Incomplete Carney Triad: A Surgical Case of a Rare Syndrome.

We describe a 36-year-old woman with multiple gastric gastrointestinal stromal tumors, hepatic and lymphatic metastasis, and a mediastinal paraganglioma as a presentation of an incomplete Carney triad. We present our therapeutic approach, with emphasis on the surgical and oncologic specificities of this syndrome.

Robotic Resection of a Left Brachiocephalic Vein Aneurysm Mimicking Thymoma.

A 70-year-old man was scheduled for the robotic resection of a 21×16 × 30 mm thymic nodule incidentally detected by a computed tomography scan (CT) for thoracic trauma after a domestic accident. Positron emission tomography (PET) scan confirmed a low [18F]-FDG uptake (SUVmax = 1,9). During the surgery, the mass showed to be a saccular aneurysm of the left brachiocephalic vein (LBCV). A complete tangential resection of the aneurysm, with the use of EndoGIA stapler (Covidien® Endo GIA™) at its origin, was performed. The patient's recovery was uneventful, and postoperative CT with contrast administration confirmed the patency of the vein.

Comparison of two preventive dual antiplatelet regimens for unruptured intracranial aneurysm embolization with flow diverter/disrupter: A matched-cohort study comparing clopidogrel with ticagrelor.

PURPOSE: Standard dual antiplatelet therapy (DAPT) for complex aneurysms treated with flow diversion and flow disruption is acetylsalicylic acid (ASA) plus clopidogrel. However, clopidogrel resistance frequently occurs and can lead to thromboembolic events. Ticagrelor is an alternative not requiring platelet inhibition testing. We compared two DAPT regimens (ASA with clopidogrel or ticagrelor) on morbi-mortality, safety and efficacy of unruptured aneurysm embolization with flow diverter/disrupter. MATERIALS AND METHODS: This retrospective analysis of a 1:1 matched cohort compares patients treated with ASA + clopidogrel (March 2013-December 2015) vs. ASA + ticagrelor (January 2016-March 2017). No platelet inhibition testing was conducted. Patients matched for age (±10 years), type of treatment and aneurysm sac size ( ± 2 mm). Primary outcome measures were morbidity and mortality at 1-month; secondary outcomes were thromboembolic and hemorrhagic complications [on angiography and magnetic resonance imaging (MRI)] and groin complications. Outcomes were compared using bivariate analyses. RESULTS: Ninety patients fulfilled inclusion criteria, of which 80 remained after matching (40 per group). There was no statistical difference in 1-month morbidity between the ticagrelor and clopidogrel groups (2.5% vs. 10%, P = 0.36) and no deaths reported. We observed no significant differences between ticagrelor and clopidogrel groups in terms of angiographic thromboembolic complications (5% vs. 12.5%, P = 0.43), territorial infarction on DWI (2.5% vs. 7.5%, P = 0.61), angiographic (0% vs. 0%, P = 1) and MRI (5% vs 5%, P = 1) hemorrhagic complications, new microbleeds (57.5% vs. 40%, P = 0.12) and groin puncture complications (2.5% vs. 0%, P = 1). At three months, there was no delayed territorial infarction or hemorrhage in either group. CONCLUSIONS: Ticagrelor is safe and effective in replacing clopidogrel as DAPT for unruptured aneurysms.

Endovascular treatment of intracranial aneurysms with Barricade coils: Feasibility, procedural safety, and immediate postoperative anatomical results.

BACKGROUND AND PURPOSE: The safety of bare platinum coils has been widely described in the literature. This study aimed to report the first series of intracranial aneurysms treated with Barricade bare platinum coils with a comprehensive evaluation of their procedural safety and postprocedural anatomical results. METHODS: Patients with intracranial aneurysms treated between October 2013 and December 2015 by simple coiling or balloon-assisted coiling with Barricade coils (Blockade Medical, Irvine, California, USA) were prospectively included in a database and retrospectively studied. For all included patients, the patient and aneurysm characteristics, procedural complications, technical issues, postoperative anatomical results, and one-month clinical outcome (modified Rankin Scale) were evaluated by an independent interventional neuroradiologist. RESULTS: Eighty-eight patients harboring 97 aneurysms were included. Procedural complications and technical issues were encountered in 17 and 5 patients (19.3 and 5.7%, respectively), but clinical worsening in only 2 patients (2.2%). There was no treatment-related mortality. After one month, morbidity (mRS≥1) was observed in 19 patients (21.8%), 17 related to subarachnoid hemorrhage (SAH) in patients with ruptured aneurysms (19.4%) and 2 related to thromboembolic events in patients with unruptured aneurysms (2.3%). Nine patients initially presenting with a ruptured aneurysm were deceased at 1 month as a consequence of SAH (10.2%). Adequate occlusion was observed postoperatively in 94.8% of the aneurysms (complete occlusion in 81.4% and residual neck in 13.4%). CONCLUSION: Endovascular treatment of intracranial aneurysms with Barricade coils is feasible and the demonstrated overall safety results are within the ranges found in the literature for other coils. Immediate anatomical results are satisfying.