Decision-Making in the Scheduling of Endovascular Treatment after Brain Arteriovenous Malformation Haemorrhage: A Retrospective Single Centre Study

2011 ◽  
Vol 24 (6) ◽  
pp. 879-885 ◽  
Author(s):  
J.J. Downer ◽  
M. Cellerini ◽  
R.A. Corkill ◽  
S. Lalloo ◽  
W. Küker ◽  
...  
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Complication Rate ◽  
Injury Severity ◽  
Endovascular Intervention ◽  
Brain Arteriovenous Malformation ◽  
Single Centre ◽  
Significant Difference

The appropriate timing for endovascular intervention after brain arteriovenous malformation (bAVM) rupture is not known. This paper aims to determine factors that lead to early endovascular intervention and to investigate whether early intervention has the same complication rate as late intervention in a single centre. All patients who underwent endovascular treatment for a ruptured bAVM at our institution in the period January 2007 and July 2010 were included in this retrospective observational study. Of 50 patients, 33 had early endovascular intervention, defined as within 30 days of haemorrhage and the remaining 17 patients had endovascular treatment at day 30 or beyond. A greater proportion of patients treated within the first 30 days were in neurointensive care preoperatively (51.5% vs. 23.5%, p=0.07). A ‘high-risk’ angioarchitectural feature was identified in more patients who had acute intervention (78.8% vs. 11.8%, p<0.0001) and targeted embolization was also more frequent in this group (48.5% vs. 5.9%, p=0.004). Nidal aneurysms, venous varices and impaired venous outflow (venous stenosis) were the principal ‘high risk’ features. Clinically apparent complications occurred in 10.8% of procedures with permanent neurological deficit in 3.6%. There was no directly procedure-related mortality. There was no statistically significant difference in the complication rate of early procedures compared with delayed interventions (12.5% vs. 7.4%, p=0.71). Greater initial injury severity and the presence of high-risk lesion characteristics are the factors that lead to early endovascular intervention. Early intervention is associated with a higher complication rate, but this difference is not statistically significant.

Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report

2019 ◽  
Vol 1 (1) ◽  
pp. 16-18 ◽  
Author(s):  
Norafida Bahari ◽  
Nik Azuan Nik Ismail ◽  
Jegan Thanabalan ◽  
Ahmad Sobri Muda
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Value ◽  
Cone Beam ◽  
Brain Arteriovenous Malformation ◽  
Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report.

2019 ◽  
pp. 16-18
Author(s):  
Norafida Bahari ◽  
NikAzuan Nik Ismail ◽  
Jegan Thanabalan ◽  
Ahmad Sobri Muda
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Endovascular Treatment ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Value ◽  
Cone Beam ◽  
Brain Arteriovenous Malformation ◽  
Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

scholarly journals Comparing the safety and efficacy of endovascular treatment versus bypass surgery for infrarenal aortic occlusion: a single-center experience

2019 ◽  
Author(s):  
Jingjing Wang ◽  
Jiang Shao ◽  
Chenyang Qiu ◽  
Lijing Fang ◽  
Kang Li ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Bypass Surgery ◽  
Aortic Occlusion ◽  
Long Term Results ◽  
Infrarenal Aorta ◽  
Aortofemoral Bypass ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Significant Difference

Abstract Background Infrarenal aortic occlusion (IAO) is a complete occlusion of infrarenal aorta, which is the most complicated and severe subclass of aortoiliac occlusive disease(AIOD). The first-line treatment for IAO is bypass surgery due to its favorable patency rate. As endovascular technique advances, several retrospective studies have reported their endovascular experience for IAO. However, whether endovascular treatment(EVT) is comparable to bypass surgery for IAO required further study. This research was to study the safety and efficacy of EVT for IAO compared to bypass surgery. Methods From 2003 to 2017, 44 consecutive patients with IAO was treated with EVT(n=16) or aortofemoral bypass surgery(n=28). The therapeutic strategy depended on patient’s will and state of health. Demographics, comorbidity, mortality, complication rate, and symptom-free survival proportion was compared by T-tests or chi-square test, to illustrate the safety and efficacy of EVT and bypass surgery. Results The demographics and pre-operative Rutherford classification equally distributed in the two groups(P>0.05). As for technical success, comorbidities, mortality, complication rate, and Rutherford classification after procedures, clinical success, no significant difference was observed(P>0.05). The median post-procedure hospital stay was 4 days in the EVT group and was significantly shorter than that of the bypass, which was 11 days(P<0.05). As for short-term and long-term results, the 1-year, 3-year, and 5-year the cumulative symptom-free survival rates were 85.7%, 85.7% and 85.7% in the EVT group, 100%, 94.1% and 80.7% in the aortofemoral bypass group. There was no significant difference in symptom-free survival rate between the two groups according to log-rank test (P=0.92) Conclusions The safety and efficacy of EVT were comparable to that of anatomic bypass surgery for IAO. EVT could be a feasible option for IAO.

