scholarly journals Endovascular Treatment of Carotid Cavernous Fistulas in the Area of Cavernous Sinus

2019 ◽  
Vol 14 (2) ◽  
pp. 21-29
Author(s):  
A. I. Beliy ◽  
A. N. Fedorchenko ◽  
O. S. Volkolup ◽  
V. V. Efimov ◽  
E. S. Suslov ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Endovascular Treatment ◽  
Transcatheter Embolization ◽  
Early Postoperative Period ◽  
Angiographic Study ◽  
Safe Method ◽  
Endovascular Methods ◽  
Male Patients ◽  
Carotid Cavernous Fistulas ◽  
Traumatic Damage

Background Assessment of endovascular methods possibilities in the treatment for carotid-cavernous fistulas. Material and Methods The results of endovascular treatment in 22 patients with carotid-cavernous fistulas in the period from 2008 to 2018 were evaluated. The number of male patients was 13 (59%), female patients – 9 (41%). Fifteen patients (68%) had traumatic damage, 7 patients developed a spontaneous disease. All patients had a specific clinical features of carotidcavernous fistula, confirmed by anamnesis and angiographic study. After verification of the diagnosis, all patients underwent permanent transcatheter embolization of the pathological connection using detachable balloons, microspirals and adhesive composition. Results Twenty-one patients (95.5%) underwent one-stage embolization of carotid-cavernous fistulas. One patient (4.5%) required three procedures: two embolization with detachable balloons, final embolization with detachable spirals, due to deflation of the balloons in the early postoperative period. Destructive embolization of carotid-cavernous fistulas was performed in 2 cases (9%), reconstructive interventions were performed in 20 cases (91%). The angiographic success of the procedure was 100%. All treated patients had regression of symptoms during their hospital stay. During this period, one complication was identified in the form of post puncture hematoma, which required conservative treatment. Conclusion Endovascular treatment is a modern, effective and safe method for treating carotid-cavernous fistulas. Destructive occlusion (if there is no possibility of performing reconstructive intervention) is also a safe and clinically justified method for treating this pathology.

A systematic review and meta-analysis on endovascular treatment as an attractive alternative for acute superior mesenteric venous thrombosis

Vascular ◽  
2021 ◽  
pp. 170853812199127
Author(s):  
Lixin Wang ◽  
Enci Wang ◽  
Fei Liu ◽  
Wei Zhang ◽  
Xiaolong Shu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Published Data ◽  
Mesenteric Venous Thrombosis ◽  
Surgery Group

Objective This systematic review and meta-analysis evaluated the published data on the efficacy and safety of therapies for superior mesenteric venous thrombosis (SMVT), aiming to provide a reference and set of recommendations for clinical treatment. Methods Relevant databases were searched for studies published from 2000 to June 2020 on SMVT treated with conservative treatment, surgical treatment, or endovascular approach. Different treatment types were grouped for analysis and comparison, and odds ratios with corresponding 95% confidence intervals were calculated. The outcomes were pooled using meta-analytic methods and presented by forest plots. Results Eighteen articles, including eight on SMVT patients treated with endovascular therapies, were enrolled. The treatment effectiveness was compared between different groups according to the change of symptoms, the occurrence of complications, and mortality as well. The conservative treatment group had better efficacy compared to the surgery group (89.0% vs. 78.6%, P <0.05), and the one-year survival rate was also higher (94.4% vs. 80.0%, P >0.05), but without statistical significance. As for endovascular treatment, the effectiveness was significantly higher than the surgery group (94.8% vs. 75.2%, P <0.05), and the conservative treatment group as well (93.3% vs. 86.3%, P >0.05), which still requires further research for the lack of statistical significance. Conclusions Present findings indicate that anticoagulation, as conservative treatment should be the preferred clinical option in the clinic for SMVT, due to its better curative effect compared to other treatment options, including lower mortality, fewer complications, and better prognosis. Moreover, endovascular treatment is a feasible and promising approach that is worth in-depth research, for it is less invasive than surgery and has relatively better effectiveness, thus can provide an alternative option for SMVT treatment and may be considered as a reliable method in clinical.

scholarly journals Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas

2012 ◽  
Vol 18 (3) ◽  
pp. 326-332 ◽  
Author(s):  
P. Gölitz ◽  
T. Struffert ◽  
M. Arc Saake ◽  
F. Knossalla ◽  
A. Doerfler
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Parent Artery ◽  
Angiographic Ct ◽  
Complex Anatomy ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Contrast Medium Injection ◽  
Carotid Cavernous Fistulas ◽  
Coil Migration

This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multiplanar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.

