Selective endovascular techniques in the treatment of cerebral mycotic aneurysms

1993 ◽  
Vol 78 (4) ◽  
pp. 661-665 ◽  
Author(s):  
Mazen H. Khayata ◽  
Armand Aymard ◽  
Alfredo Casasco ◽  
Denis Herbreteau ◽  
France Woimant ◽  
...  
Keyword(s):  
Standard Procedure ◽  
Endovascular Embolization ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Distal Localization ◽  
Risk Of Hemorrhage

✓ The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms. The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively. Patients were selected for this treatment according to the clinical setting and aneurysm location. In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue. The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils. Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography. All three aneurysms had been excluded from the circulation at the 6-month follow-up review. The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils. Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure. The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion. This endovascular procedure represents a safe and effective treatment for these lesions.

Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization

1995 ◽  
Vol 83 (5) ◽  
pp. 843-853 ◽  
Author(s):  
John H. Gurian ◽  
Neil A. Martin ◽  
Wesley A. King ◽  
Gary R. Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Content Type ◽  
Neurological Improvement ◽  
Parent Vessel Occlusion ◽  
Group B

✓ Modern endovascular techniques permit treatment of intracranial aneurysms in many circumstances when surgery is associated with significant morbidity. Occasionally, embolization of aneurysms is unsuccessful or incomplete or followed by complications, in which case surgical management is required. Since 1986, 196 patients have undergone embolization of intracranial aneurysms at the authors' institution and 21 (11%) required subsequent surgical treatment. Attempted embolization failed in five patients (Group A). Ten patients (Group B) had only partial occlusion of the aneurysm or demonstrated recanalization on follow-up studies. Eight of these Group B patients underwent embolization with Guglielmi detachable coils (GDCs), representing 5.7% of the 141 GDC-treated patients in this experience. Surgical treatment in these two groups consisted of clipping (eight cases), surgical parent vessel occlusion (one case), and parent vessel occlusion with extracranial—intracranial bypass (six cases). Fourteen (93%) of the 15 patients in these two groups had an excellent or good outcome with complete aneurysm occlusion. Six patients underwent surgery to treat complications related to the endovascular procedure (Group C). Of these, four patients had neurological improvement compared to their preoperative state, and two died. This series of cases demonstrates that surgical treatment of aneurysms is usually possible with good results following incomplete embolization and emphasizes the need for close and continued neurosurgical involvement in the endovascular management of intracranial aneurysms.

Management of spinal dural arteriovenous malformations

1989 ◽  
Vol 70 (6) ◽  
pp. 832-836 ◽  
Author(s):  
Michael K. Morgan ◽  
W. Richard Marsh
Keyword(s):  
Arteriovenous Malformations ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Content Type ◽  
Early Improvement ◽  
Time To Treatment Failure ◽  
Spinal Arteriovenous Malformations ◽  
Progressive Paraparesis ◽  
Dural Avm

✓ Dura-based spinal arteriovenous malformations (AVM's) are being diagnosed with increasing frequency. The optimal management of such lesions remains a topic of discussion. In an effort to guide this discussion, the authors review their experience with 17 cases of spinal dural AVM treated between January, 1984, and July, 1987. All patients presented with a slowly progressive paraparesis. The abnormalities were initially identified on myelography and confirmed by selective spinal angiography. Fourteen patients underwent endovascular embolization as a primary treatment, and a total of 18 embolization procedures were performed. After all but two of these, obliteration was confirmed at angiography. Patients' symptoms improved following 15 or these procedures but early improvement was not sustained in 10 instances; patients were unchanged after two procedures and worse after one. Follow-up angiography was performed at varying intervals after 15 of the 18 procedures, and recanalization of the previously obliterated spinal dural AVM was demonstrated in 13 instances. Eight patients ultimately underwent surgical treatment of their dura-based spinal AVM. No patient suffered deterioration of symptoms following operation. While embolization may allow angiographic obliteration of a spinal dural AVM and early clinical improvement, for the majority of patients these are not sustained. The average time to treatment failure was 5 months. Newer embolization materials will be necessary to effect permanent treatment in many of these patients.

scholarly journals Stent Deployment as an Emergency Alternative Treatment for Acute Stroke. Case Series

2019 ◽  
Vol 29 (3) ◽  
pp. 517-522
Author(s):  
Roberto Crosa ◽  
Alejandro M. Spiotta
Keyword(s):  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel Occlusion ◽  
Good Clinical Outcome ◽  
Vessel Occlusion ◽  
Stent Deployment ◽  
Small Series ◽  
Treatment Variant

