Stent-assisted coil embolization for cavernous carotid artery aneurysms.

PubMed

Kono, Kenichi; Shintani, Aki; Okada, Hideo; Tanaka, Yuko; Terada, Tomoaki

2014-01-01

Internal carotid artery (ICA) occlusion with or without a bypass surgery is the traditional treatment for cavernous sinus (CS) aneurysms with cranial nerve (CN) dysfunction. Coil embolization without stents frequently requires retreatment because of the large size of CS aneurysms. We report the mid-term results of six unruptured CS aneurysms treated with stent-assisted coil embolization (SACE). The mean age of the patients was 72 years. The mean size of the aneurysms was 19.8 mm (range: 13-26 mm). Before treatment, four patients presented with CN dysfunction and two patients had no symptoms. SACE was performed under local or general anesthesia in three patients each. Mean packing density was 29.1% and tight packing was achieved. There were no neurological complications. CN dysfunction was cured in three patients (75%) and partly resolved in one patient (25%). Transient new CN dysfunction was observed in two patients (33%). Clinical and imaging follow-up ranged from 6 to 26 months (median: 16 months). Recanalization was observed in three patients (50%; neck remnant in two patients and dome filling in one patient), but no retreatment has yet been required. No recurrence of CN dysfunction has occurred yet. In summary, SACE increases packing density and may reduce requirement of retreatment with an acceptable cure rate of CN dysfunction. SACE may be a superior treatment for coiling without stents and be an alternative treatment of ICA occlusion for selected patients, such as older patients and those who require a high-flow bypass surgery or cannot receive general anesthesia.

Angiographic and clinical outcomes of balloon remodeling versus unassisted coil embolization in the ruptured aneurysm cohort of the GEL THE NEC study.

PubMed

Dabus, Guilherme; Brinjikji, Waleed; Amar, Arun P; Delgado Almandoz, Josser E; Diaz, Orlando M; Jabbour, Pascal; Hanel, Ricardo; Hui, Ferdinand; Kelly, Michael; Layton, Kennith F; Miller, Jeffrey W; Levy, Elad I; Moran, Christopher J; Suh, Dae Chul; Woo, Henry; Sellar, Robbin; Hoh, Brian; Evans, Avery; Kallmes, David F

2018-05-01

GEL THE NEC (GTN) was a multicenter prospective registry developed to assess the safety and efficacy of HydroSoft coils in treating intracranial aneurysms. We compared the angiographic and clinical outcomes of aneurysms treated with balloon assisted coil embolization (BACE) versus unassisted coil embolization (CE) in the ruptured aneurysm cohort. GTN was performed at 27 centers in five countries. Patients aged 21-90 years with a ruptured aneurysm 3-15 mm in size were eligible for enrollment. We analyzed demographics/comorbidities, aneurysm location, and geometry, including maximum diameter, neck size, and dome to neck ratio, immediate and long term angiographic outcomes (graded by an independent core laboratory using the modified Raymond Scale), and procedure related adverse events. Angiographic and clinical outcomes were studied using χ 2 and t tests. Of the 599 patients in the GTN, 194 met the inclusion criteria. 84 were treated with BACE and 110 with CE. There were more prior smokers in the BACE group (p=0.01). The BACE group also had more vertebrobasilar aneurysms (p=0.006) and a larger mean neck size (p=0.02). More aneurysms were immediately completely occluded in the BACE group (p=0.02) Procedure- related major morbidity and mortality were no different between the techniques (p=0.4 and p=1, respectively). In this prospective ruptured aneurysm cohort from the GTN, BACE resulted in greater occlusion rates compared with unassisted CE with similar morbi-mortality. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Stent-Assisted Coil Embolization of a Transverse-Sigmoid Sinus Diverticulum Presenting with Pulsatile Tinnitus.

PubMed

Li, Baomin; Lv, Xianli; Wu, Zhongxue; Cao, Xiangyu; Wang, Jun; Ge, Aili; Liu, Xinfeng; Li, Sheng

When tinnitus is pulse-synchronous, a vascular etiology is suggested. We present a case of persistent and troublesome pulsatile tinnitus caused by a transverse-sigmoid sinus diverticulum that was endovascularly treated with stent-assisted coiling. A 39-yearold woman presented with a 4-year history of progressive pulsatile tinnitus involving the right ear. Slight pulsatile bruit was heard on the right mastoid bone by auscultation. Cerebral angiography demonstrated a diverticulum of the transverse-sigmoid sinus. The procedure was performed with an 8F guiding catheter (Cordis, USA) catheterized into the right sigmoid sinus. The diverticulum was completely coiled following deployment of a 5.5 mm-50 mm Leo stent. This patient awakened without any neurological deficit and with immediate resolution of her tinnitus. This case report describes a stent-assisted coil embolization of venous sinus diverticulum, which provides immediate resolution of pulsatile tinnitus.

Flow control techniques for Onyx embolization of intracranial dural arteriovenous fistulae.

PubMed

Shi, Zhong-Song; Loh, Yince; Gonzalez, Nestor; Tateshima, Satoshi; Feng, Lei; Jahan, Reza; Duckwiler, Gary; Viñuela, Fernando

2013-07-01

Experience of flow control techniques during endovascular treatment of intracranial dural arteriovenous fistulas (DAVFs) using the Onyx liquid embolic system is reported, with an emphasis on high flow shunts. Data were evaluated in patients with DAVFs treated endovascularly with Onyx. Adjunctive techniques with coils, acrylics and balloon assistance were utilized to reduce the rate of flow with transarterial and transvenous approaches. The following types of adjunctive techniques were used in 58 patients who underwent a total of 84 embolization sessions with Onyx: transvenous coiling with transvenous or transarterial Onyx embolization in 36 patients, transarterial coiling with transarterial Onyx embolization in eight patients, arterial or venous balloon assisted technique with transarterial or transvenous Onyx embolization in 11 patients, transarterial high concentration acrylics with transarterial Onyx embolization in one patient and staged transarterial or transvenous coiling and Onyx embolization in two patients. Complete obliteration of the fistulae was achieved in 41 patients (70.7%) and 27 patients (65.9%) with high flow fistulae after endovascular treatment alone. Periprocedural complications were encountered in 16 patients, and 13 complications were associated with the adjunctive techniques. There were four neurologic and two non-neurologic clinical sequelae. Distal Onyx migration occurred in four, microcatheter retention in three and cranial neuropathy in three patients. There was one instance each of cerebellar hemorrhage, thromboembolism, coil stretching and retention, and dissection. 56 survivors experienced complete resolution or significant improvement of their symptoms on follow-up. Flow control techniques are safe and effective adjunctive methods in primary endovascular Onyx embolization of high flow DAVFs.

Management of a traumatic hepatic artery pseudoaneurysm and arterioportal fistula with a combination of a stent graft and coil embolization using flow control with balloon remodeling.

PubMed

Flum, Andrew S; Geiger, James D; Gemmete, Joseph J; Williams, David M; Teitelbaum, Daniel H

2009-10-01

We describe a child who presented with a traumatic hepatic artery pseudoaneurysm and arterioportal fistula, which were subsequently managed with an endovascular stent graft and coil embolization using flow control with balloon remodeling. This case demonstrates a rarely seen condition in the pediatric population and a novel management strategy, which should be considered in the management of this complex injury.

Erosion of Embolization Coils into the Renal Collecting System: Removal with Prone Transradial Renal Arteriography and Nephroscopy.

PubMed

Srinivasa, Ravi N; Chick, Jeffrey Forris Beecham; Hage, Anthony; Ramamurthi, Aishu; Wolf, J Stuart; Gemmete, Joseph J; Dauw, Casey A

2017-10-01

Removal of embolization coils eroded into the renal collecting system poses a risk of hemorrhage, which may need to be addressed with arteriography and embolization at the time of treatment. The purpose of this report is to describe a novel approach, by which prone percutaneous nephroscopic coil retrieval is coupled with simultaneous prone transradial renal arterial access to mitigate this potential complication. A retrospective chart review of the electronic medical record systems was performed from January 2008 to May 2017 to identify patients who had undergone percutaneous removal of embolization coils eroded into the renal collecting system. Patients who had migration of embolization coils into the renal collecting system who were symptomatic with pain, hydronephrosis, or infection were considered for inclusion. Patients who had coil migration, but were asymptomatic were not offered removal. Patient demographics and case characteristics were examined as were operative outcomes. A total of three patients fulfilled the study criteria. Migrated embolization coils were able to be effectively removed in all patients. Of the patients, two underwent simultaneous prone transradial renal arteriography with placement of an occlusion balloon catheter into the segmental artery of interest. In one patient, significant arterial bleeding was encountered after coil removal, which was effectively addressed with simultaneous arteriography and glue embolization. Erosion of embolization coils into the renal collecting system, while rare, may be a significant long-term complication of coil embolization. Combining nephroscopy with prone transradial arteriography in preparation for procedure-associated hemorrhage may make removal of migrated coils safer.

Stent-Assisted Coil Embolization of a Mycotic Renal Artery Aneurysm by Use of a Self-Expanding Neurointerventional Stent

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rabellino, Martin, E-mail: jmrabellino@hotmail.com; Garcia-Nielsen, Luis, E-mail: luisgarcia@hospiten.es; Zander, Tobias, E-mail: tobiaszander@hospiten.es

2011-02-15

Mycotic aneurysms are uncommon, especially those located in visceral arteries. We present a case of a patient with two visceral mycotic aneurysms due to bacterial endocarditis, one located in right upper pole renal artery and the second in the splenic artery. Both aneurysms were treated as endovascular embolization using microcoils. In the aneurysm located at the renal artery, the technique of stent-assisted coils embolization was preferred to avoid coils migration due to its wide neck. The stent used was the Solitaire AB, which was designed for the treatment of intracranial aneurysms and was used recently in acute stroke as amore » mechanical thrombectomy device. Complete embolization of the aneurysm was achieved, preserving all the arterial branches without nephrogram defects in the final angiogram.« less

Endovascular embolization

MedlinePlus

... plastic particles, glue, metal coils, foam, or a balloon through it to seal off the faulty blood vessel. (If coils are used, it is called coil embolization.) This procedure can take several hours.

Balloon-Assisted Technique for Trapped Microcatheter Retrieval Following Onyx Embolization

PubMed Central

Santillan, A.; Zink, W.; Knopman, J.; Riina, H.; Gobin, Y.P.

2009-01-01

Summary During embolization of a large frontal arteriovenous malformation (AVM), Onyx-18 (eV3) was injected into an M3 branch of the middle cerebral artery via a Marathon microcatheter (eV3). After 40 minutes of embolization, the microcatheter could not be retracted due to fixation within the Onyx cast despite prolonged, robust attempts. A balloon microcatheter (HyperformTM, eV3) was advanced distally and inflated to provide distal counter tension, allowing microcatheter retrieval with minimal traction on the vasculature. PMID:20465885

Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience.

PubMed

Spiotta, Alejandro M; James, Robert F; Lowe, Stephen R; Vargas, Jan; Turk, Aquilla S; Chaudry, M Imran; Bhalla, Tarun; Janjua, Rashid M; Delaney, John J; Quintero-Wolfe, Stacey; Turner, Raymond D

2015-10-01

Conventional Onyx embolization of cerebral arteriovenous malformations (AVMs) requires lengthy procedure and fluoroscopy times to form an adequate 'proximal plug' which allows forward nidal penetration while preventing reflux and non-targeted embolization. We review our experience with balloon-augmented Onyx embolization of cerebral AVMs using a dual-lumen balloon catheter technique designed to minimize these challenges. Retrospectively acquired data for all balloon-augmented cerebral AVM embolizations performed between 2011 and 2014 were obtained from four tertiary care centers. For each procedure, at least one Scepter C balloon catheter was advanced into the AVM arterial pedicle of interest and Onyx embolization was performed through the inner lumen after balloon inflation via the outer lumen. Twenty patients underwent embolization with the balloon-augmented technique over 24 discreet treatment episodes. There were 37 total arterial pedicles embolized with the balloon-augmented technique, a mean of 1.9 per patient (range 1-5). The treated AVMs were heterogeneous in their location and size (mean 3.3±1.6 cm). Mean fluoroscopy time for each procedure was 48±26 min (28 min per embolized pedicle). Two Scepter C balloon catheter-related complications (8.3% of embolization sessions, 5.4% of pedicles embolized) were observed: an intraprocedural rupture of a feeding pedicle and fracture and retention of a catheter fragment. This multicenter experience represents the largest reported series of balloon-augmented Onyx embolization of cerebral AVMs. The technique appears safe and effective in the treatment of AVMs, allowing more efficient and controlled injection of Onyx with a decreased risk of reflux and decreased fluoroscopy times. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Dissecting Vertebral Artery Aneurysm Presenting Regrowth After Stent-Assisted Coil Embolization in Acute Stage.

PubMed

Hijikata, Takamichi; Baba, Eiichi; Shirokane, Kazutaka; Tsuchiya, Atsushi; Nomura, Motohiro

2018-06-01

For a case of dissecting vertebral artery aneurysm (DVAA) in a dominant vertebral artery (VA) or posterior inferior cerebellar artery (PICA)-involving lesion, stent-assisted coil embolization (SACE) is an effective technique to preserve blood flow of the VA. A 41-year-old man presented with subarachnoid hemorrhage. Angiography demonstrated DVAA on the left VA just distal to the PICA, and the right VA was thinner than the left. For this case, SACE was performed to preserve the left VA and PICA. On the 10th day, angiography showed recurrence of the dissection. The dissected portion had thickened and extended to both distal and proximal sides involving the PICA origin and proximal portion to the PICA. A second endovascular embolization was performed and the recurrent dissecting aneurysm was embolized including the main VA cavity. In cases of DVAA, there is a possibility of recurrence after SACE, if a dissecting cavity remains unembolized. Therefore, total embolization is necessary under close observation from multiple angles, including the down-the-barrel view.

Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization : Analysis of Related Factors and Long-Term Outcomes.

PubMed

Lim, Jeong Wook; Lee, Jeongjun; Cho, Young Dae

2017-08-08

Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) wherein saccular filling with contrast medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion. Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression. In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization. Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.

A Mechanical Coil Insertion System for Endovascular Coil Embolization of Intracranial Aneurysms

PubMed Central

Haraguchi, K.; Miyachi, S.; Matsubara, N.; Nagano, Y.; Yamada, H.; Marui, N.; Sano, A.; Fujimoto, H.; Izumi, T.; Yamanouchi, T.; Asai, T.; Wakabayashi, T.

2013-01-01

Summary Like other fields of medicine, robotics and mechanization might be introduced into endovascular coil embolization of intracranial aneurysms for effective treatment. We have already reported that coil insertion force could be smaller and more stable when the coil delivery wire is driven mechanically at a constant speed. Another background is the difficulty in synchronizing operators' minds and hands when two operators control the microcatheter and the coil respectively. We have therefore developed a mechanical coil insertion system enabling a single operator to insert coils at a fixed speed while controlling the microcatheter. Using our new system, the operator manipulated the microcatheter with both hands and drove the coil using foot switches simultaneously. A delivery wire force sensor previously reported was used concurrently, allowing the operator to detect excessive stress on the wire. In vitro coil embolization was performed using three methods: simple mechanical advance of the coil; simple mechanical advance of the coil with microcatheter control; and driving (forward and backward) of the coil using foot switches in addition to microcatheter control. The system worked without any problems, and did not interfere with any procedures. In experimental coil embolization, delivery wire control using the foot switches as well as microcatheter manipulation helped to achieve successful insertion of coils. This system could offer the possibility of developing safer and more efficient coil embolization. Although we aim at total mechanization and automation of procedures in the future, microcatheter manipulation and synchronized delivery wire control are still indispensable using this system. PMID:23693038

Transcatheter Coil Embolization of Splenic Artery Aneurysm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamamoto, Satoshi, E-mail: s-yama@hyo-med.ac.jp; Hirota, Shozo; Maeda, Hiroaki

2008-05-15

The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10).more » The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.« less

Double-Balloon-Assisted n-Butyl-2-Cyanoacrylate Embolization of Intrahepatic Arterioportal Shunt Prior to Chemoembolization of Hepatocellular Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takao, Hidemasa, E-mail: takaoh-tky@umin.ac.jp; Shibata, Eisuke; Ohtomo, Kuni

A case of multiple hepatocellular carcinomas with a severe intrahepatic arterioportal shunt that was successfully embolized with n-butyl-2-cyanoacrylate with coaxial double-balloon occlusion prior to transcatheter arterial chemoembolization is presented. A proximal balloon positioned at the proper hepatic artery was used for flow control, and a coaxial microballoon, positioned in the closest of three arterial feeding branches to the arterioportal shunt, was used to control the delivery of n-butyl-2-cyanoacrylate. This coaxial double-balloon technique can prevent proximal embolization and distal migration of n-butyl-2-cyanoacrylate and enable precise control of the distribution of n-butyl-2-cyanoacrylate. It could also be applicable to n-butyl-2-cyanoacrylate embolization for othermore » than intrahepatic arterioportal shunt.« less

Successful embolization using interlocking detachable coils for a congenital extrahepatic portosystemic venous shunt in a child.

PubMed

Yamagami, Takuji; Yoshimatsu, Rika; Matsumoto, Tomohiro; Terayama, Koshi; Nishiumra, Akira; Maeda, Yousuke; Nishimura, Tsunehiko

2007-11-01

The authors report the case of a 6-year-old boy with a congenital extrahepatic portosystemic venous shunt. He had hyperammonemia. The shunt was 18 mm in diameter and located between the inferior mesenteric vein and the left internal iliac vein. The flow in the shunt was very rapid. After decreasing blood flow by inflating a balloon catheter inserted into the left internal iliac vein from the femoral vein, a microcatheter was coaxially advanced to the shunt to embolize the shunt. Embolization was successfully performed with interlocking detachable coils and microcoils without any complication. This patient's hyperammonemia resolved soon after the procedure.

Stent-assisted coil embolization of aneurysms with small parent vessels: safety and efficacy analysis.

PubMed

Kühn, Anna Luisa; Hou, Samuel Y; Puri, Ajit S; Silva, Christine F; Gounis, Matthew J; Wakhloo, Ajay K

2016-06-01

Stent-assisted coil embolization (SACE) is a viable therapeutic approach for wide-neck intracranial aneurysms. However, it can be technically challenging in small cerebral vessels (≤2 mm). To present our experience with stents approved for SACE in aneurysms with small parent arteries. All patients who underwent stent-assisted aneurysm treatment with either a Neuroform or an Enterprise stent device at our institution between June 2006 and October 2012 were identified. Additionally, we evaluated each patient's vascular risk factors, aneurysm characteristics (ruptured vs non-ruptured, incidental finding, recanalized) and follow-up angiography data. A total of 41 patients with 44 aneurysms met our criteria, including 31 women and 10 men. Most of the aneurysms were located in the anterior circulation (75%). Stent placement in vessels 1.2-2 mm in diameter was successful in 93.2%. Thromboembolic complications occurred in 6 cases and vessel straightening was seen in 1 case only. Initial nearly complete to complete aneurysm obliteration was achieved in 88.6%. Six-month follow-up angiography showed coil compaction in three cases, one asymptomatic in-stent stenosis and stent occlusion. Twelve to 20-months' follow-up showed stable coil compaction in two patients compared with previous follow-up, and aneurysm recanalization in two patients. Twenty-four to 36-months' follow-up showed further coil compaction in one of these patients and aneurysm recanalization in a previous case of stable coil compaction on mid-term follow-up. Our results suggest that SACE of aneurysms with small parent vessels is feasible in selected cases and shows good long-term patency rates of parent arteries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Onyx Embolization for Isolated Type Dural Arteriovenous Fistula Using a Dual-Lumen Balloon Catheter.

PubMed

Kim, Jin Woo; Kim, Byung Moon; Park, Keun Young; Kim, Dong Joon; Kim, Dong Ik

2016-05-01

Utilization of a dual-lumen balloon may improve Onyx penetration into isolated dural arteriovenous fistulas (i-DAVFs). To compare the results of Onyx embolization using a dual-lumen balloon with those using a non-balloon catheter for i-DAVFs. Twenty-nine patients underwent Onyx embolization for i-DAVFs using a non-balloon (n = 14) or a dual-lumen balloon catheter (n = 15). Since its introduction, a dual-lumen balloon catheter has been preferred. We compared the dual-lumen balloon group with the non-balloon catheter group regarding angiographic outcome, treatment-related complications, total procedural time, Onyx injection time, and the number of feeders requiring embolization. The dual-lumen balloon group showed complete occlusion of i-DAVFs in 13 and near-complete in 2 patients, while the non-balloon group showed complete occlusion in 5, near-complete in 5, and incomplete in 4 patients (P < .05). Treatment-related complications occurred in 2 patients: 1 in the non-balloon group and 1 in the dual-lumen balloon group. The mean total procedural time was 62 ± 32 minutes in the dual-lumen balloon and 171 ± 88 minutes in the non-balloon group (P < .05). The mean Onyx injection time was 10 ± 6 minutes in the dual-lumen balloon and 49 ± 32 minutes in the non-balloon group (P < .05). The median number of feeders requiring embolization was 1 (range, 1-3) in the dual-lumen balloon and 2 (range, 1-4) in the non-balloon group (P < .05). Utilization of a dual-lumen balloon catheter for Onyx embolization of i-DAVF seemed to significantly increase the immediate complete occlusion rate and decrease total procedural time, Onyx injection time, and number of feeders requiring embolization.

A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients

PubMed Central

Lu, Xiaojian; Hussain, Mohammed; Ni, Lanchun; Huang, Qinfeng; Zhou, Fei; Gu, Zhikai; Chen, Jian; Ding, Yuchuan; Xu, Feng

2014-01-01

Objective Transarterial treatment of direct carotid cavernous fistulas (DCCF) via embolic materials has been well documented. This study reports, validates, and compares with existing literature our experience treating DCCFs via endovascular approaches by using detachable balloons, coils, and covered stents. Methods Between June 2006 to October 2011, 32 patients (21 male, 11 female) with 32 DCCFs (30 traumatic, 2 spontaneous cavernous ICA aneurysms) were embolized endovascularly. Followup was performed for at least 6 months. Results Among the 32 DCCFs, 21 (65.6%) were embolized using detachable balloons, eight (25.0%) with coils, one (3.1%) with balloons and coils, and two (6.3%) with covered stents. Complete DCCF obliteration was achieved in 31 (96.9%) cases. One fistula failed to respond due to premature balloon detachment. Intracranial bruit in 31 (100%) chemosis and exophthalmos in 28 (100%) cases resolved after embolization. Visual acuity and oculomotor palsy improved in 18 (90%) and 18 (69.2%) cases, respectively. There was no evidence of DCCF recurrence. Thirteen DCCFs were followed up by MRI and five by DSA. In these cases, four (4/13, 30.8%) balloon-embolized DCCFs showed pseudoaneurysms. Three patients were asymptomatic; one had minor left oculomotor palsy. Conclusions Our results correlate and reinforce literature regarding endovascular treatment of DCCFs. Application of Transarterial embolization with detachable balloons, despite extensive use has been decreasing. Coil embolization is an effective and safe alternative for treatment, especially when balloon embolization fails. Covered stent placement may be used as another alternative for selected cases. PMID:25566340

Computational study for the effects of coil configuration on blood flow characteristics in coil-embolized cerebral aneurysm.

PubMed

Otani, Tomohiro; Ii, Satoshi; Shigematsu, Tomoyoshi; Fujinaka, Toshiyuki; Hirata, Masayuki; Ozaki, Tomohiko; Wada, Shigeo

2017-05-01

Coil embolization of cerebral aneurysms with inhomogeneous coil distribution leads to an incomplete occlusion of the aneurysm. However, the effects of this factor on the blood flow characteristics are still not fully understood. This study investigates the effects of coil configuration on the blood flow characteristics in a coil-embolized aneurysm using computational fluid dynamics (CFD) simulation. The blood flow analysis in the aneurysm with coil embolization was performed using a coil deployment (CD) model, in which the coil configuration was constructed using a physics-based simulation of the CD. In the CFD results, total flow momentum and kinetic energy in the aneurysm gradually decayed with increasing coil packing density (PD), regardless of the coil configuration attributed to deployment conditions. However, the total shear rate in the aneurysm was relatively high and the strength of the local shear flow varied based on the differences in coil configuration, even at adequate PDs used in clinical practice (20-25 %). Because the sufficient shear rate reduction is a well-known factor in the blood clot formation occluding the aneurysm inside, the present study gives useful insight into the effects of coil configuration on the treatment efficiency of coil embolization.

Clinical Application of Insertion Force Sensor System for Coil Embolization of Intracranial Aneurysms.

PubMed

Matsubara, Noriaki; Miyachi, Shigeru; Izumi, Takashi; Yamada, Hiroyuki; Marui, Naoki; Ota, Keisuke; Tajima, Hayato; Shintai, Kazunori; Ito, Masashi; Imai, Tasuku; Nishihori, Masahiro; Wakabayashi, Toshihiko

2017-09-01

In endovascular embolization for intracranial aneurysms, it is important to properly control the coil insertion force. However, the force can only be subjectively detected by the subtle feedback experienced by neurointerventionists at their fingertips. The authors envisioned a system that would objectively sense and quantify that force. In this article, coil insertion force was measured in cases of intracranial aneurysm using this sensor, and its actual clinical application was investigated. The sensor consists of a hemostatic valve (Y-connector). A little flexure was intentionally added in the device, and it creates a bend in the delivery wire. The sensor measures the change in the position of the bent wire depending on the insertion force and translates it into a force value. Using this, embolization was performed for 10 unruptured intracranial aneurysms. The sensor adequately recorded the force, and it reflected the operators' usual clinical experience. The presence of the sensor did not affect the procedures. The sensor enabled the operators to objectively note and evaluate the insertion force and better cooperative handling was possible. Additionally, other members of the intervention team shared the information. Force records demonstrated the characteristic patterns according to every stage of coiling (framing, filling, and finishing). The force sensor system adequately measured coil insertion force in intracranial aneurysm coil embolization procedures. The safety of this sensor was demonstrated in clinical application for the limited number of patients. This system is useful adjunct for assisting during coil embolization for an intracranial aneurysm. Copyright © 2017 Elsevier Inc. All rights reserved.

Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions.

PubMed

Spiotta, Alejandro M; Miranpuri, Amrendra S; Vargas, Jan; Magarick, Jordan; Turner, Raymond D; Turk, Aquilla S; Chaudry, M Imran

2014-09-01

Endovascular embolization for tumors and vascular malformations has emerged as an important preoperative adjunct prior to resection. We describe the advantages of utilizing a recently released dual lumen balloon catheter for ethylene vinyl alcohol copolymer, also known as Onyx (ev3, Irvine, California, USA), embolization for a variety of head and neck pathologies. A retrospective review of all cases utilizing the Scepter C balloon catheter (MicroVention Inc, Tustin, California, USA) for use in balloon augmented embolization was performed over a 4 month period from October 2012 to February 2013 at the Medical University of South Carolina, Charleston, South Carolina, USA. Charts and angiographic images were reviewed. Representative cases involving diverse pathologies are summarized and illustrate the observed advantages of balloon augmented Onyx embolization with a dual lumen balloon catheter. Balloon augmented Onyx embolization utilizing a novel dual lumen balloon catheter was employed to treat both ruptured and unruptured arteriovenous malformations, intracranial dural arteriovenous fistulae, intracranial neoplasms, carotid body tumors, a thyroid mass, and an extracranial arteriovenous fistula. The dual lumen balloon catheter has several advantages for use with Onyx embolization over older devices, including more efficient proximal plug formation and enhanced navigability for placement deep within the pedicles. The balloon augmented Onyx embolization technique represents a valuable tool to add to the armamentarium of the neurointerventionalist to address a variety of head and neck lesions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Relationship between Angiographic Results and Morphology in Sidewall Intracranial Aneurysms after Stent-Assisted Coil Embolization.

PubMed

Nii, Kouhei; Aikawa, Hiroshi; Tsutsumi, Masanori; Eto, Ayumu; Iko, Minoru; Sakamoto, Kimiya; Inoue, Ritsuro; Mitsutake, Takafumi; Hanada, Hayatsura; Kazekawa, Kiyoshi

2016-03-01

Stent-assisted coil embolization (SACE) is used to address wide-necked or complex aneurysms. However, as they may recanalize after SACE, predictors of recanalization are needed. We investigated the relationship between follow-up angiographic results and the morphology of sidewall (SW) aneurysms in patients treated by SACE. Between September 2010 and September 2014, we performed 80 SACE procedures for SW intracranial aneurysms. Angiographic findings, obtained immediately after the procedure, 3-6 months thereafter, and when aneurysmal recanalization was suspected on MR angiogram scan, were recorded. Morphologically, the SW aneurysms were classified as "outside" (OS) and "partially inside" (PI) based on the curve of the axes of the proximal or distal parent artery with respect to the aneurysmal neck. Follow-up angiographic studies on OS- and PI SW aneurysms were compared. On the initial angiograms, we classified 42 aneurysms as OS and 38 as PI. Immediately after SACE, there was no significant difference in the angiographic findings on OS and PI aneurysms. However, on follow-up angiograms, there was a significant difference in the rate of spontaneous improvement (4 of 42 [OS] versus 21 of 38 [PI], P = .001). We performed additional coil embolization to treat 3 recanalized OS aneurysms. SW aneurysms classified morphologically as PI tended to occlude progressively even after incomplete occlusion by SACE. In contrast, aneurysms classified as OS must be observed carefully after SACE. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Initial experience with dual-lumen balloon catheter injection for preoperative Onyx embolization of skull base paragangliomas.

PubMed

Ladner, Travis R; He, Lucy; Davis, Brandon J; Yang, George L; Wanna, George B; Mocco, J

2016-06-01

OBJECT Paragangliomas are highly vascular head and neck tumors for which preoperative embolization is often considered to facilitate resection. The authors evaluated their initial experience using a dual-lumen balloon to facilitate preoperative embolization in 5 consecutive patients who underwent preoperative transarterial Onyx embolization assisted by the Scepter dual-lumen balloon catheter between 2012 and 2014. OBJECT The authors reviewed the demographic and clinical records of 5 patients who underwent Scepter-assisted Onyx embolization of a paraganglioma followed by resection between 2012 and 2014. Descriptive statistics of clinical outcomes were assessed. RESULTS Five patients (4 with a jugular and 1 with a vagal paraganglioma) were identified. Three paragangliomas were embolized in a single session, and each of the other 2 were completed in 3 staged sessions. The mean volume of Onyx used was 14.3 ml (range 6-30 ml). Twenty-seven vessels were selectively catheterized for embolization. All patients required selective embolization via multiple vessels. Two patients required sacrifice of parent vessels (1 petrocavernous internal carotid artery and 1 vertebral artery) after successful balloon test occlusion. One patient underwent embolization with Onyx-18 alone, 2 with Onyx-34 alone, and 1 with Onyx-18 and -34. In each case, migration of Onyx was achieved within the tumor parenchyma. The mean time between embolization and resection was 3.8 days (range 1-8 days). Gross-total resection was achieved in 3 (60%) patients, and the other 2 patients had minimal residual tumor. The mean estimated blood loss during the resections was 556 ml (range 200-850 ml). The mean postoperative hematocrit level change was -17.3%. Two patients required blood transfusions. One patient, who underwent extensive tumor penetration with Onyx, developed a temporary partial cranial nerve VII palsy that resolved to House-Brackmann Grade I (out of VI) at the 6-month follow-up. One patient

Radio aneurysm coils for noninvasive detection of cerebral embolization failures: a preliminary study.

PubMed

Mohammadi, Abdolreza Rashidi; Chen, Keqin; Ali, Mohamed Sultan Mohamed; Takahata, Kenichi

2011-12-15

The rupture of a cerebral aneurysm is the most common cause of subarachnoid hemorrhage. Endovascular embolization of the aneurysms by implantation of Guglielmi detachable coils (GDC) has become a major treatment approach in the prevention of a rupture. Implantation of the coils induces formation of tissues over the coils, embolizing the aneurysm. However, blood entry into the coiled aneurysm often occurs due to failures in the embolization process. Current diagnostic methods used for aneurysms, such as X-ray angiography and computer tomography, are ineffective for continuous monitoring of the disease and require extremely expensive equipment. Here we present a novel technique for wireless monitoring of cerebral aneurysms using implanted embolization coils as radiofrequency resonant sensors that detect the blood entry. The experiments show that commonly used embolization coils could be utilized as electrical inductors or antennas. As the blood flows into a coil-implanted aneurysm, parasitic capacitance of the coil is modified because of the difference in permittivity between the blood and the tissues grown around the coil, resulting in a change in the coil's resonant frequency. The resonances of platinum GDC-like coils embedded in aneurysm models are detected to show average responses of 224-819 MHz/ml to saline injected into the models. This preliminary demonstration indicates a new possibility in the use of implanted GDC as a wireless sensor for embolization failures, the first step toward realizing long-term, noninvasive, and cost-effective remote monitoring of cerebral aneurysms treated with coil embolization. Copyright © 2011 Elsevier B.V. All rights reserved.

Therapy-resistant nephrolithiasis following renal artery coil embolization

PubMed Central

2013-01-01

Background Transcatheter renal artery embolization is an effective and minimally invasive treatment option for acute renal bleeding. Early post-interventional complications include groin hematoma, incomplete embolization, coil misplacement and coil migration. Late complications are rare and mostly related to coil migration. Case presentation A 22-year-old woman with a history of recurrent stone disease and a lumbal meningomyelocele underwent bilateral open pyelolithotomy for bilateral staghorn calculi. Post-operatively, acute hemorrhage of the left kidney occurred and selective arterial coil embolization of a lower pole interlobular renal artery was performed twice. Four years after this intervention the patient presented with a new 15.4 mm stone in the lower calyx of the left kidney. After two extracorporeal shock wave lithotripsy treatments disintegration of the stone was not detectable. Therefore, flexible ureterorenoscopy was performed and revealed that the stone was adherent to a partially intraluminal metal coil in the lower renal calyx. The intracalyceal part of the coil and the adherent stone were successfully removed using the holmium laser. Conclusion Therapy-resistant nephrolithiasis was caused by a migrated metal coil, which was placed four years earlier for the treatment of acute post-operative renal bleeding. Renal coils in close vicinity to the renal pelvis can migrate into the collecting system and trigger renal stone formation. Extracorporeal shock wave lithotripsy seems to be inefficient for these composite stones. Identification of these rare stones is possible during retrograde intrarenal surgery. It also enables immediate stone disintegration and removal of the stone fragments and the intraluminal coil material. PMID:23758632

[Coil Embolization of Bronchial Artery Aneurysm;Report of a Case].

PubMed

Hagiwara, Kenichi; Moriya, Hiroshi; Sato, Yoshiyuki

2018-05-01

An 82-year-old male was admitted due to mild chest discomfort. Enhanced computed tomography showed a large bronchial artery aneurysm(BAA) of 26×27 mm at the left hilus. To avoid the rupture of BAA, coil embolization alone was performed. There has been no enlargement of BAA for these 4 years. In general, coil embolization only should be indicated in a patient with BAA with a stalk because of thoracic endovascular aortic repair (TEVAR) being off-label and low cost performance. TEVAR would be considered as a last resort only in case of enlarging BAA even after coil embolization.

Long-Term Follow-up After Embolization of Pulmonary Arteriovenous Malformations with Detachable Silicone Balloons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andersen, Poul Erik; Kjeldsen, Anette D.

2008-05-15

Long-term follow-up results after embolization of 13 pulmonary arteriovenous malformations in 10 patients by use of 14 detachable silicone balloons are given. Patients were followed for a mean of 99 months (range, 63-123 months) with chest x-rays and for a mean of 62 months (range, 3-101 months) with pulmonary angiography. Fifty-four percent of the balloons were deflated at latest radiographic chest film follow-up, but at pulmonary angiographic follow-up all embolized malformations were without flow irrespective of whether or not the balloons were visible. Detachable silicone balloons are not available anymore, but use of these balloons for embolization of pulmonary arteriovenousmore » malformations has been shown to be a safe and precise method, with immediate occlusion of the feeding artery and with long-lasting occlusion, even though many balloons deflate with time, leaving a fibrotic scar replacing the pulmonary arteriovenous malformation. No case of recanalization has been discovered, and these results seem to justify a reduced number of controls of these balloon-embolized malformations.« less

Percutaneous coil embolization of massive pelvic pseudoaneurysm in an infant.

PubMed

Lillis, Anna P; Shaikh, Raja; Alomari, Ahmad I; Chaudry, Gulraiz

2015-06-01

Iatrogenic pseudoaneurysm formation is an uncommon but potentially serious complication of cardiac catheterization. This case report describes diagnosis and treatment of a large left external iliac artery pseudoaneurysm in a 3-month-old boy following cardiac catheterization and aortic balloon dilatation for aortic coarctation. A 4-cm pulsatile mass in the left hemipelvis was discovered on MRI performed 6 weeks later for possible tethered spinal cord. Sonography and angiography showed a large pseudoaneurysm of the left external iliac artery just distal to the iliac bifurcation with no flow in the external iliac artery distal to the pseudoaneurysm. Percutaneous US-guided thrombin injection was performed twice, with partial recanalization after each treatment. The residual portion of the pseudoaneurysm was then successfully embolized with percutaneous coils deployed under US and fluoroscopic guidance.

Balloon-Occluded Retrograde Transvenous Embolization of a Pelvic Arteriovenous Malformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mitsuzaki, Katsuhiko; Yamashita, Yasuyuki; Utsunomiya, Daisuke

1999-11-15

We successfully performed embolization therapy for a pelvic arteriovenous malformation by the retrograde transvenous approach using a liquid embolic material. This malformation was unique in that it had a single draining vein, which allowed this technique employing an occlusion balloon.

Use of the TriSpan Coil to Facilitate the Transcatheter Occlusion of Pulmonary Arteriovenous Malformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cil, Barbaros E., E-mail: barbaroscil@hotmail.com, E-mail: barbaros@hacettepe.edu.tr; Erdogan, Cueneyt; Akmangit, Ilkay

Pulmonary arteriovenous malformation (PAVM) is a rare vascular malformation of the lung which may occur as an isolated entity or in association with hereditary hemorrhagic telangiectasia (HHT). Because of considerable risk of serious complications such as cerebral embolism, brain abscess and pulmonary hemorrhage, definitive treatment should be considered in most patients. Embolization with coils or detachable balloons is currently the preferred treatment. Paradoxical embolization of coils and balloons may happen, especially in patients with PAVMs with large feeding arteries. In this report we present our initial experience with the use of the TriSpan coil to lower the risk of coilmore » migration during the transcatheter occlusion of PAVMs.« less

Interlocking Detachable Coil Embolization by Technique of Dumbbell-Shaped Framing and Filling and Bridge Formation Under Balloon Dilatation for Huge Conglomerate Pulmonary Arteriovenous Malformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kawai, Nobuyuki, E-mail: nobkawai@wakayama-med.ac.jp; Sato, Morio, E-mail: morisato@mail.wakayama-med.ac.jp; Minamiguchi, Hiroyuki, E-mail: hiromina4@hotmail.com

A 60-year-old woman presented with a conglomerate pulmonary arteriovenous malformation (PAVM) size 8.2 Multiplication-Sign 7.2 cm on chest X-ray. Feeding arteries were A{sub a}{sup 7} and A{sub b}{sup 7}, A{sup 8}, and A{sup 10}. The diameter and length of the A{sub b}{sup 7} neck were 15.5 and 16 mm, respectively. After percutaneous transcatheter embolization of A{sup 8} and A{sup 10}, PTE of A{sub a}{sup 7} and A{sub b}{sup 7} was conducted under balloon occlusion with interlocking detachable coils using a technique of dumbbell-shaped framing and filling, making a bridge from A{sub b}{sup 7} to the trunk of A{sup 9} andmore » A{sup 10}across A{sup 7}. Follow-up computed tomography 10 months after treatment showed marked shrinkage of the PAVM.« less

Portal vein embolization with plug/coils improves hepatectomy outcome.

PubMed

Malinowski, Maciej; Geisel, Dominik; Stary, Victoria; Denecke, Timm; Seehofer, Daniel; Jara, Maximillian; Baron, Annekathrin; Pratschke, Johann; Gebauer, Bernhard; Stockmann, Martin

2015-03-01

Portal vein embolization (PVE) has become the standard of care before extended hepatectomy. Various PVE methods using different embolization materials have been described. In this study, we compared PVE with polyvinyl alcohol particles alone (PVA only) versus PVA with plug or coils (PVA + plug/coils). Patients undergoing PVE before hepatectomy were included. PVA alone was used until December 2013, thereafter plug or coils were placed in addition. The volume of left lateral liver lobe (LLL), clinical parameters, and liver function tests were measured before PVE and resection. A total of 43 patients were recruited into the PVA only group and 42 were recruited into the PVA + plug/coils group. There were no major differences between groups except significantly higher total bilirubin level before PVE in the PVA only group, which improved before hepatectomy. Mean LLL volume increased by 25.7% after PVE in the PVA only group and by 44% in the PVA + plug/coils group (P < 0.001). Recanalization was significantly less common in the PVA + plug/coils group. In multivariate regression, initial LLL volume and use of plug or coils were the only parameters influencing LLL volume increase. The postoperative liver failure rate was significantly reduced in PVA + plug/coils group (P = <0.001). PVE using PVA particles together with plug or coils is a safe and efficient method to increase future liver remnant volume. The additional central embolization with plug or coils led to an increased hypertrophy, due to lower recanalization rates, and subsequently decreased incidence of postoperative liver failure. No additional procedure-specific complications were observed in this series. Copyright © 2015 Elsevier Inc. All rights reserved.

Onyx embolization using dual-lumen balloon catheter: initial experience and technical note.

