scholarly journals Bailout Strategies and Complications Associated with the Use of Flow-Diverting Stents for Treating Intracranial Aneurysms

2018 ◽  
Vol 8 (1) ◽  
pp. 38-54 ◽  
Author(s):  
Fawaz Al-Mufti ◽  
Eric R. Cohen ◽  
Krishna Amuluru ◽  
Vikas Patel ◽  
Mohammad El-Ghanem ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Perioperative Period ◽  
Google Scholar ◽  
Endovascular Management ◽  
Background Flow ◽  
Qualitative Review ◽  
Giant Aneurysms ◽  
Management Of Complications ◽  
Delayed Complications

Background: Flow-diverting stents (FDS) have revolutionized the endovascular management of unruptured, complex, wide-necked, and giant aneurysms. There is no consensus on management of complications associated with the placement of these devices. This review focuses on the management of complications of FDS for the treatment of intracranial aneurysms. Summary: We performed a systematic, qualitative review using electronic databases MEDLINE and Google Scholar. Complications of FDS placement generally occur during the perioperative period. Key Message: Complications associated with FDS may be divided into periprocedural complications, immediate postprocedural complications, and delayed complications. We sought to review these complications and novel management strategies that have been reported in the literature.

scholarly journals Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 4 (1) ◽  
pp. E1 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Cerebrospinal Fluid ◽  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Cerebrospinal Fluid Drainage ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation

Object The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 88 (3) ◽  
pp. 425-429 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation ◽  
Fine Print

Object. The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods. The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions. Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

2017 ◽  
Vol 1 (1) ◽  
pp. 22-27
Author(s):  
Edwin R Faulconer ◽  
Rachel M Russo ◽  
Anders J Davidson ◽  
Meryl A Simon ◽  
Erik S DeSoucy ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Open Surgery ◽  
Management Strategies ◽  
Balloon Occlusion ◽  
Vascular Injuries ◽  
Endovascular Management ◽  
Review Of The Literature ◽  
Junctional Zone ◽  
Endovascular Interventions ◽  
Direct Pressure

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

Endovascular Management of Intracranial Aneurysms

2018 ◽  
pp. 357-363
Author(s):  
Rohan Chitale ◽  
David Kung ◽  
Stavropoula Tjoumakaris ◽  
Pascal Jabbour ◽  
Robert H. Rosenwasser
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Management

Femoral Access for TAVR: Techniques for Prevention and Endovascular Management of Complications

2013 ◽  
pp. 859-873 ◽  
Author(s):  
Alice Perlowski ◽  
Michael H. Salinger ◽  
Justin P. Levisay ◽  
Ted Feldman
Keyword(s):  
Endovascular Management ◽  
Femoral Access ◽  
Management Of Complications

scholarly journals Reflections on the TEAM Trial: Why Clinical Care and Research Should be Reconciled

2011 ◽  
Vol 38 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Jean Raymond
Keyword(s):  
Clinical Research ◽  
Intracranial Aneurysms ◽  
Potential Benefit ◽  
Clinical Care ◽  
Major Change ◽  
Management Team ◽  
Endovascular Management ◽  
Public Agencies ◽  
Research And Practice ◽  
Unruptured Intracranial Aneurysms

The current clinical and research environment is one that renders any true enquiry into the value of commonly performed surgical acts practically impossible. Drawing from the recent failure of Trial on Endovascular Aneurysm Management (TEAM), a trial on the endovascular management of unruptured intracranial aneurysms, I attempt to identify some principles that sustain the current ways of doing clinical research that have paradoxically become major obstacles to trials that aim to assess the potential benefit or harm due to interventions as currently practiced. Clinical research and practice must coalesce into “clinical care trials” if we are to provide patients with optimal, prudent care in the context of uncertainty. This may require a major change in the mentalities of clinicians, scientists, and patients alike, and the adoption of novel strategies for public agencies to support the integration of clinical research and care.

The 100 most cited articles in the endovascular management of intracranial aneurysms

2018 ◽  
Vol 10 (9) ◽  
pp. 859-868 ◽  
Author(s):  
Julian Maingard ◽  
Kevin Phan ◽  
Yifan Ren ◽  
Hong Kuan Kok ◽  
Vincent Thijs ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Intracranial Aneurysms ◽  
Citation Count ◽  
Relevant Information ◽  
Endovascular Coiling ◽  
Endovascular Management ◽  
Comprehensive Overview ◽  
Endovascular Interventions ◽  
Rank List ◽  
The Usa

IntroductionEndovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms.MethodsWe performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms (‘intracranial aneurysm’, ‘aneurysm’, ‘aneurysmal subarachnoid’, ‘endovascular’, ‘coiling’, ‘stent-assisted’, ‘balloon-assisted’, ‘flow-diversion’) yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication.ResultsCitations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level–II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA.ConclusionThis study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms.

Narcotic-Free Perioperative Total Knee Arthroplasty: Does the Periarticular Injection Medication Make a Difference?

2019 ◽  
Author(s):  
J. Schneider ◽  
B. Broome ◽  
D. Keeley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Knee Arthroplasty ◽  
Management Strategies ◽  
Perioperative Period ◽  
High Variability ◽  
Cost Difference ◽  
Significant Cost ◽  
Total Knee ◽  
To Receive

AbstractMultimodal pain management strategies are critical in total knee arthroplasty (TKA). There has recently been a shift toward opioid sparing protocols, yet most publications continue to use narcotics in the perioperative period. Periarticular injections are a popular adjunct but studies regarding the optimal medications have high variability making it difficult to choose the optimal medication. The purpose of this study is to validate a perioperative, opioid-free protocol and compare two different periarticular injections without the variability in previous reports. A multimodal pain protocol was instituted that administered no narcotic medications in the perioperative period. Over 2 years, primary TKA patients were informally randomized to receive liposomal bupivacaine (LB), or a cocktail of medications (CO). A total of 189 patients were included: 101 patients in group LB and 88 patients in group CO. Postoperative opioid consumption, length of stay, and inpatient distance ambulated were compared across the two injection groups. In morphine milligram equivalents, group LB consumed a mean of 20.36 mg of oxycodone versus 23.18 mg in group CO (p = 0.543). For tramadol, group LB consumed 27.24 mg versus 28.69 mg in group CO (p = 0.714). Mean hospital stay was 1.70 days for group LB and 1.72 days for group CO (p = 0.811). Distance ambulated was 528.4ft for group LB and 499.8ft for group CO (p = 0.477). In the LB group, 50% of patients required no oxycodone, and 12% of them took neither oxycodone nor tramadol for pain. In the CO group, 40% declined oxycodone and 10% declined both oxycodone and tramadol. We successfully treated all patients without narcotic medications in the perioperative period. Although we saw trends for improvements in group LB, these were small and not clinically meaningful. It appears that both injections were effective. There is a significant cost difference and medications should be chosen based on surgeon preference and institutional needs.

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