Introduction. Acute ischemic stroke due to large vessel occlusion refractory to aspiration or mechanical thrombectomy is a therapeuticchallenge. Objective. A treatment variant is in order. Methods. In the last three years, we admitted seven patients with refractory largevessel occlusions, for all of whose aspiration and mechanical thrombectomy had failed. A Solitaire AB stent was deployed as a rescuemeasure. Results. Data was retrospectively analyzed. Six out of seven patients had a good clinical outcome as measured by mTICIand mRS twelve months after the procedure. One patient died after the first follow-up visit, one month after endovascular therapy.Conclusion. Results of this small series support the role of stent deployment as a rescue measure for such challenging patients.

scholarly journals Understanding coaching efficacy in education through activity systems: privileging the nuances of provision

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rachel M. Lofthouse ◽  
Anthea Rose ◽  
Ruth Whiteside
Keyword(s):  
Activity Systems ◽  
Content Type ◽  
Coaching Efficacy ◽  
Range Of Functions ◽  
Cultural Historical Activity ◽  
The Individual ◽  
Specific Challenge

PurposeThe research demonstrates the role of activity systems based in Cultural Historical Activity Theory as a means of analysing characteristics and efficacy of specific provisions of coaching in education.Design/methodology/approachThree examples of coaching in education were selected, involving 51 schools in England. The three examples were re-analysed using activity systems. This drew on existing evaluation evidence, gathered through interviews, questionnaires, focus groups and recordings of coaching.FindingsIn each example, the object of the coaching was to address a specific challenge to secure the desired quality of education. Using activity systems it is possible to demonstrate that coaching has a range of functions (both intended and consequential). The individual examples illustrate the potential of coaching to support change in complex and diverse education settings.Research limitations/implicationsThe use of existing data from evaluations means that direct comparisons between examples are not made. While data were collected throughout the duration of each coaching programme no follow-up data was available.Practical implicationsThe analysis of the examples of coaching using activity systems provides evidence of the efficacy of specific coaching provision in achieving individually defined objectives related to sustaining and improving specific educational practices.Originality/valueThe research offers insights into how coaching in education might be better tuned to the specific needs of contexts and the challenges experienced by the individuals working in them. In addition, it demonstrates the value of activity systems as an analytical tool to make sense of coaching efficacy.

Republished: Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis

2020 ◽  
Vol 12 (2) ◽  
pp. e1-e1
Author(s):  
Ezequiel Goldschmidt ◽  
Amir H Faraji ◽  
David Salvetti ◽  
Benjamin M Zussman ◽  
Ashutosh Jadhav
Keyword(s):  
Infectious Endocarditis ◽  
Intravenous Drug Use ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Septic Emboli ◽  
Intracranial Vessel ◽  
History Of ◽  
Mycotic Aneurysms ◽  
Vascular Occlusions

Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.

scholarly journals Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

2019 ◽  
Vol 32 (5) ◽  
pp. 353-365 ◽  
Author(s):  
Marius G Kaschner ◽  
Bastian Kraus ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Endovascular Treatment ◽  
Favourable Outcome ◽  
Modified Rankin Scale ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Aneurysm Occlusion ◽  
Vessel Reconstruction ◽  
Dissecting Aneurysms

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

Routine intraoperative angiography during aneurysm surgery

2002 ◽  
Vol 96 (6) ◽  
pp. 988-992 ◽  
Author(s):  
Veronica L. Chiang ◽  
Phillipe Gailloud ◽  
Kieran J. Murphy ◽  
Daniele Rigamonti ◽  
Rafael J. Tamargo
Keyword(s):  
Surgical Treatment ◽  
False Negative ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Negative Results ◽  
Parent Vessel Occlusion ◽  
Fine Print

Object. The routine use of intraoperative angiography as an aid in the surgical treatment of aneurysms is uncommon. The advantages of the ability to visualize residual aneurysm or unintended occlusion of parent vessels intraoperatively must be weighed against the complications associated with repeated angiography and prolonged vascular access. The authors reviewed the results of their routine use of intraoperative angiography to determine its safety and efficacy. Methods. Prospectively gathered data from all aneurysm cases treated surgically between January 1996 and June 2000 were reviewed. A total of 303 operations were performed in 284 patients with aneurysms; 24 patients also underwent postoperative angiography. Findings on intraoperative angiographic studies prompted reexploration and clip readjustment in 37 (11%) of the 337 aneurysms clipped. Angiography revealed parent vessel occlusion in 10 cases (3%), residual aneurysm in 22 cases (6.5%), and both residual lesion and parent vessel occlusion in five cases (1.5%). When compared with subsequent postoperative imaging, false-negative results were found on two intraoperative angiograms (8.3%) and a false-positive result was found on one (4.2%). Postoperative angiograms obtained in both false-negative cases revealed residual anterior communicating artery aneurysms. Both of these aneurysms also subsequently rebled, requiring reoperation. In the group that underwent intraoperative angiography, in 303 operations eight patients (2.6%) suffered complications, of which only one was neurological. Conclusions. In the surgical treatment of intracranial aneurysms, the use of routine intraoperative angiography is safe and helpful in a significant number of cases, although it does not replace careful intraoperative inspection of the surgical field.