PubMed

Paramasivam, Srinivasan; Niimi, Yasunari; Fifi, Johanna; Berenstein, Alejandro

2013-10-01

Onyx as an embolization agent for the management of vascular malformation is well established. We report our initial experience with dimethyl-sulphoxide (DMSO) compatible double lumen balloon catheters used for Onyx embolization. Between December 2011 and March 2013, we treated 22 patients aged between 1.5 to 70years with two types of DMSO compatible dual-lumen balloon catheters (Scepter C and Ascent) to treat dural arteriovenous fistulas, brain arteriovenous malformation (AVM) with dural feeders, mandibular, facial, lingual, vertebral and paravertebral AVMs. The catheter has good navigability, compliant balloon on inflation formed a "plug" that has more resistance than Onyx plug enhancing better penetration. During injection, the balloon remained stable without spontaneous deflation or rupture and withstood the pressure build-up well. The retrieval of the catheter in most cases took less than a minute (19/28) while in five, it was less than five minutes and in the remaining four, it was longer that includes a trapped catheter on prolonged attempted retrieval resulted in an epidural hematoma, requiring emergent surgical evacuation. The fluoroscopy time is reduced, as we do not form a proximal onyx plug, the injection time is shorter along with easy and instantaneous removal of the catheter after balloon deflation in most cases. Dual-lumen balloon catheter Onyx embolization is a safe and effective technique. Currently, an important tool to circumvent some of the shortcomings associated with Onyx embolization. The catheter has good navigability, the balloon has stability, tolerance, enhances penetrability. It is easy to retrieve the microcatheter. With the experience gained, and with more compliant balloon catheters available, this technique can be applied to cerebral vessels in near future. Copyright © 2013. Published by Elsevier Masson SAS.

A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Tanaka, Norimitsu; Koganemaru, Masamichi

Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM.more » This technique allows the embolization of the DOV and the nidus retrogradely.« less

Aneurysm permeability following coil embolization: packing density and coil distribution

PubMed Central

Chueh, Ju-Yu; Vedantham, Srinivasan; Wakhloo, Ajay K; Carniato, Sarena L; Puri, Ajit S; Bzura, Conrad; Coffin, Spencer; Bogdanov, Alexei A; Gounis, Matthew J

2015-01-01

Background Rates of durable aneurysm occlusion following coil embolization vary widely, and a better understanding of coil mass mechanics is desired. The goal of this study is to evaluate the impact of packing density and coil uniformity on aneurysm permeability. Methods Aneurysm models were coiled using either Guglielmi detachable coils or Target coils. The permeability was assessed by taking the ratio of microspheres passing through the coil mass to those in the working fluid. Aneurysms containing coil masses were sectioned for image analysis to determine surface area fraction and coil uniformity. Results All aneurysms were coiled to a packing density of at least 27%. Packing density, surface area fraction of the dome and neck, and uniformity of the dome were significantly correlated (p<0.05). Hence, multivariate principal components-based partial least squares regression models were used to predict permeability. Similar loading vectors were obtained for packing and uniformity measures. Coil mass permeability was modeled better with the inclusion of packing and uniformity measures of the dome (r2=0.73) than with packing density alone (r2=0.45). The analysis indicates the importance of including a uniformity measure for coil distribution in the dome along with packing measures. Conclusions A densely packed aneurysm with a high degree of coil mass uniformity will reduce permeability. PMID:25031179

Aneurysm permeability following coil embolization: packing density and coil distribution.

PubMed

Chueh, Ju-Yu; Vedantham, Srinivasan; Wakhloo, Ajay K; Carniato, Sarena L; Puri, Ajit S; Bzura, Conrad; Coffin, Spencer; Bogdanov, Alexei A; Gounis, Matthew J

2015-09-01

Rates of durable aneurysm occlusion following coil embolization vary widely, and a better understanding of coil mass mechanics is desired. The goal of this study is to evaluate the impact of packing density and coil uniformity on aneurysm permeability. Aneurysm models were coiled using either Guglielmi detachable coils or Target coils. The permeability was assessed by taking the ratio of microspheres passing through the coil mass to those in the working fluid. Aneurysms containing coil masses were sectioned for image analysis to determine surface area fraction and coil uniformity. All aneurysms were coiled to a packing density of at least 27%. Packing density, surface area fraction of the dome and neck, and uniformity of the dome were significantly correlated (p<0.05). Hence, multivariate principal components-based partial least squares regression models were used to predict permeability. Similar loading vectors were obtained for packing and uniformity measures. Coil mass permeability was modeled better with the inclusion of packing and uniformity measures of the dome (r(2)=0.73) than with packing density alone (r(2)=0.45). The analysis indicates the importance of including a uniformity measure for coil distribution in the dome along with packing measures. A densely packed aneurysm with a high degree of coil mass uniformity will reduce permeability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Y stenting assisted coiling using a new low profile visible intraluminal support device for wide necked basilar tip aneurysms: a technical report.

PubMed

Conrad, Marcelo D; Brasiliense, Leonardo B C; Richie, Alexa N; Hanel, Ricardo A

2014-05-01

Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide necked bifurcation aneurysms. This technique was first described for the treatment of basilar tip aneurysms in combination with several different devices, demonstrating encouraging results. We report the results of the first two cases of wide necked basilar tip aneurysms treated with Y stent assisted coil embolization using a new low profile visible intraluminal stent (LVIS Jr; MicroVention, Tustin, California, USA) delivered through a 0.017 inch microcatheter. We also reviewed the literature comparing other endovascular techniques (coiling alone, stent assisted coiling, and Y stent assisted coiling) for wide necked aneurysms. The LVIS Jr device offers a new option for the treatment of these challenging lesions, with clear advantages over currently available intracranial stents. Larger series and long term results are needed to confirm the applicability and durability of this technique/technology.

Risk Factors to Predict Postoperative Fever After Coil Embolization of Ruptured Intracranial Aneurysms.

PubMed

Cai, Kefu; Xu, Tian; Shen, Lihua; Ni, Yaohui; Ji, Qiuhong

2016-04-01

To investigate risk factors to predict postoperative fever after endovascular treatment of ruptured intracranial aneurysms. Patients undergoing endovascular coiling to treat subarachnoid hemorrhage in Nantong University between November 2011 and September 2014 were retrospectively reviewed. Postoperative temperature and patient demographic data, admission status, characteristic features of aneurysms, and endovascular coiling procedure were documented and analyzed. There were 336 consecutive patients included in this study, and 111 were classified as febrile (tympanic temperature >38.3°C for at least 2 consecutive days). Univariate analysis demonstrated that age, interval from onset of subarachnoid hemorrhage to operation, history of hypertension and smoking, Hunt and Hess grade, Fisher grade, temperature before coiling, leukocyte count on admission, and infectious complications were correlated with postoperative fever. Five variables were independent risk factors to predict fever by multivariate logistic regression: age >70 years (odds ratio [OR] = 2.6, 95% confidence interval [CI] = 1.2-5.6), Fisher grade 3 or 4 (OR = 2.2, 95% CI = 1.1-4.3), leukocyte count >10,000/mm(3) on admission (OR = 2.3, 95% CI = 1.3-4.0), temperature >37.5°C before coiling (OR = 4.6, 95% CI = 2.0-10.7), and infectious complications (OR = 4.4, 95% CI = 2.2-8.6). Postoperative fever after coil embolization was predicted by changeable and unchangeable risk factors in subarachnoid hemorrhage. However, characteristic features of aneurysms and the coiling procedure had no impact on development of postoperative fever. Preventing any infectious complications, lowering temperature before embolization, and draining bloody cerebrospinal fluid may assist in the prevention of subsequent fever. Copyright © 2016 Elsevier Inc. All rights reserved.

Embolization of the Gastroduodenal Artery Before Selective Internal Radiotherapy: A Prospectively Randomized Trial Comparing Standard Pushable Coils with Fibered Interlock Detachable Coils

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dudeck, Oliver, E-mail: oliver.dudeck@med.ovgu.de; Bulla, Karsten; Wieners, Gero

2011-02-15

The purpose of this study was compare embolization of the gastroduodenal artery (GDA) using standard pushable coils with the Interlock detachable coil (IDC), a novel fibered mechanically detachable long microcoil, in patients scheduled for selective internal radiotherapy (SIRT). Fifty patients (31 male and 19 female; median age 66.6 {+-} 8.1 years) were prospectively randomized for embolization using either standard coils or IDCs. Procedure time, radiation dose, number of embolization devices, complications, and durability of vessel occlusion at follow-up angiography were recorded. The procedures differed significantly in time (14:32 {+-} 5:56 min for standard coils vs. 2:13 {+-} 1:04 min formore » IDCs; p < 0.001); radiation dose for coil deployment (2479 {+-} 1237 cGycm Superscript-Two for standard coils vs. 275 {+-} 268 cGycm Superscript-Two for IDCs; p < 0.001); and vessel occlusion (17:18 {+-} 6:39 min for standard coils vs. 11:19 {+-} 7:54 min for IDCs; p = 0.002). A mean of 6.2 {+-} 1.8 coils (n = 27) were used in the standard coil group, and 1.3 {+-} 0.9 coils (p < 0.0001) were used in the IDC group (n = 23) because additional pushable coils were required to achieve GDA occlusion in 4 patients. In 2 patients, the IDC could not be deployed through a Soft-VU catheter. One standard coil dislodged in the hepatic artery and was retrieved. Vessel reperfusion was noted in only 1 patient in the standard coil group. Controlled embolization of the GDA with fibered IDCs was achieved more rapidly than with pushable coils. However, vessel occlusion may not be obtained using a single device only, and the use of sharply angled guiding catheters hampered coil pushability.« less

Embolization of Collateral Vessels Using Mechanically Detachable Coils in Young Children with Congenital Heart Disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sato, Y.; Ogino, H.; Hara, M.

2003-11-15

Our objective was to evaluate the usefulness of embolizing collateral vessels using mechanically detachable coils (MDCs) in children aged 3 years or younger with congenital heart disease. The subjects were 8 children with congenital heart disease featuring collateral vessels (age 18 days-3 years): 3 with a single ventricle, 2 with the tetralogy of Fallot, 2 with pulmonary atresia, and 1 with a ventricular septal defect. The embolized vessels were the major aortopulmonary collateral artery (MAPCA) in 5 patients, the persistent left superior vena cava in 2, and the coronary arteriovenous fistula in 1. A 4 or a 5 F cathetermore » was used as the guiding device, and embolization was performed using MDCs and other conventional coils introduced through the microcatheter. One patient had growth of new MAPCAs after embolization, and these MAPCAs were also embolized with MDCs. Thus, a total of 9 embolization procedures were performed in 8 patients. Complete occlusion of the collateral vessels was achieved in 8 of 9 procedures (89%). Seven of 8 patients (88%) had uneventful courses after embolization, and MDC procedures appeared to play important roles in avoiding coil migration and achievement of safe coil embolization. One patient who underwent MAPCA embolization showed no improvement in heart function and died 2 months and 19 days later. Embolization of collateral vessels using MDCs in young children with congenital heart disease can be an effective procedure and a valuable adjunct to surgical management.« less

Balloon-Assisted Chemoembolization Using a Micro-Balloon Catheter Alongside a Microcatheter for a Hepatocellular Carcinoma with a Prominent Arterioportal Shunt: A Case Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoshiai, Sodai, E-mail: hoshiai@sb4.so-net.ne.jp; Mori, Kensaku; Ishiguro, Toshitaka

Although transcatheter arterial chemoembolization is one of the established treatments for hepatocellular carcinoma (HCC), it is difficult to treat HCCs with prominent arterioportal (AP) shunts because anticancer drugs and embolic materials migrate into the non-tumorous liver through the AP shunts and may cause liver infarction. We developed a novel method of balloon-assisted chemoembolization using a micro-balloon catheter alongside a microcatheter simultaneously inserted through a single 4.5-Fr guiding sheath, comprising proximal chemoembolization with distal arterial balloon occlusion. We applied this method to treat an HCC with a prominent distal AP shunt induced by previous proton beam therapy and achieved successful chemoembolizationmore » without non-tumorous liver infarction under temporal balloon occlusion of a distal AP shunt.« less

Time-resolved 3D contrast-enhanced MRA on 3.0T: a non-invasive follow-up technique after stent-assisted coil embolization of the intracranial aneurysm.

PubMed

Choi, Jin Woo; Roh, Hong Gee; Moon, Won-Jin; Kim, Na Ra; Moon, Sung Gyu; Kang, Chung Hwan; Chun, Young Il; Kang, Hyun-Seung

2011-01-01

To evaluate the usefulness of time-resolved contrast enhanced magnetic resonance angiography (4D MRA) after stent-assisted coil embolization by comparing it with time of flight (TOF)-MRA. TOF-MRA and 4D MRA were obtained by 3T MRI in 26 patients treated with stent-assisted coil embolization (Enterprise:Neuroform = 7:19). The qualities of the MRA were rated on a graded scale of 0 to 4. We classified completeness of endovascular treatment into three categories. The degree of quality of visualization of the stented artery was compared between TOF and 4D MRA by the Wilcoxon signed rank test. We used the Mann-Whitney U test for comparing the quality of the visualization of the stented artery according to the stent type in each MRA method. The quality in terms of the visualization of the stented arteries in 4D MRA was significantly superior to that in 3D TOF-MRA, regardless of type of the stent (p < 0.001). The quality of the arteries which were stented with Neuroform was superior to that of the arteries stented with Enterprise in 3D TOF (p < 0.001) and 4D MRA (p = 0.008), respectively. 4D MRA provides a higher quality view of the stented parent arteries when compared with TOF.

Dual microcather-dual detachable coil technique in embolization for a congenital intrahepatic portosystemic venous shunt (IPSVS).

PubMed

Suzuki, Kazushi; Shimohira, Masashi; Hashizume, Takuya; Suzuki, Yosuke; Shibamoto, Yuta

2013-09-01

We report a 14-year-old boy with a large intrahepatic portosystemic venous shunt. The shunt seemed to be difficult to coil embolize because it was so large and short. However, it was successfully treated by coil embolization with a new dual microcatheter-dual detachable coil technique.

Initial experience of a novel sheath guide for transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation.

PubMed

Iwata, Tomonori; Mori, Takahisa; Tajiri, Hiroyuki; Miyazaki, Yuichi; Nakazaki, Masahito; Mizokami, Koji

2013-03-01

The transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery via the femoral route in patients with a tortuous aortic arch, an unfavorable supra-aortic takeoff, aortic diseases, or occlusion of the femoral artery. To report our initial experiences of coil embolization of cerebral aneurysms in the anterior cerebral circulation with a novel sheath guide for transbrachial carotid cannulation. A sheath guide designed specifically for transbrachial carotid cannulation was developed; transbrachial coil embolization for cerebral aneurysms began in May 2011. Included for analysis were patients who underwent transbrachial coil embolization for cerebral aneurysms in the anterior cerebral circulation from May 2011 to January 2012. Adjuvant techniques, angiographic results, procedural success, and periprocedural complications were investigated. Ten patients underwent transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation. All procedures were successful using the brachial route. No periprocedural complications occurred. Patients were permitted to get seated immediately after coil embolization even during hemostasis. The sheath guide specifically designed for transbrachial carotid cannulation was useful for coil embolization of cerebral aneurysms in the anterior cerebral circulation.

Minimizing bleeding complications in spinal tumor surgery with preoperative Onyx embolization via dual-lumen balloon catheter.

PubMed

Ladner, Travis R; He, Lucy; Lakomkin, Nikita; Davis, Brandon J; Cheng, Joseph S; Devin, Clinton J; Mocco, J

2016-02-01

Intraoperative bleeding is a significant risk in surgery for highly vascular spinal tumors, but preoperative embolization can safely decrease intraoperative blood loss in extrinsic spine tumors. Onyx, widely used for cerebrovascular embolization, has been increasingly used as an embolic agent for preoperative spinal tumor embolization. The Scepter catheter, a dual-lumen balloon catheter, may improve tumor parenchymal penetration without the danger and limitations of significant embolic reflux. This may reduce bleeding risk during spinal surgery. Eleven consecutive cases of preoperative Onyx embolization of extrinsic spinal tumors were identified, all of whom had subsequent spinal surgery. Demographic data and clinical variables were collected. Patients were divided into Scepter (n=6) and non-Scepter (n=5) groups. The Mann-Whitney U test was used to compare continuous outcome variables and the Fisher exact test was used to compare categorical variables. Estimated blood loss in the Scepter group was significantly lower than in the non-Scepter group (584±124 vs 2400±738 mL, p=0.004). The volume of intraoperative transfusion was also significantly lower (1.2±0.4 vs 5.8±1.7 units, p=0.004). There was no significant difference in the number of vessels embolized, vials of Onyx used, use of coiling adjunct, contrast load, radiation dose, or fluoroscopy time per pedicle (p>0.05). The addition of the Scepter catheter to preoperative Onyx embolization is safe and feasible. In this small series, the Scepter catheter was associated with a reduction of intraoperative bleeding by 76% and a 79% lower transfusion volume. This was not accompanied by any unwanted increase in vials of Onyx used, contrast load, radiation dose, or fluoroscopy time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Endovascular Treatment of Cerebral Aneurysm with Coils and Onyx

PubMed Central

Ueno, J.; Tohma, N.

2004-01-01

Summary We investigated endovascular treatment of cerebral aneurysm by coil and Onyx in vivo experiment in order to promote the advantages of coil embolization,. The aim of this study was to clarify the advantages and problems of coil and Onyx embolization and to evaluate its potentials for application in clinical medicine. We set experimental aneurysms made of external jugular vein to bilateral carotid arteries of 10 Beagle dogs and embolized aneurysm with coils and Onyx. Two months later, the dogs were sacrificed and took out the experimental aneurysms and examined them histologically. We have experienced Onyx migration into the vessel at the beginning of our experiment. Technical problems were as follows; Onyx was not easily visible on DSA monitor particularly in tight coil packing. Catheter tip was often stuck to the Onyx in the aneurysm. Protect balloon could not completely protect the Onyx leakage into the vessel. Microscopic examinations were as follows; The aneurysm was filled with Onyx, coils, and inflammatory reactants. The orifice of the aneurysm was packed with augmented fibrous tissue. 1. This method increased contact between the aneurysm wall and coils. 2. Onyx filled the intra-aneurismal space more tightly. 3. Coils prevented Onyx from flowing out into the vessel. 4. In Onyx, intimal layer was more rapidly formed at the neck of the aneurysm than coils only. 5. The most important problems during Onyx embolization is how to prevent Onyx migration into the vessel. We should like to propose the guideline for Onyx embolization. PMID:20587272

Embolization of a High-Output Postnephrectomy Aortocaval Fistula with Gianturco Coils and Cyanoacrylate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cekirge, Saruhan; Oguzkurt, Levent; Saatci, Isil

1996-11-15

The authors describe the endovascular treatment of a high-output, large-caliber, postnephrectomy aortocaval fistula using a mixture of cyanoacrylate and lipiodol combined with Gianturco coil embolization. Thirty-nine coils were used to decrease the flow through the fistula so that a fast-polymerizing glue mixture could be injected into the fistula. During rapid polymerization, the N-butyl-2-cyanoacrylate (NBCA) mixture was trapped within the coils, providing an easily controllable glue cast in the fistula, thereby preventing inadvertent embolization into the lungs. This approach can be of considerable benefit for the endovascular treatment of central high-output fistulas.

Onyx, a New Liquid Embolic Material for Peripheral Interventions: Preliminary Experience in Aneurysm, Pseudoaneurysm, and Pulmonary Arteriovenous Malformation Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vanninen, Ritva L., E-mail: ritva.vanninen@kuh.fi; Manninen, I.

Purpose. To describe our preliminary experience with a new liquid embolization agent, Onyx, in peripheral interventions. Methods and results. We successfully treated two peripheral aneurysms (one in an internal iliac artery, one in a thoracic collateral artery of an aortic coarctation), two peripheral pseudoaneurysms (one in a lumbar artery, one in a renal artery), and one pulmonary arteriovenous malformation. Conclusion. Onyx is a promising alternative embolic material for peripheral interventions. It can be combined with coils in selected cases, and balloon catheters can be effectively used during slow injection of embolic material to control flow and protect the aneurysm neck.

Follow-Up of 58 Traumatic Carotid-Cavernous Fistulas after Endovascular Detachable-Balloon Embolization at a Single Center

PubMed Central

Xu, Xiao-Quan; Liu, Sheng; Zu, Qing-Quan; Zhao, Lin-Bo; Xia, Jin-Guo; Zhou, Chun-Gao; Zhou, Wei-Zhong

2013-01-01

Background and Purpose This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. Methods Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. Results All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. Conclusions Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence. PMID:23626645

Onyx HD-500 embolization of intracranial aneurysms: modified technique using continuous balloon inflation under conscious sedation.

PubMed

Rahme, Ralph; Grande, Andrew; Jimenez, Lincoln; Abruzzo, Todd A; Ringer, Andrew J

2014-08-01

The conventional technique of intracranial aneurysm embolization using Onyx HD-500 (ev3 Neurovascular, Irvine, CA, USA) involves repetitive balloon inflation-deflation cycles under general anesthesia. By limiting parent artery occlusion to 5 minutes, this cyclic technique is thought to minimize cerebral ischemia. However, intermittent balloon deflation may lengthen procedure time and allow balloon migration, resulting in intimal injury or Onyx leakage. We report our experience using a modified technique of uninterrupted Onyx injection with continuous balloon occlusion under conscious sedation. All Onyx embolization procedures for unruptured aneurysms performed by the senior author (A.J.R.) between September 2008 and April 2010 were retrospectively reviewed. Demographic, clinical, angiographic, and procedural data were recorded. Twenty-four embolization procedures were performed in 21 patients with 23 aneurysms, including four recurrences. Twenty aneurysms (87%) involved the paraclinoid or proximal supraclinoid internal carotid artery. Size ranged from 2.5 to 24mm and neck diameter from 2 to 8mm. The modified technique was employed in 19 cases. All but one patient (94.4%) tolerated continuous balloon inflation. Complete occlusion was achieved in 20 aneurysms (83.3%) and subtotal occlusion in three (12.5%). Stable angiographic results were seen in 85%, 94%, 94%, and 100% of patients at 6, 12, 24, and 36months, respectively. There were no deaths. Permanent non-disabling neurological morbidity occurred in one patient (4.2%). Minor, transient, and/or angiographic complications were seen in three patients (12.5%), none related to the technique itself. Onyx embolization of unruptured intracranial aneurysms can be safely and effectively performed using continuous balloon inflation under conscious sedation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Closure of a giant saphenous vein graft aneurysm with embolization coil.

PubMed

Kumar, Ashwani; Santana, Dixon; Jenkins, Leigh Ann

2009-01-01

Aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 x 8.4 cm aneurysm of an SVG to obtuse marginal (OM) artery. The aneurysm was prior to the distal anastamosis but no flow into the OM artery was noted. Cook Tornado Embolization Coils were used successfully to occlude the SVG proximal to the aneurysm. No complications occurred. The use of embolization coils is an effective and safe method for aneurysm occlusion when the anatomy is suitable and especially when patient is high risk for repeat surgical intervention.

Effect of electromagnetic radiation on the coils used in aneurysm embolization.

PubMed

Lv, Xianli; Wu, Zhongxue; Li, Youxiang

2014-06-01

This study evaluated the effects of electromagnetic radiation in our daily lives on the coils used in aneurysm embolization. Faraday's electromagnetic induction principle was applied to analyze the effects of electromagnetic radiation on the coils used in aneurysm embolization. To induce a current of 0.5mA in less than 5 mm platinum coils required to stimulate peripheral nerves, the minimum magnetic field will be 0.86 μT. To induce a current of 0.5 mA in platinum coils by a hair dryer, the minimum aneurysm radius is 2.5 mm (5 mm aneurysm). To induce a current of 0.5 mA in platinum coils by a computer or TV, the minimum aneurysm radius is 8.6 mm (approximate 17 mm aneurysm). The minimum magnetic field is much larger than the flux densities produced by computer and TV, while the minimum aneurysm radius is much larger than most aneurysm sizes to levels produced by computer and TV. At present, the effects of electromagnetic radiation in our daily lives on intracranial coils do not produce a harmful reaction. Patients with coiled aneurysm are advised to avoid using hair dryers. This theory needs to be proved by further detailed complex investigations. Doctors should give patients additional instructions before the procedure, depending on this study.

Effect of Electromagnetic Radiation on the Coils Used in Aneurysm Embolization

PubMed Central

Lv, Xianli; Wu, Zhongxue; Li, Youxiang

2014-01-01

Summary This study evaluated the effects of electromagnetic radiation in our daily lives on the coils used in aneurysm embolization. Faraday’s electromagnetic induction principle was applied to analyze the effects of electromagnetic radiation on the coils used in aneurysm embolization. To induce a current of 0.5mA in less than 5 mm platinum coils required to stimulate peripheral nerves, the minimum magnetic field will be 0.86 μT. To induce a current of 0.5 mA in platinum coils by a hair dryer, the minimum aneurysm radius is 2.5 mm (5 mm aneurysm). To induce a current of 0.5 mA in platinum coils by a computer or TV, the minimum aneurysm radius is 8.6 mm (approximate 17 mm aneurysm). The minimum magnetic field is much larger than the flux densities produced by computer and TV, while the minimum aneurysm radius is much larger than most aneurysm sizes to levels produced by computer and TV. At present, the effects of electromagnetic radiation in our daily lives on intracranial coils do not produce a harmful reaction. Patients with coiled aneurysm are advised to avoid using hair dryers. This theory needs to be proved by further detailed complex investigations. Doctors should give patients additional instructions before the procedure, depending on this study. PMID:24976203

Transcatheter arterial embolization--major complications and their prevention.

PubMed

Miller, F J; Mineau, D E

1983-01-01

A thorough account is given of the complications of embolization techniques in nonneurovascular areas, including hepatic infarction, renal and splenic abscess formation. Infarction of the urinary bladder, gallbladder, stomach, and bowel are discussed. Suggestions are offered to prevent complications from embolization where possible. Specific agents for embolization are detailed and their relative merits are compared; ethyl alcohol has recently gained popularity for treating esophageal varices and infarcting renal tumors. Care is advocated when using alcohol in the renal arteries; employing this agent is currently contraindicated in the celiac and mesenteric arteries. Coils and balloon systems are also described along with their potential complications.

Closure of a Giant Saphenous Vein Graft Aneurysm with Embolization Coil

PubMed Central

Kumar, Ashwani; Santana, Dixon; Jenkins, Leigh Ann

2009-01-01

Aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 × 8.4 cm aneurysm of an SVG to obtuse marginal (OM) artery. The aneurysm was prior to the distal anastamosis but no flow into the OM artery was noted. Cook Tornado Embolization Coils were used successfully to occlude the SVG proximal to the aneurysm. No complications occurred. The use of embolization coils is an effective and safe method for aneurysm occlusion when the anatomy is suitable and especially when patient is high risk for repeat surgical intervention. PMID:19946632

In vitro simulator with numerical stress analysis for evaluation of stent-assisted coiling embolization in cerebral aneurysm treatments.

PubMed

Shi, Chaoyang; Kojima, Masahiro; Tercero, Carlos; Najdovski, Zoran; Ikeda, Seiichi; Fukuda, Toshio; Arai, Fumihito; Negoro, Makoto

2014-12-01

There are several complications associated with Stent-assisted Coil Embolization (SACE) in cerebral aneurysm treatments, due to damaging operations by surgeons and undesirable mechanical properties of stents. Therefore, it is necessary to develop an in vitro simulator that provides both training and research for evaluating the mechanical properties of stents. A new in vitro simulator for three-dimensional digital subtraction angiography was constructed, followed by aneurysm models fabricated with new materials. Next, this platform was used to provide training and to conduct photoelastic stress analysis to evaluate the SACE technique. The average interaction stress increasingly varied for the two different stents. Improvements for the Maximum-Likelihood Expectation-Maximization method were developed to reconstruct cross-sections with both thickness and stress information. The technique presented can improve a surgeon's skills and quantify the performance of stents to improve mechanical design and classification. This method can contribute to three-dimensional stress and volume variation evaluation and assess a surgeon's skills. Copyright © 2013 John Wiley & Sons, Ltd.

Temporary subclavian steal to reduce intraprocedural embolic risk during detachable balloon occlusion of vertebrobasilar aneurysms: technical note with two case reports.

PubMed

Eckard, D A; O'Boynick, P L; Han, P P

1996-11-01

Unintentional intracerebral embolization is a serious, ever present threat during neurointerventional procedures. We have devised a method to reduce this intraprocedural risk in vertebral artery interventions by creating a temporary subclavian steal. For this technique, a temporary balloon occlusion catheter is advanced into the proximal subclavian artery via a femoral artery approach, while a second introducer catheter is passed into the target vertebral artery via an axillary artery access. The temporary occluding balloon is then inflated within the proximal subclavian artery, establishing a subclavian steal that diverts blood flow into the arm. Permanent balloon occlusion of the vertebral artery can then be accomplished without fear of intracerebral embolization. Two patients with vertebrobasilar junction aneurysms were successfully treated with detachable balloon embolization using this cerebral protection technique. The permanent occlusion balloons were easily passed through the introducer catheter without difficulty despite reversed vertebral artery flow. No complications were encountered, and the aneurysms were successfully occluded in both patients. Temporary subclavian steal can be easily created to reduce the risk of cerebral embolic complications when performing interventional neuroradiological procedures in the vertebral artery.

Peri-stent aneurysm formation following a stent implant for stenotic intracranial vertebral artery dissection: a technical report of two cases successfully treated with coil embolization.

PubMed

Ishimaru, Hideki; Nakashima, Kazuaki; Takahata, Hideaki; Matsuoka, Yohjiro

2013-02-01

Although stenting for stenotic vertebral artery dissection (VAD) improves compromised blood flow, subsequent peri-stent aneurysm (PSA) formation is not well-known. We report two cases with PSA successfully treated with coil embolization. Three patients with stenotic intracranial VAD underwent endovascular angioplasty at our institution because they had acute infarction in posterior circulation territory and clinical evidence of hemodynamic insufficiency. In two of three patients balloon angioplasty at first session failed to relieve the stenosis, and a coronary stent was implanted. Angiography immediately after stenting showed no abnormality in case 1 and minimal slit-like projection at proximal portion of the stent in case 2. Angiography obtained 16 months after the stenting revealed PSA in case 1. In case 2, angiography performed 3 months later showed that the projection at proximal portion enlarged and formed an aneurysm outside the stent. Because follow-up angiographies showed growth of the aneurysm in both cases, endovascular aneurysmal embolization was performed. We advanced a microcatheter into the aneurysm through the strut of existing stent and delivered detachable coils into the aneurysm lumen successfully in both cases. The post-procedural course was uneventful, and complete obliteration of aneurysm was confirmed on angiography in both cases. Stenting for stenotic intracranial VAD may result in delayed PSA; therefore, follow-up angiographies would be necessary after stenting for stenotic intracranial arterial dissection. Coil embolization through the stent strut would be a solution for enlarging PSA.

Temporary Percutaneous Aortic Balloon Occlusion to Enhance Fluid Resuscitation Prior to Definitive Embolization of Post-Traumatic Liver Hemorrhage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matsuoka, Shin; Uchiyama, Katsuhiro; Shima, Hideki

2001-07-15

We successfully stabilized severe hemorrhagic shock following traumatic liver injury by percutaneous transcarotid supraceliac aortic occlusion with a 5 Fr balloon catheter. Then we were able to perform transfemoral embolization therapy of the hepatic arterial bleeding source. Transient aortic occlusion using a balloon catheter appears to be a useful adjunct in select cases where stabilization of the patient is necessary to allow successful selective embolization of the bleeding source.

Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia.

PubMed

Tau, Noam; Atar, Eliyahu; Mei-Zahav, Meir; Bachar, Gil N; Dagan, Tamir; Birk, Einat; Bruckheimer, Elchanan

2016-08-01

Coil embolization of pulmonary arteriovenous malformations (PAVMs) has a high re-canalization/re-perfusion rate. Embolization with Amplatzer plugs has been previously described, but the long-term efficacy is not established. This study reports the experience of a referral medical center with the use of coils and Amplatzer plugs for treating PAVMs in patients with hereditary hemorrhagic telangiectasia. The study was approved by the Institutional Review Board with waiver of informed consent. The cohort included all patients who underwent PAVM embolization in 2004-2014 for whom follow-up imaging scans were available. The medical files were retrospectively reviewed for background data, embolization method (coils, Amplatzer plugs, both), and complications. Re-canalization of treated PAVMs was assessed from intrapulmonary angiograms (following percutaneous procedures) or computed tomography angiograms. Fisher's exact test and Pearson Chi-squared test or t test were used for statistical analysis, with significance at p < 0.05. 16 patients met the study criteria. Imaging scans were available for 63 of the total 110 PAVMs treated in 41 procedures. Coils were used for embolization in 37 PAVMs, Amplatzer plugs in 21, and both in five. Median follow-up time was 7.7 years (range 1.4-18.9). Re-canalization was detected in seven vessels, all treated with coils; there were no cases of re-canalization in plug-occluded vessels (p = 0.0413). The use of Amplatzer plugs for the embolization of PAVMs in patients with hemorrhagic telangiectasia is associated with a significantly lower rate of re-canalization of feeding vessels than coils. Long-term prospective studies are required to confirm these findings.

The Influence of Dome Size, Parent Vessel Angle, and Coil Packing Density on Coil Embolization Treatment in Cerebral Aneurysms

NASA Astrophysics Data System (ADS)

Frakes, David H.; Indahlastari, Aprinda; Ryan, Justin; Babiker, M. Haithem; Nair, Priya; Parthas, Varsha

2013-11-01

Intracranial aneurysms (ICAs) are dilated cerebral blood vessels. Treating ICAs effectively prior rupture is crucial since their association with 45% mortality rate. Embolic coiling is the most effective ICA treatment. Series of embolic coils are deployed into the aneurysm with the intent of reaching a sufficient packing density (PD) to help seal off the ICA from circulation. While coiling is effective, treatment failures have been associated with basilar tip aneurysms (BTAs), perhaps because of their geometry. The aim of this study was to examine the effect of dome size, parent vessel (PV) angle, and PD on intraaneurysmal (IA) velocity, crossneck (CN) flow and low wall shear stress (WSS) area using simulations and experiments in idealized BTA models. IA velocity and CN flow decreased after coiling, while low WSS area increased. With increasing PD, IA velocity and CN flow were further reduced, but low WSS area had a minimal change. Coil PD had the greatest impact on post-treatment flow while dome size had a greater impact than PV angle. Overall, the role of aneurysmal geometries may vary depending on treatment goal and timing e.g., high coil PD may reduce IA velocity more effectively during early aneurysmal growth when the dome size is small. Funded by the American Heart Association.

Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tau, Noam, E-mail: taunoam@gmail.com; Atar, Eliyahu; Mei-Zahav, Meir

PurposeCoil embolization of pulmonary arteriovenous malformations (PAVMs) has a high re-canalization/re-perfusion rate. Embolization with Amplatzer plugs has been previously described, but the long-term efficacy is not established. This study reports the experience of a referral medical center with the use of coils and Amplatzer plugs for treating PAVMs in patients with hereditary hemorrhagic telangiectasia.MethodsThe study was approved by the Institutional Review Board with waiver of informed consent. The cohort included all patients who underwent PAVM embolization in 2004–2014 for whom follow-up imaging scans were available. The medical files were retrospectively reviewed for background data, embolization method (coils, Amplatzer plugs, both),more » and complications. Re-canalization of treated PAVMs was assessed from intrapulmonary angiograms (following percutaneous procedures) or computed tomography angiograms. Fisher’s exact test and Pearson Chi-squared test or t test were used for statistical analysis, with significance at p < 0.05.Results16 patients met the study criteria. Imaging scans were available for 63 of the total 110 PAVMs treated in 41 procedures. Coils were used for embolization in 37 PAVMs, Amplatzer plugs in 21, and both in five. Median follow-up time was 7.7 years (range 1.4–18.9). Re-canalization was detected in seven vessels, all treated with coils; there were no cases of re-canalization in plug-occluded vessels (p = 0.0413).ConclusionThe use of Amplatzer plugs for the embolization of PAVMs in patients with hemorrhagic telangiectasia is associated with a significantly lower rate of re-canalization of feeding vessels than coils. Long-term prospective studies are required to confirm these findings.« less

Yttrium-90 Resin Microsphere Radioembolization Using an Antireflux Catheter: An Alternative to Traditional Coil Embolization for Nontarget Protection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morshedi, Maud M., E-mail: maud.morshedi@my.rfums.org; Bauman, Michael, E-mail: mbauman@ucsd.edu; Rose, Steven C., E-mail: scrose@ucsd.edu

2015-04-15

PurposeSerious complications can result from nontarget embolization during yttrium-90 (Y-90) transarterial radioembolization. Hepatoenteric artery coil embolization has been traditionally performed to prevent nontarget radioembolization. The U.S. Food and Drug Administration–approved Surefire Infusion System (SIS) catheter, designed to prevent reflux, is an alternative to coils. The hypothesis that quantifiable SIS procedural parameters are comparable to coil embolization was tested.MethodsFourteen patients aged 36–79 years with colorectal, neuroendocrine, hepatocellular, and other predominantly bilobar hepatic tumors who underwent resin microsphere Y-90 radioembolization using only the SIS catheter (n = 7) versus only detachable coils (n = 7) for nontarget protection were reviewed retrospectively. Procedure time, fluoroscopy time, contrast dose,more » radiation dose, and cost were evaluated.ResultsMultivariate analysis identified significant cohort differences in the procedural parameters evaluated (F(10, 3) = 10.39, p = 0.04). Between-group comparisons of the pretreatment planning procedure in the SIS catheter group compared to the coil embolization group demonstrated a significant reduction in procedure time (102.6 vs. 192.1 min, respectively, p = 0.0004), fluoroscopy time (14.3 vs. 49.7 min, respectively, p = 0.0016), and contrast material dose (mean dose of 174.3 vs. 265.0 mL, respectively, p = 0.0098). Procedural parameters were not significantly different between the two groups during subsequent dose delivery procedures. Overall cost of combined first-time radioembolization procedures was significantly less in the SIS group ($4252) compared to retrievable coil embolization ($11,123; p = 0.001).ConclusionThe SIS catheter results in a reduction in procedure time, fluoroscopy time, and contrast material dose and may be an attractive cost-effective alternative to detachable coil embolization for prevention of nontarget radioembolization.« less

Stand-alone coil embolization of anterior communicating artery aneurysms: Efficacy and technical issues.

PubMed

Kocur, Damian; Zbroszczyk, Miłosz; Przybyłko, Nikodem; Hofman, Mariusz; Jamróz, Tomasz; Baron, Jan; Bażowski, Piotr; Kwiek, Stanisław

2016-10-01

We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications. The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months. Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 27 (96%) cases and incomplete occlusion in one (4%) case. Imaging follow-up, performed in 15 (53.6%) patients, showed no change in the degree of occlusion in 11 (73%), coil compaction in one (7%) and progressive occlusion in three (20%) patients. Three (20%) patients underwent a second coil embolization. The procedure-related severe morbidity and mortality rate was 6.4% (2/31). Coil prolapse was present in one (3.2%) case and intraprocedural aneurysm rupture in three (9.6%) cases. The clinical follow-up evaluation achieved in 19 (67.9%) patients showed no change in 17 (89.5%) patients and improvement in two (10.5%) patients. Although the efficacy of coil embolization of anterior communicating artery aneurysms is unquestionable and the procedure-related complications are acceptable, they should not be neglected. Further investigations are needed to better understand protective factors, as well as to establish unequivocally appropriate management strategy of these complications. © The Author(s) 2016.

Stand-alone coil embolization of anterior communicating artery aneurysms: Efficacy and technical issues

PubMed Central

Zbroszczyk, Miłosz; Przybyłko, Nikodem; Hofman, Mariusz; Jamróz, Tomasz; Baron, Jan; Bażowski, Piotr; Kwiek, Stanisław

2016-01-01

Objective We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications. Materials and methods The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months. Results Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 27 (96%) cases and incomplete occlusion in one (4%) case. Imaging follow-up, performed in 15 (53.6%) patients, showed no change in the degree of occlusion in 11 (73%), coil compaction in one (7%) and progressive occlusion in three (20%) patients. Three (20%) patients underwent a second coil embolization. The procedure-related severe morbidity and mortality rate was 6.4% (2/31). Coil prolapse was present in one (3.2%) case and intraprocedural aneurysm rupture in three (9.6%) cases. The clinical follow-up evaluation achieved in 19 (67.9%) patients showed no change in 17 (89.5%) patients and improvement in two (10.5%) patients. Conclusions Although the efficacy of coil embolization of anterior communicating artery aneurysms is unquestionable and the procedure-related complications are acceptable, they should not be neglected. Further investigations are needed to better understand protective factors, as well as to establish unequivocally appropriate management strategy of these complications. PMID:27531863

Ischemic Stroke After Treatment of Intraprocedural Thrombosis During Stent-Assisted Coiling and Flow Diversion.

PubMed

Adeeb, Nimer; Griessenauer, Christoph J; Moore, Justin M; Foreman, Paul M; Shallwani, Hussain; Motiei-Langroudi, Rouzbeh; Gupta, Raghav; Baccin, Carlos E; Alturki, Abdulrahman; Harrigan, Mark R; Siddiqui, Adnan H; Levy, Elad I; Ogilvy, Christopher S; Thomas, Ajith J

2017-04-01

Intraprocedural thrombosis poses a formidable challenge during neuroendovascular procedures because the risks of aggressive thromboembolic treatment must be balanced against the risk of postprocedural hemorrhage. The aim of this study was to identify predictors of ischemic stroke after intraprocedural thrombosis after stent-assisted coiling and pipeline embolization device placement. A retrospective analysis of intracranial aneurysms treated with stent-assisted coiling or pipeline embolization device placement between 2007 and 2016 at 4 major academic institutions was performed to identify procedures that were complicated by intraprocedural thrombosis. Intraprocedural thrombosis occurred in 34 (4.6%) procedures. Postprocedural ischemic stroke and hemorrhage occurred in 20.6% (7/34) and 11.8% (4/34) of procedures complicated by intraprocedural thrombosis, respectively. Current smoking was an independent predictor of ischemic stroke. There was no statistically significant difference in the rate of ischemic stroke or postprocedural hemorrhage with the use of abciximab compared with the use of eptifibatide in treatment of intraprocedural thrombosis. Current protocols for treatment of intraprocedural thrombosis associated with placement of intra-arterial devices were effective in preventing ischemic stroke in ≈80% of cases. Current smoking was the only independent predictor of ischemic stroke. © 2017 American Heart Association, Inc.