Abstract TP9: Safety of Endovascular Treatment in Acute Stroke Patients Taking Oral Anticoagulants

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Timo Uphaus ◽  
Oliver C Singer ◽  
Joachim Berkefeld ◽  
Christian H Nolte ◽  
Georg Bohner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Positive Impact ◽  
Therapeutic Option ◽  
Oral Anticoagulants ◽  
Intravenous Thrombolysis ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Male Patients

Introduction: The endovascular treatment (EVT) of cerebral ischemia in the case of large vessel occlusion has been established over recent years. Randomized trials showed a positive impact on the clinical outcome of endovascular treatment in addition to thrombolysis with respect to clinical outcome and safety, so that this therapeutic option will be implemented in future guidelines. The role of EVT in patients treated with oral anticoagulants remains uncertain. Hypothesis: We assessed the hypothesis that application of EVT is safe with regard to the occurrence of intracranial bleeding and clinical outcome in patients taking anticoagulants. Methods: The ENDOSTROKE-Registry is a commercially independent, prospective observational study in 12 stroke centers in Germany and Austria launched in January 2011. An online tool served for data acquisition of pre-specified variables concerning endovascular stroke therapy. Results: Data from 815 patients (median age 70, 57% male) undergoing EVT and known anticoagulation status were analyzed. A total of 85 (median age 76, 52% male) patients (10.4%) took oral anticoagulants prior to EVT. Anticoagulation status as measured with INR was 2.0-3.0 in 24 patients (29%), <2.0 in 52 patients (63%) and above 3.0 in 7 patients (8%) of 83 patients with valid INR data prior to EVT. Patients taking anticoagulants were significantly older (median age 76 vs. 69, p < 0.001). Comparing those patients taking anticoagulants and those not, there were no differences concerning NIHSS at admission (with anticoagulants Median-NIHSS 17 vs. without Median-NIHSS 15, p = 0.492, Mann Whitney Test) and the rate of intracranial hemorrhage after intervention (with anticoagulants 11.8% vs. without 12.2%, p = 0.538). After adjustment for age and NIHSS at admission there were no significant differences between the two groups with regard to good clinical outcome, as measured with the modified ranking scale (mRS, 90d-mRS 0-2, 39.2% of patients not receiving anticoagulants; 25.9% of those receiving anticoagulants). Conclusion: The application of endovascular treatment in patients taking oral anticoagulants is safe and should be considered in acute stroke treatment as an important alternative to contraindicated intravenous thrombolysis.

Endovascular Treatment for Type A Carotid Cavernous Fistulas with Detachable Coils

2008 ◽  
Vol 4 (2) ◽  
pp. 77
Author(s):  
Pyung Goo Cho ◽  
Kum Whang ◽  
Jhin Soo Pyen ◽  
Chul Hu ◽  
Soon Ki Hong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Type A ◽  
Detachable Coils ◽  
Carotid Cavernous Fistulas

Endovascular Treatment of Bilateral Intracranial Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Hemorrhage

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons75-ons81 ◽  
Author(s):  
Yong Sam Shin ◽  
Byung Moon Kim ◽  
Se-Hyuk Kim ◽  
Sang Hyun Suh ◽  
Chang Woo Ryu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Stent Insertion ◽  
Treatment Methods ◽  
Cerebellar Artery ◽  
Endovascular Methods ◽  
Dissecting Aneurysms

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

scholarly journals Effect of corvitin on oxygen homeostasis and blood gas transmitters in ischemia-reperfusion of the lower limbs

2021 ◽  
Vol 20 (2) ◽  
pp. 37-44
Author(s):  
V. N. Zasimovich ◽  
V. V. Zinchuk ◽  
N. N. Ioskevich
Keyword(s):  
Lower Limb ◽  
Ischemia Reperfusion ◽  
Venous Blood ◽  
Nitrogen Monoxide ◽  
Early Postoperative Period ◽  
Lower Limbs ◽  
Healthy Individuals ◽  
Oxygen Homeostasis ◽  
Group I ◽  
Male Patients

Introduction. Reperfusion-reoxygenation syndrome (RRS) after revascularization of the lower limbs in obliterating atherosclerosis of the arteries is accompanied by a violation of the oxygen transport function of the blood (OTFB) and the content of gas transmitters (GTs). Reperfusion injury affects not only the tissues of the lower limbs, but also of anatomically distant organs, which supposes that effective RRS correction is required. Aim. To study the effect of Corvitin on the OTFB parameters and the content of GT of nitrogen monoxide (NO) and hydrogen sulfide (H2S) in the venous blood of the forearm after revascularization of the lower limb in chronic atherosclerotic occlusion of the superficial femoral artery (SFA). Materials and methods. The study included 118 male patients. Revascularization of the lower limb was carried out by the method of loop endaterectomy from the SFA. Patients of group I (n=52) received traditional medication, 51 patients of group II additionally received Corvitin. In the blood from the vein of the elbow bend before the operation, on the 3rd and 8th days after it, the indices of OTFB and GTs were determined. Results. In group I, on the 3rd day after surgery, pO2 increased in relation to healthy individuals by 5.2–18.5%, while pCO2 decreased by 4.8–6.7%, depending on the stage of initial ischemia. The concentrations of NO and H2S increased by 9.2–50.1% and 9.2–21.1%, respectively. The increase in the parameters of hyperoxemia, hypocapnemia and GT after the return of blood circulation decreases with the use of Corvitin (p˂0.05). By the end of the early postoperative period, the indicators of OTFB and GT not only return to their initial values, but also do not significantly differ from the group of healthy individuals (p˃0.05). Conclusion. The use of Corvitin effectively corrects violations of OTFB and GT during ischemia-reperfusion of the lower limbs, which prevents tissue reperfusion damage.

