scholarly journals Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report

2021 ◽  
Vol 12 ◽  
pp. 57
Author(s):  
Tomoya Kamide ◽  
Kouichi Misaki ◽  
Takehiro Uno ◽  
Akifumi Yoshikawa ◽  
Naoyuki Uchiyama ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Orthopedic Surgery ◽  
Rescue Therapy ◽  
Flow Diverter ◽  
Additional Treatment ◽  
High Flow ◽  
Osteoarthritis Of The Knee ◽  
Complete Obliteration ◽  
Endovascular Coil Embolization ◽  
Large Aneurysm

Background: Excellent treatment outcomes using a pipeline embolization device (PED) have been reported. However, several limitations exist. For example, patients must receive antiplatelet therapy for at least several months, and few alternative treatments exist except for inserting additional flow diverter stents in cases where aneurysm obliteration is not obtained. Case Description: A 67-year-old female suffered from an asymptomatic large aneurysm of the left paraclinoid internal carotid artery (ICA). She underwent endovascular coil embolization, but coil compaction was confirmed at 2-year follow-up. A PED was inserted as an additional treatment. Unfortunately, the patient was required to discontinue antiplatelet therapy to undergo orthopedic surgery for her severe osteoarthritis of the knee. However, surveillance imaging performed 2 years after insertion of the PED revealed persistent filling into the aneurysm, and we could not stop the antiplatelet therapy to proceed with orthopedic surgery. Therefore, we performed ICA trapping with extracranial-intracranial high-flow bypass to cease antiplatelet therapy promptly. Antiplatelet therapy was completed 3 months after the rescue surgery, and the patient underwent orthopedic surgery. Conclusion: The authors describe a case of failure of complete obliteration after treatment using a PED, which required cessation of antiplatelet therapy to receive orthopedic surgery. Although safety and efficacy of PED treatment have been reported, we must consider the possibility of other diseases requiring discontinuation of antiplatelet therapy after PED embolization.

scholarly journals Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

2020 ◽  
Vol 26 (5) ◽  
pp. 532-538
Author(s):  
Takashi Fujii ◽  
Hidenori Oishi ◽  
Kohsuke Teranishi ◽  
Kenji Yatomi ◽  
Kazumoto Suzuki ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Oral Anticoagulant ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulant Therapy ◽  
Flow Diverter ◽  
Aneurysm Rupture ◽  
Additional Treatment ◽  
Oral Anticoagulant Treatment ◽  
Complete Obliteration ◽  
Ischemic Complications

Purpose Antiplatelet therapy initiated before flow diverter placement is effective for the prevention of ischemic complications. However, the effectiveness of oral anticoagulant treatment is unclear. This retrospective study evaluated the complications and obliteration rates after flow diverter placement in patients taking anticoagulants. Methods A total of 155 cases were treated by Pipeline Flex placement for unruptured large and giant cerebral aneurysms in our hospital between October 2015 and June 2019. The groups of 8 patients taking anticoagulants before operation and 147 patients not taking anticoagulants were compared. Results Clopidogrel oral dose ( P = 0.002) was significantly lower in the anticoagulant group. Delayed aneurysm rupture ( P = 0.002) and additional treatment ( P = 0.009) rates were significantly higher and complete obliteration rate ( P = 0.011) was lower in the anticoagulant group. Conclusions Additional oral anticoagulant administration before flow diverter placement does not reduce ischemic complications compared to dual antiplatelet therapy, but does increase hemorrhagic complications, especially delayed aneurysm rupture. Complete obliteration of the cerebral aneurysm is difficult to achieve in patients taking anticoagulants.

scholarly journals Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Min Ho Lee ◽  
Hyun Joo Kim
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Rescue Therapy ◽  
High Flow ◽  
Mask Ventilation ◽  
Induction Process ◽  
Management Method ◽  
Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

scholarly journals Extraintracranial Bypass as a Rescue Therapy for Symptomatic Flow Diverter Thrombosis