Splenic Artery Embolization in Blunt Trauma: A Single-Center Retrospective Comparison of the Use of Gelatin Sponge Versus Coils.

PubMed

Rasuli, Pasteur; Moosavi, Bardia; French, Gordon J; Petrcich, William; Hammond, Ian

2017-12-01

The purpose of this study was to compare the efficacy of gelatin sponge with that of coils for splenic artery embolization in the treatment of blunt splenic injury. A single-center retrospective review was performed with the records of 63 patients (45 men, 18 women; mean age, 45.5 years; range, 16-84 years) with blunt splenic injury treated at a tertiary care trauma center by splenic artery embolization with gelatin sponge (n = 30 patients) or metallic coils (n = 33 patients) between 2005 and 2014. The two groups had comparable median American Association for the Surgery of Trauma grades of IV and comparable angiographic appearances regarding active extravasation and pseudoaneurysm formation at preembolization splenic arteriography (p = 0.32). Clinical outcomes and procedure-related outcomes were evaluated. The success rates were similar in the two groups: splenic artery embolization failed in 6.6% (2/30) of patients in the gelatin sponge group and 12.1% (4/33) in the coil embolization group (p = 0.45; 95% CI, -30.1% to 19.2%). Major complications occurred in six patients (20.0%) in the gelatin sponge group and in six patients (18.1%) in the coil group (p = 0.85; 95% CI, -23.0% to 26.6%). Minor complications occurred in three patients (10.0%) in the gelatin sponge group and seven patients (21.2%) in the coil group (p = 0.21; 95% CI, -35.4% to 14.0%). Procedure time was significantly shorter in the gelatin sponge group (median, 32 minutes; interquartile range, 18-48 minutes) than in the coil group (median, 53 minutes; interquartile range, 30-76 minutes) (p = 0.01). Splenic artery embolization with gelatin sponge appears to be as effective and as safe as coil embolization and can be completed in a shorter time.

Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases.

PubMed

Kocur, Damian; Zbroszczyk, Miłosz; Przybyłko, Nikodem; Hofman, Mariusz; Jamróz, Tomasz; Baron, Jan; Bażowski, Piotr; Kwiek, Stanisław

We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications. The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months. Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration. The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Post-Mortem Pathological Examination of Two Patients after Intraaneurysmal Embolization Using Guglielmi Detachable Coils

PubMed Central

Nakahara, T.; Sakamoto, S.; Hamasaki, O.; Sakoda, K.

2003-01-01

Summary We report the histological findings in two patients treated using Guglielmi detachable coils with almost complete occlusion of the aneurysms. Autopsies of these patients were performed one week and one year after GDC embolization respectively. In one aneurysm that was obtained at autopsy one week after embolization, the histological findings revealed coils and an unorganized thrombus-filled aneurysm sac; an incomplete cell-lining on the luminal side of fibrin thrombi in the region of the neck of the aneurysm was recognized. In the other aneurysm in which autopsy was performed one year after embolization, an organized fibrous tissue at the margin of the aneurysmal wall and vascular granulation tissue at the center of the aneurysm were observed. There is a single layer of endothelium covering fibrous tissue in the neck of the aneurysm. We discuss the healing process after GDC treatment. PMID:20591231

PERCUTANEOUS RADIOFREQUENCY ASSISTED LIVER PARTITION WITH PORTAL VEIN EMBOLIZATION FOR STAGED HEPATECTOMY (PRALPPS).

PubMed

Giménez, Mariano E; Houghton, Eduardo J; Davrieux, C Federico; Serra, Edgardo; Pessaux, Patrick; Palermo, Mariano; Acquafresca, Pablo A; Finger, Caetano; Dallemagne, Bernard; Marescaux, Jacques

2018-03-01

When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure.

Healing of Saccular Aneurysms Following Platinum Coil Embolization: Lack of Improved Efficacy with Vitamin C Supplementation

PubMed Central

Dai, Daying; Ding, Yong-Hong; Rezek, Issa; Lewis, Debra A.; Kallmes, David F.; Kadirvel, Ramanathan

2013-01-01

BACKGROUND AND PURPOSE To test the hypothesis that systemic administration of vitamin C, through its action of stimulating collagen synthesis and cross-linking, would decrease the recurrence and improve the occlusion experimental aneurysms treated with platinum coil embolization. METHODS Nineteen experimental aneurysms in female rabbits were embolized with platinum coils (>30% packing density). The animals were divided into three groups: Group 1 (n=6) rabbits served as controls, Group 2 (n=5) rabbits were fed with a vitamin C-supplemented feed and Group 3 (n=8) rabbits were medicated with vitamin C pills. Digital subtraction angiography was used to evaluate stability after embolization. Subjects were euthanized at 12 weeks after coil implantation, and serum vitamin C levels were then measured. Histological samples were examined with a grading system (range, 0-12) based on the neck and dome features. Masson Trichrome staining was employed to evaluate collagen deposition. Parametric data were analyzed with one-way analysis of variance and non-parametric data were examined using a Kruskal-Wallis test. RESULTS There were no significant differences between groups in mean aneurysm size. Mean serum vitamin C concentration was significantly higher in Group 3 and Group 2 compared to Group 1, while vitamin C levels between Group 2 and Group 3 were statistically comparable. Coil compaction was noted in one of six subjects in Group 1 and three of eight subjects in Group 3. All the remaining aneurysms in the test and control groups showed stable occlusion. There were no significant differences in histological scores or collagen deposition among groups. CONCLUSION Vitamin C supplementation following platinum coil embolization does not demonstrate improvement of long-term occlusion rates of aneurysms. PMID:22914744

Jailed double-microcatheter technique following horizontal stenting for coil embolization of intracranial wide-necked bifurcation aneurysms: A technical report of two cases.

PubMed

Kitahara, Takahiro; Hatano, Taketo; Hayase, Makoto; Hattori, Etsuko; Miyakoshi, Akinori; Nakamura, Takehiko

2017-04-01

The horizontal stenting technique facilitates endovascular treatment of wide-necked bifurcation intracranial aneurysms. Previous literature shows, however, that subsequent coil embolization at initial treatment results in incomplete obliteration in many cases. The authors present two consecutive cases of wide-necked large bifurcation aneurysms to describe an additional coil embolization technique following horizontal stenting. The patients were a 53-year-old female with an unruptured internal carotid artery terminus aneurysm and a 57-year-old female with a recurrent basilar artery tip aneurysm. Both patients underwent endovascular treatment with horizontal stenting followed by coil embolization with jailed double-microcatheters. Immediate complete obliteration was achieved with no complications, and no recanalization was observed at the one-year follow-up in both cases. Coil embolization with jailed double-microcatheter technique following horizontal stenting is a safe and effective strategy for wide-necked bifurcation aneurysms.

Congenital Aorto-azygous Fistula Treated with Coil Embolization: Case Report and Review of the Literature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Romero, Francisco Diaz; Fernandez, Eudaldo M. Lopez-Tomassetti; Albelo, Tomas Perez

2006-10-15

Arteriovenous fistulas between the aorta and the azygous vein usually manifest as a continuous audible murmur mimicking a patent ductus arteriosus when observed at birth. Symptoms when present during childhood are related to dyspnea or cardiac insufficiency. Embolotherapy of congenital vascular malformations is possible. However when this less invasive treatment fails, surgical treatment is sometimes necessary. We describe the case of a 12-year-old child with a large thoracic arteriovenous fistula between the descending thoracic aorta and the azygous vein, which was closed successfully by coil embolization. Available data in the literature suggest that coil embolization of aorto-azygous fistulas is usuallymore » successful.« less

Double-lumen balloon for Onyx® embolization via extracranial arteries in transverse sigmoid dural arteriovenous fistulas: initial experience.

PubMed

Clarençon, Frédéric; Di Maria, Federico; Gabrieli, Joseph; Carpentier, Alexandre; Pistochi, Silvia; Bartolini, Bruno; Zeghal, Chiheb; Chiras, Jacques; Sourour, Nader-Antoine

2016-10-01

Transverse-sigmoid dural arteriovenous fistulas (TS DAVFs) can be challenging to treat by endovascular means. Indeed, a total cure of the fistula can only be achieved when complete occlusion of the fistulous point(s) is obtained by penetration of the embolic agent. However, in some cases, especially for transosseous branches from extracranial arteries like the occipital artery (OcA) or the superficial temporal artery (STA), such penetration is usually poor, leading to major proximal reflux and incomplete fistula obliteration. We present three cases of embolization in two patients with TS DAVF through the OcA and/or the STA with Onyx® using a double-lumen balloon (Microvention, Tustin, CA, USA). This technique allows the penetration of the embolic agent in the transosseous branches by forming a counter-pressure with the inflated balloon. This technique may be useful to achieve complete occlusion of TS DAVFs by endovascular means.

Relevance of Occlusion Test in Endovascular Coiling of Posterior Cerebral Artery (P2 Segment) Aneurysms

PubMed Central

Jayakumar, P. N.; Desai, S.; Srikanth, S. G.; Ravishankar, S.; Kovoor, J. M. E.

2004-01-01

Summary P2 segment aneurysms are located on the posterior cerebral artery (PCA) between the junction of the posterior communicating artery with the PCA and the quadrigeminal cisternal part of the PCA. We reviewed our experience with endovascular coiling in such aneurysms. Clinical and pre-procedural data from four patients, referred for endovascular treatment of P2 segment aneurysms, were retrospectively studied for factors influencing post-interventional neurological deficits caused by ischemia of the PCA distal territory. Balloon occlusion was done in three patients and patient tolerance was assessed using clinical and anatomic criteria. Embryologic and anatomic features of the PCA were reviewed. Balloon occlusion test and endovascular coiling of aneurysms was possible in three patients. Control angiogram after embolization showed elimination of aneurysms from the circulation and the distal PCA filled through leptomeningeal anastomoses. One patient deteriorated due to aneurysmal rupture soon after the balloon occlusion test and coiling could not be done. In the other three patients post-intervention CT and MRI images showed PCA territory infarcts in spite of demonstration of good collateral circulation distal to the occluded PCA. In conclusion, P2 aneurysms can be effectively treated by endovascular coiling without a balloon occlusion test. While the balloon occlusion test does not contribute to clinical decision-making it may be associated with potential morbidity and mortality. PMID:20587236

Coil embolization for pulmonary artery injury caused by chest tube drainage.

PubMed

Shigefuku, Shunsuke; Kudo, Yujin; Saguchi, Toru; Maeda, Junichi

2017-05-01

Pulmonary artery injury caused by chest tube drainage is rare, but it requires prompt diagnosis to perform urgent surgical repair. We report that a 53-year-old man who suffered from pulmonary artery injury by chest tube drainage was successfully treated by coil embolization. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Healing of saccular aneurysms following platinum coil embolization: lack of improved efficacy with vitamin C supplementation.

PubMed

Dai, Daying; Yong-Hong, Ding; Rezek, Issa; Lewis, Debra A; Kallmes, David F; Kadirvel, Ramanathan

2013-11-01

To test the hypothesis that systemic administration of vitamin C, through its action of stimulating collagen synthesis and crosslinking, would decrease the recurrence and improve the occlusion of experimental aneurysms treated with platinum coils. Experimental aneurysms were created in female rabbits and were embolized with platinum coils (>30% packing density). The animals were divided into three groups: group 1 (n=6) rabbits served as controls, group 2 (n=5) rabbits were fed with a vitamin C supplemented feed and group 3 (n=8) rabbits were medicated with vitamin C pills. Digital subtraction angiography was used to evaluate stability after embolization. Subjects were euthanized at 12 weeks after coil implantation, and serum vitamin C levels were then measured. Histological samples were examined with a grading system (range 0-12) based on the neck and dome features. Masson Trichrome staining was used to evaluate collagen deposition. Parametric data were analyzed with one way analysis of variance and non-parametric data were examined using a Kruskal-Wallis test. There were no significant differences between groups in mean aneurysm size. Mean serum vitamin C concentration was significantly higher in group 3 and group 2 compared with group 1, while vitamin C levels between group 2 and group 3 were statistically comparable. Coil compaction was noted in one of six subjects in group 1 and in three of eight subjects in group 3. All of the remaining aneurysms in the test and control groups showed stable occlusion. There were no significant differences in histological scores or collagen deposition among groups. Vitamin C supplementation following platinum coil embolization does not demonstrate improvement of long term occlusion rates of aneurysms.

Coil embolization of an aneurysmal type B dissection persistent false lumen after visceral hybrid repair.

PubMed

Riga, Celia; Bicknell, Colin; Jenkins, Michael; Hamady, Mohamad

2009-01-01

Complex aortic dissections with subsequent dilatation may be managed by using a visceral hybrid approach. In some cases, however, there is substantial retrograde blood flow into the false lumen, leaving a pressurized aneurysmal segment. The authors describe a novel treatment method whereby successful seal of a distal type 1 endoleak was achieved with coil embolization and a liquid injectable embolic agent. The patient was followed up for 2 years without further aortic dilatation or complications.

Embolization with Tornado coils to control bleeding from an arterioureteral fistula.

PubMed

Jacobs, Bruce L; Maranchie, Jodi K

2007-12-01

Arterioureteral fistulae are rare, but potentially life-threatening causes of bleeding. We present a case of an 82 year-old woman with refractory, transfusion-dependent bleeding from an arterial fistula to her right ureteral stump, following right radical nephrectomy for advanced renal cell carcinoma. Cystoscopy with retrograde ureteral stump embolization using Tornado (Cook Medical, Bloomington, Indiana, USA) coils plus a slurry of thrombin-soaked Gelfoam (Pfizer Inc., New York, New York, USA) was performed, which led to prompt resolution of the patient's hematuria requiring no further hospitalizations or transfusions. Retrograde insertion of coils and injection of thrombin-soaked Gelfoam can be a minimally invasive, safe, and durable alternative for controlling hemorrhage from an arterioureteral fistula to a ureteral stump.

Internal Maxillary Artery Preoperative Embolization Using n-Butyl Cyanoacrylate and Pushable Coils for Temporomandibular Joint Ankylosis Surgery.

PubMed

Alderazi, Yazan J; Shastri, Darshan; Wessel, John; Mathew, Melvin; Kass-Hout, Tareq; Aziz, Shahid R; Prestigiacomo, Charles J; Gandhi, Chirag D

2017-05-01

Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss. Copyright © 2017 Elsevier Inc. All rights reserved.

Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization

PubMed Central

TOYOTA, Shingo; TAKI, Takuyu; WAKAYAMA, Akatsuki; YOSHIMINE, Toshiki

2015-01-01

Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment. PMID:26437796

Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization.

PubMed

Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

2015-01-01

Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment.

IN VITRO QUANTIFICATION OF THE SIZE DISTRIBUTION OF INTRASACCULAR VOIDS LEFT AFTER ENDOVASCULAR COILING OF CEREBRAL ANEURYSMS.

PubMed

Sadasivan, Chander; Brownstein, Jeremy; Patel, Bhumika; Dholakia, Ronak; Santore, Joseph; Al-Mufti, Fawaz; Puig, Enrique; Rakian, Audrey; Fernandez-Prada, Kenneth D; Elhammady, Mohamed S; Farhat, Hamad; Fiorella, David J; Woo, Henry H; Aziz-Sultan, Mohammad A; Lieber, Baruch B

2013-03-01

Endovascular coiling of cerebral aneurysms remains limited by coil compaction and associated recanalization. Recent coil designs which effect higher packing densities may be far from optimal because hemodynamic forces causing compaction are not well understood since detailed data regarding the location and distribution of coil masses are unavailable. We present an in vitro methodology to characterize coil masses deployed within aneurysms by quantifying intra-aneurysmal void spaces. Eight identical aneurysms were packed with coils by both balloon- and stent-assist techniques. The samples were embedded, sequentially sectioned and imaged. Empty spaces between the coils were numerically filled with circles (2D) in the planar images and with spheres (3D) in the three-dimensional composite images. The 2D and 3D void size histograms were analyzed for local variations and by fitting theoretical probability distribution functions. Balloon-assist packing densities (31±2%) were lower ( p =0.04) than the stent-assist group (40±7%). The maximum and average 2D and 3D void sizes were higher ( p =0.03 to 0.05) in the balloon-assist group as compared to the stent-assist group. None of the void size histograms were normally distributed; theoretical probability distribution fits suggest that the histograms are most probably exponentially distributed with decay constants of 6-10 mm. Significant ( p <=0.001 to p =0.03) spatial trends were noted with the void sizes but correlation coefficients were generally low (absolute r <=0.35). The methodology we present can provide valuable input data for numerical calculations of hemodynamic forces impinging on intra-aneurysmal coil masses and be used to compare and optimize coil configurations as well as coiling techniques.

Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results

PubMed Central

Lee, Edward W; Saab, Sammy; Gomes, Antoinette S; Busuttil, Ronald; McWilliams, Justin; Durazo, Francisco; Han, Steven-Huy; Goldstein, Leonard; Tafti, Bashir A; Moriarty, John; Loh, Christopher T; Kee, Stephen T

2014-01-01

OBJECTIVES: To describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage. METHODS: From October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up. All patients had detachable coils placed to occlude the efferent shunt and retrograde gelfoam embolization to achieve complete thrombosis/obliteration of varices. Technical success, clinical success, rebleeding, and complications were evaluated at follow-up. RESULTS: A 100% technical success rate (defined as achieving complete occlusion of efferent shunt with complete thrombosis/obliteration of bleeding varices and/or stopping variceal bleeding) was demonstrated in all 20 patients. Clinical success rate (defined as no variceal rebleeding) was 100%. Follow-up computed tomography after CARTO demonstrated decrease in size with complete thrombosis and disappearance of the varices in all 20 patients. Thirteen out of the 20 had endoscopic confirmation of resolution of varices. Minor post-CARTO complications, including worsening of esophageal varices (not bleeding) and worsening of ascites/hydrothorax, were noted in 5 patients (25%). One patient passed away at 24 days after the CARTO due to systemic and portal venous thrombosis and multi-organ failure. Otherwise, no major complication was noted. No variceal rebleeding was noted in all 20 patients during mean follow-up of 384±154 days. CONCLUSIONS: CARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-esophageal variceal bleeding. PMID:25273155

Brain 'Embolism' Detected by Magnetic Resonance Imaging During Percutaneous Mitral Balloon Commissurotomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rocha, Paulo; Qanadli, Salah D.; Strumza, Pierre

1999-05-15

Purpose: The common finding of thrombi between the bifoil balloons when they were extracted after mitral dilation prompted us to look for evidence of minor brain embolisms using the sensitive technique of BMRI (brain magnetic resonance T2-weighted imaging). Methods: BMRI was performed within 48 hr before and after a percutaneous mitral balloon commissurotomy (PMBC) in each of the 63 patients in this study. Results: There was evidence (hyperintensity foci: HI) of a previous asymptomatic brain embolism in 38 of 63 patients before PMBC and a new HI appeared in 18 of 63 patients after the procedure. New HI signals weremore » found exclusively in the white matter in 8 of 18 patients and in only 3 of 18 were HI signs larger than 1 cm. One patient, with an HI signal >1 cm in the thalamus and another <1 cm in the brain stem, presented diplopia accompanied by other minor clinical signs. The differences in HI rate among four subgroups (1, older vs younger than 43 years; 2, sinus rhythm vs atrial fibrillation; 3, echo score <8 vs >8; 4, patients from western countries vs the others) were not statistically significant, probably because the number of patients in each subgroup was low. Patients in atrial fibrillation had slightly more (not significant) HI before PMBC (15/20, 75%) than patients in sinus rhythm (23/43, 53%), but after PMBC their HI frequencies were similar (atrial fibrillation: 5/20, 25%; sinus rhythm: 13/43, 30%). Conclusion: Brain microembolism is frequent during PMBC, but is often anatomically limited and free from clinical signs in most cases. Brain embolism seems to be related mainly to the procedure itself and not the features of the patient.« less

[Transcatheter embolization for huge pulmonary arteriovenous fistula using metallic "spider" and spring embolus--application of hand-made metallic "spider" using partial monorail technique].

PubMed

Hirota, S; Sako, M; Fujita, Y; Hasegawa, Y; Sugimoto, K; Suzuki, Y; Kono, M

1992-07-25

We performed transcatheter embolization in two cases with huge pulmonary arteriovenous fistula (AVF) using a metallic "spider" and spring embolus. Conventional spring embolus or detachable balloon could not be used in these cases. Metallic spider was indicated for pulmonary AVF with a feeding artery diameter of more than 16 mm to prevent embolus passing through the AVF. In the first case, we used large handmade metallic spiders of 25 mm in diameter followed by embolization by numerous spring coils. At that time, a partial monorail technique was newly devised to carry the large metallic spider into the feeding artery, otherwise the spider could not pass into a 9F catheter. After embolization, symptoms and PaO2 in arterial blood improved remarkably in both cases. In the second case, a spring coil migrated into the normal pulmonary artery, but no infarction resulted. In conclusion, the metallic spider was very useful for embolization of hugee pulmonary AVF to avoid the embolus passing through and to tangle spring coils together with it. If commercially available "spiders" are too small, ones can be made easily.

Successful Transarterial Guglielmi Detachable Coil Embolization of Post-Traumatic Fistula between a Posterior Communicating Artery Aneurysm and the Cavernous Sinus

PubMed Central

Chen, Y.; Jiang, D-Y.; Tan, H-Q.; Wang, L-H.; Chen, X-Y.; Sun, J-H.

2009-01-01

Summary We describe a case of a post-traumatic posterior communicating artery (PCoA) aneurysmcavernous sinus fistula, which is an extremely rare complication of craniocerebral trauma, successfully treated with endosaccular coil embolization via transarterial route. Endosaccular embolization with Guglielmi detachable coils via transarterial route appears to be a feasible, effective and minimally invasive option for the treatment of post-traumatic fistula between the PCoA aneurysm with a small ostia and the cavernous sinus in the subacute phase. PMID:20465883

Application of endovascular coiling and subsequent Onyx 34 embolization in anterior communicating artery aneurysms with adjacent hematoma.

PubMed

Fang, Yi-Bin; Li, Qiang; Yang, Peng-Fei; Zhang, Qi; Wu, Yi-Na; Feng, Zheng-Zhe; Huang, Qing-Hai; Xu, Yi; Liu, Jian-Min

2014-08-01

Small anterior communicating artery aneurysms with recurrent bleeding and adjacent hematoma may have a high risk of post-operative rebleeding. This clinical study summarizes our preliminary experience with this subset of aneurysms, which were treated with endovascular coiling and subsequent Onyx 34 embolization. We retrospectively reviewed the data of 9 patients suffering from small anterior communicating artery aneurysms treated with the combination of coils and Onyx. The clinical characteristics, angiographic outcomes, and follow-up results are reviewed. Endovascular coiling and Onyx embolization were successfully accomplished in all 9 cases. The Raymond scale ratings of the treatments are all class I with the parent arteries kept patent. One patient died of severe brain edema on the 5th post-operative day. The modified Rankin scale (mRS) score for the other 8 patients at follow-ups (6m to 26m, 15.8m on average) was 0 in 5 cases, 1 in 2 cases, and 3 in 1 case. Seven of 8 patients (87.5%) underwent angiographic follow-up that demonstrated persistent durable occlusion with no recanalization. Endovascular coiling and subsequent Onyx 34 embolization may be effective in treating anterior communicating artery aneurysms with adjacent hematoma. Further studies with larger sample size and adequate follow-up are required to verify its safety and efficacy as well as to evaluate the long-term outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique).

PubMed

Zakharchenko, A; Kaitoukov, Y; Vinnik, Y; Tradi, F; Sapoval, M; Sielezneff, I; Galkin, E; Vidal, V

2016-11-01

The purpose of this study was to comprehensively evaluate the short-term outcomes after percutaneous embolization of the superior rectal artery (SRA) with metallic coils and particles for the management of hemorrhoids. Forty patients (15 men, 25 women) with a mean age of 35±5 years (SD) (range: 25-65 years) were prospectively enrolled. All patients had symptomatic hemorrhoids. The distribution of internal hemorrhoids was as follows: grade I (n=6, 16%); grade II (n=28, 69%) and grade III (n=6; 15%). All patients had percutaneous embolization of the SRA with metallic coils and synthetic polyvinyl alcohol particles. Follow-up evaluation included clinical examination, rectoscopy, histopathological analysis of rectal mucosa, duplex Doppler blood flow quantification, electromyography, sphincterometry of the anal sphincter and analysis of patient satisfaction. No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (P<0.05). Taking into account the symptom resolutions such as irritation, discomfort, bloody discharge and pain, satisfaction was observed in 5/6 (83%) patients with grade III hemorrhoids and 32/34 patients (94%) with grades I-II hemorrhoids. One month after embolization, anal sphincter contractility normalized and no changes in anal electromyography were observed. Blood flow in the hemorrhoidal plexus dropped from 109±1.2ml/min/100g (SD) before treatment to 60.2±4.4ml/min/100g (SD) (P<0.05) the day after embolization and remained unchanged one month after embolization. Our study demonstrates that embolization of SRA with particle and coils does not lead to ischemia in patients with symptomatic hemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS

Portal Vein Embolization before Right Hepatectomy: Improved Results Using n-Butyl-Cyanoacrylate Compared to Microparticles Plus Coils

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Bize, Pierre; Gunthern, Daniel

Background: There is currently no consensus in the literature on which embolic agent induces the greatest degree of liver hypertrophy after portal vein embolization (PVE). Only experimental results in a pig model have demonstrated an advantage of n-butyl-cyanoacrylate (NBCA) over 3 other embolic materials (hydrophilic gel, small and large polyvinyl alcohol particles) for PVE. Therefore, the aim of this human study was to retrospectively compare the results of PVE using NBCA with those using spherical microparticles plus coils. Methods: A total of 34 patients underwent PVE using either NBCA (n = 20), or spherical microparticles plus coils (n = 14).more » PVE was decided according to preoperative volumetry on the basis of contrast-enhanced CT. Groups were compared for age, sex, volume of the left lobe before PVE and future remnant liver ratio (FRL) (volume of the left lobe/total liver volume - tumor volume). The primary end point was the increase in left lobe volume 1 month after PVE. Secondary end points were procedure complications and biological tolerance. Results: Both groups were similar in terms of age, sex ratio, left lobe volume, and FRL before PVE. NBCA induced a greater increase in volume after PVE than did microparticles plus coils (respectively, +74 {+-} 69 % and +23 {+-} 14 %, p < 0.05). The amount of contrast medium used for the procedure was significantly larger when microparticles and coils rather than NBCA were used (respectively, 264 {+-} 43 ml and 162 {+-} 34 ml, p < 0.01). The rate of PVE complications as well as the biological tolerance was similar in both groups. Conclusion: NBCA seems more effective than spherical microparticles plus coils to induce left-lobe hypertrophy.« less

Coils versus gelatin particles with or without intraarterial antibiotics for partial splenic embolization: a comparative evaluation.

PubMed

Masada, Tetsuya; Tanaka, Toshihiro; Sakaguchi, Hiroshi; Nakagomi, Masahiro; Miura, Yuko; Hidaka, Teruyuki; Sato, Yozo; Sato, Takeshi; Inoue, Masayoshi; Furuich, Kinya; Nishiofuku, Hideyuki; Kichikawa, Kimihiko

2014-06-01

To compare the efficacy, complications, and inflammatory levels in partial splenic embolization (PSE) with coils or gelatin sponge (GS) particles with or without intraarterial antibiotic agents. Forty-four patients with hypersplenism treated by PSE were assessed. GS particles were used in 31 patients, and coils were used in 13 patients. In 17 of the 31 patients who received GS, GS suspended in antibiotic solution was injected via the splenic artery. In the other 14 patients, antibiotic agents were not used. In all 13 coil group patients, an antibiotic solution was intraarterially injected before embolization. Platelet counts were compared between the GS and coil groups. Complications and serum C-reactive protein (CRP) levels were compared among the three groups. There were no significant differences in platelet counts and platelet increased ratios at 6 months (10.0 × 10(4)/µL and 193% in the GS group vs 9.0 × 10(4)/µL and 221% in the coil group), and no significant differences in frequencies of complications. However, one splenic abscess occurred in a patient treated with GS without antibiotics, resulting in death. The mean serum CRP level in the GS with antibiotic group at 2 weeks was significantly lower than in the other two groups. The efficacy of PSE is similar with the use of coils versus GS particles. Prophylactic intraarterial antibiotic treatment could be useful in preventing inflammatory reactions after PSE. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

PTA of supra-aortic arteries with temporary balloon occlusion to avoid distal embolism.

PubMed

Koike, T; Minakawa, T; Abe, H; Takeuchi, S; Sasaki, O; Nishimaki, K; Tanaka, R

1992-03-01

Percutaneous transluminal angioplasty (PTA) was carried out in eight patients with cervical arterial stenosis; six in the subclavian and brachiocephalic arteries (5 with subclavian steal syndrome), one in the common carotid artery, and one in both the brachiocephalic and common carotid arteries (with subclavian steal syndrome). The PTA balloon catheters were introduced via the femoral artery in seven and brachial artery in one. To prevent distal embolization through the vertebral and internal carotid arteries, the blood flow in these vessels was temporarily occluded with a balloon catheter. The dilation of the stenotic areas was generally satisfactory. Antegrade blood flow was promptly obtained in the vertebral artery even in patients with subclavian steal syndrome. In all patients, the clinical symptoms improved. Two patients underwent repeat PTA because of restenosis.

Balloon-Assisted Occlusion of the Internal Iliac Arteries in Patients with Placenta Accreta/Percreta

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bodner, Leonard J.; Nosher, John L.; Gribbin, Christopher

2006-06-15

Background. Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss. Purpose. To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta. Methods. The records of 28 consecutive patients with a diagnosis of placenta accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Six patients underwent prophylactic temporary balloon occlusion, followedmore » by cesarean section, transcatheter embolization of the anterior division of the internal iliac arteries and cesarean hysterectomy (n = 5) or uterine curettage (n = 1). Twenty-two patients underwent cesarean hysterectomy without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, volume of fluid replacement intraoperatively, operating room time, estimated blood loss, and postoperative morbidity and mortality. Results. Patients in the embolization group had more frequent episodes of third trimester bleeding requiring admission and bedrest prior to delivery (16.7 days vs. 2.9 days), resulting in significantly more hospitalization time in the embolization group (23 days vs. 8.8 days) and delivery at an earlier gestational age than in those in the surgical group (32.5 weeks). There was no statistical difference in mean estimated blood loss, volume of replaced blood products, fluid replacement needs, operating room time or postoperative recovery time. Conclusion. Our findings do not support the contention that in patients

Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury: permanent embolization using stainless steel coils prevents pseudoaneurysm formation.

PubMed

Hagiwara, Akiyoshi; Tarui, Takehiko; Murata, Atsuo; Matsuda, Takeaki; Yamaguti, Yoshihiro; Shimazaki, Shuji

2005-07-01

The purpose of this study was to determine the association between bilomas and pseudoaneurysm complications after severe hepatic injury. Angiography was performed in patients with American Association for the Surgery of Trauma grade > or = III hepatic injury on contrast-enhanced computed tomographic scanning. When contrast extravasation was observed, transarterial embolization (TAE) was performed. After TAE, technetium-99m pyridoxyl-5-methyl-tryptophan cholescintigraphy was performed to detect the coexistence of bilomas. Follow-up angiography was performed when a biloma was detected. Eighty consecutive patients underwent angiography; after angiography, five patients died. The remaining 75 patients who underwent cholescintigraphy were included in this study. All 11 patients who had bilomas had angiographic evidence of contrast extravasation. The biloma frequency was higher in patients with grades IV and V injuries than in those with grade III injury (p = 0.024). Follow-up angiography revealed pseudoaneurysms in 7 of these 11 patients. All six patients in whom only gelatin sponge pledget injection was used to embolize had pseudoaneurysms. Among them, two patients had computed tomographic evidence of massive intra-abdominal fluid collection. In contrast, only one of five patients who received the combination of gelatin sponge pledget injection and stainless steel coils to permanently embolize injured arteries had a pseudoaneurysm. In this patient, the pseudoaneurysm was found in the peripheral part of the collateral vessels. All patients with pseudoaneurysms underwent repeat TAE and were discharged from the hospital uneventfully. In patients with high-grade hepatic injury and arterial bleeding who developed biloma, use of a gelatin sponge, an absorbable embolic material, is associated with a risk of pseudoaneurysm formation. Permanent arterial embolization using stainless steel coils is indicated to decrease this risk.

Long-term follow-up after transvenous single coil embolization of patent ductus arteriosus in dogs.

PubMed

Hildebrandt, N; Schneider, C; Schweigl, T; Schneider, M

2010-01-01

Long-term follow-up studies after interventional therapy of patent ductus arteriosus (PDA) in dogs are rare. Transvenous PDA embolization with a single detachable coil is a highly effective method in patients with an angiographically determined PDA≤4.0 mm. Twenty-eight dogs with an angiographic PDA≤4.0 mm were included. Prospective follow-up study after PDA coil embolization. The median follow-up time was 792 days (range, 2-3, 248 days). The rate of complete closure demonstrated by Doppler color flow was 54% at day 3 after intervention and the final cumulative rate was 71%. The rate of complete closure was significantly different between small and moderately sized PDA over the study period (P<.0001) and finally was 100 and 50%, respectively. In 16 dogs with complete closure, no recanalization was found. Disappearance of the continuous heart murmur was found in 89% after 3 days, and this increased to a final cumulative rate of 96%. Indexed left ventricular internal diameter in diastole (LVDd-I) decreased significantly (P<.0001). In the group with moderately sized PDA, a significant difference (P=.0256) was seen in LVDd-I between patients with and without residual shunt after exclusion of patients with persistent severe mitral valve regurgitation. Long-term follow-up after single coil embolization showed complete closure in all small PDA but a residual shunt with mild hemodynamic consequences was present in half of the moderately sized PDA. Copyright © 2010 by the American College of Veterinary Internal Medicine.

Periprocedural safety of aneurysm embolization with the Medina Coil System: the early human experience.

PubMed

Turk, Aquilla S; Maia, Orlando; Ferreira, Christian Candido; Freitas, Diogo; Mocco, J; Hanel, Ricardo

2016-02-01

Intracranial saccular aneurysms, if untreated, carry a high risk of morbidity and mortality from intracranial bleeding. Embolization coils are the most common treatment. We describe the periprocedural safety and performance of the initial human experience with the next generation Medina Coil System. The Medina Coil System is a layered three-dimensional coil made from a radiopaque, shape set core wire, and shape memory alloy outer coil filaments. Nine aneurysms in five patients were selected for treatment with the Medina Coil System. Nine aneurysms in five patients, ranging from 5 to 17 mm in size in various locations, were treated with the Medina Coil System. No procedural or periprocedural complications were encountered. Procedure times, number of coils used to treat the aneurysm, and use of adjunctive devices were much less than anticipated if conventional coil technology had been used. The Medina Coil System is a next generation coil that combines all of the familiar and expected procedural safety and technique concepts associated with conventional coils. We found improved circumferential aneurysm filling, which may lead to improved long term outcomes, with fewer devices and faster operating times. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Flow-Diverting Devices versus Coil Embolization for Intracranial Aneurysms: A Systematic Literature Review and Meta-analysis.

PubMed

Zhou, Geng; Zhu, Yue-Qi; Su, Ming; Gao, Kai-Di; Li, Ming-Hua

2016-04-01

To review the literature on flow-diverting device (FDD) treatments for intracranial aneurysms (IAs) and to compare the safety and efficacy of FDDs with coil embolization treatment (CET) for IAs using a meta-analysis of published studies. A systematic electronic search was conducted of PubMed, Springer Link, EBSCO, and the Cochrane Database on all accessible published articles through September 2015. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Studies that explicitly compared FDD and CET approaches to the treatment of IAs were included. Odds ratios (ORs) and 95% CIs were calculated for the complete occlusion rate and the morbidity rate using a random-effects model. Nine studies were included in the analysis, containing retrospectively collected data for 863 patients. FDD treatment showed a significantly higher complete occlusion rate than CET (OR = 3.13; 95% confidence interval [CI], 2.11-4.65) and the subgroup of stent-assisted coiling did (OR = 2.08; 95% CI, 1.34-3.24). FDDs did not achieve a significantly lower overall morbidity rate compared with CET (OR = 0.87; 95% CI, 0.45-1.69) or the SAC (stent-assisted coiling) subgroup (OR = 0.86; 95% CI, 0.33-2.26), and our results did not show a significant difference in mortality between the two techniques. FDD treatment of IAs yielded satisfactory results in complete occlusion rate compared with CET. The FDD procedure is feasible and has no significant difference in morbidity risk. Despite the findings reported herein, further validation with well-designed, multicenter randomized controlled trials is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Temporary Arterial Balloon Occlusion as an Adjunct to Yttrium-90 Radioembolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hagspiel, Klaus D., E-mail: kdh2n@virginia.edu; Nambiar, Ashwin, E-mail: uvashwin@gmail.com; Hagspiel, Lauren M., E-mail: lmh4gg@virginia.edu

2013-06-15

Purpose. This study was designed to describe the technique of arterial occlusion using a temporary occlusion balloon system as an alternative to coil occlusion during Yttrium-90 radioembolization of hepatic tumors. Methods. Review of charts, angiography, and follow-up imaging studies of consecutive patients undergoing oncological embolization procedures in which a HyperForm system (ev3 Neurovascular, Irvine, CA) was used. Intraprocedural target vessel occlusion and patency of the target vessel on follow-up were recorded. Clinical data and Bremsstrahlung scans were reviewed for evidence of nontarget embolization. Results. Four radioembolization procedures were performed in three patients (all female, age 48-54 (mean 52) years). Fivemore » arteries were temporarily occluded (three gastroduodenal arteries, one right gastric artery, and one cystic artery). All radioembolization procedures were successfully completed. Follow-up imaging (either digital subtraction angiography (DSA) or computed tomography angiography (CTA)) was available for all patients between 28-454 (mean 183) days following the procedure, demonstrating all five vessels to be patent. No clinical or imaging evidence for nontarget embolization was found. Conclusions. Temporary balloon occlusion of small and medium-sized arteries during radioembolization allows safe therapy with preserved postprocedural vessel patency on early and midterm follow-up.« less

Percutaneous protective coil occlusion of the proximal inferior mesenteric artery before N-butyl cyanoacrylate embolization of type II endoleaks after endovascular repair of abdominal aortic aneurysms.

PubMed

Chao, Christine P; Paz-Fumagalli, Ricardo; Walser, Eric M; McKinney, J Mark; Stockland, Andrew H; Falkensammer, Jürgen; Hakaim, Albert G; Oldenburg, W Andrew

2006-11-01

Bowel ischemia can complicate treatment of type II endoleak with liquid or semiliquid agents such as n-butyl cyanoacrylate (NBCA) if nontarget embolization of the inferior mesenteric artery (IMA) occurs. The current report describes four cases of type II endoleak in which the IMA was the main outflow vessel and was prophylactically occluded with embolization coils before NBCA injection into the endoleak nidus. The purpose was to prevent unintentional embolization of the NBCA into IMA branches. If feasible, protective IMA coil occlusion should be considered in type II endoleaks with IMA outflow in cases of NBCA embolization.

Video-assisted open supraclavicular sympathectomy following air embolism.

PubMed

Shpolyanski, G; Hashmonai, M; Rudin, M; Abaya, N; Kaplan, U; Kopelman, D

2012-01-01

Air embolism is a relatively rare complication of thoracoscopic surgery. Open supraclavicular sympathectomy was indicated to overcome the risk of re-embolization. A novel video-assisted technique was performed. conclusions: The previously prevalent open supraclavicular sympathectomy is a good choice for avoiding air embolism. Laparoscopic instrumentation and technology can be used to improve open procedures, especially when exposure and visibility are limited. Sometimes we should remember to use the experience of our teachers.

Usefulness of monochromatic imaging with metal artifact reduction software for computed tomography angiography after intracranial aneurysm coil embolization.

PubMed

Shinohara, Yuki; Sakamoto, Makoto; Iwata, Naoki; Kishimoto, Junichi; Kuya, Keita; Fujii, Shinya; Kaminou, Toshio; Watanabe, Takashi; Ogawa, Toshihide

2014-10-01

Recently, a newly developed fast-kV switching dual energy CT scanner with a gemstone detector generates virtual high keV images as monochromatic imaging (MI). Each MI can be reconstructed by metal artifact reduction software (MARS) to reduce metal artifact. To evaluate the degree of metal artifacts reduction and vessel visualization around the platinum coils using dual energy CT with MARS. Dual energy CT was performed using a Discovery CT750 HD scanner (GE Healthcare, Milwaukee, WI, USA). In a phantom study, we measured the mean standard deviation within regions of interest around a 10-mm-diameter platinum coil mass on MI with and without MARS. Thirteen patients who underwent CTA after endovascular embolization for cerebral aneurysm with platinum coils were included in a clinical study. We visually assessed the arteries around the platinum coil mass on MI with and without MARS. Each standard deviation near the coil mass on MI with MARS was significantly lower than that without MARS in a phantom study. On CTA of a clinical study, better visibility of neighboring arteries was obtained in 11 of 13 patients on MI with MARS compared to without MARS due to metal artifact reduction. Dual energy CT with MARS reduces metal artifact of platinum coils, resulting in favorable vessel visualization around the coil mass on CTA after embolization. © The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Endovascular Coil Embolization in a Postnephrostomy Renal Vein to Renal Pelvis Fistula

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anil, Gopinathan, E-mail: ivyanil10@gmail.com; Taneja, Manish

2011-02-15

We report the case of a 74-year-old man with post-percutaneous-nephrostomy venous hemorrhage from an iatrogenic fistula between the renal pelvis and a large tributary of the renal vein. Conservative management failed to contain the hemorrhage. Hence the fistula was occluded by coil embolization through the renal vein. This endovascular approach enabled rapid and effective stoppage of the venous bleed.There was no recurrence of the bleed or any pertinent complication at 3-month follow-up.