scholarly journals Comparison between different modalities of Endovascular treatment in Carotid Cavernous Fistula (CCF) and its short term outcome – Our Experience

2019 ◽  
Vol 8 (2) ◽  
pp. 68-76
Author(s):  
Mst Shamima Sultana ◽  
Md Shafiqul Islam ◽  
Md Sumon Rana ◽  
Kanij Fatema Ishrat Zahan Rifat ◽  
Md Abul Kalam Azad ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Carotid Cavernous Fistula ◽  
Short Term ◽  
Term Outcome ◽  
Invasive Approach ◽  
Cavernous Fistula ◽  
Short Term Outcome ◽  
Choice Of Treatment ◽  
Glue Embolization ◽  
Carotid Cavernous Fistulas

Introduction: Endovascular treatment offers different technique (Balloon assisted coiling / simple coiling, glue embolization) to treat Carotid Cavernous Fistula (CCF). This less invasive approach avoids morbidity and residual fistulas. The choice of treatment depends on the anatomy of the fistulas and cost effectiveness. Objective: To describe different endovascular treatment option of Carotid Cavernous fistulas (CCF), its short term outcome (clinical and angiographical) and to compare between trans-venous coiling and trans-arterial balloon assisted sinus coiling. Method: We have treated nine (9) cases of CCF during a period of three years. Out of them eight patients had direct CCF and one had indirect CCF. In two patients simple coiling done through trans-venous route and in another three patients through trans-arterial route. Balloon assisted coiling through trans-arterial route done in three patients. In two patients trans-arterial glue embolization was done. Results: Successful obliteration of fistula was achieved in all cases. Vision was improved in eight (8) patients. Postoperatively some proptosis remains in two patients. In one patient there was reappearance of proptosis two months after treatment, then balloon assisted coiling was done. One patient died from complication of glue (NBCA). Conclusion: Endovascular treatment is the mainstay of treatment in CCF. Trans-venous is the treatment of choice but recently balloon assisted sinus coiling through trans-arterial route is adopted. Bang. J Neurosurgery 2019; 8(2): 68-76

scholarly journals Early experience with the Penumbra SMART coil in the endovascular treatment of intracranial aneurysms: Safety and efficacy

2016 ◽  
Vol 22 (6) ◽  
pp. 654-658 ◽  
Author(s):  
Christopher J Stapleton ◽  
Collin M Torok ◽  
Aman B Patel
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Thromboembolic Complication ◽  
Flow Diversion ◽  
Long Term Results ◽  
Conformational Structure ◽  
Safety And Efficacy ◽  
Endovascular Coil Embolization ◽  
Male Patients

Background Penumbra SMART coils differ from traditional microcoils used for endovascular coil embolization of intracranial aneurysms (IAs) in that they (1) become progressively softer from their distal to proximal end, rather than being of uniform stiffness, (2) have a tight conformational structure, and (3) have a more robust stretch-resistance platform. These properties aid in preventing microcatheter prolapse and coil herniation during coil deployment and in filling small pockets of the aneurysm sac. Objective/Methods To determine the safety and efficacy of this device, the records of 17 consecutive patients with IAs treated with SMART coils were retrospectively analyzed. Results Thirteen female and four male patients were identified. Eleven patients presented with subarachnoid hemorrhage, four had recurrent aneurysms, and two had incidentally discovered aneurysms. Twelve aneurysms (two of which were recurrent) were treated with stand-alone coiling, three were treated with stent-assisted coiling, and two with flow diversion with adjuvant coiling. Microcatheter prolapse occurred in one case of a recurrent aneurysm, due to mechanical limitations imposed by a stent placed during prior coiling. Raymond-Roy Occlusion Classification (RROC) I or II occlusion was achieved in 12 aneurysms, including all 10 undergoing primary stand-alone coiling. Of the five RROC III occlusions, two were expected given treatment with flow diversion, while the other three occurred in complex, recurrent aneurysms. One patient suffered a thromboembolic complication of unclear clinical significance. Conclusions The Penumbra SMART coil is a safe and effective device for the endovascular treatment of IAs. Follow-up studies are required to establish long-term results.

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