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Luigi A. Lanterna ◽  
Alessandro Lunghi ◽  
Carlo Brembilla ◽  
Paolo Gritti ◽  
Claudio Bernucci
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rescue Therapy ◽  
Flow Diverter ◽  
Minor Stroke ◽  
Transient Ischemic Attacks ◽  
Postoperative Course ◽  
A Minor ◽  
Ischemic Events

A 56-year-old female with a giant partially thrombosed unruptured carotid-ophthalmic aneurysm was treated with a Pipeline flow diverter. Three months after the procedure, in concomitance with the discontinuation of one of the antiplatelet medications, the patient suffered from a minor stroke and relapsing transient ischemic attacks. The angiography demonstrated the occlusion of the internal carotid artery, and a perfusion-weighted CT scan showed a condition of hypoperfusion. The patient underwent a double-barrel extraintracranial bypass. The postoperative course was uneventful and she has experienced no further ischemic events to date.

scholarly journals Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

2020 ◽  
pp. 1-9
Author(s):  
Alejandro Tomasello ◽  
David Hernandez ◽  
Laura Ludovica Gramegna ◽  
Sonia Aixut ◽  
Roger Barranco Pons ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Acute Subarachnoid Hemorrhage ◽  
Endovascular Coil Embolization ◽  
The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

scholarly journals The p48_HPC antithrombogenic flow diverter: initial human experience using single antiplatelet therapy

2019 ◽  
Vol 48 (1) ◽  
pp. 030006051987958 ◽  
Author(s):  
Pervinder Bhogal ◽  
Carlos Bleise ◽  
Jorge Chudyk ◽  
Ivan Lylyk ◽  
Nicolas Perez ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Flow Diverter ◽  
Human Experience

scholarly journals Rescue Therapy for Procedural Complications Associated With Deployment of Flow-Diverting Devices in Cerebral Aneurysms

2018 ◽  
Vol 15 (6) ◽  
pp. 624-633 ◽  
Author(s):  
Fawaz Al-Mufti ◽  
Krishna Amuluru ◽  
Eric R Cohen ◽  
Vikas Patel ◽  
Mohammad El-Ghanem ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Significant Risk ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Side Branch ◽  
Parent Vessel ◽  
Vessel Injury ◽  
Procedural Complications ◽  
Background Material ◽  
Device Deployment

Abstract Flow diverting devices (FDDs) have revolutionized the treatment of morphologically complex intracranial aneurysms such as wide-necked, giant, or fusiform aneurysms. Although FDDs are extremely effective, they carry a small yet significant risk of intraprocedural complications. As the implementation of these devices increases, the ability to predict and rapidly treat complications, especially those that are iatrogenic or intraprocedural in nature, is becoming increasingly more necessary. Our objective in this paper is to provide a descriptive summary of the various types of intraprocedural complications that may occur during FDDs deployment and how they may best be treated. A systematic and qualitative review of the literature was conducted using electronic databases MEDLINE and Google Scholar. Searches consisted of Boolean operators “AND” and “OR” for the following terms in different combinations: “aneurysm,” “endovascular,” “flow diverter,” “intracranial,” and “pipeline.” A total of 94 papers were included in our analysis; approximately 87 of these papers dealt with periprocedural endovascular (mainly related to FDDs) complications and their treatment; 7 studies concerned background material. The main categories of periprocedural complications encountered during deployment of FDDs are failure of occlusion, parent vessel injury and/or rupture, spontaneous intraparenchymal hemorrhage, migration or malposition of the FDDs, thromboembolic or ischemic events, and side branch occlusion Periprocedural complications occur mainly due to thromboembolic events or mechanical issues related to device deployment and placement. With increasing use and expanding versatility of FDDs, the understanding of these complications is vital in order to effectively manage such situations in a timely manner.

scholarly journals Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 26 ◽  
Author(s):  
Gaston Camino Willhuber ◽  
Joaquin Stagnaro ◽  
Matias Petracchi ◽  
Agustin Donndorff ◽  
Daniel Godoy Monzon ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Complication Rate ◽  
Care Center ◽  
Critical Role ◽  
Tertiary Care ◽  
Additional Treatment ◽  
Clinical Severity ◽  
Type I ◽  
Short Term ◽  
Start Time