Therapeutic Benefit of Bone Marrow–Derived Endothelial Progenitor Cell Transplantation after Experimental Aneurysm Embolization with Coil in Rats

PubMed Central

Li, Qianyun; Huang, Jun; Chen, Xi; Chen, Xiaoyan; Zhang, Jun; Wang, Yongting; Yang, Guo-Yuan; Zhu, Wei

2014-01-01

Aneurysm embolization with coil is now widely used clinically. However, the recurrence of aneurysms after embolization has always plagued neurosurgeons because the endothelial layer of the aneurysm neck loses its integrity after being embolized by coil. Bone marrow–derived endothelial progenitor cells (BM-EPCs) could be incorporated into injured endothelium and differentiate into mature endothelial cells during vascular repairing processes. The aim of our study is to explore the effects of BM-EPCs on aneurysm repairing and remodeling in a rat embolization model of abdominal aortic aneurysm. BM-EPC proliferation, migration and tube formation were not affected by super-paramagnetic iron oxide nanoparticle (SPIO) labeling compared to the controls (p>0.05). The number of SPIO-labeled cells greatly increased in EPC transplanted rats compared to that of phosphate buffered saline treated rats. SPIO-labeled EPC (SPIO-EPC) are mainly located in the aneurysm neck and surrounded by fibrous tissue. A histology study showed that the aneurysm orifice was closed with neointima and the aneurysm was filled with newly formed fibrous tissue. The SPIO-EPC accumulated in the aneurysm neck, which accelerated focal fibrous tissue remodeling, suggesting that BM-EPCs play a crucial role in repairing and remodeling the aneurysm neck orifice. PMID:24587209

Stent-Assisted Coil Embolization of a Symptomatic Renal Artery Aneurysm at a Bifurcation Point.

PubMed

Nassiri, Naiem; Huntress, Lauren A

2017-07-01

Symptomatic renal artery aneurysms at bifurcation points present challenging clinical scenarios rarely amenable to endovascular repair due to concerns regarding parenchymal loss following intervention. Herein, we add to the scant body of literature describing successful endovascular repair of a saccular, symptomatic renal artery aneurysm situated at a bifurcation point. A 52-year-old woman with a 2.5-cm extraparenchymal, saccular, symptomatic left renal artery aneurysm underwent self-expanding stent-assisted detachable platinum microcoil embolization. Complete aneurysm exclusion was achieved with minimal parenchymal loss. There were no perioperative complications, and no evidence of acute kidney injury perioperatively or at 3-month follow-up. Sustained symptomatic relief was achieved. Endovascular therapy can provide safe and effective aneurysm treatment within challenging bifurcated renal artery anatomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Glue Embolization of a Blunt Traumatic Hepatic Arteriovenous Fistula under Inflow and Outflow Control.

PubMed

Mine, Takahiko; Murata, Satoru; Yasui, Daisuke; Yokota, Hiroyuki; Tajima, Hiroyuki; Kumita, Shin-ichiro

2016-01-01

We report on a rare case of blunt traumatic hepatic arteriovenous fistula arising from a pseudoaneurysm in a 35-year-old woman. Transarterial embolization was performed with n-butyl-2-cyanoacrylate, under inflow control with loose coil packing within the pseudoaneurysm and outflow control by balloon occlusion of the hepatic vein. A promising therapeutic outcome was achieved without any serious adverse events. Thus, the combination of these techniques to control inflow and outflow was successfully used to treat this rare hepatic vascular injury.

Venous air embolism in consecutive balloon kyphoplasties visualised on CT imaging.

PubMed

Tins, Bernhard J; Cassar-Pullicino, Victor N; Lalam, Radhesh; Haddaway, Mike

2012-09-01

We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken. Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position. Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16-3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system. Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered.

Endovascular treatment of ectopic bronchial artery aneurysm with brachiocephalic artery stent placement and coil embolization

PubMed Central

Di, Xiao; Ji, Dong-Hua; Chen, Yu; Liu, Chang-Wei; Liu, Bao; Yang, Juan

2016-01-01

Abstract Background: Bronchial artery aneurysm (BAA) is an uncommon but potentially life-threatening disease, and multiple BAAs are even rarer. Clinically, the tortuous and short neck of a BAA may present significant challenges for invasive intervention. Methods: This report describes the detailed process of diagnosis and treatment and includes a literature review of the etiology, clinical presentation, and therapeutic management of BAA. Results: A rare case of multiple BAAs, with one having an inflow artery arising from the brachiocephalic trunk, was referred to our hospital. The patient was successfully treated with coil embolization and brachiocephalic artery stent placement. In addition, we conducted a literature review involving 63 cases of BAA. BAA was most commonly associated with bronchiectasis and was located predominantly in the mediastinum. There was no significant difference between the diameters of the ruptured aneurysms and those of the nonruptured aneurysms (P = 0.115). Transcatheter arterial embolization was the most commonly adopted technique to treat BAA, while thoracic aortic endovascular repair was selected if the neck between the aneurysm and the aorta was short. Subgroup analysis suggested that patients with > 1 BAA were significantly more likely to be female than male (χ2 test, P = 0.034). Conclusion: Transcatheter coil embolization combined with stent placement could be a reasonable treatment option for BAAs with a tortuous and short neck. According to our literature review, patients with multiple BAAs display distinctive clinical characteristics compared with patients with a single BAA. PMID:27583854

Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization

PubMed Central

Boukhris, Marouane; Tomasello, Salvatore Davide; Azzarelli, Salvatore; Elhadj, Zied Ibn; Marzà, Francesco; Galassi, Alfredo Ruggero

2015-01-01

In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization. PMID:26136637

Transarterial Coil-Augmented Onyx Embolization for Brain Arteriovenous Malformation

PubMed Central

Gao, Xu; Liang, Guobiao; Li, Zhiqing; Wang, Xiaogang; Yu, Chunyong; Cao, Peng; Chen, Jun; Li, Jingyuan

2014-01-01

Summary Onyx has been widely adopted for the treatment of arteriovenous malformations (AVMs). However, its control demands operators accumulate a considerable learning curve. We describe our initial experience using a novel injection method for the embolization of AVMs. We retrospectively reviewed the data of all 22 patients with brain AVMs (12 men, 10 women; age range, 12-68 years; mean age, 43.2 years) treated by the transarterial coil-augmented Onyx injection technique. The size of the AVMs ranged from 25 mm to 70 mm (average 35.6 mm). The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. In every case, endovascular treatment (EVT) was completed. A total of 31 sessions were performed, with a mean injection volume of 6.1 mL (range, 1.5-16.0 mL). An average of 96.7% (range 85%-100%) estimated size reduction was achieved, and 18 AVMs could be completely excluded by EVT alone. The results remained stable on follow-up angiograms. A procedural complication occurred in one patient, with permanent mild neurologic deficit. Our preliminary series demonstrated that the coil-augmented Onyx injection technique is a valuable adjunct achieving excellent nidal penetration and improving the safety of the procedure. PMID:24556304

Patient burden and patient preference: comparing magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy.

PubMed

Wiarda, Bart M; Stolk, Mark; Heine, Dimitri G N; Mensink, Peter; Thieme, Mai E; Kuipers, Ernst J; Stoker, Jaap

2013-03-01

We aimed to prospectively determine patient burden and patient preference for magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy in patients with suspected or known Crohn's disease (CD) or occult gastrointestinal bleeding (OGIB).  Consecutive consenting patients with CD or OGIB underwent magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy. Capsule endoscopy was only performed if magnetic resonance enteroclysis showed no high-grade small bowel stenosis. Patient preference and burden was evaluated by means of standardized questionnaires at five moments in time. From January 2007 until March 2009, 76 patients were included (M/F 31/45; mean age 46.9 years; range 20.0-78.4 years): 38 patients with OGIB and 38 with suspected or known CD. Seventeen patients did not undergo capsule endoscopy because of high-grade stenosis. Ninety-five percent (344/363) of the questionnaires were suitable for evaluation. Capsule endoscopy was significantly favored over magnetic resonance enteroclysis and balloon-assisted enteroscopy with respect to bowel preparation, swallowing of the capsule (compared to insertion of the tube/scope), burden of the entire examination, duration and accordance with the pre-study information. Capsule endoscopy and magnetic resonance enteroclysis were significantly preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, and magnetic resonance enteroclysis was significantly preferred over balloon-assisted enteroscopy for bowel preparation, painfulness and burden of the entire examination. Balloon-assisted enteroscopy was significantly favored over magnetic resonance enteroclysis for insertion of the scope and procedure duration. Pre- and post-study the order of preference was capsule endoscopy, magnetic resonance enteroclysis and balloon-assisted enteroscopy. Capsule endoscopy was preferred to magnetic resonance enteroclysis and balloon-assisted enteroscopy

Retrieval of impacted broken balloon by balloon inflation in guiding catheter.

PubMed

Mehta, Vimal; Pandit, Bhagya Narayan; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay; Tyagi, Sanjay

2014-07-01

Broken catheter fragment in a coronary artery during percutaneous coronary angioplasty is a rare complication. It can result in serious problems as a result of thrombus formation and embolization of broken fragment. We report an unusual complication of a broken balloon catheter during angioplasty, which was successfully retrieved by balloon inflation in guiding catheter technique.

Initial experience of coiling cerebral aneurysms using the new Comaneci device

PubMed Central

Lawson, Aimee Louise Deborah; Chandran, Arun; Puthuran, Mani; Goddard, Tony; Nahser, Hans; Patankar, Tufail

2015-01-01

We present our initial patient experience with an innovative temporary bridging device, the Comaneci (Rapid Medical, Israel), to assist in the coiling of cerebral aneurysms. The Comaneci device confers the same benefits as balloon remodeling but without the risks of parent artery occlusion. This alleviates time pressure on the clinician, and could reduce the risk of parent artery thrombosis. Three patients were treated with the Comaneci device. Two patients had acute ruptured posterior communicating aneurysms and one patient was treated electively for a carotico-ophthalmic aneurysm. Excellent occlusion of all three aneurysms was obtained. One patient developed a distal middle cerebral artery clot, that was treated with intravenous aspirin, with minor neurological consequences. These early results show that the Comaneci device can be used to achieve good cerebral aneurysm occlusion. Vessel patency is maintained throughout the procedure with potential advantages over conventional balloon assisted coiling. PMID:26123460

Covered Stent and Coils Embolization of a Pulmonary Artery Pseudoaneurysm After Gunshot Wound

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huet, Nicolas, E-mail: nhuet@chu-grenoble.fr; Rodiere, Mathieu, E-mail: mrodiere@chu-grenoble.fr; Badet, Michel, E-mail: michel.badet@ch-chambery.fr

We report the first case of endovascular covered stent implantation for the treatment of a large pulmonary artery pseudoaneurysm (PAPA) following a right thoracic gunshot wound. After resuscitation and hemodynamic stabilization, a CT angiography was performed to analyze the neck size of the PAPA and its position relative to the branches of the parent artery. Covered stent implantation with additional coil embolization was successfully performed. At the 4-year follow-up, the stents remained patent and there was neither pseudoaneurysm recurrence nor treatment-related complication.

Successful Retreatment of Recurrent Intracranial Vertebral Artery Dissecting Aneurysms After Stent-Assisted Coil Embolization: A Self-Controlled Hemodynamic Analysis.

PubMed

Liu, Jian; Jing, Linkai; Zhang, Ying; Song, Ying; Wang, Yang; Li, Chuanhui; Wang, Yanmin; Mu, Shiqing; Paliwal, Nikhil; Meng, Hui; Linfante, Italo; Yang, Xinjian

2017-01-01

Intracranial vertebral artery dissecting aneurysms (VADAs) tend to recur despite successful stent-assisted coil embolization (SACE). Hemodynamics is useful in evaluating aneurysmal formation, growth, and rupture. Our aim was to evaluate the hemodynamic patterns of the recurrence of VADA. Between September 2009 and November 2013, all consecutive patients with recurrent VADAs after SACE in our institutions were enrolled. Recurrence was defined as recanalization and/or regrowth. We assessed the hemodynamic alterations in wall shear stress (WSS) and velocity after the initial SACE and subsequently after retreatment of the aneurysms that recurred. Five patients were included. After the initial treatment, 3 patients showed recanalization and 2 showed regrowth. In the 2 patients with regrowth, the 2 original aneurysms maintained complete occlusion; however, de novo aneurysm regrowth was confirmed near the previous site. Compared with 3 recanalized aneurysms, the completely occluded aneurysms showed high mean reductions in velocity and WSS after initial treatment (velocity, 77.6% vs. 57.7%; WSS, 74.2% vs. 52.4%); however, WSS remained high at the region near the previous lesion where the new aneurysm originated. After the second retreatment, there was no recurrence in any patient. Compared with the 3 aneurysms that recanalized, the 4 aneurysms that maintained complete occlusion showed higher reductions in velocity (62.9%) and WSS (71.1%). Our series indicated that hemodynamics might have an important role in recurrence of VADAs. After endovascular treatment, sufficient hemodynamic reduction in aneurysm dome, orifice, and parent vessel may be one of the key factors for preventing recurrence in VADAs. Copyright © 2016 Elsevier Inc. All rights reserved.

In Vitro Measurement of Tissue Integrity during Saccular Aneurysm Embolizations for Simulator-Based Training

PubMed Central

Tercero, C.; Ikeda, S.; Ooe, K.; Fukuda, T.; Arai, F.; Negoro, M.; Takahashi, I.; Kwon, G.

2012-01-01

Summary In the domain of endovascular neurosurgery, the measurement of tissue integrity is needed for simulator-based training and for the development of new intravascular instruments and treatment techniques. In vitro evaluation of tissue manipulation can be achieved using photoelastic stress analysis and vasculature modeling with photoelastic materials. In this research we constructed two types of vasculature models of saccular aneurysms for differentiation of embolization techniques according to the respect for tissue integrity measurements based on the stress within the blood vessel model wall. In an aneurysm model with 5 mm dome diameter, embolization using MicroPlex 10 (Complex 1D, with 4 mm diameter loops), a maximum area of 3.97 mm2 with stress above 1 kPa was measured. This area increased to 5.50 mm2 when the dome was touched deliberately with the release mechanism of the coil, and to 4.87 mm2 for an embolization using Micrusphere, (Spherical 18 Platinum Coil). In a similar way trans-cell stent-assisted coil embolization was also compared to human blood pressure simulation using a model of a wide-necked saccular aneurysm with 7 mm diameter. The area with stress above 1kPa was below 1 mm2 for the pressure simulation and maximized at 3.79 mm2 during the trans-cell insertion of the micro-catheter and at 8.92 mm2 during the embolization. The presented results show that this measurement system is useful for identifying techniques compromising tissue integrity, comparing and studying coils and embolization techniques for a specific vasculature morphology and comparing their natural stress variations such as that produced by blood pressure. PMID:23217635

Endovascular MR-guided Renal Embolization by Using a Magnetically Assisted Remote-controlled Catheter System

PubMed Central

Lillaney, Prasheel V.; Yang, Jeffrey K.; Losey, Aaron D.; Martin, Alastair J.; Cooke, Daniel L.; Thorne, Bradford R. H.; Barry, David C.; Chu, Andrew; Stillson, Carol; Do, Loi; Arenson, Ronald L.; Saeed, Maythem; Wilson, Mark W.

2016-01-01

Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a simple endovascular procedure (ie, renal artery embolization) in vivo and to compare with x-ray guidance to determine the value of MR imaging guidance and the specific areas where the MARC system can be improved. Materials and Methods In concordance with the Institutional Animal Care and Use Committee protocol, in vivo renal artery navigation and embolization were tested in three farm pigs (mean weight 43 kg ± 2 [standard deviation]) under real-time MR imaging at 1.5 T. The MARC catheter device was constructed by using an intramural copper-braided catheter connected to a laser-lithographed saddle coil at the distal tip. Interventionalists controlled an in-room cart that delivered electrical current to deflect the catheter in the MR imager. Contralateral kidneys were similarly embolized under x-ray guidance by using standard clinical catheters and guidewires. Changes in renal artery flow and perfusion were measured before and after embolization by using velocity-encoded and perfusion MR imaging. Catheter navigation times, renal parenchymal perfusion, and renal artery flow rates were measured for MR-guided and x-ray–guided embolization procedures and are presented as means ± standard deviation in this pilot study. Results Embolization was successful in all six kidneys under both x-ray and MR imaging guidance. Mean catheterization time with MR guidance was 93 seconds ± 56, compared with 60 seconds ± 22 for x-ray guidance. Mean changes in perfusion rates were 4.9 au/sec ± 0.8 versus 4.6 au/sec ± 0.6, and mean changes in renal flow rate were 2.1 mL/min/g ± 0.2 versus 1.9 mL/min/g ± 0.2 with MR imaging and x-ray guidance, respectively. Conclusion The MARC catheter system is feasible for renal artery catheterization and embolization under real-time MR imaging in vivo, and quantitative physiologic

Endovascular MR-guided Renal Embolization by Using a Magnetically Assisted Remote-controlled Catheter System.

PubMed

Lillaney, Prasheel V; Yang, Jeffrey K; Losey, Aaron D; Martin, Alastair J; Cooke, Daniel L; Thorne, Bradford R H; Barry, David C; Chu, Andrew; Stillson, Carol; Do, Loi; Arenson, Ronald L; Saeed, Maythem; Wilson, Mark W; Hetts, Steven W

2016-10-01

Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a simple endovascular procedure (ie, renal artery embolization) in vivo and to compare with x-ray guidance to determine the value of MR imaging guidance and the specific areas where the MARC system can be improved. Materials and Methods In concordance with the Institutional Animal Care and Use Committee protocol, in vivo renal artery navigation and embolization were tested in three farm pigs (mean weight 43 kg ± 2 [standard deviation]) under real-time MR imaging at 1.5 T. The MARC catheter device was constructed by using an intramural copper-braided catheter connected to a laser-lithographed saddle coil at the distal tip. Interventionalists controlled an in-room cart that delivered electrical current to deflect the catheter in the MR imager. Contralateral kidneys were similarly embolized under x-ray guidance by using standard clinical catheters and guidewires. Changes in renal artery flow and perfusion were measured before and after embolization by using velocity-encoded and perfusion MR imaging. Catheter navigation times, renal parenchymal perfusion, and renal artery flow rates were measured for MR-guided and x-ray-guided embolization procedures and are presented as means ± standard deviation in this pilot study. Results Embolization was successful in all six kidneys under both x-ray and MR imaging guidance. Mean catheterization time with MR guidance was 93 seconds ± 56, compared with 60 seconds ± 22 for x-ray guidance. Mean changes in perfusion rates were 4.9 au/sec ± 0.8 versus 4.6 au/sec ± 0.6, and mean changes in renal flow rate were 2.1 mL/min/g ± 0.2 versus 1.9 mL/min/g ± 0.2 with MR imaging and x-ray guidance, respectively. Conclusion The MARC catheter system is feasible for renal artery catheterization and embolization under real-time MR imaging in vivo, and quantitative physiologic

EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques.

PubMed

Chen, Yen-I; Kunda, Rastislav; Storm, Andrew C; Aridi, Hanaa Dakour; Thompson, Christopher C; Nieto, Jose; James, Theodore; Irani, Shayan; Bukhari, Majidah; Gutierrez, Olaya Brewer; Agarwal, Amol; Fayad, Lea; Moran, Robert; Alammar, Nuha; Sanaei, Omid; Canto, Marcia I; Singh, Vikesh K; Baron, Todd H; Khashab, Mouen A

2018-05-01

EUS-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches, including the direct and balloon-assisted techniques. The aim of this study was to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO. This multicenter, retrospective study involved consecutive patients who underwent EUS-GE with the direct or balloon-assisted technique for GOO (January 2014 to October 2016). The primary outcome was technical success. Secondary outcomes were success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AEs). A total of 74 patients (44.6% women; mean age 63.0 ± 11.7 years) underwent EUS-GE for GOO (direct gastroenterostomy, n = 52; balloon-assisted gastroenterostomy, n = 22). GOO was of malignant and benign etiology in 66.2% and 33.8% of patients, respectively. Technical success was achieved in 94.2% of the direct and 90.9% of the balloon-assisted approach (P = .63). Mean procedure time was shorter with the direct technique (35.7 ± 32.1 minutes vs 89.9 ± 33.3 minutes, P < .001). The clinical success rate was 92.3% for the direct technique and 90.9% for the balloon-assisted modality (P = 1.00), with a mean time to oral intake of 1.32 ± 2.76 days. The AE rate was 6.8% with only 1 severe AE noted. Rate of AEs, postprocedure length of stay, need for reintervention, and survival were similar between the 2 groups. EUS-GE is effective and safe in the management of GOO. The direct technique may be the preferred method given its shorter procedure time when compared with the balloon-assisted approach. Prospective trials are needed to confirm these findings. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Three-dimensional volume-rendering technique in the angiographic follow-up of intracranial aneurysms embolized with coils.

PubMed

Zhou, Bing; Li, Ming-Hua; Wang, Wu; Xu, Hao-Wen; Cheng, Yong-De; Wang, Jue

2010-03-01

The authors conducted a study to evaluate the advantages of a 3D volume-rendering technique (VRT) in follow-up digital subtraction (DS) angiography of coil-embolized intracranial aneurysms. One hundred nine patients with 121 intracranial aneurysms underwent endovascular coil embolization and at least 1 follow-up DS angiography session at the authors' institution. Two neuroradiologists independently evaluated the conventional 2D DS angiograms, rotational angiograms, and 3D VRT images obtained at the interventional procedures and DS angiography follow-up. If multiple follow-up sessions were performed, the final follow-up was mainly considered. The authors compared the 3 techniques for their ability to detect aneurysm remnants (including aneurysm neck and sac remnants) and parent artery stenosis based on the angiographic follow-up. The Kruskal-Wallis test was used for group comparisons, and the kappa test was used to measure interobserver agreement. Statistical analyses were performed using commercially available software. There was a high statistical significance among 2D DS angiography, rotational angiography, and 3D VRT results (X(2) = 9.9613, p = 0.0069) when detecting an aneurysm remnant. Further comparisons disclosed a statistical significance between 3D VRT and rotational angiography (X(2) = 4.9754, p = 0.0257); a high statistical significance between 3D VRT and 2D DS angiography (X(2) = 8.9169, p = 0.0028); and no significant difference between rotational angiography and 2D DS angiography (X(2) = 0.5648, p = 0.4523). There was no statistical significance among the 3 techniques when detecting parent artery stenosis (X(2) = 2.5164, p = 0.2842). One case, in which parent artery stenosis was diagnosed by 2D DS angiography and rotational angiography, was excluded by 3D VRT following observations of multiple views. The kappa test showed good agreement between the 2 observers. The 3D VRT is more sensitive in detecting aneurysm remnants than 2D DS angiography and

Spontaneous Hemothorax in Neurofibromatosis Treated with Percutaneous Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arai, Kazunori; Sanada, Junichiro; Kurozumi, Akiko

We evaluated the effectiveness of transcatheter arterial coil embolization therapy for the treatment of spontaneous hemothorax followed by aneurysm rupture in neurofibromatosis patients. Three patients were treated for massive hemothorax caused by arterial lesions associated with neurofibromatosis. Bleeding episodes were secondary to ascending cervical artery aneurysm and dissection of vertebral artery in 1 patient, and intercostal artery aneurysm with or without arteriovenous fistula in 2 patients. Patients were treated by transarterial coil embolization combined with chest drainage. In 1 patient, the ruptured ascending cervical artery aneurysm was well embolized but, shortly after the embolization, fatal hemorrhage induced by dissection ofmore » the vertebral artery occurred and the patient died. In the other 2 patients, the ruptured intercostal artery aneurysm was well embolized and they were successfully treated and discharged. Transcatheter arterial coil embolization therapy is an effective method for the treatment of spontaneous hemothorax followed by aneurysm rupture in neurofibromatosis patients.« less

Coil occlusion of residual shunts after surgical closure of patent ductus arteriosus.

PubMed

Fujii, Yoko; Keene, Bruce W; Mathews, Kyle G; Atkins, Clarke E; Defrancesco, Teresa C; Hardie, Elizabeth M; Wakao, Yoshito

2006-12-01

OBJECTIVE; To describe use of coil embolization to occlude residual flow through a patent ductus arteriosus (PDA) after incomplete surgical ligation. Clinical study. Dogs (n=4) with continuous murmur after surgical ligation of PDA. After PDA ligation, residual ductal flow through the PDA was visible on color-flow Doppler examination and left ventricular end-diastolic diameter remained increased. Coil embolization by an arterial approach was performed to achieve complete occlusion of the PDA. Embolization coils were delivered without complications and hemodynamically successful occlusion was achieved. Doppler-visible flow resolved in 2 dogs within 3 months after embolization. Left ventricular end-diastolic diameter indexed to body weight decreased in all dogs. Transcatheter coil embolization appears to be a safe and minimally invasive procedure for complete occlusion of residual PDA flow after incomplete surgical ligation. Transcatheter coil embolization should be considered for correction of hemodynamically significant residual shunts in dogs that have incomplete PDA occlusion after open surgical ligation.

Percutaneous Coil Embolization for the Treatment of a Giant Brachial Artery Pseudoaneurym in a Child.

PubMed

Yuksel, Ahmet; Nas, Omer Fatih; Kan, Irem Iris; Tok, Mustafa; Erdogan, Cuneyt

2017-11-01

Brachial artery pseudoaneurysm is a rare phenomenon. When a diagnosis of brachial artery pseudoaneurysm is established, early and appropriate treatment should be performed as soon as possible to prevent possible complications, such as hemorrhage, rupture, and upper limb and finger losses. Open surgical repair is usually the cornerstone of treatment; however, we here report a case of giant brachial pseudoaneurysm in a 2-year-old girl, which was successfully treated with percutaneous coil embolization. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of air removal with extracorporeal balloon inflation on incidence of asymptomatic cerebral embolism during cryoballoon ablation of atrial fibrillation.

PubMed

Tokuda, Michifumi; Matsuo, Seiichiro; Kato, Mika; Sato, Hidenori; Oseto, Hirotsuna; Okajima, Eri; Ikewaki, Hidetsugu; Isogai, Ryota; Tokutake, Kenichi; Yokoyama, Kenichi; Narui, Ryohsuke; Tanigawa, Shin-Ichi; Yamashita, Seigo; Inada, Keiichi; Yoshimura, Michihiro; Yamane, Teiichi

2017-09-01

Asymptomatic cerebral embolism (ACE) is sometimes detected after cryoballoon ablation of atrial fibrillation. The removal of air bubbles from the cryoballoon before utilization may reduce the rate of ACE. This study aims to compare the incidence of ACE between a conventional and a novel balloon massaging method during cryoballoon ablation. Of 175 consecutive patients undergoing initial cryoballoon ablation of paroxysmal atrial fibrillation, 60 (34.3%) patients underwent novel balloon massaging with extracorporeal balloon inflation in saline water (group N) before the cryoballoon was inserted into the body. The remaining 115 (65.7%) patients underwent conventional balloon massaging in saline water while the balloon remained folded (group C). Of those, 86 propensity score-matched patients were included. The baseline characteristics were similar between the 2 groups. In group N, even after balloon massaging in saline water was carefully performed, multiple air bubbles remained on the balloon surface when the cryoballoon was inflated in all cases. Postprocedural cerebral magnetic resonance imaging detected ACE in 14.0% of all patients. The incidence of ACE was significantly lower in group N than in group C (4.7% vs 23.3%; P = .01). According to multivariable analysis, the novel method was the sole factor associated with the presence of ACE (odds ratio 0.161; 95% confidence interval 0.033-0.736; P = .02). Preliminary removal of air bubbles in heparinized saline water with extracorporeal balloon inflation reduced the incidence of ACE. Since conventional balloon massaging failed to remove air bubbles completely, this novel balloon massaging method should be recommended before cryoballoon utilization. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Protective Embolization of the Gastroduodenal Artery with a One-HydroCoil Technique in Radioembolization Procedures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lopez-Benitez, R., E-mail: Ruben.lopez@insel.ch; Hallscheidt, P.; Kratochwil, C.

2013-02-15

Protective occlusion of the gastroduodenal artery (GDA) is required to avoid severe adverse effects and complications in radioembolization procedures. Because of the expandable features of HydroCoils, our goal was to occlude the GDA with only one HydroCoil to provide particle reflux protection. Twenty-three subjects with unresectable liver tumors, who were scheduled for protective occlusion of the GDA before radioembolization therapy, were included. The primary end point was to achieve a proximal occlusion of the GDA with only one detachable HydroCoil. Evaluated parameters were duration of deployment, and early (during the intervention) and late (7-21 days) occlusion rates of GDA. Secondarymore » end points included complete duration of the intervention, amount of contrast medium used, fluoroscopy rates, and adverse effects. In all cases, the GDA was successfully occluded with only one HydroCoil. The selected diameter/length range was 4/10 mm in 2 patients, 4/15 mm in 6 patients, and 4/20 mm in 15 patients. HydroCoils were implanted, on average, 3.75 mm from the origin of the GDA (range 1.5-6.8 mm), with an average deployment time of 2:47 (median 2:42, range 2:30-3:07) min. In 21 (91%) of 23 patients, a complete occlusion of the GDA was achieved during the first 30 min after the coil implantation; however, in all patients, a late occlusion of the GDA was present after 6 to 29 days. No clinical or technical complications were reported. We demonstrated that occlusion of the GDA with a single HydroCoil is a safe procedure and successfully prevents extrahepatic embolization before radioembolization.« less

Temporary balloon occlusion of the common hepatic artery for administration of yttrium-90 resin microspheres in a patient with patent hepatoenteric collaterals.

PubMed

Mahvash, Armeen; Zaer, Navid; Shaw, Colette; Chasen, Beth; Avritscher, Rony; Murthy, Ravi

2012-02-01

The most common serious complication of yttrium-90 ((90)Y) therapy is gastrointestinal ulceration caused by extrahepatic microsphere dispersion. The authors describe the use of a balloon catheter for temporary occlusion of the common hepatic artery to reverse hepatoenteric flow for lobar administration of resin microspheres when coil embolization of a retroportal artery was impossible. At 9 months after treatment, the patient had no gastrointestinal side effects and showed a partial response. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

Novel application of a balloon-anchoring technique for the realignment of a prolapsed pipeline embolization device: a technical report.

PubMed

Crowley, R Webster; Abla, Adib A; Ducruet, Andrew F; McDougall, Cameron G; Albuquerque, Felipe C

2014-07-01

Flow-diverting stents represent a substantial advancement in the treatment of cerebral aneurysms. They can, however, be associated with unique complications that may require management through adjunctive techniques. To present a technical report of a salvage technique used to realign a prolapsed Pipeline Embolization Device (PED) during the treatment of a giant internal carotid artery (ICA) aneurysm. A patient in his late 70s with an incidental giant supraclinoid ICA aneurysm presented for endovascular consideration. Treatment was planned using the PED. Following placement of the device there were two focal areas of incomplete expansion and balloon angioplasty was performed. This manipulation resulted in foreshortening of the distal aspect of the PED which caused the device to prolapse into the aneurysm. After multiple unsuccessful attempts to regain distal access, a salvage technique was attempted in which a balloon was inflated in the middle cerebral artery and, by applying traction, the PED was realigned with the parent artery. After the PED was realigned, direct distal catheter access was achieved and a second Pipeline device was deployed, successfully covering the aneurysm neck with resultant flow stasis. The patient had no postoperative issues and was discharged 2 days later without deficit. The balloon-anchoring technique was successfully used to realign a PED that had prolapsed into a giant ICA aneurysm. This maneuver prevented potentially disastrous complications and allowed the satisfactory completion of the aneurysm embolization. This represents a useful salvage technique that should be considered when encountering a prolapsed stent. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mycotic Celiac Artery Aneurysm Following Infective Endocarditis: Successful Treatment Using N-butyl Cyanoacrylate with Embolization Coils

PubMed Central

Ueda, Toshihiko; Koizumi, Jun; Cho, Yoshinori; Shimura, Shinichiro; Furuya, Hidekazu; Myojin, Kazunori; Okada, Kimiaki; Tanaka, Chiharu

2012-01-01

Mycotic celiac artery aneurysm following infective endocarditis is extremely rare and, to our knowledge, only four cases have been reported in the literature to date. We describe the case of a 60 year-old man who developed a mycotic aneurysm of the celiac artery, which was detected by computed tomography (CT) following an episode of infective endocarditis. He successfully underwent endovascular isolation and packing of the aneurysm using N-butyl cyanoacrylate (NBCA) with embolization coils. PMID:23555513

Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms.

PubMed

Jeon, Pyoung; Kim, Byung Moon; Kim, Dong Joon; Kim, Dong I K; Park, Keun Young

2014-09-01

This study aimed to evaluate clinical and angiographic outcomes of Y-configuration double-stent-assisted (Y-stent) coiling using two closed-cell stents for wide-necked basilar tip aneurysm (BTA). A total of 25 patients underwent Y-stent coiling using two closed-cell stents as a first-time treatment in 18 (3 ruptured) BTAs, retreatment in 2 BTAs and as a third treatment in 5 wide-necked BTAs. Clinical and angiographic outcomes were evaluated retrospectively. Treatment-related complications were three (12.0 %) thromboembolic infarctions due to two acute in-stent thromboses and one embolism. Twenty-two (88 %) patients had favorable outcomes (modified Rankin scale score [mRS], 0-2) during the follow-up period (mean, 30 months; range, 6-54 months). Two patients died: one from initial subarachnoid hemorrhage and the other from intracerebral hemorrhage due to underlying Moyamoya disease. Post-treatment angiograms showed complete occlusion in nine aneurysms, residual neck in 11 aneurysms and residual sac in five aneurysms. Follow-up angiograms were available at least once between 5 to 34 months (mean, 16 months) in 21 patients. Nineteen patients showed improved or stable states (complete occlusion, n = 17; residual neck, n = 2). Major recurrences occurred in two BTAs (9.5 %). Those two major recurrent aneurysms had been large-sized aneurysms at the initial coiling procedure. Both showed not only coil compaction but also progressive growth to giant-sized aneurysms and intra-aneurysmal thrombus formation at the Y-stent coiling as a third-time treatment. Y-stent coiling using two closed-cell stents is a safe and durable treatment option for wide-necked BTA, but may have limited efficacy for large/giant sized and thrombosed aneurysms.

Endovascular rescue method for undesirably stretched coil.

PubMed

Cho, Jae Hoon

2014-10-01

Undesirable detachment or stretching of coils within the parent artery during aneurysm embolization can be related with thrombus formation, which can be caused occlusion of parent artery or embolic event(s). To escape from this situation, several rescue methods have been reported. A case with undesirably stretched coil in which another rescue method was used, is presented. When the stretched coil is still located in the coil delivery microcatheter, the stretched coil can be removed safely using a snare and a handmade monorail microcatheter. After a snare is lodged in the handmade monorail microcatheter, the snare is introduced over the coil delivery micorcatheter and located in the distal part of the stretched coil. After then, the handmade monorail microcatheter captures the stretched coil and the snare as one unit. This technique using a handmade monorail microcatheter and a snare can be a good rescue modality for the undesirably stretched coil, still remained within the coil delivery microcatheter.

Endovascular Rescue Method for Undesirably Stretched Coil

PubMed Central

2014-01-01

Undesirable detachment or stretching of coils within the parent artery during aneurysm embolization can be related with thrombus formation, which can be caused occlusion of parent artery or embolic event(s). To escape from this situation, several rescue methods have been reported. A case with undesirably stretched coil in which another rescue method was used, is presented. When the stretched coil is still located in the coil delivery microcatheter, the stretched coil can be removed safely using a snare and a handmade monorail microcatheter. After a snare is lodged in the handmade monorail microcatheter, the snare is introduced over the coil delivery micorcatheter and located in the distal part of the stretched coil. After then, the handmade monorail microcatheter captures the stretched coil and the snare as one unit. This technique using a handmade monorail microcatheter and a snare can be a good rescue modality for the undesirably stretched coil, still remained within the coil delivery microcatheter. PMID:25371791

The nature of thrombosis induced by platinum and tungsten coils in saccular aneurysms.

PubMed

Byrne, J V; Hope, J K; Hubbard, N; Morris, J H

1997-01-01

To compare the efficacy and biocompatability of electrolytic and mechanically detachable embolization coils of two metal types. Experimental saccular aneurysms in pigs were used to assess embolization induced by platinum or tungsten coils. Longitudinal angiographic and histologic studies were performed on treated and untreated (control) aneurysms to compare thrombosis and cellular responses after embolization with electrolytically detachable platinum coils and with mechanically detached tungsten coils. Fewer tungsten than platinum coils were needed to induce thrombosis. The inflammatory response within the aneurysmal lumen was more florid in embolized aneurysms than in control aneurysms. No difference was found in the timing or extent of accumulation of eosinophils, lymphocytes, or polymorphs between the two coils used. Giant cell responses were more marked in treated aneurysms; tungsten coils more than platinum coils. The amount of collagen and fibrosis present increased over the study period and was similar in treated and control aneurysms. The coil type influenced the initial cellular response but had little effect on the rate or degree to which blood clot within the aneurysm was replaced by fibrous tissue.

Long-term angiographic outcome of stent-assisted coiling compared to non-assisted coiling of intracranial saccular aneurysms

PubMed Central

Ozretić, David; Radoš, Marko; Pavliša, Goran; Poljaković, Zdravka

2015-01-01

Aim To compare angiographic result at long-term follow-up, and rates of progressive occlusion, recurrence, and retreatment of stent-assisted coiled (SAC) and non-assisted coiled (NAC) intracranial saccular aneurysms. Methods Retrospective evaluation of department records identified 260 patients with 283 saccular intracranial aneurysms who had long-term angiographic follow-up (more than 12 months) and were successfully treated with SAC (89 aneurysms) or NAC (194 aneurysms) at the University Hospital Center Zagreb from June 2005 to July 2012. Initial and control angiographic results in both groups were graded using Roy/Raymond scale, converted to descriptive terms, and the differences between them were evaluated for statistical significance. A multivariate analysis was performed to identify factors related to progression of aneurysm occlusion and recurrence at follow-up, and those related to aneurysm retreatment. Results There were more progressively occluded aneurysms in SAC group (38 of 89 aneurysms, 42.7%) than in NAC group (46 of 194, 23.7%) (P = 0.002), but there were no significant differences in the rates of recanalization, regrowth, and stable result. Multivariate logistic regression identified the use of stent as the most important factor associated with progressive occlusion (P = 0.015, odds ratio 2.22, 95% confidence interval 1.17-4.21), and large aneurysm size and posterior circulation location as most predictive of aneurysm recurrence and retreatment. Conclusion The use of stent is associated with delayed occlusion of initially incompletely coiled aneurysms during follow-up, but does not reduce the rate of recurrence and retreatment compared to coiling alone. Long-term angiographic follow-up is needed for both SAC and NAC aneurysms. PMID:25727039

Cerebral Fat Embolism After Video-Assisted Thoracic Surgery.

PubMed

Scarpino, Maenia; Lanzo, Giovanni; Cappelli, Francesco; Moretti, Marco; Misuri, Gianni; Voltolini, Luca; Pistolesi, Massimo; Amantini, Aldo; Grippo, Antonello

2016-11-01

Cerebral fat embolism (CFE) is an uncommon disease occurring mainly after traumatic lower limb long bone fractures. A 64-year-old woman with pneumonia and bilateral pleural effusion underwent video-assisted thoracic surgery (VATS). After 3 days, the patient had an acute decrease in consciousness level followed by the onset of seizures and right hemiparesis. Brain computed tomography and magnetic resonance imaging showed findings suggestive of CFE. CFE occurring after an uncommon nontraumatic cause of fat embolism, such as VATS, is a rare clinical event whose diagnosis could be challenging. Neuroimaging can hasten diagnosis and prevent other unnecessary investigations and treatments. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A Less Invasive Strategy for Ruptured Cerebral Aneurysms with Intracerebral Hematomas: Endovascular Coil Embolization Followed by Stereotactic Aspiration of Hematomas Using Urokinase

PubMed Central

Kim, Sang Heum; Kong, Min Ho

2017-01-01

Objective Aneurysm clipping and simultaneous hematoma evacuation through open craniotomy is traditionally recommended for ruptured cerebral aneurysms accompanied by intracerebral or intrasylvian hemorrhages. We report our experience of adapting a less invasive treatment strategy in poor-grade patients with intracerebral or intrasylvian hemorrhages associated with ruptured cerebral aneurysms, where the associated ruptured cerebral aneurysms were managed by endovascular coil embolization, followed by stereotactic aspiration of hematomas (SRH) using urokinase. Materials and Methods We retrospectively analyzed 112 patients with ruptured cerebral aneurysms. There were accompanying intracerebral or intrasylvian hemorrhages in 36 patients (32.1%). The most common site for these ruptured aneurysms was the middle cerebral artery (MCA) (n = 15; 41.6%). Endovascular coil embolization followed by SRH using urokinase was performed in 9 patients (25%). Results In these 9 patients, the most common site of aneurysms was the MCA (n = 3; 33.4%); the hematoma volume ranged from 19.24 to 61.68 mL. Four patients who were World Federation of Neurological Surgeons (WFNS) grade-IV on admission, achieved favorable outcomes (Glasgow Outcome Score [GOS] 4 or 5) at 6-months postoperatively. In the five patients who were WFNS grade-V on admission, one achieved a favorable outcome, whereas 4 achieved GOS scores of 2 or 3, 6-months postoperatively. There was no mortality. Conclusion If immediate hematoma evacuation is not mandated by clinical or radiological signs of brain herniation, a less invasive strategy, such as endovascular coil embolization followed by SRH using urokinase, may be a good alternative in poor-grade patients with intracerebral or intrasylvian hemorrhages associated with ruptured cerebral aneurysms. PMID:29152466

Radiation exposure, and procedure and fluoroscopy times in endovascular treatment of intracranial aneurysms: a methodological comparison.

