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1.
J Neurointerv Surg ; 16(3): 228, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38171604

RESUMO

Treatment of large dysplastic middle cerebral artery (MCA) aneurysms can be challenging.1 2 Catheterization of M2 branches at hyperacute angles often requires an 'around the world' approach/microcatheter reduction, which can be accomplished with rapid pull,3 balloon anchor,4 and stent anchor5 techniques. In this video video 1, Atlas stents (Stryker) are used for double microcatheter reduction along with Y stent assisted coil embolization (Video 1). Steps include (1) catheterization of the more difficult M2 branch with 'around the world' maneuver; (2) reduction/stent deployment; (3) similar catheterization of the second M2 branch; (4) microcatheter reduction/stent deployment; (5) coil embolization (jailed). Important nuances include: (1) low threshold for a staged procedure; (2) awareness of the possibility of stent twisting; (3) jailed coiling. Final views show adequate treatment of the aneurysm dome with stent protection of the dysplastic neck without thromboembolic complications. Given the residual near the base, close angiographic follow-up is important. neurintsurg;16/3/228/V1F1V1Video 1 Technical video demonstrating double stent reduction technique.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents , Prótese Vascular , Cateterismo , Angiografia Cerebral/métodos , Embolização Terapêutica/métodos , Resultado do Tratamento , Estudos Retrospectivos
2.
Neuroradiol J ; 36(4): 464-469, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36409963

RESUMO

BACKGROUND: Flow diversion and stent assisted coiling are increasingly utilized strategies in the endovascular treatment of cerebral aneurysms. Ischemic and hemorrhagic complications play an important role in the outcome following such embolizations. Little is published regarding patients on concurrent oral anticoagulation and undergoing such embolizations and the rates of complications and patient outcomes. MATERIALS AND METHODS: Retrospective data for consecutive patients on concurrent oral anticoagulation undergoing flow diversion or stent assisted coiling for cerebral aneurysms was accessed from databases at the participating sites. Patient demographics, comorbidities, antiplatelet regimens, aneurysm characteristics, complications, and radiographic results were recorded and descriptive statistics reported. RESULTS: Eleven patients were identified undergoing embolization in the setting of preoperative anticoagulant use and included seven patients undergoing flow diversion and four patients undergoing stent assisted coiling. There was a wide range of antiplatelet and anticoagulant management strategies. There were four major complications in three patients (27.2%) to include two serious bleeding events in addition to ischemic strokes. Both serious bleeding events occurred in patients continued on oral anticoagulation with the addition of antiplatelets. At a mean follow-up of 9.6 months, three aneurysms had continued filling for a good radiographic outcome of 72.7%. CONCLUSIONS: Anticoagulant and antiplatelet use in the setting of flow diversion or stent assisted coiling may carry increased risks as compared to historical norms and, for flow diversion, offer decreased efficacy.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Estudos Retrospectivos , Embolização Terapêutica/métodos , Stents , Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/métodos , Resultado do Tratamento
3.
J Neurointerv Surg ; 12(2): 176-180, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31300534

RESUMO

BACKGROUND: The transradial approach as a frontline approach is a novel technique in neuroendovascular procedures. In this study we aim to present our early experience with full transition to transradial access as the first-line approach for neuroendovascular procedures. METHODS: We prospectively collected data on the first 100 consecutive patients who underwent a diagnostic or interventional neuroendovascular procedure using the transradial approach at our institution between March 22 and April 30, 2019. Baseline characteristics were collected in addition to the type of procedure, access site, catheters and wires used, complications, and whether there was crossover to transfemoral access. RESULTS: Transradial access was attempted in 121 cases and 91 cases were completed successfully (72 diagnostic procedures and 19 interventional procedures). Mean (SD) age was 56.8 (14.7) years, 54.9% (50/91) underwent the procedure in the outpatient setting, and 60.4% (55/91) were women. Seven patients had minor immediate complications related to the radial access. Interventional procedures successfully performed included aneurysm embolization (ruptured (n=3) and unruptured (n=8)), tumor embolization (n=2), cervical internal carotid artery stenting (n=2), balloon occlusion test (n=1), vertebral artery sacrifice (n=1), and arteriovenous malformation embolization (n=2). CONCLUSION: In this early experience, full transition to the transradial approach as the frontline approach is feasible with a low complication rate for both diagnostic and interventional neuroendovascular procedures.


Assuntos
Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Procedimentos Endovasculares/métodos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Cateterismo/métodos , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents , Fatores de Tempo
4.
Audiol Neurootol ; 18(6): 392-405, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24192718

RESUMO

Dexamethasone administered prior to cochlear implantation has been shown to reduce the loss of residual hearing in experimental settings. However, its effect on the tissue response around the implant has not been extensively studied. In this study dexamethasone sodium phosphate was administered to guinea pigs via local delivery to the round window (2% dexamethasone for 120 min prior to surgery, 'local 2/120', or 20% dexamethasone for 30 min prior to surgery) or intravenously (2 mg/kg dexamethasone for 60 min) prior to implantation. Auditory brainstem responses (ABR) were monitored for 3 months, after which the cochleae were embedded in Spurr's resin and sectioned. The extent of the tissue response and the survival of the neurosensory structures were analysed. Both local 2/120 and systemically delivered dexamethasone improved ABR thresholds when compared with control animals. Systemic dexamethasone also reduced the tissue response around the electrode. This suggests that whilst both locally and systemically administered dexamethasone can protect residual hearing after cochlear implantation, their effects upon the tissue response to implantation may differ.


Assuntos
Implante Coclear/métodos , Dexametasona/farmacologia , Glucocorticoides/farmacologia , Audição/efeitos dos fármacos , Animais , Limiar Auditivo/efeitos dos fármacos , Cóclea/efeitos dos fármacos , Cóclea/patologia , Cóclea/cirurgia , Dexametasona/farmacocinética , Potenciais Evocados Auditivos do Tronco Encefálico/efeitos dos fármacos , Fibrose/tratamento farmacológico , Glucocorticoides/farmacocinética , Cobaias , Células Ciliadas Auditivas/efeitos dos fármacos , Células Ciliadas Auditivas/patologia , Humanos , Modelos Animais , Distribuição Aleatória , Janela da Cóclea/metabolismo
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