Single-center experience of cerebral artery thrombectomy using the TREVO device in 60 patients with acute ischemic stroke.

BACKGROUND AND PURPOSE: We sought to explore the safety and efficacy of the new TREVO stent-like retriever in consecutive patients with acute stroke. METHODS: We conducted a prospective, single-center study of 60 patients (mean age, 71.3 years; male 47%) with stroke lasting <8 hours in the anterior circulation (n=54) or <12 hours in the vertebrobasilar circulation (n=6) treated if CT perfusion/CT angiography confirmed a large artery occlusion, ruled out a malignant profile, or showed target mismatch if symptoms >4.5 hours. Successful recanalization (Thrombolysis In Cerebral Infarction 2b-3), good outcome (modified Rankin Scale score 0-2) and mortality at Day 90, device-related complications, and symptomatic hemorrhage (parenchymal hematoma Type 1 or parenchymal hematoma Type 2 and National Institutes of Health Stroke Scale score increment ≥ 4 points) were prospectively assessed. RESULTS: Median (interquartile range) National Institutes of Health Stroke Scale score on admission was 18 (12-22). The median (interquartile range) time from stroke onset to groin puncture was 210 (173-296) minutes. Successful revascularization was obtained in 44 (73.3%) of the cases when only the TREVO device was used and in 52 (86.7%) when other devices or additional intra-arterial tissue-type plasminogen activator were also required. The median time (interquartile range) of the procedure was 80 (45-114) minutes. Good outcome was achieved in 27 (45%) of the patients and the mortality rate was 28.3%. Seven patients (11.7%) presented a symptomatic intracranial hemorrhage. No other major complications were detected. CONCLUSIONS: The TREVO device was reasonably safe and effective in patients with severe stroke. These results support further investigation of the TREVO device in multicentric registries and randomized clinical trials.

Percutaneous arterial embolization in the management of rectus sheath hematoma.

OBJECTIVE: Spontaneous rectus sheath hematoma can become clinically relevant and necessitate hemostatic intervention. The aim of this study was to describe the efficacy of percutaneous arterial embolization in the management of this condition. CONCLUSION: Selective transcatheter embolization is effective hemostatic treatment of patients with large, clinically relevant rectus sheath hematoma.

Transarterial embolization of an inferior genicular artery pseudoaneurysm with arteriovenous fistula after arthroscopy.

Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. We report here on a unique case of a 55-year-old man with a lateral inferior genicular artery pseudoaneurysm and a concomitant arteriovenous fistula that developed after arthroscopic meniscectomy; this was successfully treated with selective angiographic embolization. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after an arthroscopic procedure.

Nodular pattern at lung computed tomography in fat embolism syndrome: a helpful finding.

The purpose of this study is to describe the computed tomography (CT) findings in pulmonary fat embolism syndrome (FES). The chest radiographs and CT scans of 5 patients with the diagnosis of FES as determined by the presence of at least 1 major and 4 minor criteria were reviewed. The radiologic features included ground-glass opacities, with different patterns of presentation seen in all patients. Three patients presented with alveolar opacities, and small (<1 cm) ill-defined nodules were seen in 4 of 5 patients. In the context of a patient with previous trauma and the clinical suspicion of FES, the presence of nodules at CT examination may be a helpful finding in the diagnosis of this entity. The chest radiographs and CT scans of 5 patients with the diagnosis of FES as determined by the presence of at least 1 major and 4 minor criteria as defined by Gurd and Wilson were reviewed.

Diseases affecting the peribronchovascular interstitium: CT findings and pathologic correlation.