PubMed

Cheung, Nicholas K; Boutchard, Michelle; Carr, Michael W; Froelich, Jens J

2018-01-09

Limited data are available for radiation exposure, and procedure and fluoroscopy times in neuroendovascular treatment (NET) strategies. This study establishes and compares related parameters between coil embolization (COIL), balloon assisted coil embolization (BAC), stent assisted coil embolization (SAC), and flow diverting technology (FDT) in NET of intracranial aneurysms. Between 2010 and 2017, 249 consecutive intracranial aneurysms underwent NET at a single center, all performed by the same operator. Dose area products (DAP), and procedure and fluoroscopy times were recorded and compared between COIL, BAC, SAC, and FDT techniques. Differences in parameters between cohorts were analyzed for significance using the Mann-Whitney U test, unpaired t test and χ 2 test. Additional subgroup analysis was performed for emergency and elective cases. 83 aneurysms were treated with COIL (33%), 72 with BAC (29%), 61 with SAC (25%), and 33 with FDT (13%). Baseline characteristics were largely similar within these groups (P>0.05). Among COIL, BAC, and FDT cohorts, no significant difference was found for mean DAP, or procedure and fluoroscopy times (P>0.05). However, compared with all other cohorts, SAC was associated with a significantly higher DAP and longer procedure and fluoroscopy times (P<0.005). No significant difference was recorded for emergency and elective case subgroups. Compared with other NET strategies, SAC was associated with a significantly higher DAP, and longer procedure and fluoroscopy times. This study provides an initial dataset regarding radiation exposure, and procedure and fluoroscopy times for common NET, and may assist ALARA (As Low As Reasonably Achievable) principles to reduce radiation risks. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Embolization of the Systemic Arterial Supply via a Detachable Silicon Balloon in a Child with Scimitar Syndrome

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sahin, Sinan; Celebi, Ahmet; Yalcin, Yalim

2005-04-15

Scimitar syndrome is a rare congenital disorder. It is characterized by partial or total abnormal venous drainage of the right lung into the inferior vena cava, which is often associated with anomalous systemic arterial supply to the right lung, congenital cardiac anomalies, hypoplasia of the right lung and bronchial anomalies. Symptoms depend on the degree of the shunt and severity of the associated anomalies, which determine the treatment. We present a 6-year-old boy who was diagnosed as having the adult form of scimitar syndrome during evaluation for recurrent pulmonary infections, and underwent embolization with a detachable silicon balloon of themore » anomalous systemic arterial supply from the abdominal aorta to the right lower lung lobe. Successful elective surgery was performed 6 months later, in which right pulmonary veins were directed to the left atrium using a Gore-Tex patch by creating an intra-atrial tunnel. The patient has been symptom-free period during 6 months of follow-up, which supports the idea that recurrent pulmonary infections can be eliminated by embolization of the anomalous arterial supply.« less

Transarterial treatment of direct carotico-cavernous fistulas with coils and Onyx.

PubMed

Ramalingaiah, Arvinda Hanumanthapura; Prasad, Chandrajit; Sabharwal, Paramveer Singh; Saini, Jitender; Pandey, Paritosh

2013-10-01

The purpose of this study was to evaluate the role of combination of liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) and detachable coils in the treatment of direct carotico-cavernous fistulas (CCFs). We prospectively collected clinical and radiological data of all patients who underwent embolization of direct CCFs at our institution over a period of 21 months. The clinical parameters, angioarchitecture, presence of cortical venous reflux, volume of Onyx used, number of coils used, extent of embolization and complications were recorded. A total of 21 consecutive patients (18 men and 3 women, 14 to 48 years) with direct CCF underwent embolization with a combination of coils and Onyx. Embolization was done through the arterial route in all cases. Complete obliteration of the fistula was achieved in 19 of 21 cases. Cast embolization in middle cerebral artery occurred in one patient; however, the cast was completely retrieved with Solitaire device, and the patient did not have any neurological deficit. All completely treated patients reported relief of symptoms at varying intervals. At 6-month follow-up, none of the patients with complete occlusion of the fistula showed any recurrence. The adjuvant use of Onyx with detachable coils in direct CCF through the arterial route is a safe and effective method for embolization with immediate and complete occlusion of the fistula. To the best of our knowledge, this is the first case series of demonstration of arterial use of Onyx with coils in the treatment of direct CCFs.

Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mitra, Kakali; Prabhudesai, Vikramaditya; James, R. Lester

Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioningmore » kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.« less

Results of coil closure of patent ductus arteriosus using a tapered tip catheter for enhanced control.

PubMed

Devanagondi, Rajiv; Latson, Larry; Bradley-Skelton, Sharon; Prieto, Lourdes

2016-08-01

This article describes the efficacy and embolization rates of coil delivery via modified vertebral catheter (MVC) for patent ductus arteriosus (PDA) closure. Various techniques have been devised to enhance coil control and prevent embolization during PDA closure. Since 1995, they have delivered coils via tapered vertebral catheters for improved coil control. Catheterization reports, angiograms, and echocardiograms were reviewed for patients with PDA occlusion via MVC from 2001 to 2014. Residual shunting was determined by angiography and echocardiogram within 24 hr post-procedure. Procedural success was defined as ≤ trivial angiographic and echocardiographic shunt, and no aortic nor LPA obstruction, after final coil delivery. About 125 coil occlusions were attempted in 103 patients. Minimal PDA diameter was 2 (0.6-6) mm. Four coils were removed with a snare/bioptome due to aortic/LPA obstruction following release. Seven were malpositioned while still held by the MVC of which three embolized while attempting withdrawal. Five embolized after full release from the MVC. The embolization rate was 6.4%. Embolizations were more likely in PDAs ≥ 2.5 mm (P < 0.05). Ultimately, 98/103 PDAs were occluded using the MVC. No patient had greater trivial residual shunt or aortic/LPA obstruction for an overall success rate of 95%. For PDAs < 2.5 mm the success rate was 97%. Coil delivery via MVC was safe and effective for small PDAs. While fully controlled release and retrieval devices are now available for PDA closure with lower embolization rates, coil occlusion by MVC should still be considered for small PDAs, especially in resource limited regions. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula.

PubMed

Tercan, Fahri; Koçyiğit, Ali; Güney, Bünyamin

2016-09-01

The present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses. The cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery. Of 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41-78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery. In palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

Emergent Embolization of Arterial Bleeding after Vacuum-Assisted Breast Biopsy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org; Epelboym, Yan, E-mail: yan.epelboym@mssm.edu; Siegelbaum, Robert H., E-mail: rhsiegelbaum@gmail.com

2012-02-15

Vacuum-assisted core breast biopsy has become important in evaluating patients with suspicious breast lesions. It has proven to be a relatively safe procedure that in rare cases can result in vascular complications. These are the first reported cases of transcatheter embolization of uncontrolled breast hemorrhage after vacuum-assisted breast biopsy. With increased use of biopsy and larger-gauge devices, breast imaging groups may consider embolotherapy as a safe alternative for treatment of hemorrhage in a select group of patients.

Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation

PubMed Central

Wan, Jun; Gu, Weijin; Zhang, Xiaolong; Geng, Daoying; Lu, Gang; Huang, Lei; Zhang, Lei; Ge, Liang; Ji, Lihua

2014-01-01

Background Ruptured intracranial aneurysm (ICA) with bleb formation (RICABF) is a special type of ruptured ICA. However, the exact role and effectiveness of endovascular coil embolization (ECE) in RICABF is unknown. We aimed to investigate the effectiveness and safety of ECE of aneurysm neck for RICABF treatment. Material/Methods We retrospectively assessed consecutive patients who were hospitalized in our endovascular intervention center between October 2004 and May 2012. Overall, 86 patients underwent ECE of aneurysm neck for 86 RICABF. Treatments outcomes included secondary rupture/bleeding rate, aneurysm neck embolization rate, residual/recurrent aneurysm, intraoperative incidents, and post-embolization complications, as well as improvements in the Glasgow outcome scale (extended) (GOS-E). Results Complete occlusion was achieved in 72 aneurysms (72/86, 83.7%), while 12 aneurysms (12/86, 14.0%) had a residual neck, and 2 aneurysms (2/86, 2.3%) had a residual aneurysm. The postoperative GOS-E was 3 in 3 patients (3.5%), 4 in 10 patients (11.6%), and 5 in 73 patients (84.9%). Follow-up angiography was performed in all patients (mean 9.0 months, interquartile range of 9.0). Recurrence was found in 3 patients (3/86, 3.5%). No aneurysm rupture or bleeding was reported. Conclusions Our mid-term follow-up study showed that ECE of aneurysm neck was an effective and safe treatment modality for RICABF. The long-term effectiveness and safety of this interventional radiology technique need to be investigated in prospective and comparative studies. PMID:24986761

Safety of Radioembolization with {sup 90}Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paprottka, P. M., E-mail: philipp.paprottka@med.lmu.de, E-mail: philipp.paprottka@med.uni-muenchen.de; Paprottka, K. J., E-mail: karolin.paprottka@med.lmu.de; Walter, A., E-mail: alexandra.Walter@campus.lmu.de

2015-08-15

PurposeTo evaluate the safety of radioembolization (RE) with {sup 90}Yttrium ({sup 90}Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels.Materials and MethodsEarly and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group).ResultsClinically relevant late toxicities (≥Grade 3) were observed in 1 % of our overall cohort. The no-coiling group had significantlymore » less “any” (P = 0.0001) or “clinically relevant” (P = 0.0003) early toxicity. There was no significant difference (P > 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures.ConclusionRE with {sup 90}Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.« less

Crural artery traumatic injuries: treatment with embolization.

PubMed

Lopera, Jorge E; Suri, Rajeev; Cura, Marco; Kroma, Ghazwan; El-Merhi, Fadi

2008-01-01

The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15-56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1-180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.

Crural Artery Traumatic Injuries: Treatment with Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lopera, Jorge E., E-mail: Lopera@uthscssa.edu; Suri, Rajeev; Cura, Marco

The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15-56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulasmore » (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1-180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.« less

Pulmonary Angiography and Embolization for Severe Hemoptysis Due to Cavitary Pulmonary Tuberculosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sanyika, Charles; Corr, Peter; Royston, Duncan

1999-11-15

Purpose: To identify the role of pulmonary angiography in the diagnosis and treatment of severe hemoptysis due to cavitary pulmonary tuberculosis. Methods: Selective pulmonary angiography was performed on eight patients with severe hemoptysis uncontrolled by previous bronchial and systemic arterial embolization. Results: Three (38%) patients had Rasmussen aneurysms, which were successfully embolized with steel coils. Five patients demonstrated pulmonary arterial hypoperfusion in the diseased lung. Conclusions: We recommend pulmonary angiography in cavitary tuberculous patients with severe hemoptysis who do not respond to systemic arterial embolization. Rasmussen aneurysms are effectively treated by steel coil occlusion.

Carotid and vertebral artery sacrifice with a combination of Onyx and coils: technical note and case series.

PubMed

Chalouhi, Nohra; Starke, Robert M; Tjoumakaris, Stavropoula I; Jabbour, Pascal M; Gonzalez, L Fernando; Hasan, David; Rosenwasser, Robert H; Dumont, Aaron S

2013-08-01

Permanent vessel sacrifice has become a routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. The purpose of this study is to describe a new technique for carotid and vertebral artery sacrifice using a combination of Onyx and coils and to assess its feasibility, safety, and efficacy. The technique consists of deploying a few coils in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. A total of 41 patients underwent carotid/vertebral artery sacrifice using this technique in our institution. A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial sacrifice. The mean number of coils used was 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). No patient developed a recurrence during the follow-up period (mean, 14 months). Parent vessel sacrifice with a combination of Onyx and coils appears to be feasible, safe, and effective and may be an alternative to the traditional deconstruction technique with coils alone. The risk of thromboembolism exists with this technique, but there were no instances of Onyx migration.

Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique.

PubMed

Sharma, Sam K; Hiratsuka, Takahiro; Hara, Hisashi; Milsom, Jeffrey W

2018-06-01

 Complex colorectal polyps or those positioned in difficult anatomic locations are an endoscopic therapeutic challenge. Underwater endoscopic submucosal dissection (UESD) is a potential technical solution to facilitate efficient polyp removal. In addition, endoscopic tissue retraction has been confined to limited methods of varying efficacy and complexity. The aim of this study was to evaluate the efficiency of a unique UESD technique for removing complex polyps using double-balloon-assisted retraction (R).  Using fresh ex-vivo porcine rectum, 4-cm polyps were created using electrosurgery and positioned at "6 o'clock" within an established ESD model. Six resections were performed in each group. Underwater techniques were facilitated using a novel double-balloon platform (Dilumen, Lumendi, Westport, Connecticut, United States).  UESD-R had a significantly shorter total procedural time than cap-assisted ESD and UESD alone (24 vs. 58 vs. 56 mins). UESD-R produced a dissection time on average of 5 minutes, attributed to the retraction provided. There was also a subjective significant reduction in electrosurgical smoke with the underwater techniques contributing to improved visualization.  Here we report the first ex-vivo experience of a unique double-balloon endoscopic platform optimized for UESD with tissue traction capability. UESD-R removed complex lesions in significantly shorter time than conventional means. The combined benefits of UESD and retraction appeared to be additive when tackling complex polyps and should be studied further.

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tercan, Fahri, E-mail: ftercan@yahoo.com; Koçyiğit, Ali, E-mail: alkoc@yahoo.com; Güney, Bünyamin

PurposeThe present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.MethodThe cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery.ResultsOf 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (rangemore » 41–78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery.ConclusionIn palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.« less

Feasibility and Safety of Distal and Proximal Combined Endovascular Approach with a Balloon-Guiding Catheter for Subclavian Artery Total Occlusion.

PubMed

Yamamoto, Taiki; Ohshima, Tomotaka; Ishikawa, Kojiro; Goto, Shunsaku; Tamari, Yosuke

2017-04-01

Symptomatic subclavian artery total occlusion is widely treated with an endovascular procedure that often results in distal vertebral artery embolism. Therefore, protection devices are important. Establishing a filter or balloon device in the vertebral artery can protect against this distal embolism. However, the use of embolic protection devices is not easy, and it makes the procedure more complicated. Here, we report a case of symptomatic subclavian artery total occlusion that was treated successfully with a balloon-guiding catheter and the pull-through technique. A 67-year-old man developed intermittent motor weakness in his left arm. Aortic angiography demonstrated a complete occlusion of the left proximal subclavian artery and a retrograde flow through the left vertebral artery to the distal brachial artery. In this case, we used a balloon-guiding catheter and the pull-through technique to prevent distal embolism. The balloon-guiding system was useful not only for embolic protection but also for scaffold during excavation and for the centering effect against invisible vessels. The pull-through technique enabled our devices to deliver easily and smoothly. The patient was treated successfully without complications. The distal and proximal combined endovascular treatment with a transbrachial balloon-guiding catheter is a beneficial treatment option for patients with subclavian artery total occlusion. Copyright © 2017 Elsevier Inc. All rights reserved.

Cerebral Arterial Gas Embolism During Upper Endoscopy.

PubMed

Eoh, Eun J; Derrick, Bruce; Moon, Richard

2015-09-15

Arterial gas embolism can be caused by direct entry of gas into systemic arteries or indirectly by venous-to-arterial shunting. Although arterial gas embolism is rare, most documented cases are iatrogenic, resulting from the entry of gas during procedures that involve direct vascular cannulation or intracavitary air insufflation. Of the 18 identified case reports of air embolism during endoscopy, 11 cases describe findings of cerebral arterial gas embolism during upper endoscopy. Only 1 of these occurred during endoscopic balloon dilation of an esophageal stricture. We report a rare case of cerebral arterial gas embolism in a 64-year-old woman, which occurred during endoscopic dilation of an esophageal stricture and was subsequently treated with hyperbaric oxygen therapy. In this case report, we explore the possible etiologies, clinical workup, and therapeutic management of cerebral artery gas embolisms. Hyperbaric oxygen therapy is the treatment of choice for cerebral arterial gas embolism, with earlier treatments resulting in better outcomes.

Comparison of Two Endovascular Steerable Robotic Catheters for Percutaneous Robot-Assisted Fibroid Embolization.

PubMed

Del Giudice, C; Pellerin, O; Nouri Neville, M; Amouyal, G; Fitton, I; Leré-Déan, C; Sapoval, M

2018-03-01

To compare outcomes of percutaneous robot-assisted uterine fibroid embolization (UFE) using two different endovascular robotic catheters. Twenty-one patients with a symptomatic uterine fibroid were prospectively enrolled in a single-center study to be treated with a percutaneous robot-assisted embolization using the Magellan system. Fourteen patients were treated using a first generation steerable robotic catheter, version 1.0 (group 1), and seven were treated using the new version 1.1 (group 2). Demographic, pathologic, and procedural variables were recorded. Dose Area Product (DAP) and physician equivalent doses were registered for each procedure. Procedural related complications and clinical midterm outcomes were also evaluated. Successful robot-assisted UFE was obtained in eight patients (57.1%) in group 1 and 7 patients (100%) in group 2 (p = 0.01). A successful robot-assisted catheterization of the internal iliac artery anterior branch was performed in all patients of both groups. Median selective target vessel catheterization time was 21.0 ± 12.8 vs 13.4 ± 7 min (p = 0.04) and total fluoroscopy time was 30.3 ± 11.2 vs 19.3 ± 5.9 min, respectively, in group 1 and 2. Mean DAP decreased from 18472.6 ± 15622 to 5469.1 ± 4461.0 cGy·cm 2 (p = 0.04). All patients obtained a symptoms relief at 6 months follow-up. Robot-assisted uterine fibroid embolization is safe and effective. New version of steerable robotic catheter allows performing a faster procedure without related adverse events compared to old version.

Paraspinal arteriovenous malformation Onyx embolization via an Ascent balloon.

PubMed

Martínez-Galdámez, Mario; Rodriguez-Arias, Carlos A; Utiel, Elena; Arreba, Emilio; Gonzalo, Miguel; Arenillas, Juan F

2013-03-22

Purely extradural lumbar spinal arteriovenous malformations (AVMs) are rare lesions that have diverse presentations and imaging features. The treatment of a symptomatic high flow paraspinal AVM with multiple feeders remains a challenge. We report the first use of an Ascent balloon (dual lumen balloon catheter) to deliver Onyx with excellent penetration to a paraspinal AVM.

Paraspinal arteriovenous malformation Onyx embolization via an Ascent balloon.

PubMed

Martínez-Galdámez, Mario; Rodriguez-Arias, Carlos A; Utiel, Elena; Arreba, Emilio; Gonzalo, Miguel; Arenillas, Juan F

2014-04-01

Purely extradural lumbar spinal arteriovenous malformations (AVMs) are rare lesions that have diverse presentations and imaging features. The treatment of a symptomatic high flow paraspinal AVM with multiple feeders remains a challenge. We report the first use of an Ascent balloon (dual lumen balloon catheter) to deliver Onyx with excellent penetration to a paraspinal AVM.

Paraspinal arteriovenous malformation Onyx embolization via an Ascent balloon

PubMed Central

Martínez-Galdámez, Mario; Rodriguez-Arias, Carlos A; Utiel, Elena; Arreba, Emilio; Gonzalo, Miguel; Arenillas, Juan F

2013-01-01

Purely extradural lumbar spinal arteriovenous malformations (AVMs) are rare lesions that have diverse presentations and imaging features. The treatment of a symptomatic high flow paraspinal AVM with multiple feeders remains a challenge. We report the first use of an Ascent balloon (dual lumen balloon catheter) to deliver Onyx with excellent penetration to a paraspinal AVM. PMID:23524491

Coil Embolization of Pancreaticoduodenal Artery Aneurysms Associated with Celiac Artery Stenosis: Report of Three Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ikeda, Osamu, E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka

2007-06-15

Aneurysms of the pancreaticoduodenal artery are rare. Degeneration of pancreaticoduodenal arcade vessels due to these aneurysms is associated with celiac artery stenosis or occlusion. Untreated lesions enlarge progressively and may rupture spontaneously. As the location of aneurysms of pancreaticoduodenal arcade vessels renders their surgical extirpation a challenge, we examined whether endovascular techniques offer a treatment alternative. We report on 3 patients with aneurysms of the pancreaticoduodenal arcade vessels and concomitant celiac artery stenosis/occlusion due to compression by the median arcuate ligament or chronic pancreatitis. All patients were treated by percutaneous coil embolization of the aneurysm. The aneurysmal sac was successfullymore » excluded and the native circulation was preserved. Endovascular surgery can be used to treat these aneurysms safely and permits retention of the native circulation.« less

Embolization of the Gastroduodenal Artery Before Selective Internal Radiotherapy: A Prospectively Randomized Trial Comparing Platinum-Fibered Microcoils with the Amplatzer Vascular Plug II

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pech, Maciej, E-mail: maciej.pech@med.ovgu.de; Kraetsch, Annett; Wieners, Gero

2009-05-15

The Amplatzer Vascular Plug II (AVP II) is a novel device for transcatheter vessel occlusion, for which only limited comparative data exist. Embolotherapy of the gastroduodenal artery (GDA) is essential before internal radiotherapy (SIRT) in order to prevent radiation-induced peptic ulcerations due to migration of yttrium-90 microspheres. The purpose of this study was to compare the vascular anatomical limitations, procedure time, effectiveness, and safety of embolization of the GDA with coils versus the AVP II. Fifty patients stratified for SIRT were prospectively randomized for embolization of the GDA with either coils or the AVP II. The angle between the aortamore » and the celiac trunk, diameter of the GDA, fluoroscopy time and total time for embolization, number of embolization devices, complications, and durability of vessel occlusion at follow-up angiography for SIRT were recorded. A t-test was used for statistical analysis. Embolizations with either coils or the AVP II were technically feasible in all but two patients scheduled for embolization of the GDA with the AVP II. In both cases the plug could not be positioned due to the small celiac trunk outlet angles of 17{sup o} and 21{sup o}. The mean diameter of the GDA was 3.7 mm (range, 2.2-4.8 mm) for both groups. The procedures differed significantly in fluoroscopy time (7.8 min for coils vs. 2.6 min for the AVP II; P < 0.001) and embolization time (23.1 min for coils vs. 8.8 min for the AVP II; P < 0.001). A mean of 6.0 {+-} 3.2 coils were used for GDA embolization, while no more than one AVP II was needed for successful vessel occlusion (P < 0.001). One coil migration occurred during coil embolization, whereas no procedural complication was encountered with the use of the AVP II. Vessel reperfusion was noted in only one patient, in whom coil embolization was performed. In conclusion, embolization of the GDA with the AVP II is safe, easy, rapid, and highly effective; only an extremely sharp

Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy.

PubMed

Poyraz, Necdet; Balasar, Mehmet; Gökmen, İbrahim Erdem; Koç, Osman; Sönmez, Mehmet Giray; Aydın, Arif; Göger, Yunus Emre; Öztürk, Ahmet

2017-12-01

Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment. To evaluate endovascular treatments and outcomes of vascular complications observed after PNL. We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed. Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19-75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3-18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively. Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization.

Transjugular Intrahepatic Portosystemic Shunt Creation and Variceal Coil or Plug Embolization Ineffectively Attain Gastric Variceal Decompression or Occlusion: Results of a 26-Patient Retrospective Study.

PubMed

Lakhoo, Janesh; Bui, James T; Lokken, R Peter; Ray, Charles E; Gaba, Ron C

2016-07-01

To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation with or without variceal coil and/or plug embolization in decompressing or occluding gastric varices (GVs). In this retrospective study, 78 patients with GV bleeding who underwent TIPS creation with or without embolotherapy with metallic coils and/or plugs from 1999 to 2014 were identified. Individuals who had a bare-metal TIPS and/or lacked post-TIPS imaging or endoscopic follow-up were excluded. The final cohort included 26 patients (16 men; median age, 54 y; median Model for End-stage Liver Disease score, 16). Variceal types, supplying vessels, and postprocedure GV patency on cross-sectional imaging or endoscopy were assessed. The primary study outcome measure was GV patency rate as a surrogate for efficacy of TIPS creation with or without embolization. GVs included gastroesophageal varix types 1 (n = 10) and 2 (n = 2), isolated GV types 1 (n = 4) and 2 (n = 2), and unspecified (n = 8). TIPS creation resulted in a median final portosystemic pressure gradient of 7 mm Hg. Multiple GV-supplying vessels (left/posterior/short gastric veins) were present in 65% of patients (n = 17). Embolization was performed in 69% (n = 18). Thirteen, four, and nine patients had imaging, endoscopic, or both imaging/endoscopic follow-up. GV patency rate was 65% (n = 17; 61%/75% with/without embolization) at a median of 128.5 days (range, 1-1,295 d) after TIPS creation. Incidence of recurrent bleeding was 27% (n = 7), and the 90-day mortality rate was 15% (n = 4). In this study, most GVs showed persistent patency despite TIPS decompression and variceal embolization, and the incidence of recurrent bleeding was high. The findings suggest suboptimal efficacy for GVs, and indicate a need for study of alternative or adjunctive approaches to GV treatment, such as chemical obliteration. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Endovascular Patch Embolization for Blood Blister-Like Aneurysms in Dorsal Segment of Internal Carotid Artery.

PubMed

Hao, Xudong; Li, Guilin; Ren, Jian; Li, Jingwei; He, Chuan; Zhang, Hong-Qi

2018-05-01

Blood blister-like aneurysms (BBAs) in the dorsal segment of the internal carotid artery are fragile and difficult to treat, and the optimal treatment for BBAs is still controversial. We report clinical and angiographic results with procedural details for the treatment of BBA by using the endovascular patch embolization method. We retrospectively reviewed patients who presented with subarachnoid hemorrhage caused by internal carotid artery-BBAs and were treated with the endovascular patch embolization method in our center from October 2011 to March 2015. Clinical records, angiographic findings, procedural details, and follow-up results are reported in this study. Eight patients were enrolled in this study. All patients were treated with the endovascular patch embolization method. The key points of this method are step-by-step stent deployment and swaying of the microcatheter to coil the aneurysm sac and the wedge-shaped space between the stent and parent artery and, thereby, in the aneurysm sac and parent artery around the aneurysm neck. When the stent is completely deployed, an endovascular patch is formed and anchored around the neck of the BBA. The procedure was successful in all cases. No acute complications developed in any case. No rerupture or recurrence of the BBA occurred during follow-up. One patient with Hunt-Hess V subarachnoid hemorrhage died of multiple organ failure 4 months post treatment. Another patient died of intracranial infection related to the ventricle-peritoneal shunt. The remaining 6 patients had good clinical outcomes (modified Rankin Scale score of zero). Endovascular patch embolization is an improvement on stent-assisted coil embolization, which could be successfully performed only with extensive skill and patience. Endovascular patch embolization could be an effective method in BBA treatment. However, its efficacy and safety should be verified in a larger patient cohort and long-term follow-up study. Copyright © 2018. Published by

Tuberothalamic Artery Infarction Following Coil Embolization of a Ruptured Posterior Communicating Artery Aneurysm Belonging to a Transitional Type Posterior Cerebral Artery

PubMed Central

Lee, Kyeong Duk; Kwon, Soon Chan; Muniandy, Sarawana; Park, Eun Suk; Sim, Hong Bo; Lyo, In Uk

2013-01-01

Summary There are many potential anatomical variations in the connection between the internal carotid artery and the posterior circulation through the posterior communicating artery (PCoA). We describe the endovascular treatment of an aneurysm arising near the origin of the PCoA belonging to a transitional type posterior cerebral artery. Coil embolization subsequently resulted in thrombo-occlusion of the adjacent PCoA causing thalamic infarction even though sufficient retrograde flow had been confirmed pre-operatively by Allcock’s test. PMID:24070079

Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysms

PubMed Central

Lukic, Snezana; Jankovic, Slobodan; Popovic, Katarina Surlan; Bankovic, Dragic; Popovic, Peter; Mijailovic, Milan

2015-01-01

Background Endovascular embolization is a treatment of choice for the management of unruptured intracranial aneurysms, but sometimes is complicated with perianeurysmal oedema. The aim of our study was to establish incidence and outcomes of perianeurysmal oedema after endovascular coiling of unruptured intracranial aneurysms, and to reveal possible risk factors for development of this potentially serious complication. Methods In total 119 adult patients with endovascular embolization of unruptured intracranial aneurysm (performed at Department for Interventional Neuroradiology, Clinical Center, Kragujevac, Serbia) were included in our study. The embolizations were made by electrolite-detachable platinum coils: pure platinum, hydrophilic and combination of platinum and hydrophilic coils. Primary outcome variable was perianeurysmal oedema visualized by magnetic resonance imaging (MRI) 7, 30 and 90 days after the embolization. Results The perianurysmal oedema appeared in 47.6% of patients treated with hydrophilic coils, in 21.6% of patients treated with platinum coils, and in 53.8% of those treated with mixed type of the coils. The multivariate logistic regression showed that variables associated with occurrence of perianeurysmal oedema are volume of the aneurysm, hypertension, diabetes and smoking habit. Hypertension is the most important independent predictor of the perianeurysmal oedema, followed by smoking and diabetes. Conclusions The results of our study suggest that older patients with larger unruptured intracranial aneurysms, who suffer from diabetes mellitus and hypertension, and have the smoking habit, are under much higher risk of having perianeurysmal oedema after endovascular coiling. PMID:26834520

Balloon-assisted enteroscopy for suspected Meckel’s diverticulum and indefinite diagnostic imaging workup

PubMed Central

Gomes, Guilherme Francisco; Bonin, Eduardo Aimore; Noda, Rafael William; Cavazzola, Leandro Totti; Bartholomei, Thiago Ferreira

2016-01-01

Meckel’s diverticulum (MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99m scintigraphy (99mTc) using either labeled red blood cells or pertechnetate (known as the Meckel’s scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloon-assisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel’s scan. PMID:27803776

Successful treatment of acquired uterine arterial venous malformation using N-butyl-2-cyanoacrylate under balloon occlusion

PubMed Central

Ogasawara, Go; Ishida, Kenichiro; Fujii, Kaoru; Yamane, Takuro; Nishimaki, Hiroshi; Matsunaga, Keiji; Inoue, Yusuke

2014-01-01

We present two cases of acquired uterine arterial venous malformation (AVM) which was diagnosed because of massive genital bleeding successfully treated with transcatheter arterial embolization (TAE), using N-butyl-2-cyanoacrylate (NBCA) under balloon occlusion. Balloon occlusion at the uterine artery was performed in both patients for diffuse distribution of NBCA in multiple feeding branches, as well as to the pseudoaneurysm, and for the prevention of NBCA reflux. In one of our patients, balloon occlusion of the draining vein was simultaneously performed to prevent NBCA migration through accompanying high-flow arteriovenous fistula (AVF). Doppler ultrasound at 6 months of both patients documented persistent complete occlusion of AVM. Complete and safe obliteration of acquired uterine AVM was accomplished using NBCA as embolic agent, under balloon occlusion at the communicating vessels of acquired uterine AVM. PMID:25346850

Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent: Treatment of Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Occlusion.

PubMed

Sanal, Bekir; Nas, Omer Fatih; Hacikurt, Kadir; Hakyemez, Bahattin; Erdogan, Cuneyt

2016-02-01

True aneurysm of pancreaticoduodenal arcade (PDA) is usually accompanied by stenosis or occlusion of celiac trunk (CeT). The up-to-date and first choice treatment modality of PDA aneurysm is the endovascular approach in nearly all cases except few selected ones necessitating surgery. The main approach in endovascular treatment is embolization of the aneurysm by preserving the parent artery. A case with concomitant CeT occlusion and PDA aneurysm was treated with coil embolization by preserving inferior pancreaticoduodenal artery with retrievable Solitaire(®) stent. In our knowledge, this is the first case with PDA aneurysm treated with this technique. © The Author(s) 2016.

[Life-threatening hemoptysis. Treatment with transcatheter embolization].

PubMed

Gimeno Peribáñez, M J; Madariaga, B; Alfonso Aguirán, E R; Medrano Peña, J; Fernández Gómez, J A; Herrera, M; de Gregorio Ariza, M A

1999-09-01

To evaluate the immediate and long-term efficacy of transcatheter embolization of bronchial, systemic and pulmonary arteries to treat life-threatening hemoptysis. Likewise, we propose the systematic treatment of life-threatening hemoptysis by means of transcatheter embolization. One hundred seven angiographies were performed on the same number of patients experiencing life-threatening hemoptysis with bleeding exceeding 150 ml in 24 hours. Before angiography, we rinsed the vessels with cold saline solution and adrenalin through the catheter. Thirty-three patients were female and 74 were male. Mean age was 52.3 years (range 12 to 75 years). Embolization was performed in 104 (3 in patients with recurrent hemoptysis) using polyvinyl alcohol and micro-coils. Bronchial and systemic arteries of the affected hemithorax (mammary and lateral thoracic arteries) were checked in all patients. If findings were negative or bleeding was recurrent, we also performed pulmonary arteriography. In two cases we were unable to catheterize the artery theoretically responsible for bleeding. Examination of both arterial and systemic vessels proved normal in one patient. The embolization technique was successful in 99% (103/104) of the cases and the rate of immediate clinical success was 95.1% (99/104). The mean time of follow-up was 43.2 months (range 3 to 66 months). Hemoptysis recurred in 15.3% (16 cases) within a mean 8.3 months (range 15 days to 48 months); embolization was repeated in 14 of these patients with satisfactory results, while two underwent surgery. In five patients (4.8%) we observed complications requiring no additional medical treatment: one instance of coil migration to the deep femoral artery, from which the coil was removed in a basket; two cases of bronchial artery extravasation with small mediastinal hematomas; and two hematomas at the points of puncture. Selective or supra-selective embolization of the arteries that feed the bronchi provides effective management of

Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization.

PubMed

Sun, Long; Guan, Yong-Song; Wu, Hua; Pan, Wei-Min; Li, Xiao; He, Qing; Liu, Yuan

2006-05-07

A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

Use of the Ascent balloon for a 2-in-1 remodeling technique: feasibility and initial experience: case report.

PubMed

Clarençon, Frédéric; Pérot, Guillaume; Biondi, Alessandra; Di Maria, Federico; Szatmary, Zoltan; Chiras, Jacques; Sourour, Nader

2012-03-01

To present the feasibility of using the Ascent balloon, a new double-lumen remodeling balloon, for a new 2-in-1 technique allowing coiling through the lumen of the balloon without the use of an additional coiling microcatheter. Remodeling technique had enlarged the indications for endovascular treatment of intracranial aneurysm. Nevertheless, one of the limitations of this technique is that it requires using 2 devices in the same parent artery. A 55-year-old woman presented with a 7.7 × 4.5-mm incidental anterior communicating artery aneurysm. Only 1 A1 segment (left side) was patent on the cerebral angiogram. A 6F Fargo Max guiding catheter was positioned in the left petrous internal carotid artery. The Ascent balloon was placed in front of the neck of the aneurysm after navigation on a Traxcess 0.014-in guidewire. Coiling of the aneurysm sac was performed via 1 lumen of the device under iterative inflations of the balloon through the second lumen. This new 2-in-1 technique using a sole remodeling balloon without an additional coiling microcatheter is very promising, especially in cases of a small-caliber parent artery.

Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy

PubMed Central

Poyraz, Necdet; Balasar, Mehmet; Gökmen, İbrahim Erdem; Koç, Osman; Aydın, Arif; Göger, Yunus Emre; Öztürk, Ahmet

2017-01-01

Introduction Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment. Aim To evaluate endovascular treatments and outcomes of vascular complications observed after PNL. Material and methods We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed. Results Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19–75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3–18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively. Conclusions Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization. PMID:29362656

Onyx versus nBCA and coils in the treatment of intracranial dural arteriovenous fistulas

PubMed Central

Choo, Douglas M

2016-01-01

Background and purpose Intracranial dural arteriovenous fistulas (DAVFs) with cortical venous drainage have significant morbidity and mortality. Complete closure of these lesions is necessary to reduce these risks. The purpose of our study was to compare the outcome of DAVFs treated with Onyx versus those treated with n-Butyl Cyanoacrylate (nBCA) and coil embolization in a case-control study. Compared with nBCA and coil embolization, we hypothesized that Onyx embolization for DAVF is safer and has a higher chance of complete obliteration, with no need for post-embolization surgery for the DAVF. Materials and methods From 1998 to 2015, 29 patients who had DAVFs were treated with endovascular embolization. Of these, 24 patients had imaging available for analysis. Successful closure rates, complications, and procedure time were compared between the embolization techniques. Results The chance of not requiring post-embolization surgery with Onyx (81.8%) was significantly higher (p = 0.005) than with nBCA (22.22%). The complication rate with Onyx (9.1%) tended to be lower compared with that of nBCA (22.22%; p = 0.37). Procedural time was not significantly different between Onyx (mean 267 minutes) and nBCA (mean 288 minutes) (p = 0.59). The odds ratio of a DAVF being treated with Onyx and then requiring no follow-up surgery was 17.5 (95% CI 1.97–155.4). Conclusion Our case-control study suggests that Onyx embolization is superior to nBCA and coil embolization in completely obliterating DAVFs, with higher odds of no post-embolization surgery. We also found that Onyx is safe for embolization of DAVFs, with no associated neurological mortality and morbidity. PMID:26748082

Onyx versus nBCA and coils in the treatment of intracranial dural arteriovenous fistulas.

PubMed

Choo, Douglas M; Shankar, Jai Jai Shiva

2016-04-01

Intracranial dural arteriovenous fistulas (DAVFs) with cortical venous drainage have significant morbidity and mortality. Complete closure of these lesions is necessary to reduce these risks. The purpose of our study was to compare the outcome of DAVFs treated with Onyx versus those treated with n-Butyl Cyanoacrylate (nBCA) and coil embolization in a case-control study. Compared with nBCA and coil embolization, we hypothesized that Onyx embolization for DAVF is safer and has a higher chance of complete obliteration, with no need for post-embolization surgery for the DAVF. From 1998 to 2015, 29 patients who had DAVFs were treated with endovascular embolization. Of these, 24 patients had imaging available for analysis. Successful closure rates, complications, and procedure time were compared between the embolization techniques. The chance of not requiring post-embolization surgery with Onyx (81.8%) was significantly higher (p = 0.005) than with nBCA (22.22%). The complication rate with Onyx (9.1%) tended to be lower compared with that of nBCA (22.22%; p = 0.37). Procedural time was not significantly different between Onyx (mean 267 minutes) and nBCA (mean 288 minutes) (p = 0.59). The odds ratio of a DAVF being treated with Onyx and then requiring no follow-up surgery was 17.5 (95% CI 1.97-155.4). Our case-control study suggests that Onyx embolization is superior to nBCA and coil embolization in completely obliterating DAVFs, with higher odds of no post-embolization surgery. We also found that Onyx is safe for embolization of DAVFs, with no associated neurological mortality and morbidity. © The Author(s) 2016.

Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

PubMed Central

Sun, Long; Guan, Yong-Song; Wu, Hua; Pan, Wei-Min; Li, Xiao; He, Qing; Liu, Yuan

2006-01-01

A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives. PMID:16718774

Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques.

PubMed

Saad, Wael E; Nicholson, David B

2013-06-01

Since the conception of balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices 25 years ago, the placement of an indwelling balloon for hours has been central to the BRTO procedure. Numerous variables and variations of the BRTO procedure have been described, including methods to reduce sclerosant, combining percutaneous transhepatic obliteration, varying sclerosant, and using multiple sclerosants within the same procedure. However, the consistent feature of BRTO has always remained the indwelling balloon. Placing an indwelling balloon over hours for the BRTO procedure is a logistical burden that taxes the interventional radiology team and hospital resources. Substituting the balloon with hardware (coils or Amplatzer vascular plugs [AVPs] or both) is technically feasible and its risks most likely correlate with gastrorenal shunt (GRS) size. The current authors use packed 0.018- or 0.035-in coils or both for small gastric variceal systems (GRS size A and B) and AVPs for GRS sizes up to size E (from size A-E). The current authors recommend an indwelling balloon (no hardware substitute) for very large gastric variceal system (GRS size F). Substituting the indwelling balloon for hardware in size F and potentially size E GRS can also be risky. The current article describes the techniques of placing up to 16-mm AVPs through balloon occlusion guide catheters and then deflating the balloon once it has been substituted with the AVPs. In addition, 22-mm AVPs can be placed through sheaths once the balloon occlusion catheters are removed to further augment the 16-mm Amplatzer occlusion. To date, there are no studies describing, let alone evaluating, the clinical feasibility of performing BRTO without indwelling balloons. The described techniques have been successfully performed by the current authors. However, the long-term safety and effectiveness of these techniques is yet to be determined. Copyright © 2013 Elsevier Inc. All rights reserved.

Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms - Literature Review.

PubMed

Kocur, Damian; Ślusarczyk, Wojciech; Przybyłko, Nikodem; Bażowski, Piotr; Właszczuk, Adam; Kwiek, Stanisław

2016-01-01

The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates.

[Embolization as a treatment method in post-traumatic right hepatic artery pseudoaneurysm].

PubMed

Dobrowolska-Bak, Malgorzata; Brzegowy, Paweł; Urbanik, Andrzej

2012-01-01

A case of 42-year-old man with post-traumatic right hepatic artery pseudoaneurysm successfully treated by endovascular embolization with histoacrylate glue is presented. Despite coils are mostly used embolic material in pseudoaneurysm, embolization with histoacrylate glue can be highly effective and quick treatment modality for post-traumatic hepatic artery pseudoaneurysm, especially in cases when it is impossible to use standard materials.

Robot-assisted ligation of bronchial artery could be an alternative to embolization.

