Neuroendovascular Management of Acute Ischemic Basilar Strokes: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Guilherme B F Porto ◽  
Mithun G Sattur ◽  
Sami Al Kasab ◽  
Alejandro M Spiotta ◽  
Adam Arthur ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Balloon Angioplasty ◽  
Poor Prognosis ◽  
Treatment Options ◽  
Lessons Learned ◽  
Critical Flow ◽  
High Morbidity ◽  
Intracranial Atherosclerotic Disease ◽  
Catheter Size ◽  
Underlying Pathology

Abstract Basilar artery occlusions (BAOs) are devastating ischemic strokes that account for 1% of all strokes with high morbidity and mortality; however, neuroendovascular techniques such as ADAPT have recently revolutionized the clinical outcomes of these patients.1-3 Common underlying pathology in patients with BAO include intracranial atherosclerotic disease (ICAD) as well as thromboembolic origin.4 Basilar artery ICAD in a setting of acute stroke portends a poor prognosis and post-thrombectomy residual critical flow limiting stenosis treatment options, including balloon angioplasty with or without stent placement.5-7 We present a video illustration of neuroendovascular technique and challenges encountered when managing this pathology. Image at 5:42 reprinted with permission from Alawieh et al, Lessons learned over more than 500 stroke thrombectomies using ADAPT with increasing aspiration catheter size, Neurosurgery, 86(1), 2020, pp. 61-70, with permission from the Congress of Neurological Surgeons.1

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

scholarly journals Neglected femoral neck fractures in cerebral palsy: a narrative review

2020 ◽  
Vol 5 (1) ◽  
pp. 58-64
Author(s):  
Giuseppe Toro ◽  
Antimo Moretti ◽  
Marco Paoletta ◽  
Annalisa De Cicco ◽  
Adriano Braile ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
Motor Function ◽  
Treatment Options ◽  
High Morbidity ◽  
Fibular Graft ◽  
Motor Impairments ◽  
High Prevalence ◽  
Neck Fracture

Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a ‘neglected femoral neck fracture’ (NFNF). Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain. Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function. Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients. After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019

scholarly journals Glioblastoma and MiRNAs

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1581
Author(s):  
Swalih P. Ahmed ◽  
Javier S. Castresana ◽  
Mehdi H. Shahi
Keyword(s):  
Brain Tumors ◽  
Human Body ◽  
Diagnostic Tool ◽  
Poor Prognosis ◽  
Treatment Options ◽  
Diagnosis And Treatment ◽  
Therapeutic Success ◽  
Knowing That ◽  
Almost All ◽  
Cell Signaling Pathways

Glioblastoma (GB) is one of the most common types of lethal brain tumors. Although several treatment options are available including surgery, along with adjuvant chemo and radiotherapy, the disease has a poor prognosis and patients generally die within 14 months of diagnosis. GB is chemo and radio resistant. Thus, there is a critical need for new insights into GB treatment to increase the chance of therapeutic success. This is why microRNA (miRNA) is being potentially considered in the diagnosis and treatment of glioblastoma. The objective of our review is to provide a holistic picture of GB up-regulated and down-regulated miRNA, in relationship with the expression of other genes, cell signaling pathways, and their role in GB diagnosis and treatment. MiRNA treatment is being considered to be used against GB together with radiotherapy and chemotherapy. Moreover, the use of miRNA as a diagnostic tool has also begun. Knowing that miRNAs are isolated in almost all human body fluids and that there are more than 3000 miRNAs in the human genome, plus the fact that each miRNA controls hundreds of different mRNAs, there is still much study needed to explore how miRNAs relate to GB for its proliferation, progression, and inhibition.

scholarly journals A metabolomic endotype of bioenergetic dysfunction predicts mortality in critically ill patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Raymond J. Langley ◽  
Marie E. Migaud ◽  
Lori Flores ◽  
J. Will Thompson ◽  
Elizabeth A. Kean ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Patient Outcomes ◽  
Medical Intensive Care Unit ◽  
Close Association ◽  
Treatment Options ◽  
Feature Model ◽  
High Morbidity ◽  
Medical Intensive Care ◽  
Poor Outcomes