Introduction: Registration of adverse events following orthopedic surgery has a critical role in patient safety and has received increasing attention. The purpose of this study was to determine the prevalence and severity of postoperative complications in the department of orthopedic unit in a tertiary hospital. Methods: A retrospective review from the postoperative complication registry of a cohort of consecutive patients operated in the department of orthopedic surgery from May 2015 to June 2016 was performed. Short-term complications (3 months after surgery), age gender, types of surgery (elective, scheduled urgency, non-scheduled urgency, and emergency), operative time, surgical start time (morning, afternoon or evening), American Society of Anesthesiologists score and surgeon's experience were assessed. Complications were classified based on their severity according to Dindo-Clavien system: Grade I complications do not require alterations in the postoperative course or additional treatment; Grade II complications require pharmacological treatment; Grade III require surgical, endoscopic, or radiological interventions without (IIIa) or with (IIIb) general anesthesia; Grade IV are life-threatening with single (IVa) or multi-organ (IVb) dysfunction(s), and require ICU management; and Grade V result in death of the patient. Complications were further classified in minor (Dindo I, II, IIIa) and major (Dindo IIIb, IVa, IVb and V), according to clinical severity. Results: 1960 surgeries were performed. The overall 90-day complication rate was 12.7% (249/1960). Twenty-three complications (9.2 %) were type I, 159 (63.8%) type II, 9 (3.6%) type IIIa, 42 (16.8%) type IIIb, 7 (2.8%) type IVa and 9 (3.6%) were grade V according to Dindo-Clavien classification (DCC). The most frequent complication was anemia that required blood transfusion (27%) followed by wound infection (15.6%) and urinary tract infection (6%). Discussion: The overall complication rate after orthopedic surgery in our department was 12.7%. The implementation of the DCC following orthopedic surgery was an important tool to measure the standard of care.

scholarly journals Transvenous Detachable Coil Embolization of Direct & High-Flow Carotid-Cavernous Fistula Alternative of Transarterial Detachable Balloon Embolization

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 117-124 ◽  
Author(s):  
T. Nishizawa ◽  
K. Terada ◽  
N. Matsuyama
Keyword(s):  
High Flow ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Transfemoral Approach ◽  
Detachable Coil ◽  
Cavernous Fistula ◽  
Guglielmi Detachable Coil ◽  
Arteriovenous Shunts ◽  
Complete Obliteration ◽  
Platinum Coil

We encountered 8 cases of high-flow and direct carotid cavernous fistula (CCF) since 1994. Four patients were treated with transarterial fistula occlusions using detachable balloons before 1997. Complete obliteration of CCFs with preservation of internal carotid artery (ICA) were achieved in all 4 cases using each one balloon. Three cases were approached to the fistulas via the percutaneous transfemoral approach, but one aged patient needed a direct carotid puncture because of her tortuous vessels. Meanwhile, transvenous embolizations with detachable coils (DCs); Guglielmi detachable coil (GDC), interlocking detachable coil (IDC) and fibered platinum coil were attempted in four cases after 1997; in 2 cases after failure of transarterial approach and in 2 as initial form of treatment. All 4 cases were successfully approached to the cavernous sinuses (CS) through the inferior petorosal sinus (IPS). At first we intended to block dangerous outflow points for the superior ophthalmic vein (SOV), cortical venous reflux (CVR) and contra-lateral CS. And then obliteration of the fistulas were performed with tight packing of GDCs covering the outside of the ICA. At this time, the arteriovenous shunts were disappeared abruptly, so we finished all procedure without occlusion of IPS. We compared the two methods and concluded that the transvenous embolizaton with DCs is an useful alternative of transarterial detachable balloon therapy of high flow CCF, especially when transarterial approach is difficult or proper balloons are not available.

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