 0.04). In multivariate analysis, cardiogenic shock, out-of-hospital cardiac arrest, and previously known coronary artery disease were independent predictors of higher MACE rate, whereas early reperfusion and final TIMI 3 flow reduced 6-month MACE rate. Abciximab pretreatment of patients with AMI for primary PCI results in better initial and final TIMI flow and tends to improve 6-month clinical outcome.