AbstractAcute respiratory failure (ARF) requiring mechanical ventilation, a complicating factor in sepsis and other disorders, is associated with high morbidity and mortality. Despite its severity and prevalence, treatment options are limited. In light of accumulating evidence that mitochondrial abnormalities are common in ARF, here we applied broad spectrum quantitative and semiquantitative metabolomic analyses of serum from ARF patients to detect bioenergetic dysfunction and determine its association with survival. Plasma samples from surviving and non-surviving patients (N = 15/group) were taken at day 1 and day 3 after admission to the medical intensive care unit and, in survivors, at hospital discharge. Significant differences between survivors and non-survivors (ANOVA, 5% FDR) include bioenergetically relevant intermediates of redox cofactors nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), increased acyl-carnitines, bile acids, and decreased acyl-glycerophosphocholines. Many metabolites associated with poor outcomes are substrates of NAD(P)-dependent enzymatic processes, while alterations in NAD cofactors rely on bioavailability of dietary B-vitamins thiamine, riboflavin and pyridoxine. Changes in the efficiency of the nicotinamide-derived cofactors’ biosynthetic pathways also associate with alterations in glutathione-dependent drug metabolism characterized by substantial differences observed in the acetaminophen metabolome. Based on these findings, a four-feature model developed with semi-quantitative and quantitative metabolomic results predicted patient outcomes with high accuracy (AUROC = 0.91). Collectively, this metabolomic endotype points to a close association between mitochondrial and bioenergetic dysfunction and mortality in human ARF, thus pointing to new pharmacologic targets to reduce mortality in this condition.

scholarly journals Cancer Vaccines for Genitourinary Tumors: Recent Progresses and Future Possibilities

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 623
Author(s):  
Brigida Anna Maiorano ◽  
Giovanni Schinzari ◽  
Davide Ciardiello ◽  
Maria Grazia Rodriquenz ◽  
Antonio Cisternino ◽  
...  
Keyword(s):  
Cancer Vaccines ◽  
Viral Vectors ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Tumor Development ◽  
Resistance Mechanisms ◽  
High Morbidity ◽  
Therapeutic Vaccines ◽  
Combination Strategies ◽  
New Treatment

Background: In the last years, many new treatment options have widened the therapeutic scenario of genitourinary malignancies. Immunotherapy has shown efficacy, especially in the urothelial and renal cell carcinomas, with no particular relevance in prostate cancer. However, despite the use of immune checkpoint inhibitors, there is still high morbidity and mortality among these neoplasms. Cancer vaccines represent another way to activate the immune system. We sought to summarize the most recent advances in vaccine therapy for genitourinary malignancies with this review. Methods: We searched PubMed, Embase and Cochrane Database for clinical trials conducted in the last ten years, focusing on cancer vaccines in the prostate, urothelial and renal cancer. Results: Various therapeutic vaccines, including DNA-based, RNA-based, peptide-based, dendritic cells, viral vectors and modified tumor cells, have been demonstrated to induce specific immune responses in a variable percentage of patients. However, these responses rarely corresponded to significant survival improvements. Conclusions: Further preclinical and clinical studies will improve the knowledge about cancer vaccines in genitourinary malignancies to optimize dosage, select targets with a driver role for tumor development and growth, and finally overcome resistance mechanisms. Combination strategies represent possibly more effective and long-lasting treatments.

scholarly journals Epilepsy in Mitochondrial Diseases—Current State of Knowledge on Aetiology and Treatment

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 532
Author(s):  
Dorota Wesół-Kucharska ◽  
Dariusz Rokicki ◽  
Aleksandra Jezela-Stanek
Keyword(s):  
Oxidative Phosphorylation ◽  
Mitochondrial Dysfunction ◽  
Mitochondrial Disease ◽  
Clinical Picture ◽  
Poor Prognosis ◽  
Treatment Options ◽  
Mitochondrial Diseases ◽  
Energy Deficit ◽  
Atp Production ◽  
Current State

Mitochondrial diseases are a heterogeneous group of diseases resulting from energy deficit and reduced adenosine triphosphate (ATP) production due to impaired oxidative phosphorylation. The manifestation of mitochondrial disease is usually multi-organ. Epilepsy is one of the most common manifestations of diseases resulting from mitochondrial dysfunction, especially in children. The onset of epilepsy is associated with poor prognosis, while its treatment is very challenging, which further adversely affects the course of these disorders. Fortunately, our knowledge of mitochondrial diseases is still growing, which gives hope for patients to improve their condition in the future. The paper presents the pathophysiology, clinical picture and treatment options for epilepsy in patients with mitochondrial disease.

scholarly journals Dissecting Aneurysm of the Basilar Arterial Trunk Presenting with Pontine Infarction

2007 ◽  
Vol 13 (4) ◽  
pp. 381-384 ◽  
Author(s):  
Y.-G. Jang ◽  
C.W. Ryu ◽  
J.S. Kim ◽  
E.Y. Cha ◽  
H.W. Pyun ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
High Morbidity ◽  
Complete Disappearance ◽  
Collateral Flow ◽  
Arterial Trunk ◽  
Pontine Infarction ◽  
Diseased Segment ◽  
Procedural Complication

Dissecting basilar aneurysms have rarely been reported but are associated with high morbidity and mortality. Therefore, controversy exists as to the proper management of such lesions because their natural course is not well understood. We describe a 50-year-old man with a dissecting aneurysm involving the lower basilar trunk who presented with pontine infarction corresponding to the aneurysmal sac location. We obliterated the dissecting basilar aneurysm by coil embolization of the aneurysmal sac as well as the diseased segment of the basilar trunk after confirmation of collateral filling of the basilar artery through the posterior communicating artery. The patient recovered without any procedural complication. Eight month follow-up revealed complete disappearance of the aneurysm without symptom recurrence together with preservation of collateral flow in the distal basilar artery. Obliteration of the parent artery as well as the aneurysmal sac with coils could be considered in a lower basilar aneurysm of a dissecting nature.