PubMed

Pochulu, Bruno; Sarsam, Omar; Peillon, Christophe; Baste, Jean-Marc

2018-03-01

A 37-year-old patient presented with a self-limiting episode of moderate haemoptysis. Contrast-enhanced chest computed tomography showed a tortuous and dilated right bronchial artery arising from the descending aorta at the level of T6. Therapeutic angiography was attempted, but in the presence of spinal artery arising from the bronchial artery in question, selective embolization was contraindicated due to risk of spinal cord ischaemia. After a multidisciplinary meeting, it was decided to attempt surgery to ligate this pathological artery. We performed minimally invasive robot-assisted ligation of this pathological artery. The postoperative course was uneventful with good clinical and radiological outcome at 3-month follow-up. A minimally invasive approach provides a real alternative to embolization and could be a therapeutic option.

PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy - evaluation of a double embolic protection approach in endovascular stroke treatment.

PubMed

Maegerlein, Christian; Mönch, Sebastian; Boeckh-Behrens, Tobias; Lehm, Manuel; Hedderich, Dennis M; Berndt, Maria Teresa; Wunderlich, Silke; Zimmer, Claus; Kaesmacher, Johannes; Friedrich, Benjamin

2017-12-08

Stent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique. We performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included. PROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT. The PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Pipeline embolization device versus coiling for the treatment of large and giant unruptured intracranial aneurysms: a cost-effectiveness analysis.

PubMed

Wali, Arvin R; Park, Charlie C; Santiago-Dieppa, David R; Vaida, Florin; Murphy, James D; Khalessi, Alexander A

2017-06-01

OBJECTIVE Rupture of large or giant intracranial aneurysms leads to significant morbidity, mortality, and health care costs. Both coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for the treatment of unruptured large and giant intracranial aneurysms; however, the relative cost-to-outcome ratio is unknown. The authors present the first cost-effectiveness analysis to compare the economic impact of the PED compared with coiling or no treatment for the endovascular management of large or giant intracranial aneurysms. METHODS A Markov model was constructed to simulate a 60-year-old woman with a large or giant intracranial aneurysm considering a PED, endovascular coiling, or no treatment in terms of neurological outcome, angiographic outcome, retreatment rates, procedural and rehabilitation costs, and rupture rates. Transition probabilities were derived from prior literature reporting outcomes and costs of PED, coiling, and no treatment for the management of aneurysms. Cost-effectiveness was defined, with the incremental cost-effectiveness ratios (ICERs) defined as difference in costs divided by the difference in quality-adjusted life years (QALYs). The ICERs < $50,000/QALY gained were considered cost-effective. To study parameter uncertainty, 1-way, 2-way, and probabilistic sensitivity analyses were performed. RESULTS The base-case model demonstrated lifetime QALYs of 12.72 for patients in the PED cohort, 12.89 for the endovascular coiling cohort, and 9.7 for patients in the no-treatment cohort. Lifetime rehabilitation and treatment costs were $59,837.52 for PED; $79,025.42 for endovascular coiling; and $193,531.29 in the no-treatment cohort. Patients who did not undergo elective treatment were subject to increased rates of aneurysm rupture and high treatment and rehabilitation costs. One-way sensitivity analysis demonstrated that the model was most sensitive to assumptions about the costs and mortality risks for PED

Monorail snare technique for the recovery of stretched platinum coils: technical case report.

PubMed

Fiorella, David; Albuquerque, Felipe C; Deshmukh, Vivek R; McDougall, Cameron G

2005-07-01

Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling microcatheter and stretched portion of the coil as a monorail guide. We have used this technique successfully in four patients to snare coils stretched during cerebral aneurysm embolization. Three of these patients were undergoing Neuroform (Boston Scientific/Target, Fremont, CA) stent-supported coil embolization of unruptured aneurysms. In all cases, the snare was advanced easily to the targeted site for coil engagement by use of the microcatheter as a monorail guide. Once the intact distal segment of the coil was ensnared, coil removal was uneventful, with no disturbance of the remainder of the indwelling coil pack or Neuroform stent. A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Prowler-14 microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling SL-10 microcatheter (Boston Scientific, Natick, MA) was then cut away with a scalpel, leaving the coil pusher wire intact, and removed. The open 2-mm snare was then advanced over the outside of the coil pusher wire and microcatheter. The snare and Prowler-14 microcatheter were then advanced into the guiding catheter (6- or 7-French) as a unit over the indwelling SL-10 microcatheter. By use of the SL-10 microcatheter and coil as a "monorail" guide, the snare was advanced over and beyond the microcatheter and the stretched portion of the coil until the snare was in position to

Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms – Literature Review

PubMed Central

Kocur, Damian; Ślusarczyk, Wojciech; Przybyłko, Nikodem; Bażowski, Piotr; Właszczuk, Adam; Kwiek, Stanisław

2016-01-01

Summary The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates. PMID:27559426

Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases.

PubMed

Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan

2014-01-01

We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced

Mechanisms of Healing in Coiled Intracranial Aneurysms: A Review of the Literature

PubMed Central

Brinjikji, Waleed; Kallmes, David F; Kadirvel, Ramanathan

2016-01-01

Summary Recanalization of intracranial aneurysms following endovascular coiling remains a frustratingly common occurrence. An understanding of the molecular and histopathological mechanisms of aneurysm healing following coil embolization is essential to improving aneurysm occlusion rates. Histolopathologic studies in coiled human and experimental aneurysms suggest that during the first month post-coiling, thrombus formation and active inflammation occur within the aneurysm dome. Several months following embolization, the aneurysm is excluded from the parent vessel by formation of a neointimal layer, which is often thin and discontinuous, across the aneurysm neck. Numerous coil modifications and systemic therapies have been tested in animals and humans in an attempt to improve the aneurysm healing process; these modifications have met with variable levels of success. In this review, we summarize the histopathologic and molecular biology of aneurysm healing and discuss how these findings have been applied in an attempt to improve angiographic outcomes in patients harboring intracranial aneurysm. PMID:25430855

Tuberothalamic artery infarction following coil embolization of a ruptured posterior communicating artery aneurysm belonging to a transitional type posterior cerebral artery. A case report.

PubMed

Lee, Kyeong Duk; Kwon, Soon Chan; Muniandy, Sarawana; Park, Eun Suk; Sim, Hong Bo; Lyo, In Uk

2013-09-01

There are many potential anatomical variations in the connection between the internal carotid artery and the posterior circulation through the posterior communicating artery (PCoA). We describe the endovascular treatment of an aneurysm arising near the origin of the PCoA belonging to a transitional type posterior cerebral artery. Coil embolization subsequently resulted in thrombo-occlusion of the adjacent PCoA causing thalamic infarction even though sufficient retrograde flow had been confirmed pre-operatively by Allcock's test.

Successful Coil Embolization of a Ruptured Basilar Artery Aneurysm in a Child with Leukemia: A Case Report

PubMed Central

HAYASHI, Shihori; MAEHARA, Taketoshi; MUKAWA, Maki; AOYAGI, Masaru; YOSHINO, Yoshikazu; NEMOTO, Shigeru; ONO, Toshiaki; OHNO, Kikuo

2014-01-01

Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms. PMID:24257487

Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

PubMed

Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

2014-01-01

Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique: results and outcomes in 75 aneurysms.

PubMed

Lee, J Y; Seo, J H; Cho, Y D; Kang, H-S; Han, M H

2011-05-01

The microcatheter protective technique positions an additional microcatheter in the parent or side-branching artery to protect it during coil embolization. The purpose of this study was to describe this method and to evaluate its efficacy and safety as an alternative to a multiple-microcatheter or balloon- or stent-assisted technique for wide-neck aneurysms. A retrospective review of 74 patients (43 women; mean age, 59.6 years) with 75 wide-neck aneurysms treated with the microcatheter protective technique between January 2003 and April 2010 was performed. Immediate postembolization angiograms were evaluated by using a conventional angiographic scale, and clinical evaluation was performed by using the GOS. Clinical and imaging follow-up were available in 57 (76%) patients, with a mean of 14.7 months. Postembolization angiograms demonstrated total occlusion in 45 of 75 (60%) aneurysms, a neck remnant in 17 (22.7%), and body filling in 13 (17.3%). The technique-related complication rate was 17.4% (13/75), and the procedural-related morbidity rate was 1.3% (1/74). All patients, except 3 complicated cases with a GOS of <4, had a GOS of 5 at the end of the study period. Of the 57 aneurysms with follow-up, recanalization developed in 5 (8.8%) aneurysms, and 3 (5.3%) cases of major recanalization were re-treated endovascularly. The microcatheter protective technique is feasible and safe for coil embolization of wide-neck aneurysms, especially in cases that are not suitable for multiple catheter or balloon- or stent-assisted techniques.

Superselective Embolization with Coils in High-Flow Priapism

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kress, Oliver; Heidenreich, A.; Klose, Klaus Jochen

2002-08-15

Priapism can be divided into 'low-flow' veno-occlusive priapism and, especially in children, rare 'high-flow' arterial priapism. We report a 5-year-old boy who developed arterial priapism after blunt perineal trauma that was successfully treated by superselective embolization with microcoils.

Occlusion of M1 segment after superficial temporal artery-middle cerebral artery bypass in a giant M1 aneurysm with Onyx-34 injected via a double-lumen balloon under balloon inflation.

PubMed

Clarençon, Frédéric; Nouet, Aurelien; Redondo, Aimée; Di Maria, Federico; Iosif, Christina; Le Jean, Lise; Chiras, Jacques; Sourour, Nader

2013-05-31

A 29-year-old patient attended our institution for recurrent strokes related to a giant partially thrombosed M1 aneurysm. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass and subsequent occlusion of both the aneurysm and the dysplastic M1 segment were planned. However, owing to the shortness of the non-dysplastic segment of M1 and the risk of occlusion of the lenticulostriate arteries, the use of a double-lumen balloon was considered for coiling and subsequent injection of Onyx. STA-MCA bypass was performed using a regular technique. Endovascular occlusion of both the aneurysm and the parent artery was subsequently performed by means of coils and Onyx-34 that was injected via the Ascent balloon under balloon inflation. No complications were recorded and no stroke was observed on control MRI. The injection of Onyx-34 through a double-lumen balloon under balloon inflation is a quick and safe technique for precise occlusion of a parent artery.

Occlusion of M1 segment after superficial temporal artery-middle cerebral artery bypass in a giant M1 aneurysm with Onyx-34 injected via a double-lumen balloon under balloon inflation.

PubMed

Clarençon, Frédéric; Nouet, Aurelien; Redondo, Aimée; Di Maria, Federico; Iosif, Christina; Le Jean, Lise; Chiras, Jacques; Sourour, Nader

2014-05-01

A 29-year-old patient attended our institution for recurrent strokes related to a giant partially thrombosed M1 aneurysm. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass and subsequent occlusion of both the aneurysm and the dysplastic M1 segment were planned. However, owing to the shortness of the non-dysplastic segment of M1 and the risk of occlusion of the lenticulostriate arteries, the use of a double-lumen balloon was considered for coiling and subsequent injection of Onyx. STA-MCA bypass was performed using a regular technique. Endovascular occlusion of both the aneurysm and the parent artery was subsequently performed by means of coils and Onyx-34 that was injected via the Ascent balloon under balloon inflation. No complications were recorded and no stroke was observed on control MRI. The injection of Onyx-34 through a double-lumen balloon under balloon inflation is a quick and safe technique for precise occlusion of a parent artery.

Occlusion of M1 segment after superficial temporal artery-middle cerebral artery bypass in a giant M1 aneurysm with Onyx-34 injected via a double-lumen balloon under balloon inflation

PubMed Central

Clarençon, Frédéric; Nouet, Aurelien; Redondo, Aimée; Di Maria, Federico; Iosif, Christina; Le Jean, Lise; Chiras, Jacques; Sourour, Nader

2013-01-01

A 29-year-old patient attended our institution for recurrent strokes related to a giant partially thrombosed M1 aneurysm. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass and subsequent occlusion of both the aneurysm and the dysplastic M1 segment were planned. However, owing to the shortness of the non-dysplastic segment of M1 and the risk of occlusion of the lenticulostriate arteries, the use of a double-lumen balloon was considered for coiling and subsequent injection of Onyx. STA-MCA bypass was performed using a regular technique. Endovascular occlusion of both the aneurysm and the parent artery was subsequently performed by means of coils and Onyx-34 that was injected via the Ascent balloon under balloon inflation. No complications were recorded and no stroke was observed on control MRI. The injection of Onyx-34 through a double-lumen balloon under balloon inflation is a quick and safe technique for precise occlusion of a parent artery. PMID:23729720

Complications of retrograde balloon cautery endopyelotomy.

PubMed

Schwartz, B F; Stoller, M L

1999-11-01

Adult ureteropelvic junction obstruction is increasingly managed with endoscopic techniques. Retrograde balloon cautery endopyelotomy is quick, requires minimal hospital stay and allows most patients a rapid return to work. The complication rate of retrograde balloon cautery endopyelotomy ranges from 13 to 34%, with vascular injury in 0 to 16% of patients. We report 5 uncommon complications, including 4 vascular injuries, that clinicians should be familiar with when using this technique. We reviewed 52 retrograde endoscopic endopyelotomy procedures performed during a 5-year period. There were 5 uncommon complications. Accessory lower pole renal artery injuries occurred in 3 patients, 1 of whom presented 12 days after endopyelotomy. Embolization was successfully performed in all 3 cases and none had subsequent hypertension. In 1 case a right ovarian vein laceration was not evident on preoperative or postoperative angiography. Emergency post-embolization abdominal exploration revealed a 2 mm. injury to the right ovarian vein before entering the right renal vein close to the ureteropelvic junction incision. Nephrectomy and ovarian vein ligature were curative. In 1 case the electrocautery wire broke intracorporeally after firing, resulting in a bobby pin-like configuration. Successful removal was accomplished by twisting the catheter and wrapping the wire around the tip, enabling atraumatic removal. Retrograde balloon cautery endopyelotomy is an emerging technology with potential adverse outcomes. The complications we noted are complex and potentially life threatening. Awareness of these complications may help avoid poor outcomes and expedite appropriate treatment.

Genuine splenic artery aneurysm rupture treated by N‐butyl cyanoacrylate and metallic coils under resuscitative endovascular balloon occlusion of the aorta

PubMed Central

Hagiwara, Shuichi; Miyazaki, Masaya; Kaneko, Minoru; Murata, Masato; Nakajima, Jun; Ohyama, Yoshio; Tamura, Jun'ichi; Tsushima, Yoshito; Oshima, Kiyohiro

2016-01-01

Case A 66 year‐old woman who presented with sudden lower abdominal pain was transferred to our emergency room. Vital signs were stable on arrival at the hospital, but immediately became unstable. Systolic/diastolic blood pressure and heart rate were 66/33 mmHg and 70 b.p.m., respectively. Computed tomography scanning showed splenic artery aneurysm rupture and extravasation. The patient was treated non‐operatively and definitively by endovascular therapy comprising resuscitative endovascular occlusion of the aorta for hemodynamic control, N‐butyl cyanoacrylate, and metallic coils as an embolization material. Outcome On admission day 3, she was enrolled in another department and admission day 54, she was discharged. Conclusion Although resuscitative endovascular occlusion of the aorta and N‐butyl cyanoacrylate is known to be effective, the use of resuscitative endovascular occlusion of the aorta with transcatheter arterial embolization and N‐butyl cyanoacrylate for non‐traumatic bleeding has not previously been reported. By combining and adapting these devices, their applications in endovascular management may be increased. PMID:29123801

Microcoil embolization during abdominal vascular interventions through microcatheters with a tip of 2 French or less.

PubMed

Miyayama, Shiro; Yamashiro, Masashi; Hattori, Yuki; Orito, Nobuaki; Matsui, Ken; Tsuji, Kazunobu; Yoshida, Miki; Matsui, Osamu

2011-05-01

The aim of this study was to evaluate the technical aspects of embolization using microcoils through a microcatheter with a tip of 2F or smaller during abdominal vascular interventions. Coil embolization through a microcatheter with a tip of 2F or smaller was attempted in 73 procedures. Two types of microcoil-Liquid Coil (Boston Scientific, Watertown, MA, USA) and Tornado Coil (Cook, Bloomington, IN, USA)-were deployed through four types of thinner microcatheter [2F tip (n = 49) and 1.8F tip (n = 24)]. Coil jams in the microcatheter and coil migration were evaluated. In total, 286 microcoils were placed (mean ± SD, 3.9 ± 4.3 coils per procedure, range 1-32 coils). In 19 procedures (26.9%), Liquid Coils were used alone. In 44 (60.3%), Tornado Coils were used alone. In 10 (13.7%), Liquid Coils and Tornado Coils were combined. There were no coil jams in the microcatheter in this series. One Tornado Coil (0.3%) delivered into the gastroduodenal artery migrated to the right hepatic artery. Liquid Coils and Tornado Coils can be placed through a thinner microcatheter without difficulty. However, there is a risk of coil migration in large vessels or at the proximal site because the catheter tip is not stabilized.

Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein.

PubMed

Conway, Allan M; Qato, Khalil; Drury, Jennifer; Rosen, Robert J

2015-04-01

The aim of this study was to assess the management and outcomes of arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) treated with retrograde venous embolization. A retrospective review was performed from November 2010 to May 2014 on all patients with a high-flow AVM and associated DOV who underwent transvenous embolization of the DOV. Indications, techniques, complications, and outcomes were reviewed. Fourteen patients (five male; 36%) underwent transvenous embolization of high-flow AVMs with a DOV. Median age was 41.6 years (15.7-65.8 years). The AVM was located on an extremity in eight patients (57%) and in the pelvis in six patients (43%). The indication for the procedure was pain in 11 patients (79%), swelling in 3 patients (21%), a nonhealing wound in 1 patient (7%), and impotence in 1 patient (7%). The median number of prior procedures to treat the AVM was 2.5 (0-13). Transvenous embolization with coils was performed in 13 patients (93%). The Amplatzer vascular plug and Amplatzer septal occluder (St. Jude Medical, St. Paul, Minn) were used in four patients (29%). Concurrent percutaneous puncture embolization of the AVM nidus was used in seven patients (50%) and transcatheter arterial embolization in eight patients (57%). Technical angiographic success was seen in all patients. Five patients (36%) experienced a complete response to treatment, whereas eight (57%) experienced a partial response. Seven patients (50%) required further procedures for residual symptoms. AVMs with a DOV can be successfully treated by a transvenous approach. Percutaneous puncture embolization of the nidus or draining vein and transcatheter arterial embolization may assist in reducing flow. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Clinical experience with the Monorail balloon catheter for coronary angioplasty.

PubMed

Finci, L; Meier, B; Roy, P; Steffenino, G; Rutishauser, W

1988-01-01

The Monorail balloon catheter is distinctly different from other current balloon catheters: the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the guiding catheter. Monorail coronary angioplasty was attempted in 61 patients on 73 lesions with balloons from 2.0 to 3.7 mm. Angiographic success was obtained in 66 lesions (90%). For 15 lesions, balloon exchanges were needed. In three lesions, the Monorail balloon failed to cross the lesion, while a standard balloon succeeded; two lesions could not be crossed with any balloon. Vessel occlusion occurred in four patients: two had emergency surgery without infarct (one died suddenly 4 days later and one had a stroke 1 day later), one was recanalized with a standard balloon, and one had a myocardial infarct. Continuous infusion of urokinase was used until patient 3 in whom problems with the delivery system led to cardiocerebral air embolization (with complete recovery). No thrombotic complications were observed in the subsequent 58 patients with only a bolus of 10,000 U of heparin. The Monorail balloon facilitates contrast injections and balloon exchanges but appears more difficult to pass through tight lesions. Omission of the previously recommended infusion with a thrombolytic agent proved safe.

Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection.

PubMed

Francisco, Lloret Estañ; Asunción, López Conesa; Antonio, Capel Alemán; Ricardo, Robles Campos; Manuel, Reus Pintado; Caridad, Marín Hernández

2010-02-27

Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique.

Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection

PubMed Central

Francisco, Lloret Estañ; Asunción, López Conesa; Antonio, Capel Alemán; Ricardo, Robles Campos; Manuel, Reus Pintado; Caridad, Marín Hernández

2010-01-01

Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique. PMID:21160978

Direct Surgery of Previously Coiled Large Internal Carotid Ophthalmic Aneurysm for the Purpose of Optic Nerve Decompression

PubMed Central

Kawabata, Shuhei; Toyota, Shingo; Kumagai, Tetsuya; Goto, Tetsu; Mori, Kanji; Taki, Takuyu

2017-01-01

Background Progressive visual loss after coil embolization of a large internal carotid ophthalmic aneurysm has been widely reported. It is generally accepted that the primary strategy for this complication should be conservative, including steroid therapy; however, it is not well known as to what approach to take when the conservative therapy is not effective. Case Presentation We report a case of a 55-year-old female presenting with progressive visual loss after the coiling of a ruptured large internal carotid ophthalmic aneurysm. As the conservative therapy had not been effective, we performed neck clipping of the aneurysm with optic canal unroofing, anterior clinoidectomy, and partial removal of the embolized coils for the purpose of optic nerve decompression. After the surgery, the visual symptom was improved markedly. Conclusions It is suggested that direct surgery for the purpose of optic nerve decompression may be one of the options when conservative therapy is not effective for progressive visual disturbance after coil embolization. PMID:28229036

Preoperative fiducial coil placement facilitates robot-assisted laparoscopic excision of retroperitoneal small solitary metastasis of kidney cancer.

PubMed

Agrawal, Vineet; Sharma, Ashwani; Wu, Guan

2014-11-01

Image-guided fiducial markers are being used in surgery, especially in spine and breast surgery, and radiotherapy, allowing localization of tumor sites precisely. We report a case of fiducial coil use in a man undergoing a robot-assisted laparoscopic resection of a metastatic nodule under the ipsilateral diaphragm after robot-assisted partial nephrectomy performed 2 years ago for a left upper pole renal tumor. The fiducial coil facilitated the localization of the lesion, which would otherwise have been challenging because of its small size and location. In addition, the fiducial coil was helpful to avoid cutting into the lesion directly. Copyright © 2014 Elsevier Inc. All rights reserved.

CE-MRA for follow-up of aneurysms post stent-assisted coiling.

PubMed

Agid, R; Schaaf, M; Farb, Ri

2012-09-01

This study compared the accuracy of contrast-enhanced MR angiography (CE-MRA) to intra-arterial cerebral angiography (IA-DSA) for assessment of intracranial aneurysms after stent-assisted coiling and to check if the presence of a stent in the parent artery diminishes the accuracy of CE-MRA. Consecutive patients with cerebral aneurysms treated by stent-assisted coiling were evaluated retrospectively. Matching follow-up CE-MRA and IA-DSA were evaluated separately. Evaluation included the presence of aneurysmal remnant, patency and stenosis of parent artery. Twenty-seven patients with 28 aneurysms and 33 matched CE-MRA and IA-DSA studies were evaluated. Nineteen aneurysmal remnants were seen on CE-MRA and 16 on IA-DSA. CE-MRA diagnosed three aneurysmal remnants not appreciated on IA-DSA. Five other remnants were larger on CE-MRA than IA-DSA. None of the remnants were missed on CE-MRA. Parent arteries were patent on both modalities. CE-MRA showed false stenosis of the stented artery in six cases and exaggerated stenosis in two. In 18 cases, CE-MRA showed a short focal "pseudo-stenosis" where the stent's marker bands were located. This was noted whenever the stent's marker bands were located in an artery with luminal diameter ≤2 mm and was called "marker band effect". CE-MRA is an accurate technique for follow-up of aneurysms post stent-assisted coiling with excellent depiction of remnants in spite of the presence of a stent. Apparent stenosis of the stented parent artery on CE-MRA is often false or exaggerated. "Marker band effect" should be recognized as an artifact that appears when stent's marker bands are in a small artery.

Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms.

PubMed

Heiferman, Daniel M; Billingsley, Joshua T; Kasliwal, Manish K; Johnson, Andrew K; Keigher, Kiffon M; Frudit, Michel E; Moftakhar, Roham; Lopes, Demetrius K

2016-07-01

Flow-diverting stents, including the Pipeline embolization device (PED) and Silk, have been beneficial in the treatment of aneurysms previously unable to be approached via endovascular techniques. Recurrent aneurysms for which stent-assisted embolization has failed are a therapeutic challenge, given the existing intraluminal construct with continued blood flow into the aneurysm. We report our experience using flow-diverting stents in the repair of 25 aneurysms for which stent-assisted embolization had failed. Nineteen (76%) of these aneurysms at the 12-month follow-up showed improved Raymond class occlusion, with 38% being completely occluded, and all aneurysms demonstrated decreased filling. One patient developed a moderate permanent neurologic deficit. Appropriate stent sizing, proximal and distal construct coverage, and preventing flow diverter deployment between the previously deployed stent struts are important considerations to ensure wall apposition and prevention of endoleak. Flow diverters are shown to be a reasonable option for treating previously stented recurrent cerebral aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Subdural and intracerebral hemorrhage caused by spontaneous bleeding in the middle meningeal artery after coil embolization of a cerebral aneurysm.

PubMed

Kohyama, Shinya; Kakehi, Yoshiaki; Yamane, Fumitaka; Ooigawa, Hidetoshi; Kurita, Hiroki; Ishihara, Shoichiro

2014-10-01

Nontraumatic acute subdural hemorrhage (SDH) with intracerebral hemorrhage (ICH) is rare and is usually caused by severe bleeding from aneurysms or arteriovenous fistulas. We encountered a very rare case of spontaneous bleeding from the middle meningeal artery (MMA), which caused hemorrhage in the temporal lobe and subdural space 2 weeks after coil embolization of an ipsilateral, unruptured internal cerebral artery aneurysm in the cavernous portion. At onset, the distribution of hematoma on a computed tomography scan led us to believe that the treated intracavernous aneurysm could bleed into the intradural space. Emergency craniotomy revealed that the dura of the middle fossa was intact except for the point at the foramen spinosum where the exposed MMA was bleeding. Retrospectively, angiography just before and after embolization of the aneurysm did not show any aberrations in the MMA. Although the MMA usually courses on the outer surface of the dura and is unlikely to rupture without an external force, physicians should be aware that the MMA may bleed spontaneously and cause SDH and ICH. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Endovascular rescue of a fused monorail balloon and cerebral protection device.

PubMed

Campbell, John E; Bates, Mark C; Elmore, Michael

2007-08-01

To present a case of successful endovascular retrieval of a monorail predilation balloon fused to an embolic protection device (EPD) in the distal internal carotid artery (ICA) of a high-risk symptomatic patient. A 60-year-old man with documented systemic atherosclerotic disease had a severe (>70%) restenosis in the left ICA 3 years after endarterectomy. He was scheduled for carotid artery stenting (CAS) with cerebral protection; however, he developed unstable angina and was transferred to our facility, where the admitting team decided that staged CAS followed by coronary bypass grafting would be the best option. During the CAS procedure, a 6-mm AccuNet filter was passed across the lesion via a 6-F carotid sheath and deployed in the distal ICA without incident. However, the 4-x20-mm predilation monorail balloon was then advanced without visualizing the markers, resulting in inadvertent aggressive interaction that trapped the balloon's tip in the filter. Several maneuvers to separate the devices were unsuccessful. Finally, the filter/balloon combination was moved gently retrograde until the balloon was straddling the subtotal ICA lesion. The lesion was dilated to 4 mm with the balloon, and the sheath was gently advanced across the lesion as the balloon was deflated. Angiography excluded interval occlusion of the filter from the embolic debris during the aforementioned aggressive maneuvers and documented antegrade flow. The filter was slowly withdrawn into the 6-F sheath with simultaneous aspiration. A second 6-mm filter was deployed, and the procedure was completed satisfactorily. The patient did well, with no neurological sequelae. EPDs are an essential in carotid artery stenting and, keeping in mind the potential risks associated with their use, will help the operator avoid complications such as this one.

Novel device and technique for minimally invasive intracerebral hematoma evacuation in the same setting of a ruptured intracranial aneurysm: combined treatment in the neurointerventional angiography suite.

PubMed

Turner, Raymond D; Vargas, Jan; Turk, Aquilla S; Chaudry, M Imran; Spiotta, Alejandro M

2015-03-01

The presence of intracerebral hematoma from aneurysm rupture is an indication for craniotomy for clot evacuation and aneurysm clipping. Some centers have begun securing aneurysms with coil embolization followed by clot evacuation in the operating room. This approach requires transporting a patient from the angiography suite to the operating room, which can take valuable time and resources. To report our experience with 3 cases in which a novel technique for minimally invasive evacuation of intracerebral hematomas after endovascular treatment of ruptured intracranial aneurysms was used. The Penumbra Apollo system can be used in the angiography suite in conjunction with neuroendovascular techniques to simultaneously address a symptomatic hematoma associated with a ruptured aneurysm. Standard preoperative computed tomography angiography was performed on arrival to the emergency department. The patients underwent diagnostic cerebral angiography followed by balloon-assisted coil embolization and then remained in the neurointerventional suite for intracerebral hematoma evacuation with the Apollo system. All patients tolerated coil embolization and hematoma evacuation well. The combined procedures lasted <3 hours in both cases. Two patients were eventually discharged to acute rehabilitation facilities less than a month after their initial insult, and 1 has been cleared to return to work. The other patient was transferred to hospice care. The Apollo aspiration system appears to be a safe and effective minimally invasive option for intracerebral hematoma evacuation, particularly when coupled with endovascular embolization of ruptured intracranial aneurysms. Future work will address which patient population is most likely to benefit from this promising technique.

Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yoshimatsu, Rika; Yamagami, Takuji, E-mail: yamagami@kochi-u.ac.jp; Ishikawa, Masaki

2016-06-15

PurposeTo evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE).MethodsBoth B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated.ResultsAmong 27 tumors, tumormore » enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor.ConclusionsTumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.« less

Onyx embolization of anterior condylar confluence dural arteriovenous fistula

PubMed Central

Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

2013-01-01

The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material. PMID:23459160

Endovascular minimally invasive treatment of the intracranial aneurysms – first 124 cases

PubMed Central

Dima, S; Scheau, C; Stefanescu, F; Danaila, L

2012-01-01

Introduction: Since May 2005, we have started to treat the intracranial aneurysms endovascular way as an alternative minimally invasive technique to the classic neurosurgery treatment. Objective: Studying the patients’ demographics, clinical presentation, aneurysm size and configuration, type of coils used for embolization, the percentage of compaction and recanalization (especially in patients who presented with subarachnoid hemorrhage), and immediate complications. Methods and Results: An all-inclusive retrospective review of every patient who underwent coils embolization (stent or balloon assisted included) of saccular aneurysms from May 2005 to September 2011 was performed. A total of 116 patients (46 men and 60 women) and 124 aneurysms were treated. A total of 96 patients (41 men and 55 women) underwent follow-up femoral cerebral angiograms (mean follow-up was 25 months and the longest was at 37 months). Five patients required intra-arterial abciximab due to thrombus formation. Four patients had aneurysm rupture while the coil was being advanced. Eleven patients were treated during vasospasm peak. Seven patients had recanalization at 12 months follow-up. Discussion: The average hospitalization period was of 4 days. There is a close relation between Hunt and Hess scale score before treatment and post interventional neurological status. Due to subarachnoid hemorrhage, the vasospasm remains a threat to the patient’s neurological status. The treatment of cerebral aneurysms with endosacular embolization by coils is a safe and durable option. The risk of recanalization or re-rupture in our cohort is small compared to series published elsewhere. Larger series of patients are needed to support our evidence. PMID:23049642

Endovascular minimally invasive treatment of the intracranial aneurysms--first 124 cases.

PubMed

Dima, S; Scheau, C; Stefanescu, F; Danaila, L

2012-09-15

Since May 2005, we have started to treat the intracranial aneurysms endovascular way as an alternative minimally invasive technique to the classic neurosurgery treatment. Studying the patients' demographics, clinical presentation, aneurysm size and configuration, type of coils used for embolization, the percentage of compaction and recanalization (especially in patients who presented with subarachnoid hemorrhage), and immediate complications. An all-inclusive retrospective review of every patient who underwent coils embolization (stent or balloon assisted included) of saccular aneurysms from May 2005 to September 2011 was performed. A total of 116 patients (46 men and 60 women) and 124 aneurysms were treated. A total of 96 patients (41 men and 55 women) underwent follow-up femoral cerebral angiograms (mean follow-up was 25 months and the longest was at 37 months). Five patients required intra-arterial abciximab due to thrombus formation. Four patients had aneurysm rupture while the coil was being advanced. Eleven patients were treated during vasospasm peak. Seven patients had recanalization at 12 months follow-up. The average hospitalization period was of 4 days. There is a close relation between Hunt and Hess scale score before treatment and post interventional neurological status. Due to subarachnoid hemorrhage, the vasospasm remains a threat to the patient's neurological status. The treatment of cerebral aneurysms with endosacular embolization by coils is a safe and durable option. The risk of recanalization or re-rupture in our cohort is small compared to series published elsewhere. Larger series of patients are needed to support our evidence.

Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists.

PubMed

Zuckerman, Scott L; Lakomkin, Nikita; Magarik, Jordan A; Vargas, Jan; Stephens, Marcus; Akinpelu, Babatunde; Spiotta, Alejandro M; Ahmed, Azam; Arthur, Adam S; Fiorella, David; Hanel, Ricardo; Hirsch, Joshua A; Hui, Ferdinand K; James, Robert F; Kallmes, David F; Meyers, Philip M; Niemann, David B; Rasmussen, Peter; Turner, Raymond D; Welch, Babu G; Mocco, J

2018-05-01

The angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment. The main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms. A panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0-100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization. 10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58). Identifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights

CE-MRA for Follow-up of Aneurysms Post Stent-Assisted Coiling

PubMed Central

Agid, R.; Schaaf, M.; Farb, RI.

2012-01-01

Summary This study compared the accuracy of contrast-enhanced MR angiography (CE-MRA) to intra-arterial cerebral angiography (IA-DSA) for assessment of intracranial aneurysms after stent-assisted coiling and to check if the presence of a stent in the parent artery diminishes the accuracy of CE-MRA. Consecutive patients with cerebral aneurysms treated by stent-assisted coiling were evaluated retrospectively. Matching follow-up CE-MRA and IA-DSA were evaluated separately. Evaluation included the presence of aneurysmal remnant, patency and stenosis of parent artery. Twenty-seven patients with 28 aneurysms and 33 matched CE-MRA and IA-DSA studies were evaluated. Nineteen aneurysmal remnants were seen on CE-MRA and 16 on IA-DSA. CE-MRA diagnosed three aneurysmal remnants not appreciated on IA-DSA. Five other remnants were larger on CE-MRA than IA-DSA. None of the remnants were missed on CE-MRA. Parent arteries were patent on both modalities. CE-MRA showed false stenosis of the stented artery in six cases and exaggerated stenosis in two. In 18 cases, CE-MRA showed a short focal “pseudo-stenosis” where the stent’s marker bands were located. This was noted whenever the stent’s marker bands were located in an artery with luminal diameter ≤2 mm and was called “marker band effect”. CE-MRA is an accurate technique for follow-up of aneurysms post stent-assisted coiling with excellent depiction of remnants in spite of the presence of a stent. Apparent stenosis of the stented parent artery on CE-MRA is often false or exaggerated. “Marker band effect” should be recognized as an artifact that appears when stent’s marker bands are in a small artery. PMID:22958765

Perianeurysm edema with second-generation bioactive coils.

PubMed

Marden, Franklin A; Putman, Christopher M

2008-06-01

Perianeurysm edema is an uncommon complication of intracranial aneurysms, occurring mostly in giant aneurysms that suddenly thrombose. We present the first report of an unruptured, nongiant, saccular aneurysm that developed marked perianeurysm edema after embolization with Matrix2 coils. In this case, follow-up catheter angiography showed a new coil tail protruding beyond the dome of the aneurysm in the region of the most intense edema. We postulate that perianeurysm edema may occur after breakdown of the aneurysm wall accompanied by an inflammatory response to exposed bioactive coils. Clinicians should be aware of this potential complication and consider performing earlier surveillance angiography when this occurs to ensure that there has not been a shift in the coil mass and recurrence of the aneurysm.

Septic pulmonary arteriovenous fistula. An unusual conduit for systemic embolization in right-sided valvular endocarditis.

PubMed

Stagaman, D J; Presti, C; Rees, C; Miller, D D

1990-06-01

Right-sided valvular (tricuspid, pulmonic) endocarditis is frequently complicated by septic pulmonary embolization. Systemic embolization may also rarely occur due to associated left-sided endocarditis or right-to-left shunting in patients with septal defects. This report documents the occurrence of systemic embolization causing a cerebrovascular accident in an intravenous drug abuser with recurrent tricuspid valve endocarditis due to an isolated peripheral septic pulmonary arteriovenous fistula. Noninvasive diagnosis of the fistula by cardiac auscultation, contrast echocardiography, and nuclear magnetic resonance imaging was confirmed by selective pulmonary angiography. Subselective balloon embolization of the pulmonary arteries feeding this fistula was accomplished.

Preoperative Embolization of Skull Base Meningiomas: Outcomes in the Onyx Era.

PubMed

Przybylowski, Colin J; Baranoski, Jacob F; See, Alfred P; Flores, Bruno C; Almefty, Rami O; Ding, Dale; Chapple, Kristina M; Sanai, Nader; Ducruet, Andrew F; Albuquerque, Felipe C

2018-05-09

Preoperative embolization may facilitate skull base meningioma resection, but its safety and efficacy in the Onyx era have not been investigated. In this retrospective cohort study, we evaluated the outcomes of preoperative embolization of skull base meningiomas using Onyx as the primary embolysate. We queried an endovascular database for patients with skull base meningiomas who underwent preoperative embolization at our institution in 2007-2017. Patient, tumor, procedure, and outcome data were analyzed. Twenty-eight patients (28 meningiomas) underwent successful preoperative meningioma embolization. The mean patient age ± SD was 56 ± 13 years, and 18 patients (64%) were women. The mean tumor size was 49 cm 3 . There were 1, 2, or 3 arterial pedicles embolized in 21 cases (75%), 6 cases (21%), and 1 case (4%), respectively. The embolized pedicles included branches of the middle meningeal artery in 19 cases (68%), the internal maxillary artery in 8 cases (29%), the ascending pharyngeal artery in 2 cases (7%), and the posterior auricular, ophthalmic, occipital, and anterior cerebral arteries in 1 case each (4%). The embolysates used were Onyx alone in 20 cases (71%), n-butyl cyanoacrylate alone in 3 cases (11%), coils/particles and Onyx/n-butyl cyanoacrylate in 2 cases each (7%), and Onyx and coils in 1 case (4%). The median degree of tumor devascularization was 60%. Significant neurologic morbidity occurred in 1 patient (4%) who developed symptomatic peritumoral edema after Onyx embolization. For appropriately selected skull base meningiomas supplied by dura mater-based arterial pedicles without distal cranial nerve supply, preoperative embolization with current embolysate technology affords substantial tumor devascularization with a low complication rate. Copyright © 2018 Elsevier Inc. All rights reserved.

Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu; Niemeyer, Matthew M.; Dasika, Narasimham L., E-mail: narasimh@med.umich.edu

2013-10-15

Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 daysmore » (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.« less

Use of Intermediate Guide Catheters as an Adjunct in Extracranial Embolization to Avoid Onyx Reflux into the Anastomotic Vasculature

PubMed Central

Puri, Ajit S; Kühn, Anna L; Hou, Samuel Y; Wakhloo, Ajay K

2014-01-01

Summary Onyx is a non-adhesive polymer used for embolization of arteriovenous malformations and dural arteriovenous fistulas (DAVFs). The limiting factor for Onyx embolization is usually the amount of microcatheter reflux, which can be safely tolerated. The dual microcatheter technique, compliant balloon use proximally and the use of the dual lumen Scepter balloon have been described to prevent and limit proximal Onyx reflux. We describe the use the Navien 058 intermediate guide catheter to accept the Onyx reflux in its lumen and possibly also serve as a mechanical barrier to avoid reflux into the anastomotic channel connecting the occipital artery to the vertebral artery during DAVF embolization via the occipital artery. Complete embolization of the DAVF was achieved using the lumen of the Navien catheter to accept aggressive Onyx reflux. Complete cure of the DAVF was obtained with Onyx cast filling the entire venous pouch. Besides providing distal access support, intermediate guide catheters can also prevent embolic material reflux by accepting reflux into the lumen and providing a mechanical barrier. PMID:25207904

Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography.

PubMed

Beller, Ebba; Klopp, David; Göttler, Jens; Kaesmacher, Johannes; Zimmer, Claus; Kirschke, Jan S; Prothmann, Sascha

2016-01-01

Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤ .001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤ .001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤ .01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05). Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.

Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

PubMed Central

Beller, Ebba; Klopp, David; Göttler, Jens; Kaesmacher, Johannes; Zimmer, Claus; Kirschke, Jan S.; Prothmann, Sascha

2016-01-01

Background Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. Methods 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Results Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤ .001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤ .001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤ .01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05). Conclusion Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome. PMID:27073908

Detection Rate and Clinical Relevance of Ink Tattooing during Balloon-Assisted Enteroscopy

PubMed Central

Ebigbo, A.; Schrempf, M.; Messmann, H.; Gölder, S. K.

2017-01-01

Background and Aims Balloon-assisted enteroscopy (BAE) is a well-established tool in the diagnosis and therapy of small bowel diseases. Ink tattooing of the small bowel is used to mark pathologic lesions or the depth of small bowel insertion. The purpose of this study was to determine the safety, the detection rate, and the clinical relevance of ink tattooing during BAE. Methods We performed a retrospective analysis of all 81 patients who received an ink tattooing during BAE between 2010 and 2015. Results In all patients, ink tattooing was performed with no complications. 26 patients received a capsule endoscopy after BAE. The tattoo could be detected via capsule endoscopy in 19 of these 26 patients. The tattoo of the previous BAE could be detected via opposite BAE in 2 of 11 patients. In 9 patients, ink tattooing influenced the choice of approach for reenteroscopy. In 7 patients, the tattoo was used for intraoperative localization and in 3 patients for intraoperative localization as well as for reenteroscopy. The intraoperative detection rate of the tattoo was 100%. Conclusion Ink tattooing of the small intestine is a safe endoscopic procedure to mark the depth of scope insertion or a pathologic lesion during balloon-assisted enteroscopy. PMID:29230241

Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com

ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolizationmore » was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.« less

Impending rupture of saphenous vein graft aneurysm with floating fractured bare metal stent treated by coil embolization and covered stent implantation.