scholarly journals Comparing the safety and efficacy of endovascular treatment versus bypass surgery for infrarenal aortic occlusion: a single-center experience

2019 ◽  
Author(s):  
Jingjing Wang ◽  
Jiang Shao ◽  
Chenyang Qiu ◽  
Lijing Fang ◽  
Kang Li ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Bypass Surgery ◽  
Aortic Occlusion ◽  
Long Term Results ◽  
Infrarenal Aorta ◽  
Aortofemoral Bypass ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Significant Difference

Abstract Background: Infrarenal aortic occlusion (IAO) is a complete occlusion of infrarenal aorta, which is the most complicated and severe subclass of aortoiliac occlusive disease (AIOD). The first-line treatment for IAO is bypass surgery due to its favorable patency rate. As endovascular technique advances, several retrospective studies have reported their endovascular experience for IAO. However, whether endovascular treatment(EVT) is comparable to bypass surgery for IAO required further study. This research was to study the safety and efficacy of EVT for IAO compared to bypass surgery. Methods: From 2003 to 2017, 44 consecutive patients with IAO was treated with EVT(n=16) or aortofemoral bypass surgery(n=28). The therapeutic strategy depended on patient’s will and state of health. Demographics, comorbidity, mortality, complication rate, and symptom-free survival proportion was compared by T-tests or chi-square test, to illustrate the safety and efficacy of EVT and bypass surgery. Results:The demographics and pre-operative Rutherford classification equally distributed in the two groups(P>0.05). As for technical success, comorbidities, mortality, complication rate, and Rutherford classification after procedures, clinical success, no significant difference was observed(P>0.05). The median post-procedure hospital stay was 4 days in the EVT group and was significantly shorter than that of the bypass, which was 11 days(P<0.05). As for short-term and long-term results, the 1-year, 3-year, and 5-year the cumulative symptom-free survival rates were 85.7%, 85.7% and 85.7% in the EVT group, 100%, 94.1% and 80.7% in the aortofemoral bypass group.There was no significant difference insymptom-free survival ratebetween the two groups according to log-rank test (P=0.92) Conclusions: The safety and efficacy of EVT were comparable to that of anatomic bypass surgery for IAO . EVT could be a feasible option for IAO.

scholarly journals Pathogenesis of non-hereditary brain arteriovenous malformation and therapeutic implications

2020 ◽  
Vol 26 (3) ◽  
pp. 244-253 ◽  
Author(s):  
Takahiro Ota ◽  
Masaki Komiyama
Keyword(s):  
High Risk ◽  
Arteriovenous Malformation ◽  
Signaling Pathways ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Genetic Factors ◽  
Angiogenic Factors ◽  
Brain Arteriovenous Malformation ◽  
Therapeutic Implications ◽  
Brain Arteriovenous Malformations

Brain arteriovenous malformations have a high risk of intracranial hemorrhage, which is a substantial cause of morbidity and mortality in patients with brain arteriovenous malformations. Although a variety of genetic factors leading to hereditary brain arteriovenous malformations have been extensively investigated, their pathogenesis is still not well elucidated, especially in sporadic brain arteriovenous malformations. The authors have reviewed the updated data of not only the genetic aspects of sporadic brain arteriovenous malformations, but also the architecture of microvasculature, the roles of the angiogenic factors, and the signaling pathways. This knowledge may allow us to infer the pathogenesis of sporadic brain arteriovenous malformations and develop pre-emptive treatments for them.

scholarly journals Improving maternal–infant bonding after prenatal diagnosis of CHD

2018 ◽  
Vol 28 (11) ◽  
pp. 1306-1315 ◽  
Author(s):  
Piers C. A. Barker ◽  
Gregory H. Tatum ◽  
Michael J. Campbell ◽  
Michael G. W. Camitta ◽  
Angelo S. Milazzo ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
High Risk ◽  
Fetal Echocardiography ◽  
Adverse Outcomes ◽  
Single Centre ◽  
Cardiac Intervention ◽  
Lengths Of Stay ◽  
Significant Difference ◽  
Single Centre Study ◽  
Cardiac Diagnosis