Multistage Openhole Completion Using Integrated Dynamic Diversion Frac Technique in Highly Depleted Well: First Successful Application in West Kuwait Field

2021 ◽  
Author(s):  
Abdullah Abu-Eida ◽  
Salem Al-Sabea ◽  
Milan Patra ◽  
Bader Akbar ◽  
Kutbuddin Bhatia ◽  
...  
Keyword(s):  
Best Practice ◽  
Treatment Options ◽  
High Energy ◽  
Lessons Learned ◽  
High Potential ◽  
Fracture Plane ◽  
Fluid Loss ◽  
Field Development ◽  
Two Fluids

Abstract The Minagish field in West Kuwait is a high potential field which poses several challenges in terms of hydrocarbon flow assurance through highly depleted tight carbonate intervals with uneven reservoir quality and curtailed mobility. These conditions have shifted the field development from vertical to horizontal wellbore completions. Achieving complete wellbore coverage is a challenge for any frac treatment performed in a long openhole lateral with disparities in reservoir characteristics. The fluid will flow into the path of least resistance leaving large portions of the formation untreated. As a result, economic fracturing treatment options dwindle significantly, thus reservoir stimulation results are not always optimum. A multistage fracturing technique using Integrated Dynamic Diversion (IDD) has been performed first time in West Kuwait field well. The process uses active fluid energy to divert flow into a specific fracture point in the lateral, which can initiate and precisely place a fracture. The process uses two self-directed fluid streams: one inside the pipe and one in the annulus. The process mixes the two fluids downhole with high energy to form a consistent controllable mixture. The technique includes pinpoint fluid jetting at the point of interest, followed by in-situ HCL based crosslinked systems employed for improving individual stage targets. The IDD diversion shifts the fracture to unstimulated areas to create complex fractures which increases reservoir contact volume and improved overall conductivity in the lateral. The kinetic and chemical diversion of the IDD methodology is highly critical to control fluid loss in depleted intervals and results in enhanced stimulation. Pumping a frac treatment in openhole without control would tend to initiate a longitudinal fracture along the wellbore and may restrict productivity. By using specialized completion tools with nozzles at the end of the treating string, a new pinpoint process has been employed to initiate a transverse fracture plane in IDD applications. Proper candidate selection and fluid combination with in-situ crosslink acid effectively plug the fracture generated previously and generate pressure high enough to initiate another fracture for further ramification. By combining these processes into one continuous operation, the use of wireline/coiled tubing for jetting, plug setting and milling is eliminated, making the new multistage completion technology economical for these depleted wells. The application of the IDD methodology is a fit-for-purpose solution to address the unique challenges of openhole operations, formation technical difficulties, high-stakes economics, and untapped high potential from intermittent reservoirs. The paper will present post-operation results of this completion from all fractured zones along the lateral and will describe the lessons learned in implementation of this methodology which can be considered as best practice for application in similar challenges in other fields.

Endovascular treatment of a fusiform basilar artery aneurysm using multiple “in-stent stents”

2009 ◽  
Vol 3 (6) ◽  
pp. 496-500 ◽  
Author(s):  
R. Webster Crowley ◽  
Avery J. Evans ◽  
Neal F. Kassell ◽  
Mary E. Jensen ◽  
Aaron S. Dumont
Keyword(s):  
Basilar Artery ◽  
Pediatric Patients ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
High Morbidity ◽  
Endovascular Techniques ◽  
Basilar Artery Aneurysm ◽  
Open Surgical Treatment ◽  
Cumulative Risks ◽  
Frequent Presence

Fusiform aneurysms of the basilar artery present difficult challenges for the treating physician. On one hand, these aneurysms are difficult and dangerous to treat. On the other, the relatively high rupture rate, risk of thromboemboli, and the frequent presence of mass effect on the brainstem often demand treatment rather than observation. While conservative treatment may be reasonable in an elderly patient, the relative resiliency and the larger lifetime cumulative risks of pediatric patients are compelling arguments for treatment. With the advancement of endovascular techniques some of these lesions have become treatable without the high morbidity and mortality rates associated with open surgical treatment, albeit with risks of their own. The authors present the case of a fusiform aneurysm arising from a severely tortuous basilar artery in a 22-month-old boy. The aneurysm was successfully treated using flow diversion by placing multiple intracranial stents without coil embolization. This allowed for thrombosis of the aneurysm and resolution of the mass effect on the brainstem without compromising blood flow to the brainstem.

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