PubMed

Kodama, Atsuko; Kurita, Tairo; Kato, Osamu; Suzuki, Takahiko

2016-11-01

Aneurysmal degeneration of a saphenous vein graft (SVG) is a rare, but potentially fatal complication of coronary artery bypass graft (CABG) surgery. In this case report, a patient that had undergone prior CABG surgery and bare metal stent (BMS) implantation at the site of a stenotic SVG lesion presented at our hospital with chest pain, and an SVG aneurysm was detected at the previous BMS implantation site. In addition, the implanted BMS was fractured and floating in the SVG aneurysm. The SVG aneurysm was successfully occluded by percutaneous intervention, using a combination of distal covered stent deployment at the site of the anastomosis between the native coronary artery and the SVG and proximal coil embolization of the aneurysm.

Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

PubMed Central

Yamauchi, Hiroshi; Kida, Mitsuhiro; Imaizumi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Koizumi, Wasaburo

2015-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy. PMID:26074685

Microcatheter Embolization of Intractable Idiopathic Epistaxis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi

1999-11-15

Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of themore » sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up.« less

High-Flow Arterio-Hepatic Venous Shunt in Hepatocellular Carcinoma: Use of Multi-Electrode Radiofrequency for Shunt Obliteration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pua, Uei, E-mail: druei@yahoo.com

2015-10-15

Intra-tumoral arterio-hepatic venous shunting (AHVS) poses an impediment to transarterial chemoembolization of liver tumors. Not only does it present a potential hazard for systemic shunting and embolization, but also the altered flow dynamics may also result in poor delivery of drug/embolics to the target tumor bed. Current available techniques to overcome AVHS include arterial embolization (particles, coils, glue, etc.) or temporary venous occlusion using balloons. We hereby illustrate the use of radiofrequency ablation to obliterate a complex AHVS consisting of a varix-like venous aneurysm.

[Selective embolization to treat obstetric hemorrhage].

PubMed

Ferrer Puchol, M D; Lanciego, C; Esteban, E; Ciampi, J J; Edo, M A; Ferragud, S

2014-01-01

To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Use of intermediate guide catheters as an adjunct in extracranial embolization to avoid onyx reflux into the anastomotic vasculature. A technical note.

PubMed

Puri, Ajit S; Kühn, Anna L; Hou, Samuel Y; Wakhloo, Ajay K

2014-01-01

Onyx is a non-adhesive polymer used for embolization of arteriovenous malformations and dural arteriovenous fistulas (DAVFs). The limiting factor for Onyx embolization is usually the amount of microcatheter reflux, which can be safely tolerated. The dual microcatheter technique, compliant balloon use proximally and the use of the dual lumen Scepter balloon have been described to prevent and limit proximal Onyx reflux. We describe the use the Navien 058 intermediate guide catheter to accept the Onyx reflux in its lumen and possibly also serve as a mechanical barrier to avoid reflux into the anastomotic channel connecting the occipital artery to the vertebral artery during DAVF embolization via the occipital artery. Complete embolization of the DAVF was achieved using the lumen of the Navien catheter to accept aggressive Onyx reflux. Complete cure of the DAVF was obtained with Onyx cast filling the entire venous pouch. Besides providing distal access support, intermediate guide catheters can also prevent embolic material reflux by accepting reflux into the lumen and providing a mechanical barrier.

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report.

PubMed

Maruhashi, Takaaki; Minehara, Hiroaki; Takeuchi, Ichiro; Kataoka, Yuichi; Asari, Yasushi

2017-12-14

The resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing around the site proximal to the occlusion by resuscitative endovascular balloon occlusion of the aorta have almost never been studied. A 50-year-old Japanese woman fell from a height of approximately 10 m. At initial arrival, her respiratory rate was 24 breaths/minute, her blood oxygen saturation was 95% under 10 L/minute oxygenation, her pulse rate was 90 beats per minute, and her blood pressure was 180/120 mmHg. Mild lung contusion, hemopneumothorax, unstable pelvic fracture, and retroperitoneal bleeding with extravasation of contrast media were observed in initial computed tomography. As her vital signs had deteriorated during computed tomography, a 7-French aortic occlusion catheter (RESCUE BALLOON®, Tokai Medical Products, Aichi, Japan) was inserted and inflated for aortic occlusion at the first lumbar vertebra level and transcatheter arterial embolization was performed for the pelvic fracture. Her bilateral internal iliac arteries were embolized with a gelatin sponge; however, the embolized sites presented recanalization as coagulopathy appeared. Her bilateral internal iliac arteries were re-embolized by n-butyl-2-cyanoacrylate. The balloon was deflated 18 minutes later. After embolization, repeat computed tomography was performed and a massive hemothorax, which had not been captured on arrival, had appeared in her left pleural cavity. Thoracotomy hemostasis was performed and a hemothorax of approximately 2500 ml was aspirated to search for the source of bleeding. However, clear active bleeding was not captured; resuscitative endovascular balloon occlusion of the aorta may have been the cause of the increased bleeding of the thoracic injury at the proximal site of the aorta occlusion. It is necessary to note that the use of resuscitative endovascular

Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bagla, Sandeep, E-mail: sandeep.bagla@gmail.com; Smirniotopoulos, John; Orlando, Julie C.

PurposeProstatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH.Materials and MethodsIRB-approved retrospective study of 40 consecutive patients 49–81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performedmore » within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months.ResultsNo significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm{sup 2} vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred.ConclusionsRobotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.« less

Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis.

PubMed

Bagla, Sandeep; Smirniotopoulos, John; Orlando, Julie C; Piechowiak, Rachel

2017-03-01

Prostatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH. IRB-approved retrospective study of 40 consecutive patients 49-81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months. No significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm 2 vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred. Robotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.

Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

PubMed Central

Chacón-Quesada, Tatiana; Maud, Alberto; Ramos-Duran, Luis; Torabi, Alireza; Fitzgerald, Tamara; Akle, Nassim; Cruz Flores, Salvador; Trier, Todd

2015-01-01

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma. PMID:25763296

Percutaneous Glue Embolization of a Visceral Artery Pseudoaneurysm in a Case of Sickle Cell Anemia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gulati, Gurpreet S.; Gulati, Manpreet S.; Makharia, Govind

2006-08-15

Although aneurysmal complications of sickle cell anemia have been described in the intracranial circulation, visceral artery pseudoaneurysms in this disease entity have not previously been reported in the literature. Conventional treatment of visceral pseudoaneurysms has been surgical ligation or resection of the aneurysm. Transcatheter embolization has emerged as an attractive, minimally invasive alternative to surgery in the treatment of these lesions. In certain situations, however, due to the unfavorable angiographic anatomy precluding safe transcatheter embolization, direct percutaneous glue injection of the pseudoaneurysm sac may be considered to achieve successful occlusion of the sac. The procedure may be rendered safer bymore » simultaneous balloon protection of the parent artery. We describe this novel treatment modality in a case of inferior pancreaticoduodenal artery pseudoaneurysm in a patient with sickle cell anemia. Although a complication in the form of glue reflux into the parent vessel occurred that necessitated surgery, this treatment modality may be used in very selected cases (where conventional endovascular embolization techniques are not applicable) after careful selection of the balloon diameter and appropriate concentration of the glue-lipiodol mixture.« less

Transarterial Embolization of a Renal Artery Aneurysm Concomitant With Renal Arteriovenous Fistula.

PubMed

Hongsakul, Keerati; Bannangkoon, Kittipitch; Boonsrirat, Ussanee; Kritpracha, Boonprasit

2018-01-01

Congenital renal artery aneurysm is uncommon. Moreover, renal artery aneurysm concomitant with a congenital renal arteriovenous fistula is extremely rare. Transarterial embolization is the first-line treatment for these conditions. We report a case of a patient with congenital renal artery aneurysm concomitant with a congenital renal arteriovenous fistula of the upper polar left renal artery which was successfully treated by transarterial embolization with coil, glue, and Amplatzer vascular plug.

Transvenous Endovascular Treatment for Scalp Arteriovenous Fistulas: Results with Combined Use of Onyx and Coils.

PubMed

Ni, Wei; Tian, Yanlong; Gu, Yuxiang; Mao, Ying

2017-11-01

Scalp arteriovenous fistulas (AVFs) are rare lesions that may occur spontaneously or secondary to head trauma. A standard treatment strategy for these lesions has not been established to date. We present 3 cases of successful treatment of scalp AVFs using a combination of Onyx-18 and coils via a transvenous approach. The patient database at Huashan Hospital, Fudan University, Shanghai, China was reviewed, and patients with scalp AVFs treated with Onyx-18 and coils via a transvenous approach were identified for analysis. Between 2014 and 2016, 3 consecutive patients with scalp AVFs were treated transvenously with Onyx embolization in combination with coil placement at our hospital. No procedure-related complications were noted. Postembolization angiography demonstrated successful and complete occlusion of the AVFs immediately after treatment. Clinical follow-up showed resolution of symptoms. The technique of transvenous "armored concrete" embolization using a combination of coils and Onyx is an effective treatment modality for scalp AVFs, particularly in type C cases. Copyright © 2017 Elsevier Inc. All rights reserved.

The endovascular treatment of a spinal perimedullary arteriovenous fistula with coils: a case report.

PubMed

Pasqualetto, L; Papa, R; Isalberti, M; Nuzzi, N P; Branca, V

2011-03-01

We report a case of direct spinal intradural ventral arteriovenous fistula of the thoraco-lumbar region. Angiography demonstrated a single feeder from the anterior spinal artery that drained directly into a markedly dilated vein without an intervening nidus. The endovascular treatment was performed by a transarterial approach and the occlusion of the fistula, after a failed treatment by a detachable balloon, was obtained by coils released in the initial fistulous site inside a venous dilatation with complete clinical cure. This case indicates that endovascular treatment is possible using coils as a valid and safe alternative to a balloon, glue or surgical approach.

A coil placement technique to treat intracranial aneurysm with incorporated artery.

PubMed

Luo, Chao-Bao; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

2018-03-01

Endovascular coil embolization is an accepted treatment option for intracranial aneurysms. However, the coiling of aneurysms with an incorporated artery (IA) poses a high risk of IA occlusion. Here we report our experience of endovascular coil placement using a technique that avoids IA occlusion in aneurysms with IAs. Over a 6-year period, 185 patients harboring 206 intracranial aneurysms underwent endosaccular coiling. Forty-two of these patients with 45 aneurysms were treated by coil placement to avoid IAs occlusion. We assessed the anatomy of the aneurysms and IAs, technical feasibility of the procedure, and degree of aneurysm occlusion. Clinical and angiographic outcomes were assessed as well. Aneurysms were located in the supra-clinoid intracranial internal carotid artery (n = 24), anterior cerebral artery (n = 6), middle cerebral artery (n = 7), and vertebrobasilar artery (n = 8). The IA was at the aneurysm neck in 34 patients, body in 10, and dome in 1. Immediate post-coiling angiogram showed preservation of blood flow through the IA in all aneurysms. Coil compaction with aneurysmal regrowth was found in 7 of 36 patients having follow-up conventional angiography. One patient had an IA territory infarction after embolization. All 42 patients were followed up (mean: 21 months) and showed no re-bleeding. This technique is effective and safe in managing intracranial aneurysms with IAs. Although aneurysmal recurrence may occur in some aneurysms because of insufficient coiling, this technique is simpler to perform and requires less skill than other techniques. It can be an alternative option for treating some selected intracranial aneurysms with IAs. Copyright © 2017. Published by Elsevier Taiwan LLC.

High-grade traumatic torso visceral injury with hemodynamic instability: effectiveness of transarterial embolization using n-butyl cyanoacrylate.

PubMed

Tsurukiri, Junya; Ohta, Shoichi; Hoshiai, Akira; Sano, Hidefumi; Okumura, Eitaro; Tsubouchi, Nobuhiko; Konishi, Hiroyuki; Yukioka, Tetsuo

2017-04-01

Trauma patients with uncontrolled hemorrhage encountering coagulopathy are often associated with poor outcome. Recently, the concept of damage control interventional radiology, which focuses on "speedy stoppage of bleeding" by interventional radiology among trauma patients with hemodynamic instability and acute traumatic coagulopathy, was proposed as an alternative to damage control surgery. N-butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non-traumatic situations, where it has been shown to have a high technical success rate and low recurrent bleeding rate, especially in patients with coagulopathy. In this case, we treated a young patient with hemodynamic instability caused by a high-grade hepatic injury, who underwent arterial embolization (AE) using NBCA assisted with resuscitative endovascular balloon occlusion of the aorta and achieved successful hemostasis. A review of published works using PUBMED was carried out, and 10 published reports involving 23 trauma patients who underwent AE using NBCA were identified. Among them, only four reports involving five trauma patients with torso visceral injuries were identified. Three of five patients who were hemodynamically unstable underwent AE using NBCA, resulting in the stabilization of hemodynamics. We concluded that AE with resuscitative endovascular balloon occlusion of the aorta as a damage control interventional radiology procedure might be acceptable for the hemodynamically unstable hepatic injury, and NBCA could be one of the effective hemostatic agents for this purpose, in cases of trauma-induced coagulopathy.

Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with Enterprise and Neuroform stents: a comparative analysis of the literature.

PubMed

King, Brent; Vaziri, Sasha; Singla, Amit; Fargen, Kyle M; Mocco, J

2015-12-01

The most widely used intracranial stents for stent-assisted coiling are Neuroform (NEU) and Enterprise stents (ENT). This study compares published outcomes between the ENT and NEU coil-assist systems and comments on the published safety and efficacy of stent-assisted coiling in general. A literature search was performed through PubMed for all published series of ENT or NEU stent-assisted coiling of cerebral aneurysms from 2004 to 2014. All studies including 10 or more published cases of stent-assisted coiling with ENT or NEU were included. 47 studies met the inclusion criteria, containing 4238 aneurysms in 4039 patients. 2111 aneurysms were treated with NEU and 2127 were treated with ENT. Mean follow-up was 14.1 months. Overall, thromboembolic events occurred in 6.4% of aneurysms, intracranial hemorrhage (ICH) in 2.6%, permanent morbidity in 3.9%, and mortality in 2.3%. Initial and final 100% angiographic occlusion was seen in 53% and 69% of patients, respectively. Deployment failures (p<0.001), ICH (p=0.001), mortality among all patients (p=0.03), and recanalization (p=0.02) were more commonly reported in NEU treated aneurysms. The ENT system was also associated with higher reported complete occlusion at follow-up (p<0.001). This literature review represents the largest and most robust comparison of stent-assisted coiling devices to date, containing over 4200 aneurysms in more than 4000 patients. Comparative analyses demonstrate that both devices are reported to be safe and effective with comparable permanent morbidity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Long-term follow-up of aneurysms treated electively with woven stent-assisted coiling.

PubMed

Cheung, Nicholas K; Chiu, Albert Hy; Cheung, Andrew K; Wenderoth, Jason D

2017-12-15

Preliminary short-term results for stent-assisted coil embolization (SACE) using woven/braided stents have been promising. However, evidence supporting mid- to long-term efficacy and durability is lacking. To report the long-term results for the durability of elective intracranial aneurysms treated with woven stents. Between May 2012 and May 2015, 98 consecutive patients with 103 aneurysms underwent elective woven SACE across three Australian neurovascular centres. All patients had immediate, 6- and 18-month clinical and radiological follow-up. Radiological assessment was performed with modified Raymond-Roy occlusion scores based on angiography results, while clinical assessment was based on the modified Rankin Scale. Six-month follow-up was available in 100 aneurysms, and an 18-month follow-up in 97 aneurysms. Total occlusion rates of 82% were achieved at inception, 82% at 6 months, and 90% at 18 months. Satisfactory occlusion with small neck remnants was present in 17% at inception, 16% at 6 months, and 9% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Intraprocedural thromboembolic events were recorded in 3% and delayed events in 1% (all in patients taking clopidogrel). Aneurysm recurrence occurred in one patient (1%). Technical complications occurred in 5%. The total complication rate was 10%. Woven SACE is safe, efficacious, and durable at long-term 18-month follow-up, with very low recurrence and re-treatment rates. Preliminary results appear better than those for traditional laser-cut stents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cerebral ischemic lesions detected with diffusion-weighted magnetic resonance imaging after carotid artery stenting: Comparison of several anti-embolic protection devices.

PubMed

Taha, Mahmoud M; Maeda, Masayuki; Sakaida, Hiroshi; Kawaguchi, Kenji; Toma, Naoki; Yamamoto, Akitaka; Hirose, Tomofumi; Miura, Youichi; Fujimoto, Masashi; Matsushima, Satoshi; Taki, Waro

2009-09-01

Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusion-weighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm(3) vs. 86.9 mm(3), respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm(3)) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm(3) and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.

Aneurysm coil embolization: cost per volumetric filling analysis and strategy for cost reduction.

PubMed

Wang, Charlie; Ching, Esteban Cheng; Hui, Ferdinand K

2016-05-01

One of the primary device expenditures associated with the endovascular treatment of aneurysms is that of detachable coils. Analyzing the cost efficiency of detachable coils is difficult, given the differences in design, implantable volume, and the presence of additives. However, applying a volume per cost metric may provide an index analogous to unit price found in grocery stores. The price information for 509 different coils belonging to 31 different coil lines, available as of September 2013, was obtained through the inventory management system at the study site, and normalized to the price of the least expensive coil. Values were used to calculate the logarithmic ratio of volume over cost. Operator choice among coil sizes can vary the material costs by five-fold in a hypothetical aneurysm. The difference in coil costs as a function of cost per volume of coil can vary tremendously. Using the present pricing algorithms, using the longest available length at a particular helical dimension and system yields improved efficiency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Fat embolism syndrome

PubMed Central

Richards, Robin R.

1997-01-01

Fat embolism syndrome, an important contributor to the development of acute respiratory distress syndrome, has been associated with both traumatic and nontraumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. Fat emboli can deform and pass through the lungs, resulting in systemic embolization, most commonly to the brain and kidneys. The diagnosis of fat embolism syndrome is based on the patient’s history, supported by clinical signs of pulmonary, cerebral and cutaneous dysfunction and confirmed by the demonstration of arterial hypoxemia in the absence of other disorders. Treatment of fat embolism syndrome consists of general supportive measures, including splinting, maintenance of fluid and electrolyte balance and the administration of oxygen. Endotracheal intubation and mechanical ventilatory assistance can be indicated. The role of corticosteroids remains controversial. Early stabilization of long bone fractures has been shown to decrease the incidence of pulmonary complications. Clinical and experimental studies suggest that the exact method of fracture fixation plays a minor role in the development of pulmonary dysfunction. As more is learned about the specifics of the various triggers for the development of fat embolism syndrome, it is hoped that the prospect of more specific therapy for the prevention and treatment of this disorder will become a reality. PMID:9336522

Treatment of type I endoleaks using transcatheter embolization with onyx.

PubMed

Eberhardt, Karla Maria; Sadeghi-Azandaryani, Mojtaba; Worlicek, Stefanie; Koeppel, Thomas; Reiser, Maximilian F; Treitl, Marcus

2014-02-01

To report a single-center experience with transcatheter embolization of type I endoleaks using the liquid embolic agent Onyx, an ethylene vinyl alcohol copolymer. Eight patients (4 men; mean age 74.8 years, range 63-86) with 10 type I endoleaks (6 abdominal and 4 thoracic) diagnosed 2 days to 9 years after endovascular repair were treated with Onyx embolization because cuff extension was precluded by an insufficient landing zone in 6 cases and an unsuitable aortic diameter in 2. Endoleaks were accessed with a 4-F diagnostic catheter and a coaxially introduced dimethylsulfoxide-compatible microcatheter. Onyx-34 was predominantly applied due to its high viscosity; patent side branches were coil embolized prior to Onyx delivery in 3 cases. Technical success of the procedure was achieved in all cases. The mean volume of Onyx used for abdominal endoleaks was 11.8 mL (range 3.0-25.5) and 19.4 mL (range 4.5-31.5) for thoracic endoleaks. The average duration of the procedure was 76.7 minutes (range 34.5-110.6), and the average radiation dose area product was 18.8 cGy*cm (2) (range 10.6-55.8). Reperfusion of the endoleak was detected in one case 2 days after the procedure. A second case showed an occluded endoleak but a small trace of contrast between the aortic wall and the stent-graft. Non-target embolization was not found in any case. Mean follow-up was 13.2 months (range 8-24). The mean reduction in diameters for thoracic aneurysms after 6 and 12 months was 0.4 and 0.9 cm, respectively, and 0.6 and 1.2 cm, respectively, for abdominal aneurysms. Transcatheter embolization of type I endoleaks using Onyx is a simple, safe, and sustainable treatment option with a high primary success rate for cases in which stent-graft extension is not possible. The benefit of additional coil embolization remains uncertain.

Endovascular treatment for traumatic scalp arteriovenous fistulas: results with Onyx embolization.

PubMed

Dabus, Guilherme; Pizzolato, Raffaella; Lin, Eugene; Kreusch, Andreas; Linfante, Italo

2014-06-01

Arteriovenous fistulas of the scalp (S-AVFs) are rare lesions and may occur spontaneously or secondary to trauma. The use of Onyx for the treatment of S-AVFs is not well established at this time. We discuss three cases of traumatic S-AVFs treated successfully with Onyx embolization alone or in association with coils. The database of patients treated at the Baptist Cardiac and Vascular Institute, Miami, Florida, was reviewed. All patients with traumatic S-AVFs treated with Onyx were included. Two men and one woman with progressive enlarging pulsatile mass with bruit or tinnitus had angiographic evidence of S-AVF and were treated. In two patients the S-AVFs were secondary to hair transplantation. They were treated with Onyx-18 embolization as the single treatment modality. One patient with S-AVF resulting from temporomandibular joint arthroscopy was treated with coils and subsequent Onyx-34 embolization. In one patient, transarterial microcatheterization and injection of Onyx-18 was performed. In another patient, the intra-arterial approach was prevented by arterial vessel tortuosity. Therefore, access to the fistula was obtained through direct puncture of a large frontal vein; contrast injection confirmed the positioning of the needle within the draining vein of the AVF and Onyx-18 was then injected while the outflow vein was compressed. In the third patient in this series, coils were deployed to allow safer and more controlled injection of Onyx-34. No procedure related complications were noted. Post-embolization angiography demonstrated successful and complete occlusion of the AVF immediately after treatment. Follow-up revealed complete resolution of the symptoms. Our experience in this small series indicates that endovascular treatment of S-AVFs with Onyx is rapid, safe, and highly effective.

Stent-assisted coiling of wide-neck bifurcation aneurysms with a branch incorporated in the aneurysm base: long-term follow-up in 49 patients with 53 aneurysms.

PubMed

Lubicz, Boris; Morais, Ricardo; Bruyère, Pierre-Julien; Ligot, Noémie; Mine, Benjamin

2017-06-01

Wide-neck bifurcation intracranial aneurysms (WNBA) with a branch incorporated in the aneurysm base remain difficult to treat by embolization. We aim to report our long-term follow-up of stent-assisted coiling (SAC) in this subgroup of patients. This study was approved by our local ethical committee. A retrospective review of our prospectively maintained database identified all patients treated in our institution by SAC for a WNBA with a branch incorporated in the aneurysm base. Technical issues, immediate, long-term outcomes were evaluated. Between 2007 and 2015, 49 patients with 53 intracranial aneurysms (IAs) (52 unruptured, 1 ruptured) were identified and successfully treated. No morbidity/mortality occurred. The incorporated branch was preserved in all patients but one who was treated during a vasospasm phase. At the first 6-month imaging control, the branch was patent. Immediate occlusion was near-complete in 11/53 aneurysms (20.8%), neck remnant in 20/53 aneurysms (37.7%), and incomplete in 22/53 aneurysms (41.5%). Available imaging follow-up of 47 IAs, ranging from 3 to 84 months (mean 26 months ± 19.6 months), showed 27 progressive thrombosis (57.4%), 17 stable occlusions (36.2%), 1 minor recanalization (2.1%), and 2 significant recanalizations that were retreated (4.3%). The latest imaging control showed 30 near-complete occlusions (63.8%), 13 neck remnants (27.7%), and 4 incomplete occlusions (8.5%). Stent-assisted coiling is safe and effective for the treatment of WNBA with a branch incorporated in the aneurysm base. Despite poor immediate anatomical results, long-term follow-up shows a high rate of progressive thrombosis achieving adequate and stable occlusion in most patients.

Pseudoaneurysm of the Profunda Femoris Artery following Blunt Trauma Treated by Endovascular Coil Embolization: Review of Two Cases and Relevant Literature

PubMed Central

McNerney, Patrick; Kiproff, Paul

2017-01-01

Profunda femoris artery (PFA) pseudoaneurysm after blunt trauma without associated femur fracture is a rare occurrence. Most of the reported cases of PFA pseudoaneurysm in the English literature developed after penetrating trauma, surgical procedures, and femur fractures. We present two such cases following blunt trauma and without any associated long bone injury. After initial imaging failed to show any long bone fracture, CT angiography confirmed pseudoaneurysm of the branch of the PFA. Both patients were then treated with emergent coil embolization of the bleeding vessel. Pseudoaneurysms typically present late and signs of persistent hip pain, thigh swelling, presence of a pulsatile mass, and even unexplained anemia all may suggest the diagnosis. Recognition of PFA pseudoaneurysm requires high index of suspicion and is often difficult to diagnose clinically because of its location. PMID:28246563

Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms.

PubMed

Chalouhi, Nohra; Tjoumakaris, Stavropoula; Starke, Robert M; Gonzalez, L Fernando; Randazzo, Ciro; Hasan, David; McMahon, Jeffrey F; Singhal, Saurabh; Moukarzel, Lea A; Dumont, Aaron S; Rosenwasser, Robert; Jabbour, Pascal

2013-08-01

Flow diversion has emerged as an important tool for the management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥10 mm). Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. There were no differences between the 2 groups in terms of patient age, sex, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5%; P=1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared with coiled aneurysms (41%; P<0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%; P<0.001). A similar proportion of patients attained a favorable outcome (modified Rankin Scale, 0-2) in the PED group (92%) and in the coil group (94%; P=0.8). The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED might be a preferred treatment option for large unruptured saccular aneurysms.

Buttock Claudication and Erectile Dysfunction After Internal Iliac Artery Embolization in Patients Prior to Endovascular Aortic Aneurysm Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rayt, H. S., E-mail: hsrayt@hotmail.com; Bown, M. J.; Lambert, K. V.

2008-07-15

Coil embolization of the internal iliac artery (IIA) is used to extend the application of endovascular aneurysm repair (EVAR) in cases of challenging iliac anatomy. Pelvic ischemia is a complication of the technique, but reports vary as to the rate and severity. This study reports our experience with IIA embolization and compares the results to those of other published series. The vascular unit database of the Leicester Royal Infirmary was used to identify patients who had undergone IIA coil embolization prior to EVAR. Data were collected from hospital case notes and by telephone interviews. Thirty-eight patients were identified; 29 ofmore » these were contactable by telephone. A literature search was performed for other studies of IIA embolization and the results were pooled. In this series buttock claudication occurred in 55% (16 of 29 patients) overall: in 52% of unilateral embolizations (11 of 21) and 63% of bilateral embolizations (5 of 8). New erectile dysfunction occurred in 46% (6 of 13 patients) overall: in 38% of unilateral embolizations (3 of 8) and 60% of bilateral embolizations (3 of 5). The literature review identified 18 relevant studies. The results were pooled with our results, to give 634 patients in total. Buttock claudication occurred in 28% overall (178 of 634 patients): in 31% of unilateral embolizations (99 of 322) and 35% of bilateral embolizations (34 of 98) (p = 0.46, Fisher's exact test). New erectile dysfunction occurred in 17% overall (27 of 159 patients): in 17% of unilateral embolizations (16 of 97) and 24% of bilateral embolizations (9 of 38) (p = 0.33). We conclude that buttock claudication and erectile dysfunction are frequent complications of IIA embolization and patients should be counseled accordingly.« less

Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx.

PubMed

Regine, Renato; Palmieri, Francesco; De Siero, Michele; Rescigno, Antonio; Sica, Vincenzo; Cantarela, Raffaele; Villari, Vincenzo

2015-03-01

The aim of our study is to verify the feasibility and the efficacy of Onyx as embolization agent in the treatment of traumatic and non-traumatic peripheral vascular lesions. In the period between September 2006 and March 2012, we treated with Onyx 26 patients (14 males/12 females; age range, 18-85 years old; mean age, 65 years old), 11 of which with traumatic peripheral vascular lesions and 15 with non-traumatic vascular lesions (9 neoplastic hemorrhagic lesions, 3 arteriovenous malformations (AVMs) and 3 aneurysms). Follow-up controls were performed with clinical examination and by multidetector computed tomography (MDCT) imaging 1, 6, and 12 months after the procedure. All peripheral vascular lesions were embolized with Onyx; 3 patients with aneurysms were treated with Onyx associated with endovascular coils. Four elective and 22 emergency embolization procedures were performed. In all patients, we obtained cessation of bleeding and the complete and permanent embolization of all vascular lesions. Onyx is an effective and safe embolization agent for peripheral vascular lesions.

Multi-mode Intravascular RF Coil for MRI-guided Interventions

PubMed Central

Kurpad, Krishna N.; Unal, Orhan

2011-01-01

Purpose To demonstrate the feasibility of using a single intravascular RF probe connected to the external MRI system via a single coaxial cable to perform active tip tracking and catheter visualization, and high SNR intravascular imaging. Materials and Methods A multi-mode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms. Results The multi-mode coil behaves as an inductively-coupled transmit coil. Forward looking capability of 6mm is measured. Greater than 3-fold increase in SNR compared to conventional imaging using optimized external coil is demonstrated. Simultaneous active tip tracking and catheter visualization is demonstrated. Conclusions It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multi-mode intravascular RF coil that is connected to the external system via a single coaxial cable. PMID:21448969

Computational analysis of pediatric ventricular assist device implantation to decrease cerebral particulate embolization.

PubMed

Nguyen, ThuyTien; Argueta-Morales, I Ricardo; Guimond, Stephen; Clark, William; Ceballos, Andres; Osorio, Ruben; Divo, Eduardo A; De Campli, William M; Kassab, Alain J

2016-01-01

Stroke is the most devastating complication after ventricular assist device (VAD) implantation with a 19% incidence and 65% mortality in the pediatric population. Current pediatric VAD technology and anticoagulation strategies alone are suboptimal. VAD implantation assisted by computational methods (CFD) may contribute reducing the risk of cerebral embolization. Representative three-dimensional aortic arch models of an infant and a child were generated. An 8 mm VAD outflow-graft (VAD-OG) anastomosed to the aorta was rendered and CFD was applied to study blood flow patterns. Particle tracks, originating in the VAD, were computed with a Lagrangian phase model and the percentage of particles entering the cerebral vessels was calculated. Eight implantation configurations (infant = 5 and child = 3) and 5 particle sizes (0.5, 1, 2, 3, and 4 mm) were considered. For the infant model, percentage of particles entering the cerebral vessels ranged from 15% for a VAD-OG anastomosed at 90° to the aorta, to 31% for 30° VAD-OG anastomosis (overall percentages: X(2) = 10,852, p < 0.0001). For the child model, cerebral embolization ranged from 9% for the 30° VAD-OG anastomosis to 15% for the 60° anastomosis (overall percentages: χ(2) = 10,323, p < 0.0001). Using detailed CFD calculations, we demonstrate that the risk of stroke depends significantly on the VAD implantation geometry. In turn, the risk probably depends on patient-specific anatomy. CFD can be used to optimize VAD implantation geometry to minimize stroke risk.

Embolization of a Hemorrhoid Following 18 Hours of Life-Threatening Bleeding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berczi, Viktor, E-mail: berczi@hotmail.com; Gopalan, Deepa; Cleveland, Trevor J

2008-01-15

Hemorrhoids usually do not pose diagnostic difficulties and they rarely cause massive bleeding. We report a case of massive rectal bleeding over 18 h needing 22 U blood transfusion treated by superselective transcatheter coil embolization 12 h following operative treatment performed in a different hospital. Diagnostic angiography with a view to superselective embolization, following failure of sigmoidoscopy to localize and treat the cause of hemorrhage, might act as a life-saving treatment in massive rectal bleeding, obviating the need for repeated endoscopy or emergency surgery.

Multimode intravascular RF coil for MRI-guided interventions.

PubMed

Kurpad, Krishna N; Unal, Orhan

2011-04-01

To demonstrate the feasibility of using a single intravascular radiofrequency (RF) probe connected to the external magnetic resonance imaging (MRI) system via a single coaxial cable to perform active tip tracking and catheter visualization and high signal-to-noise ratio (SNR) intravascular imaging. A multimode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms. The multimode coil behaves as an inductively coupled transmit coil. The forward-looking capability of 6 mm was measured. A greater than 3-fold increase in SNR compared to conventional imaging using optimized external coil was demonstrated. Simultaneous active tip tracking and catheter visualization was demonstrated. It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multimode intravascular RF coil that is connected to the external system via a single coaxial cable. Copyright © 2011 Wiley-Liss, Inc.

Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Technique and Intraprocedural Imaging

PubMed Central

Sabri, Saher S.; Saad, Wael E. A.

2011-01-01

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique used as a therapeutic adjunct or alternative to transjugular intrahepatic shunts (TIPS) in the management of gastric varices. Occlusion balloons are strategically placed to modulate flow within the gastrorenal or gastrocaval shunt to allow stagnation of the sclerosant material within the gastric varix. The approach and complexity of the procedure depends on the anatomic classification of inflow and outflow veins of the varix. Ethanolamine oleate has been described as the main sclerosant used in this procedure. Recently, foam sclerosants have gained popularity as alternative embolization agents, which provide the advantage of better variceal wall contact and potentially less dose of sclerosant. PMID:22942548

Disastrous Portal Vein Embolization Turned into a Successful Intervention

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dobrocky, Tomas, E-mail: tomas.dobrocky@insel.ch; Kettenbach, Joachim, E-mail: joachim.kettenbach@stpoelten.lknoe.at; Lopez-Benitez, Ruben, E-mail: Ruben.lopez@insel.ch

Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloonmore » catheter, inflating the balloon, and pulling the plug into the main right portal vein.« less

Systemic Embolic Complications of Pulmonary Vein Angioplasty in Children.

PubMed

Esch, Jesse J; Porras, Diego; Bergersen, Lisa; Jenkins, Kathy J; Marshall, Audrey C

2015-10-01

Pulmonary vein stenosis (PVS) carries significant morbidity and mortality for affected children, and its management often requires multiple angioplasty procedures. PVS angioplasty can be complicated by systemic embolic events such as stroke, but incidence and risk factors are poorly understood. We reviewed pediatric catheterizations involving PVS angioplasty and/or stent placement performed at Boston Children's Hospital between July 2005 and February 2014. A total of 406 cases were performed in 144 distinct patients. Patients underwent a median of two catheterizations, at median age 1 year and weight 6.9 kg. Eleven (2.7 %) catheterizations were complicated by clinically apparent systemic embolic events, comprising 10 strokes (one with associated hepatic embolism) and 1 renal infarct. Prevalence of clinically evident stroke among this cohort was 7.6 %. Using a prior (uncomplicated) catheterization to allow each patient to serve as their own control, we sought to identify potentially modifiable risk factors for systemic embolic events. Although this analysis was limited by low power, complicated and uncomplicated angioplasties did not appear to differ in case time, contrast dose, anticoagulation management, use of cutting balloons, number of catheter exchanges, or size of long sheath used. Significant non-embolic adverse events were common, occurring in 25 % of catheterizations. Systemic embolism appears to complicate PVS angioplasty at a rate much higher than that described for other congenital catheterizations. This risk may be inherent to the procedure rather than related to any modifiable or operator-dependent factors.

[Endovascular treatment of carotid-cavernous fistula type A with platinium coils].

PubMed

Culafić, Slobodan; Juszkat, Robert; Rusović, Sinisa; Stefanović, Dara; Minić, Ljubodrag; Spaić, Milan

2008-12-01

Carotid-cavernous fistulas are abnormal communications between carotid arteries or their branches and the cavernous system caused mostly by trauma. Posttraumatic fistulas represent 70% of all carotid-cavernous fistulas and they are mostly high-flow shunts (type A). This type gives characteristic eye symptoms. This paper presents a 44-year old male patient with carotid-cavernous fistula as a result of penetrating head injury. In clinical presentation the patient had exophthalmos, conjunctival chemosis and weakening of vision on the right eye, headache and diplopia. Digital subtracted angiography showed high-flow carotid-cavernous fistula, which was vascularised from the left carotid artery and from vertebrobasilar artery. Endovascular embolization with platinum coils was performed through the transarterial route (endoarterial approach). Check angiogram confirmed that the fistula was closed and that no new communications developed. Embolization of complex carotid-cavernous fistula type A was successfully performed with platinum coils by endovascular approach.

Outcomes of cellophane banding or percutaneous transvenous coil embolization of canine intrahepatic portosystemic shunts.

PubMed

Case, J Brad; Marvel, Sarah J; Stiles, Mandy C; Maisenbacher, Herb W; Toskich, Beau B; Smeak, Dan D; Monnet, Eric L

2018-06-01

To compare clinical outcomes of dogs with congenital intrahepatic portosystemic shunts (CIHPSS) treated with cellophane banding (CB) or percutaneous transvenous coil embolization (PTCE). Dual-institutional retrospective study. Fifty-eight dogs with CIHPSS (2001-2016). Medical records of dogs undergoing CB or PTCE for CIHPSS were reviewed for signalment, body weight, hematologic values, shunt location, attenuation technique, procedure time, duration of hospitalization, complications, date of follow-up, and cause of death if applicable. Thirty-one dogs underwent CB, and 27 dogs underwent PTCE. No differences were detected between groups for gender, preoperative packed cell volume, albumin, cholesterol, or bile acids. Body weight was greater in dogs treated via PTCE. Shunts differed in location because dogs undergoing CB were diagnosed with more left divisional shunts compared with PTCE dogs. Procedural duration of CB and PTCE did not differ. Dogs treated with CB sustained more minor postoperative complications and were hospitalized longer than dogs treated with PTCE. The 1-year and 2-year survival rates were 89% for the CB group and 87% and 80% for the PTCE group, respectively. The proportion surviving at 5 years was 75% and 80% for CB dogs and PTCE dogs, respectively. CB and PTCE are associated with similar short-term and intermediate-term survival. PTCE is a minimally invasive alternative to CB via celiotomy. However, CB allows concurrent abdominal procedures requiring the same approach. © 2017 The American College of Veterinary Surgeons.

Recanalization of Splenic Artery Aneurysm After Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matsumoto, Keiji; Ushijima, Yasuhiro, E-mail: ushijima@radiol.med.kyushu-u.ac.jp; Tajima, Tsuyoshi

2010-02-15

A 65-year-old woman who had been diagnosed as having microscopic polyangiitis developed sudden abdominal pain and entered a state of shock. Abdominal CT showed massive hemoperitoneum, and emergent angiography revealed a ruptured splenic artery aneurysm. After direct catheterization attempts failed due to tortuous vessels and angiospasm, transcatheter arterial embolization using an n-butyl cyanoacrylate (NBCA)-lipiodol mixture was successfully performed. Fifty days later, the patient developed sudden abdominal pain again. Repeated angiography demonstrated recanalization of the splenic artery and splenic artery aneurysm. This time, the recanalized aneurysm was embolized using metallic coils with the isolation method. Physicians should keep in mind thatmore » recanalization can occur after transcatheter arterial embolization using N-butyl cyanoacrylate, which has been used as a permanent embolic agent.« less

Medina® Embolization Device for the Treatment of Intracranial Aneurysms: Safety and Angiographic Effectiveness at 6 Months.

PubMed

Sourour, Nader-Antoine; Vande Perre, Saskia; Maria, Federico Di; Papagiannaki, Chrysanthi; Gabrieli, Joseph; Pistocchi, Silvia; Bartolini, Bruno; Degos, Vincent; Carpentier, Alexandre; Chiras, Jacques; Clarençon, Frédéric

2018-02-01

The Medina Embolization Device (MED) is a new concept device that combines the design of a detachable coil and the one of an intrasaccular flow disruption device. To evaluate the feasibility, safety, and 6- to 9-mo effectiveness of this new device for the treatment of intracranial wide-necked aneurysms. Twelve patients (10 females, mean age = 56 yr) with 13 wide-necked intracranial aneurysms (3 ruptured; 10 unruptured) were treated by means of the MED from January 2015 to October 2015. In 15% of the cases, MEDs were used in a standalone fashion; in 85% of the cases, additional regular coils were used. Adjunctive compliant balloon was used in 4 of 13 cases (31%). Procedure-related complications were systematically recorded; discharge and 6- to 9-mo follow-up modified Rankin Scale was assessed. Angiographic follow-up was performed with a mean delay of 5.5 ± 1.7 mo. Occlusion rate was evaluated in postprocedure and at midterm follow-up using the Roy-Raymond scale. The deployment of the MED was feasible in all cases. No perforation was recorded. One case of thromboembolic complication was observed in a ruptured anterior communicating artery aneurysm, without any clinical consequence at follow-up. Grade A occlusion rate was 61.5% in postprocedure and 83% at 6-mo follow-up. Two cases (17%) of recanalization were documented angiographically. The MED is a new generation device combining the design of a detachable coil and an intrasaccular flow disruption device. According to our early experience, this device is safe and provides a satisfactory occlusion rate at angiographic follow-up of 6 mo. Copyright © 2017 by the Congress of Neurological Surgeons

Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx

PubMed Central

Regine, Renato; De Siero, Michele; Rescigno, Antonio; Sica, Vincenzo; Cantarela, Raffaele; Villari, Vincenzo

2015-01-01

Purpose The aim of our study is to verify the feasibility and the efficacy of Onyx as embolization agent in the treatment of traumatic and non-traumatic peripheral vascular lesions. Materials and Methods In the period between September 2006 and March 2012, we treated with Onyx 26 patients (14 males/12 females; age range, 18–85 years old; mean age, 65 years old), 11 of which with traumatic peripheral vascular lesions and 15 with non-traumatic vascular lesions (9 neoplastic hemorrhagic lesions, 3 arteriovenous malformations (AVMs) and 3 aneurysms). Follow-up controls were performed with clinical examination and by multidetector computed tomography (MDCT) imaging 1, 6, and 12 months after the procedure. Results All peripheral vascular lesions were embolized with Onyx; 3 patients with aneurysms were treated with Onyx associated with endovascular coils. Four elective and 22 emergency embolization procedures were performed. In all patients, we obtained cessation of bleeding and the complete and permanent embolization of all vascular lesions. Conclusions Onyx is an effective and safe embolization agent for peripheral vascular lesions. PMID:25838923

Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection in patients with Marfan syndrome: Midterm outcomes and aortic remodeling.

