Endovascular Retrieval of Dislodged Neurovascular Devices with a Stentriever: Case Series and Technical Review.

PURPOSE: Endovascular treatment of neurovascular disorders is now well established as effective and safe; however, the nature of the intracranial vasculature poses unique challenges. The unintentional dislodgement or fracture of a device and its migration within cerebral vessels is a complication with serious potential morbidity that must be managed urgently. In this series, the authors describe 7 cases of a stentriever being used to remove foreign objects from within the cerebral vasculature. METHODS: A retrospective search of all interventional neurovascular procedures performed in 2017 at a tertiary metropolitan hospital was performed to identify cases of dislodged devices. RESULTS: Five dislodged endovascular coils, 1 microcatheter, and 1 fractured stentriever were technically successfully retrieved. In 6 of the cases, the foreign object was successfully removed with a stentriever alone, whereas 1 case used a J-tip wire and a "J-tip flick" to manipulate the coil and facilitate retrieval. Stentrievers, particularly when used alone, confer the advantages of speed, cost, as well as being tailor-made for cerebral vessels. They also allow continuous blood flow when deployed, a critical advantage when considering cerebral perfusion. Critical techniques include the gradual deployment of the stentriever alongside the foreign object to allow its entanglement and partial resheathing, so that the foreign object can become pinned within the microcatheter. Stentrievers do remain limited by vessel caliber and are less able to entangle larger, stiffer devices. CONCLUSION: The migration of foreign devices during neurointerventional procedures is a serious complication requiring urgent treatment. This case series highlights the efficacy and advantages of using a stentriever and suggests its consideration as a first-line technique in recovering dislodged foreign bodies in the cerebral vasculature.

The 100 most cited articles in the endovascular treatment of thoracic and abdominal aortic aneurysms.

OBJECTIVE: Since the introduction of endovascular technology to treat thoracic and abdominal aortic aneurysms, there has been a global research effort focused on assessing the effectiveness of treatment. A bibliometric analysis is used to identify the scientific impact of an article, impactful authors, institutions, and collaborative groups. Our objective was to identify and to analyze the 100 most cited articles in the field of endovascular treatment of thoracic and abdominal aortic aneurysms. METHODS: We performed a retrospective bibliometric analysis in April 2018. Articles were searched on the Science Citation Index Expanded database using Web of Science to identify the most cited articles in endovascular therapy for thoracic and aortic aneurysms since 1945. Use of selected key terms ("AAA," "aortic aneurysm," "thoracic aneurysm," "abdominal aneurysm," "endovascular," "endoluminal," "stent," "graft," "repair," "EVAR," and "TEVAR") yielded a total of 23,354 articles. The top 100 articles were identified and analyzed to extract relevant information including year of publication, citation count, journal, authorship country of origin, and article type. RESULTS: The earliest articles were published in 1991, with the majority being published in the 2000s (n = 59). The number of citations for the top 100 articles ranged from 151 to 1142, with a median citation count of 212. All articles were cited an average of 22.4 times per year. Almost half (n = 46) of the top 100 articles were published in the Journal of Vascular Surgery. Thirty-nine authors contributed four or more articles, with two being credited on 10 papers to make the list. The majority (n = 62) of the articles arose from the United States, while the United Kingdom contributed 11 articles. There were 7 guidelines and 12 randomized controlled trials, and the majority constituted level III or level IV evidence. CONCLUSIONS: This study provides a comprehensive and informative analysis of the most cited and impactful research undertaken in the field of endovascular treatment of abdominal and thoracic aortic aneurysms. By quantitatively assessing the 100 most cited articles in the field, we recognize the contributions of key authors, institutions, and collaborative groups and develop an understanding of the strengths of past research and the requirements for future global efforts.

A rare cause of adult ileocolic intussusception: ileal leiomyoma.

Intussusception is a rare condition in adulthood and, unlike in children, is usually caused by an identifiable underlying lesion, most commonly a gastrointestinal tumour. The clinical presentation is non-specific and often there are intermittent symptoms making the diagnosis difficult based solely on history and examination. Plain radiography may reveal signs of bowel obstruction, however, CT is the gold standard to diagnose and localise an intussusception in adults. We present an unusual case of adult ileocolic intussusception caused by an ileal leiomyoma. This case highlights the important radiological findings of intussusception presenting with a high-grade obstruction and discusses the potential causes which should be considered.

Use of single photon metal artefact reduction in the detection of an impacted capsule endoscope.

Wireless capsule endoscopy was introduced over a decade ago and is now a widely used tool in the investigation of gastrointestinal pathologies. Despite its ubiquity, the full profile of indications, contraindications and complications is still being developed. Metal artefact reduction is a software technique which can significantly reduce the artefact produced by metallic objects on CT scans. This case exemplifies a rare but noteworthy complication of capsule endoscopy and highlights a novel application of metal artefact reduction.