AbstractBackgroundInfants with prenatally diagnosed CHD are at high risk for adverse outcomes owing to multiple physiologic and psychosocial factors. Lack of immediate physical postnatal contact because of rapid initiation of medical therapy impairs maternal–infant bonding. On the basis of expected physiology, maternal–infant bonding may be safe for select cardiac diagnoses.MethodsThis is a single-centre study to assess safety of maternal–infant bonding in prenatal CHD.ResultsIn total, 157 fetuses with prenatally diagnosed CHD were reviewed. On the basis of cardiac diagnosis, 91 fetuses (58%) were prenatally approved for bonding and successfully bonded, 38 fetuses (24%) were prenatally approved but deemed not suitable for bonding at delivery, and 28 (18%) were not prenatally approved to bond. There were no complications attributable to bonding. Those who successfully bonded were larger in weight (3.26 versus 2.6 kg, p<0.001) and at later gestation (39 versus 38 weeks, p<0.001). Those unsuccessful at bonding were more likely to have been delivered via Caesarean section (74 versus 49%, p=0.011) and have additional non-cardiac diagnoses (53 versus 29%, p=0.014). There was no significant difference regarding the need for cardiac intervention before hospital discharge. Infants who bonded had shorter hospital (7 versus 26 days, p=0.02) and ICU lengths of stay (5 versus 23 days, p=0.002) and higher survival (98 versus 76%, p<0.001).ConclusionFetal echocardiography combined with a structured bonding programme can permit mothers and infants with select types of CHD to successfully bond before ICU admission and intervention.

Antifungal Prophylaxis (AFP) for Patients (Pts) with Acute Myelogenous Leukemia (AML) and High-Risk Myelodysplastic Syndrome (HR-MDS) Undergoing Intensive Chemotherapy: An Experience with 730 Pts.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3102-3102 ◽  
Author(s):  
Gloria Mattiuzzi ◽  
Hagop Kantarjian ◽  
Jennifer Ho ◽  
Guillermo Garcia-Manero ◽  
Jorge Cortes
Keyword(s):  
Early Intervention ◽  
Side Effects ◽  
High Risk ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Antifungal Prophylaxis ◽  
Myelogenous Leukemia ◽  
Liposomal Amphotericin B ◽  
Intensive Chemotherapy ◽  
Significant Difference

Abstract Abstract 3102 Poster Board III-39 Despite the advances in the development of antifungal agents, invasive fungal infections (IFI) remain a significant threat to patients with hematologic malignancies. The importance of early intervention for patients at high-risk for IFI has been widely discussed in several publications; however, the question of whether an early intervention such as prophylaxis is better than empiric or pre-emptive treatment still remains unanswered. Antifungal prophylaxis continues to be routinely used at MDACC for AML and HR-MDS patients. An ideal AFP regimen should be effective, safe, and uncomplicated for the patients. In the search of this ideal regimen, we have explored several options, including different type of drugs and various delivery schedules. Hereby, we report our experience since September 1997 to August 2009 with 730 AML and HR-MDS patients who received AFP for intensive chemotherapy. Proven IFI were defined as per the EORTC criteria. The following regimens were studied: Amphotericin B Lipid Complex (ABLC): 2.5 mg/kg IV three times/week; Liposomal Amphotericin B (AMBI 3TIW): 3 mg/kg IV three times/week; Fluconazole 400 mg (tab) /d + Itraconazole:200 mg (caps) /d (F + I); IV Itraconazole (IV ITRA):200 mg BID X 2 d, then 200 mg IV/d; Caspofungin (CASPO):50 mg IV /d; Voriconazole (IV VORI):400 mg IV BID x 2 d, then 300 mg IV BID; Liposomal Amphotericin B (AMBI 9/W): 9 mg/kg IV once per week; and Voriconazole (PO VORI ): 400 mg BID PO x 1 day, followed by 200 mg PO BID. Patients received ABLC, IV ITRA, F+I, AMBI 3TIW and CASPO since day 1 of IC until IC response was assessed. Pt on IV VORI, AMBI 3TIW and PO VORI started AFP within 24 hours after the last dose of IC until IC response was assessed. There were no significant differences among the pts in the 8 regimens with regards to age, gender, diagnosis, cytogenetics, performance status, presence of no fungal infection at start IC and stayed in protected environment. Table 1 shows our results. Although none of the pts receiving Voriconazole (IV or PO) developed proven IFI, all comparisons of efficacy among the AFP regimens were not significant (p= 0.291). None of the patients on AMBI 3TIW and either VORI had mold infections. There was a significant difference in the number of side effects among the 8 groups (p = 0.03). CASPO and PO VORI were the less toxic regimens. In addition, PO VORI was significantly less toxic than IV VORI (p=0.031). ABLC (N=131) AMBI 3TIW (N=69) F+I (N=67) IV ITRA (N=225) CASPO (N=106) VORI IV (N=61) AMBI 9/w (N=27) PO VORI (N=38) Breakthrough proven IFI n (%) 7(5) 3(4) 3(5) 17(8) 7(7) 0 2 (7) 0 –Yeast 2 3 1 11 3 0 1 0 –Mold 5 0 2 6 4 0 1 0 Drug-related side effects (%) 18 14 7 10 4 21 12 5 We conclude that PO VORI is safe, efficacious and easy to administer to the patients for the prevention of IFI in pts with AML and HR-MDS undergoing IC. CASPO is a safe alternative. Disclosures No relevant conflicts of interest to declare.

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