Child maltreatment: how can friends contribute to safety?

2015 ◽  
Vol 14 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Debra Sue Allnock
Keyword(s):  
Young People ◽  
Child Maltreatment ◽  
Emotional Abuse ◽  
Sexual Exploitation ◽  
Community Safety ◽  
Content Type ◽  
Abuse And Neglect ◽  
Rich Information

Purpose – The purpose of this paper is to present the findings of a study of support received by 60 young adults who experienced sexual, physical or emotional abuse and neglect in childhood. It is focussed on the support provided by friends in particular, and draws out relevant learning for child sexual exploitation (CSE). Design/methodology/approach – In all, 60 young people completed a questionnaire, complemented by a two hour follow-up interview to explore experiences of formal and informal support in disclosing abuse. In total, 13 young people were recruited on the basis of their prior participation in a larger, associated study of child abuse and neglect, with the remainder recruited via open invitation. Findings – There is rich information in the interviews about the ways that friends provided support to participants. Friends provided practical, moral and emotional support. They intervened to keep their friends safe. They offered emotional “escape” and a conduit to adults who could help keep them safe. Importantly, friends recognised that participants were in distress even when they did not know the participants were being abused. Practical implications – The results highlight that friends have a crucial role to play in helping children to keep safe and to feel safe, provided that they are equipped with information and knowledge of how to respond and where to seek help. Originality/value – The paper is original in considering the role of friends within a community safety framework. In addition, the study sample is larger than other studies of its kind, and considers a wider variety of child maltreatment experiences than previous studies, making clear links to CSE.

Parent vessel occlusion after Pipeline embolization of cerebral aneurysms of the anterior circulation

2017 ◽  
Vol 127 (6) ◽  
pp. 1333-1341 ◽  
Author(s):  
Matthew B. Potts ◽  
Maksim Shapiro ◽  
Daniel W. Zumofen ◽  
Eytan Raz ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Parent Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Complex Aneurysms ◽  
Aneurysm Size ◽  
Parent Vessel Occlusion ◽  
Anterior Circulation Aneurysms

OBJECTIVEThe Pipeline Embolization Device (PED) is now a well-established option for the treatment of giant or complex aneurysms, especially those arising from the anterior circulation. Considering the purpose of such treatment is to maintain patency of the parent vessel, postembolization occlusion of the parent artery can be regarded as an untoward outcome. Antiplatelet therapy in the posttreatment period is therefore required to minimize such events. Here, the authors present a series of patients with anterior circulation aneurysms treated with the PED who subsequently experienced parent vessel occlusion (PVO).METHODSThe authors performed a retrospective review of all anterior circulation aneurysms consecutively treated at a single institution with the PED through 2014, identifying those with PVO on follow-up imaging. Aneurysm size and location, number of PEDs used, and follow-up digital subtraction angiography results were recorded. When available, pre- and postembolization platelet function testing results were also recorded.RESULTSAmong 256 patients with anterior circulation aneurysms treated with the PED, the authors identified 8 who developed PVO after embolization. The mean aneurysm size in this cohort was 22.3 mm, and the number of PEDs used per case ranged from 2 to 10. Six patients were found to have asymptomatic PVO discovered incidentally on routine follow-up imaging between 6 months and 3 years postembolization, 3 of whom had documented “delayed” PVO with prior postembolization angiograms confirming aneurysm occlusion and a patent parent vessel at an earlier time. Two additional patients experienced symptomatic PVO, one of which was associated with early discontinuation of antiplatelet therapy.CONCLUSIONSIn this large series of anterior circulation aneurysms, the authors report a low incidence of symptomatic PVO, complicating premature discontinuation of postembolization antiplatelet or anticoagulation therapy. Beyond the subacute period, asymptomatic PVO was more common, particularly among complex fusiform or very large–necked aneurysms, highlighting an important phenomenon with the use of PED for the treatment of anterior circulation aneurysms, and suggesting that extended periods of antiplatelet coverage may be required in select complex aneurysms.

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