Central bronchi and pulmonary arteries are surrounded and enveloped by a strong connective-tissue sheath termed the peribronchovascular interstitium, extending from the level of the pulmonary hila into the peripheral lung. Thickening of the peribronchovascular interstitium can be seen in a wide variety of diseases. The CT appearance can be smooth, nodular, or irregular depending on the underlying cause. Many of the diseases affecting the peribronchovascular interstitium are entities that show a predilection for lymphatic routes, such as sarcoidosis, pulmonary lymphangitic carcinomatosis, silicosis, and lymphoproliferative disorders. There are other entities that mainly affect the peribronchovascular interstitium without a predominant perilymphatic distribution, such as hydrostatic pulmonary edema, cryptogenic organizing pneumonia, Kaposi's sarcoma, interstitial pulmonary emphysema, and interstitial hemorrhage. Although there is an overlap in radiologic features, some CT findings are useful in differentiating among these entities. When CT shows mainly peribronchovascular abnormality, the differential diagnosis is considerably reduced, and it is generally possible to reach the correct diagnosis by considering the clinical context. We illustrate the CT findings and pathologic correlation for a number of different disorders that mainly affect the peribronchovascular interstitium.

Punción biopsia hepática ambulatoria guiada por ultrasonografía: descripción técnica y complicaciones / Outpatient us-guided percutaneous liver biopsy: technique and complications

Objetivos: Describir la técnica y las complicaciones de la punción biopsia hepática ambulatoria (PBHA) realizada siguiendo un protocolo propio y compararlas con las biopsias con ingreso hospitalario. Comparar los costes de las dos modalidades de biopsia. Material y métodos: Desde enero de 2000 a enero de 2002, se han realizado 320 PBH en nuestro hospital, 250 de forma ambulatoria (PBHA). Para esta última modalidad, todos los pacientes cumplieron una serie de criterios mínimos de salud y de entorno social previamente establecidos. Se han registrado las complicaciones posprocedimiento. Se han calculado los costes económicos de las PBHA y PBH con ingreso. Resultados: La PBHA se realizó en 250 pacientes, 164 varones y 86 mujeres, con una edad media de 46 años. No existieron complicaciones en 160 (64%) pacientes. Existió dolor controlado con medicación en 78 (31,2%) y cuadro vagal en 8 (3,2%). Cuatro pacientes requirieron ingreso: dos hematomas subcapsulares autolimitados, un cuadro vagal prolongado y otro por no cumplir los criterios del protocolo. Se ha realizado PBH con ingreso en 50 varones y en 20 mujeres, con una edad media de 48 años. De las 70 PBH ingresadas, hubo cuatro complicaciones graves: un fallecimiento, dos hemoperitoneos y un hematoma subcapsular autolimitado. El coste unitario de las PBHA fue de 393,66 #E y de las PBH con ingreso fue de 528,71 A. Conclusiones: Si se siguen unas condiciones sociosanitarias mínimas, la PBHA es una prueba segura, que evita ingresos hospitalarios, lo que se traduce en una mayor confortabilidad de los pacientes y en un ahorro económico

Objectives: To describe the technique and complications of US-guided percutaneous liver biopsy performed on an outpatient basis accor-ding to our designated protocol, to compare these results with those performed on inpatients, and to compare the costs of biopsy in the two settings. Material and methods: From January 2000 to January 2002, 320 patients underwent liver biopsy at our hospital; 250 of these patients were treated on an outpatient basis. All patients undergoing liver biopsy on an outpatient basis fulfilled previously established health and social criteria. All post-procedural complications were recorded. Costs for liver biopsy performed on outpatients and inpatients were calculated and compared. Results: A total of 250 patients (164 males and 86 females; mean age: 46 yrs) underwent liver biopsy on an outpatient basis.No complications were observed in 160 (64%) patients. Pain treatable with medication was seen in 78 (31.2%) and vaso-vagal syncope in 8 (3.2%). Four patients required admission, two for self-limiting sub-capsular hematomas, one for prolonged vaso-vagal syncope, and another for failing to fulfill protocol criteria. A total of 70 patients (50 males and 20 females; mean age: 48 yrs) underwent liver biopsy on an inpatient basis. Serious complications were present in four cases: one death, two hemoperitoneum, and one self-limiting subcapsular hematoma. The mean cost of liver biopsy in outpatients was 393.66 #E vs. 528.71 A in inpatients. Conclusions: Provided minimal health and social criteria are met, outpatient percutaneous liver biopsy is safe. Performing liver biopsy on an outpatient basis can obviate hospital admission, resulting in greater convenience for patients and reduced costs