PubMed

Faure, Elsa Madeleine; El Batti, Salma; Abou Rjeili, Marwan; Ben Abdallah, Iannis; Julia, Pierre; Alsac, Jean-Marc

2018-05-17

The study objective was to assess the midterm outcomes and aortic remodeling in patients with Marfan syndrome with complicated acute type B aortic dissection treated with stent-assisted, balloon-induced intimal disruption and relamination. We reviewed all patients treated with stent-assisted, balloon-induced intimal disruption and relamination for a complicated acute type B aortic dissection associated with Marfan syndrome according to the revised Ghent criteria. Between 2015 and November 2017, 7 patients with Marfan syndrome underwent stent-assisted, balloon-induced intimal disruption and relamination for a complicated acute type B aortic dissection. The median age of patients was 47 years (range, 23-70). Four patients had a history of aortic root replacement. Technical success was achieved in 100%. Three patients required an adjunctive procedure for renal artery stenting (n = 2) and iliac artery stenting (n = 1). There was no in-hospital death, 30-day postoperative stroke, spinal cord ischemia, ischemic colitis, or renal failure requiring dialysis. At a median follow-up of 15 months (range, 7-28), 1 patient required aortic arch replacement for aneurysmal degeneration associated with a type Ia endoleak at 2 years, giving a late reintervention rate of 14%. There was no other secondary endoleak. The primary visceral patency rate was 100%. There were no all-cause deaths reported. At last computed tomography scan, all patients had complete aortic remodeling of the treated thoracoabdominal aorta. Distally, at the nonstented infrarenal aortoiliac level, 6 patients had persistent false lumen flow with stable aorto-iliac diameter in 5. One patient had iliac diameter growth (27 mm diameter at last computed tomography scan). Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection in patients with Marfan syndrome is feasible, safe, and associated with an immediate and midterm persisting thoracoabdominal aortic remodeling. Copyright �

Preoperative spinal tumor embolization: an institutional experience with Onyx.

PubMed

Ghobrial, George M; Chalouhi, Nohra; Harrop, James; Dalyai, Richard T; Tjoumakaris, Stavropoula; Gonzalez, L Fernando; Hasan, David; Rosenwasser, Robert H; Jabbour, Pascal

2013-12-01

Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection. We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients. A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution. Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell carcinomas. Fifty-four vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.7% with the rest of the embolic agents (p=0.08). The estimated blood loss was 1616ml (range 350-5000ml). Blood loss was 750cm(3) on average with Onyx versus 1844 with the rest of the embolic agents (p=0.14). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 versus 3.10, respectively, p=0.9). In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option. Copyright © 2013 Elsevier B.V. All rights reserved.

Prevention of Retrograde Blood Flow Into Large or Giant Internal Carotid Artery Aneurysms by Endovascular Coil Embolization with High-Flow Bypass: Surgical Technique and Long-Term Results.

PubMed

Nakajima, Norio; Nagahiro, Shinji; Satomi, Junichiro; Tada, Yoshiteru; Nakajima, Kohei; Sogabe, Shu; Hanaoka, Mami; Matsubara, Shunji; Uno, Masaaki; Satoh, Koichi

2015-06-01

Recanalization has been reported in large or giant aneurysms of the internal carotid artery (ICA) addressed by high-flow bypass and endovascular treatment. Aneurysmal recanalization may be attributable to retrograde blood flow into the aneurysm through the ICA branches, such as the ophthalmic artery or the meningohypophyseal trunk, or through the surgically created bypass. We modified the endovascular treatment of aneurysms to prevent retrograde flow and evaluated the long-term efficacy of our method. We used a hybrid operative/endovascular technique to treat 5 patients with large or giant aneurysms arising from the C2-C4 segment of the ICA who presented with visual symptoms due to the mass effect of the aneurysm. To prevent retrograde flow into the aneurysm our modified endovascular treatment involves coil embolization of the aneurysmal orifice and the ICA, including the origin of the ophthalmic artery and meningohypophyseal trunk, and placement of a high-flow bypass using a radial artery graft. During the 5- to 12-year follow-up period, 4 aneurysms disappeared, and the other decreased in size. There were no subarachnoid hemorrhages. All bypass grafts remained patent. Visual preservation was achieved in 2 patients; 1 patient manifested visual improvement. Although 2 patients experienced transient neurological deficits we encountered no permanent complications in this series. The final modified Rankin scale of the 5 patients was 0 or 1. Prevention of retrograde flow into the aneurysm by coil embolization with high-flow bypass is a safe and effective method. It prevents the recanalization of large or giant ICA aneurysms. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Orbital venous malformation: percutaneous treatment using an electrolytically detachable fibred coil.

PubMed

Diolaiuti, Sara; Iizuka, Tateyuki; Schroth, Gerhard; Remonda, Luca; Laedrach, Kurt; El-Koussy, Marwan; Frueh, Beatrice E; Goldblum, David

2009-03-01

To report the efficacy of percutaneous treatment of an orbital venous malformation with an electrolytically detachable fibred coil. We report an instance of radiography-guided percutaneous treatment with an electrolytically detachable fibred coil in a 16-year-old boy with acute, spontaneous, painless proptosis on the left side, which progressed with time. Magnetic resonance imaging, angiography and orbitophlebography revealed a low-flow, intraorbital venous malformation. Percutaneous puncture and drainage were followed by a short remission. Following an acute recurrence, a single detachable fibred coil was deployed via a percutaneous approach under angiographic guidance. No radiological or clinical recurrences were observed over 4 years. Embolization of a deep orbital venous malformation with detachable fibred coils via a percutaneous approach can be highly effective, and may be considered before proceeding with open surgery.

Value of Round Ligament Artery Embolization in the Management of Postpartum Hemorrhage.

PubMed

Leleup, Grégoire; Fohlen, Audrey; Dohan, Anthony; Bryan-Rest, Lara; Le Pennec, Vincent; Limot, Olivier; Le Dref, Olivier; Soyer, Philippe; Pelage, Jean-Pierre

2017-05-01

To evaluate the feasibility and efficacy of embolization of the round ligament arteries in the management of postpartum hemorrhage. Eleven women (mean age, 31 y) underwent round ligament artery because of persistent or recurrent hemorrhage after initial uterine or internal iliac artery embolization. A total of 16 round ligament arteries were embolized. The round ligament artery arose from the inferior epigastric artery in 11 cases (69%) and directly from the external iliac artery in 5 (31%). Embolization was performed with calibrated microspheres in 7 women (63%) and gelatin sponge pledgets in 4 (37%). Coils were used in addition to gelatin sponge pledgets in 3 patients. Hemostasis was achieved in 10 patients (91%), and 1 required additional conservative surgery. The mean hemoglobin level before embolization was 7.2 g/dL ± 1 and increased significantly on day 1 after embolization (10.3 g/dL ± 1.0; P < .05). No procedure-related complication was reported. The mean hospital stay was 5.6 days ± 2. Two patients had further pregnancies 13 and 14 months after embolization. Selective embolization of the round ligament artery is a safe and effective treatment for obstetric hemorrhage. It should be considered in cases of persistent or recurrent bleeding after initial uterine or internal iliac artery embolization. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

International survey on neuroradiological interventional and therapeutic devices and materials.

PubMed

van den Berg, René; Mayer, Thomas E

2015-12-01

A web-based survey was performed among the members of the World Federation of Interventional and Therapeutic Neuroradiology to determine the differences in availability, pricing, and performance of endovascular devices with special focus on coils, intra-arterial stroke devices, detachable balloons, and liquid embolic materials. The results of this survey show that the quality of the majority of interventional neuroradiology devices is good and compatibility issues are limited. Individual action towards suppliers is recommended to discuss the availability and pricing of devices and embolization materials. © The Author(s) 2015.

Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sofocleous, Constantinos T., E-mail: constant@pol.net; Hinrichs, Clay R.; Hubbi, Basil

Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men)more » suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.« less

Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases.

PubMed

Chalouhi, N; Tjoumakaris, S I; Gonzalez, L F; Hasan, D; Pema, P J; Gould, G; Rosenwasser, R H; Jabbour, P M

2013-12-01

Five patients were found to have spontaneous delayed migration/shortening of their Pipeline Embolization Devices on follow-up angiography. The device migrated proximally in 4 patients and distally in 1 patient. One patient had a subarachnoid hemorrhage and died as a result of migration of the Pipeline Embolization Device, and another patient presented with complete MCA occlusion and was left severely disabled. Mismatch in arterial diameter between inflow and outflow vessels was a constant finding. Migration of the Pipeline Embolization Device was managed conservatively, with additional placement of the device, or with parent vessel occlusion. Obtaining complete expansion of the embolization device by using a longer device, increasing vessel coverage, using adjunctive aneurysm coiling, and avoiding dragging and stretching of the device are important preventive measures. Neurointerventionalists should be aware of this potentially fatal complication and take all necessary preventive measures.

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery.

PubMed

Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

2016-01-01

Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures.

Arteriography after embolization before distal pancreatectomy with en bloc celiac axis resection.

PubMed

Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Murakami, Yoshiaki; Uemura, Kenichiro; Awai, Kazuo

2015-01-01

To evaluate hemodynamics by arteriographic examinations with and without CT in the stomach wall and liver after preoperative embolization to redistribute blood flow to the stomach and liver, which is unified to be supplied from the superior mesenteric artery, before distal pancreatectomy with en bloc celiac axis resection (DP-CAR). In six patients with locally advanced cancer of the pancreatic body in whom DP-CAR was planned, the left gastric artery and common hepatic artery were embolized with coils. Celiac arteriography and superior mesenteric arteriography with and without CT were performed after embolization. In all six patients, intrahepatic arteries and the left gastric artery were not visualized on celiac arteriography. On both superior mesenteric arteriography and CT obtained while contrast medium was infused via the superior mesenteric artery and which was performed immediately after embolization procedures, the right gastric artery, gastroepiploic artery, gastroduodenal artery, and all hepatic arterial branches were clearly detected. Also the distal part of the left gastric artery close to the embolized point was detected with at least one of the imaging modalities. It was clarified radiologically that preoperative embolization results in increased blood supply to the stomach wall and liver through the pancreatic arcade.

Short- and long-term results of transcatheter embolization for massive arterial hemorrhage from gastroduodenal ulcers not controlled by endoscopic hemostasis

PubMed Central

Loffroy, Romaric; Guiu, Boris; Mezzetta, Lise; Minello, Anne; Michiels, Christophe; Jouve, Jean-Louis; Cheynel, Nicolas; Rat, Patrick; Cercueil, Jean-Pierre; Krausé, Denis

2009-01-01

BACKGROUND AND AIM: Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been suggested as an alternative treatment in this situation. The present study reports on the efficacy and long-term outcomes of transcatheter embolization after failed endoscopic treatments were assessed in high-operative-risk patients. METHODS: A retrospective review of 60 consecutive emergency embolization procedures in hemodynamically unstable patients (41 men, 19 women; mean [±SD] age 69.4±15 years) was conducted. Patients were referred for selective angiography between 1999 and 2008 after failed endoscopic treatment of massive bleeding from gastrointestinal ulcers. Mean follow-up was 22 months. RESULTS: Embolization was feasible and successful in 57 patients. Sandwich coiling of the gastroduodenal artery was used in 34 patients, and superselective occlusion of the terminal feeding artery (with glue, coils or gelatin particles) was used in 23 patients. Early rebleeding occurred in 16 patients and was managed with endoscopy (n=8), reembolization (n=3) or surgery (n=5). No major embolization-related complications occurred. Sixteen patients died within 30 days after embolization (including three who died from rebleeding) and 11 died thereafter. No late bleeding recurrences were reported. CONCLUSIONS: Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers. The procedure usually obviates the need for emergency surgery in these high-risk patients. Survival depends chiefly on underlying conditions. PMID:19214287

[Tentorial Dural Arteriovenous Fistula Successfully Treated with Transvenous Embolization Using a Double Catheterization Technique through Venous Drainage:A Case Report].

PubMed

Yamakawa, Akira; Fujita, Atsushi; Tanaka, Hirotomo; Ikeda, Mitsuru; Morikawa, Masashi; Kohmura, Eiji

2017-07-01

Tentorial dural arteriovenous fistulas(dAVFs)are a rare clinical entity accounting for less than 10% of all intracranial dAVFs. Because these lesions are characterized by high hemorrhagic risk, aggressive treatment should be considered. Although the number of reported cases treated with endovascular transarterial embolization(TAE)using glue has been increasing, little is known about the transvenous approach. Here, we report the case of a patient with a tentorial dAVF who was successfully treated with transvenous embolization(TVE)through venous drainage using a double catheterization technique. A 68-year-old male patient who had a history of left putaminal hemorrhage treated with a craniotomy was diagnosed with a tentorial dAVF on a magnetic resonance angiogram. Because the patient refused another craniotomy for surgical interruption of the dAVF, an endovascular approach was considered. We first attempted to perform TAE with glue, but catheterization into the tortuous meningohypophyseal trunk failed. We then performed a TVE of the venous drainage near the shunt with detachable coils and achieved complete obliteration of the fistula. During coil embolization of the venous drainage, insertion of small coils near the shunt was supported by another anchor coil that was delivered using a double catheterization technique. The method of TVE through venous drainage using a double catheterization technique, which involved placing coils in the fragile drainage vein, was safe and effective in a case of tentorial dAVF. This technique should be considered as another option for the management of complex tentorial dAVFs.

Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vidal, V., E-mail: vincent.vidal@ap-hm.fr; Sapoval, M., E-mail: marc.sapoval@gmail.com; Sielezneff, Y., E-mail: igor.sielezneff@ap-hm.fr

2015-02-15

PurposeThe ‘emborrhoid’ technique consists of the embolization of the hemorrhoidal arteries. The endovascular arterial occlusion is performed using coils placed in the terminal branches of the superior rectal arteries. The emborrhoid technique has been modeled after elective transanal Doppler-guided hemorrhoidal artery ligation which has been shown to be effective in hemorrhoidal disease. We report the first 14 cases of our experience with emborrhoid technique.Materials and MethodsFourteen patients with disabling chronic rectal bleeding were treated using the emborrhoid technique (3 women, 11 men). The stage of the hemorrhoidal disease was II (10 patients), III (3), and IV (1). This treatment wasmore » decided by a multidisciplinary team (proctologist, visceral surgeon, and radiologist). Seven patients underwent previous proctological surgery. Ten patients had coagulation disorders (anticoagulants or cirrhosis). Superior rectal arteries were embolized with pushable microcoils (0.018).ResultsTechnical success of the embolization procedure was 100 %. Clinical success at 1 month was 72 % (10/14). Of the 4 patients who experienced rebleeding, two underwent additional embolization of the posterior rectal arteries with success. No pain or ischemic complications were observed in 13 patients. One patient experienced a temporary painful and edematous, perianal reaction.ConclusionOur case studies suggest that coil embolization of the superior rectal arteries is technically feasible, safe and well tolerated. Additional studies are needed to evaluate the efficacy of this new ‘emborrhoid’ technique in the management of hemorrhoidal disease.« less

Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy

PubMed Central

Ramasamy, Ramona; Kaliappan, Tamilarasu; Gopalan, Rajendiran; Palanimuthu, Ramasmy; Anandhan, Premkrishna

2017-01-01

with JOMIVA balloon. Post procedure mean mitral valve area was 1.7 cm2 as assessed by echocardiography. Post procedure mean gradient across the mitral valve as assessed by echocardiography was 5 mmHg. Two patients had moderate to severe mitral regurgitation after the procedure and the rest had either no mitral regurgitation or mild mitral regurgitation after the procedure. None of the patients warranted mitral valve replacement after BMV. No patients had any manifestations of systemic embolism like cerebrovascular accident or limb ischemia after the procedure. None of the patients had preterm delivery or adverse fetal outcome during index hospitalisation. Conclusion Over the wire BMV is safe and effective method during pregnancy. The results are comparable to that of Inoue technique. BMV offers a good symptomatic improvement in pregnant women presenting with symptoms of pulmonary congestion because of Rheumatic mitral stenosis. PMID:28384909

Percutaneous Antegrade Varicocele Embolization Via the Testicular Vein in a Patient with Recurrent Varicocele After Surgical Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guevara, Carlos J., E-mail: guevarac@mir.wustl.edu; El-Hilal, Alexander H., E-mail: elhilala@mir.wustl.edu; Darcy, Michael D., E-mail: darcym@mir.wustl.edu

This is a case report of an adolescent male who underwent surgical ligation for a left-sided varicocele that recurred 2 years later. Standard retrograde embolization via the left renal vein was not possible, because there was no connection from the renal vein to the gonadal vein following surgical ligation. The patient was treated via antegrade access of the spermatic vein at the inguinal level with subsequent coil embolization.

Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients.

PubMed

Sedat, Jacques; Chau, Yves; Gaudart, Jean; Sachet, Marina; Beuil, Stephanie; Lonjon, Michel

2018-02-01

Coiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique. We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months. No procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion. Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.

ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas.

PubMed

Rabinov, James David; Yoo, Albert J; Ogilvy, Christopher S; Carter, Bob S; Hirsch, Joshua A

2013-07-01

To evaluate the efficacy of n-butyl-2-cyanoacrylate (Trufill n-BCA) versus ethylene vinyl alcohol copolymer (ONYX) for the embolization of cranial dural arteriovenous fistulas (DAVF). Fifty-three consecutive patients with cranial dural AVF were treated with liquid embolic agents from November, 2003 to November, 2008. These 53 patients had 56 lesions treated with arterial embolization. Patients embolized to completion underwent follow-up angiography at 3 months to assess for durable occlusion. Twenty-one lesions were treated with n-BCA. Seven patients treated with n-BCA had initial angiographic occlusion of their DAVF, which were durable at 3 months. Six patients had adjunctive treatment with coils and/or polyvinyl alcohol particles, but none of these were occluded by endovascular treatment alone. Eleven patients underwent post-embolization surgery for closure of their DAVF. There was one death related to intractable status epilepticus at presentation. One patient developed a major stroke from venous sinus thrombosis after embolization. Thirty-five lesions were treated with ONYX in 34 patients. Twenty-nine patients treated with ONYX had initial angiographic occlusion of their DAVF by embolization alone. One patient had recurrence at 3 months and was re-treated out of 27 total follow-ups. Four patients underwent post-embolization surgical obliteration of their lesions. No deaths or major strokes occurred in this cohort. Initial angiographic occlusion (p=0.0004) and durable angiographic occlusion (p=0.0018) rates for embolization of cranial DAVF show a statistically significant higher efficacy with ONYX compared with n-BCA. Patients embolized with ONYX underwent surgery less frequently compared with those treated with n-BCA (p=0.0015).

Emergency transcatheter arterial embolization for massive gastrointestinal arterial hemorrhage.

PubMed

Shi, Zhong Xing; Yang, Jing; Liang, Hong Wei; Cai, Zhen Hua; Bai, Bin

2017-12-01

To evaluate the different arteriographic manifestations of acute arterial massive hemorrhage of the gastrointestinal (GI) tract and the efficacy of emergency transcatheter arterial embolization (ETAE).A total of 88 patients with acute massive GI bleeding who experienced failure of initial endoscopy and/or conservative treatment were referred to our interventional department for acute GI arteriography from January 2007 to June 2015. After locating the source of bleeding, appropriate embolic agents, such as spring coil, hydroxyl methyl acrylic acid gelatin microspheres, polyvinyl alcohol (PVA) particles, etc., were used to embolize the targeted vessels. The angiographic manifestations and the effects of embolization of acute arterial massive hemorrhage of the GI tract were retrospectively analyzed.Of the 88 patients, 54 were diagnosed with arterial hemorrhage of the upper GI tract and 34 with arterial hemorrhage of the lower GI tract. Eighty cases were associated with positive angiography, which showed the following: contrast extravasation (only); gastroduodenal artery stenosis; pseudoaneurysm (only); pseudoaneurysm rupture with contrast extravasation; pseudoaneurysms merged with intestinal artery stenosis; GI angiodysplasia; and tumor vascular bleeding. Eight cases were diagnosed with negative angiography. Seven-two patients underwent successful hemostasis, and a total of 81 arteries were embolized. The technical and clinical success rates (no rebleeding within 30 days) in performing transcatheter embolization on patients with active bleeding were 100% and 84.71%, respectively (72 of 85). Within 30 days, the postoperative rebleeding rate was 15.29% (13/85). Of these rebleeding cases, 2 patients were formerly treated with "blind embolization," 7 underwent interventional embolic retreatment, and 3 had surgical operations. All cases were followed-up for 1 month, and 3 patients died from multiple organ failure. No serious complications such as bowel ischemia necrosis

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery

PubMed Central

Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

2016-01-01

Background: Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Case Description: A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Conclusion: Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures. PMID:27313969

Long-term follow-up analysis of microsurgical clip ligation and endovascular coil embolization for dorsal wall blister aneurysms of the internal carotid artery.

PubMed

Brown, Mason A; Guandique, Cristian F; Parish, Jonathan; McMillan, Aubrey C; Lehnert, Stephen; Mansour, Nassir; Tu, Michael; Bohnstedt, Bradley N; Payner, Troy D; Leipzig, Thomas J; DeNardo, Andrew J; Scott, John A; Cohen-Gadol, Aaron A

2017-05-01

Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. Eighteen patients (M=7, F=11; mean age: 48.4±15.1years; range: 15-65years) harbored a total of 43 aneurysms, 25 of which were dorsal wall blister aneurysms of the ICA. Eleven (61.1%) patients presented with aneurysmal subarachnoid hemorrhage (aSAH), and 10 (55.6%) patients had multiple aneurysms at admission. Twelve patients had 18 aneurysms that were treated microsurgically. Five (41.7%) of these patients had a single recurrence that was retreated with subsequent repeat clip ligation. Six patients had 7 blister aneurysms that were treated with endovascularly. One (16.7%) of these patients had a single recurrence that was retreated with subsequent coil embolization. Postoperative vasospasm occurred in 8 (44.4%) patients, one of whom suffered from a stroke. This is one of the largest single-institution dICA blister aneurysm studies to date. There was no detected significant difference between microsurgical clip ligation and endovascular coil embolization in terms of surgical outcome. These blister aneurysms demonstrate a propensity to be associated with multiple cerebral aneurysms. Strict clinical and angiographic long-term follow-up may be warranted. Blister aneurysms are focal wall defects covered by a thin layer of fibrous tissue and adventitia, lacking the usual collagenous layer. Due to their pathologically thin vessel wall, blister aneurysms are prone to rupture. The management of these rare and fragile aneurysms presents a number of challenges. Here, we address the long-term outcome of patients treated for blister aneurysms at

Piloted simulation study of a balloon-assisted deployment of an aircraft at high altitude

NASA Technical Reports Server (NTRS)

Murray, James; Moes, Timothy; Norlin, Ken; Bauer, Jeffrey; Geenen, Robert; Moulton, Bryan; Hoang, Stephen

1992-01-01

A piloted simulation was used to study the feasibility of a balloon assisted deployment of a research aircraft at high altitude. In the simulation study, an unmanned, modified sailplane was carried to 110,000 ft with a high altitude balloon and released in a nose down attitude. A remote pilot controlled the aircraft through a pullout and then executed a zoom climb to a trimmed, 1 g flight condition. A small parachute was used to limit the Mach number during the pullout to avoid adverse transonic effects. The use of small rocket motor was studied for increasing the maximum attainable altitude. Aerodynamic modifications to the basic sailplane included applying supercritical airfoil gloves over the existing wing and tail surfaces. The aerodynamic model of the simulated aircraft was based on low Reynolds number wind tunnel tests and computational techniques, and included large Mach number and Reynolds number effects at high altitude. Parametric variations were performed to study the effects of launch altitude, gross weight, Mach number limit, and parachute size on the maximum attainable stabilized altitude. A test altitude of approx. 95,000 ft was attained, and altitudes in excess of 100,000 ft was attained.

High-Pressure Balloon-Assisted Stretching of the Coracohumeral Ligament to Determine the Optimal Stretching Positions: A Cadaveric Study.

PubMed

Baek, Sora; Lee, Kyu Jin; Kim, Keewon; Han, Seung-Ho; Lee, U-Young; Lee, Kun-Jai; Chung, Sun Gun

2016-10-01

assisted with an underlying pressure balloon were capable of decreasing CHL tightness. With further development and modification, high-pressure balloon-assisted stretching can be a potential therapeutic option to release tight CHL, including the advantage of augmenting and monitoring stretching intensity. II. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

[3-D angiography in diagnosis and treatment of intracranial aneurysm].

PubMed

Wang, D; Ling, F; Liu, S

2001-09-01

To summarize the results of initial application of three-dimensional angiography (3D-Angio) in diagnosis and treatment of intracranial aneurysms. From August 1999 to January 2001, standard digital subtraction angiography (two-dimensional angiography, 2D-Angio) and 3D-Angio(obtained by reconstruction of rotational angiography) were performed in 65 patients with confirmed or suspected aneurysms. Sixty-six aneurysms were found in 60 patients and nothing was found in 5. Of 66 the aneurysms (60 cases), 46 (43 cases) were treated by intrasaccule embolizotion with coils, 3 (3 cases) by occluding the parent artery with detachable balloon, 10 (10 cases) by surgery, and 1 (1 case) by combination of extracranial-intracranial bypass and balloon occlusion of parent artery. Six (3 cases) were not treated. Two aneurysms that could not be detected by 2D-Angio were diagnosed by 3D-Angio. Three aneurysms that were difficult or dangerous to embolize by 2D-Angio were embolized successfully with the help of 3D-Angio. Three aneurysms seemed to be embolized on 2D-Angio were proved impossible to be embolized on 3D-Angio. Of the 46 aneurysms embolized intrasaccularly, 38(82.6%) were completely embolized on 2D-Angio. In the 38, 8 had residual aneurysm on 3D-Angio. More accurate diagnosis and secure treatment of intracranial aneurysm can be reached by 3D-Angio.

Giant intracranial aneurysm embolization with a yield stress fluid material: insights from CFD analysis.

PubMed

Wang, Weixiong; Graziano, Francesca; Russo, Vittorio; Ulm, Arthur J; De Kee, Daniel; Khismatullin, Damir B

2013-01-01

The endovascular treatment of intracranial aneurysms remains a challenge, especially when the aneurysm is large in size and has irregular, non-spherical geometry. In this paper, we use computational fluid dynamics to simulate blood flow in a vertebro-basilar junction giant aneurysm for the following three cases: (1) an empty aneurysm, (2) an aneurysm filled with platinum coils, and (3) an aneurysm filled with a yield stress fluid material. In the computational model, blood and the coil-filled region are treated as a non-Newtonian fluid and an isotropic porous medium, respectively. The results show that yield stress fluids can be used for aneurysm embolization provided the yield stress value is 20 Pa or higher. Specifically, flow recirculation in the aneurysm and the size of the inflow jet impingement zone on the aneurysm wall are substantially reduced by yield stress fluid treatment. Overall, this study opens up the possibility of using yield stress fluids for effective embolization of large-volume intracranial aneurysms.

Direct Percutaneous Embolization of Bleeding Stomal Varices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Naidu, Sailen G., E-mail: naidu.sailen@mayo.ed; Castle, Erik P.; Kriegshauser, J. Scott

2010-02-15

Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.

Thrombus aspiration catheter is a Dottering balloon.

PubMed

Sheshagiri Rao, D; Barik, Ramachandra; Prasad, Akula Siva

2016-01-01

Coronary angiogram in a young man with history of STEMI with delayed presentation revealed subtotal occlusion of left anterior descending artery (LAD) with large thrombotic filling defect distal to the critical lesion. PCI was preferred without delay because of ongoing chest pain. Several runs of thrombus aspiration failed to detect any visible thrombus. However, the immediate angiogram after thrombus aspiration showed complete distal embolization of the thrombus which could have been achieved by Dottering or balloon dilatation. In contrary to the general perception, does thrombus aspiration push more thrombus than it can aspirate? Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Mechanisms of perianeurysmal edema following endovascular embolization of aneurysms.

PubMed

Tomokiyo, M; Kazekawa, K; Onizuka, M; Aikawa, H; Tsutsumi, M; Ikoh, M; Kodama, T; Nii, K; Matsubara, S; Tanaka, A

2007-03-15

After coil embolization for an aneurysm, edema surrounding the aneurysm revealed by magnetic resonance imaging (MRI) is rarely seen and is usually associated with neurological symptoms. Perianeurysmal edema was found by postoperative MRI in three out of 182 patients with cerebral aneurysm, which was treated with Guglielmi Detachable Coil (GDC), and neurological symptoms developed simultaneously. In cases where neurological symptoms improved with conservative medical treatment, a temporary increase in the volume of an aneurysm, due to coil and thrombus formation, may result in edema. In cases where symptoms were not alleviated with conservative medical treatment, persistent water-hammer effect against the residual lumen of the aneurysm as well as an increase in the volume of aneurysm by hemorrhage in the aneurysmal wall may contribute to the development of perianeurysmal edema. Consideration of the mechanism of edema development by neurological symptoms, MRI findings, and angiographic findings is needed in order to select appropriate treatment.

Mechanisms of Perianeurysmal Edema Following Endovascular Embolization of Aneurysms

PubMed Central

Tomokiyo, M.; K., Kazekawa; Onizuka, M.; Aikawa, H.; Tsutsumi, M.; Ikoh, M.; Kodama, T.; Nii, K.; Matsubara, S.; Tanaka, A.

2007-01-01

Summary After coil embolization for an aneurysm, edema surrounding the aneurysm revealed by magnetic resonance imaging (MRI) is rarely seen and is usually associated with neurological symptoms. Perianeurysmal edema was found by postoperative MRI in three out of 182 patients with cerebral aneurysm, which was treated with Guglielmi Detachable Coil (GDC), and neurological symptoms developed simultaneously. In cases where neurological symptoms improved with conservative medical treatment, a temporary increase in the volume of an aneurysm, due to coil and thrombus formation, may result in edema. In cases where symptoms were not alleviated with conservative medical treatment, persistent water-hammer effect against the residual lumen of the aneurysm as well as an increase in the volume of aneurysm by hemorrhage in the aneurysmal wall may contribute to the development of perianeurysmal edema. Consideration of the mechanism of edema development by neurological symptoms, MRI findings, and angiographic findings is needed in order to select appropriate treatment. PMID:20566093

Carotid artery stenting with double cerebral embolic protection in asymptomatic patients - a diffusion-weighted MRI controlled study.

PubMed

Vuruskan, Ertan; Saracoglu, Erhan; Ergun, Ugur; Poyraz, Fatih; Duzen, İrfan Veysel

2017-01-01

The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal filter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting. 119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal filters (n = 41, 34.4 %), proximal balloon (MoMa) protection (n = 40, 33.6 %) or double protection (n = 38, 31.9 %). Magnetic resonance imaging (MRI) was performed on all patients before the procedure, and control diffusion-weighted MRI (DW-MRI) was obtained within 24-48 h after the procedure. Procedural data, complications, success rate, major adverse cardiovascular events, and MRI findings were collected. New cerebral high-intensity (HI) lesions were observed in 47 (39.4 %) patients. HI lesions were observed in 22 (53.6 %), 15 (37.5 %), and 10 (26.3 %) of the patients with distal filters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-filter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fluoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001). The double (proximal plus distal) cerebral embolic protection technique is safe and effective for minimizing the risk of cerebral embolization, even in patients with asymptomatic carotid artery stenosis, despite slightly longer procedure and fluoroscopy times.
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Spontaneous Massive Hemothorax in a Patient with Neurofibromatosis Type 1 with Successful Transarterial Embolization

PubMed Central

Rookkapan, Sorracha; Tanutit, Pramot; Pakdeejit, Songklod; Songjamrat, Apiradee; Sungsiri, Jitpreedee

2013-01-01

Vascular involvement in neurofibromatosis type 1 is rare but has the potential to be fatal. We report a case of a patient with spontaneous rupture of a left intercostal artery aneurysm, which presented as a massive left hemothorax and was successfully treated by transarterial coil embolization. PMID:23323035

Percutaneous transfacial direct embolization of an intraosseous dural arteriovenous fistula.

PubMed

Nerva, John D; Hallam, Danial K; Ghodke, Basavaraj V

2014-03-01

An intraosseous dural arteriovenous fistula (DAVF) is a rare cerebrovascular disease. The fistulous connection occurs within intraosseous diploic or transosseous emissary veins causing dilated intraosseous vascular pouches. To the authors' knowledge, this report describes the first percutaneous transfacial direct embolization of an intraosseous DAVF. A man in his 50s with blue rubber bleb nevus syndrome presented with headaches, imbalance, decreased visual acuity bilaterally, and left eye proptosis and chemosis. Imaging demonstrated an extensive intraosseous DAVF with dilated intraosseous vascular pouches throughout his cranial base and intraorbital venous congestion. He underwent staged endovascular treatment with the goal to improve his ocular symptoms. Transarterial and transvenous approaches failed to provide adequate access to the intraosseous vascular pouches. A direct, percutaneous transfacial approach was used to access the pouches for embolization with coils and liquid embolic material. Postoperative angiography demonstrated successful embolization of the pouch within the left pterygoid wing, reduced opacification of the intraosseous fistula, and elimination of intraorbital venous congestion. At 9-month follow-up, the patient's headaches had resolved, and his ocular symptomatology had improved. Endovascular access to an intraosseous DAVF is limited by the size and location of the intraosseous vascular pouches. In this case, a direct transfacial approach under image guidance facilitated access and embolization, which led to an improvement in the patient's symptoms. This technique is a novel approach for DAVF management.

Very late stent thrombosis after sole stent-assisted coiling at the paraclinoid giant aneurysm : could prophylactic antiplatelet therapy be ceased at the only 1 year after procedure?

PubMed

Shin, Jung-Hoon; Park, Seong-Ho; Kim, Chang-Hyun; Lee, Chang-Young

2014-10-01

Stent thrombosis is a major limitation of stent-assisted coiling, which is an effective method for treating wide-necked aneurysms. Although early in-stent thrombosis has been reported, very late stent thrombosis (VLST) (>1 year) has not been reported following implantation of a single self-expandable stent designed for coiling. Herein, the authors present a case of VLST that occurred 14 months after single stent implantation in a large paraclinoid aneurysm with an ultra-wide neck involving the parent artery circumferentially. This case indicates the need for establishing guidelines regarding the optimal duration of prophylactic antiplatelet therapy following stent-assisted coiling, which remains undefined in the neuroendovascular field.

Predictors of residual flow in embolized intracranial ruptured aneurysms at early follow-up.

PubMed

Serafin, Zbigniew; Strześniewski, Piotr; Beuth, Wojciech

2014-01-01

The possibility of recanalization and the need for retreatment are the most important drawbacks of intracranial aneurysm embolization. The purpose of the study was to prospectively analyze the results of early follow-up angiography of embolized ruptured aneurysms in an attempt to determine factors predicting the presence of residual flow. Evaluation included 72 patients with 72 aneurysms, which were followed-up 3 months after the treatment. Analysis of residual flow predictors included: age and gender, clinical state in Hunt-Hess scale, aneurysm localization, aneurysm three dimensions and volume, neck width, sac-to-neck ratio, initial result of embolization, number of coils used and the use of hydrogel coils and stents. Mean sac diameter was 6.5±3.9 mm, and mean neck width was 2.9±1.4 mm. Follow-up angiography presented residual flow in 26 aneurysms (36.1%): class 2 in 8 aneurysms (11.1%), and class 3 in 18 cases (25.0%). Stable aneurysm filling was observed in 45 cases (62.5%), progression of residual flow in 25 cases (34.7%), and regression in 2 cases (2.8%). According to ROC analysis independent predictors of residual flow were aneurysm neck diameter (AUC 0.857, 95% CI: 0.755-0.928, p<0.0001) and sac-to-neck ratio (AUC 0.817, 95% CI: 0.708-0.898, p<0.0001). Cut-off point of the ROC curve was established at 2.8 mm for neck diameter, and 1.73 for sac-to-neck ratio. Aneurysm neck diameter and sac-to-neck ratio are independently related to the residual flow in embolized ruptured aneurysms at early follow-up.

Effect of Inductive Coil Geometry on the Thrust Efficiency of a Microwave Assisted Discharge Inductive Plasma Accelerator

NASA Technical Reports Server (NTRS)

Hallock, Ashley; Polzin, Kurt; Emsellem, Gregory

2012-01-01

Pulsed inductive plasma thrusters [1-3] are spacecraft propulsion devices in which electrical energy is capacitively stored and then discharged through an inductive coil. The thruster is electrodeless, with a time-varying current in the coil interacting with a plasma covering the face of the coil to induce a plasma current. Propellant is accelerated and expelled at a high exhaust velocity (O(10-100 km/s)) by the Lorentz body force arising from the interaction of the magnetic field and the induced plasma current. While this class of thruster mitigates the life-limiting issues associated with electrode erosion, pulsed inductive plasma thrusters require high pulse energies to inductively ionize propellant. The Microwave Assisted Discharge Inductive Plasma Accelerator (MAD-IPA) [4, 5] is a pulsed inductive plasma thruster that addressees this issue by partially ionizing propellant inside a conical inductive coil via an electron cyclotron resonance (ECR) discharge. The ECR plasma is produced using microwaves and permanent magnets that are arranged to create a thin resonance region along the inner surface of the coil, restricting plasma formation, and in turn current sheet formation, to a region where the magnetic coupling between the plasma and the inductive coil is high. The use of a conical theta-pinch coil is under investigation. The conical geometry serves to provide neutral propellant containment and plasma plume focusing that is improved relative to the more common planar geometry of the Pulsed Inductive Thruster (PIT) [2, 3], however a conical coil imparts a direct radial acceleration of the current sheet that serves to rapidly decouple the propellant from the coil, limiting the direct axial electromagnetic acceleration in favor of an indirect acceleration mechanism that requires significant heating of the propellant within the volume bounded by the current sheet. In this paper, we describe thrust stand measurements performed to characterize the performance

Two Cases of Postmyomectomy Pseudoaneurysm Treated by Transarterial Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ito, Nobutake, E-mail: nobutake@rad.med.keio.ac.jp; Natimatsu, Yoshiaki; Tsukada, Jitsuro

Pseudoaneurysm resulting from hysteroscopic myomectomy is a rare clinical situation, and interventional radiologists are not traditionally involved in the management. To our knowledge, endovascular treatment of a pseudoaneurysm resulting from hysteroscopic myomectomy has not yet been reported in the English-language literature. Here, two such cases are reported, including one of a woman who later became pregnant. The case is unique because little is known about the influence of unilateral coil embolization of the uterine artery on fertility.

Management of Gastric Varices in the Pediatric Population with Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Utilizing Sodium Tetradecyl Sulfate Foam Sclerosis with or without Partial Splenic Artery Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saad, Wael E. A., E-mail: wspikes@yahoo.com; Anderson, Curtis L., E-mail: dranderson@southfloridavascular.com; Patel, Rahul S., E-mail: patelr516@gmail.com

It is unknown whether spontaneous gastrorenal shunts actually develop in the pediatric population. The minimum age documented in studies from Asia is 32 (range 32–44) years. This study describes three pediatric patients undergoing balloon-occluded retrograde transvenous obliteration (BRTO) for bleeding gastric varices with two of the three patients undergoing combined partial splenic embolization. The first BRTO is a selective-BRTO via a surgical splenorenal shunt (15 years old) and the other two patients underwent conventional-BRTO via a spontaneous gastrorenal shunt (8 and 14 years old). The recurrent significant bleeding that they exhibited before the combined endovascular therapy did not recur for an averagemore » of 7.1 (range 1.4–14) months. In the second patient, quantitative digitally subtracted angiography was utilized to evaluate the inline portal venous flow before and after BRTO.« less

Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography.

PubMed

Marciano, David; Soize, Sébastien; Metaxas, Georgios; Portefaix, Christophe; Pierot, Laurent

2017-02-01

Data about non-invasive follow-up of aneurysm after stent-assisted coiling is scarce. We aimed to compare time-of-flight (TOF) magnetic resonance angiography (MRA) (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3-Tesla, with digital subtraction angiography (DSA) for evaluating aneurysm occlusion and parent artery patency after stent-assisted coiling. In this retrospective single-center study, patients were included if they had an intracranial aneurysm treated by stent-assisted coiling between March 2008 and June 2015, followed with both MRA sequences (3D-TOF-MRA and CE-MRA) at 3-Tesla and DSA, performed in an interval<48hours. Thirty-five aneurysms were included. Regarding aneurysm occlusion evaluation, agreement with DSA was better for CE-MRA (K=0.53) than 3D-TOF-MRA (K=0.28). Diagnostic accuracies for aneurysm remnant depiction were similar for 3D-TOF-MRA and CE-MRA (P=1). Both 3D-TOF-MRA (K=0.05) and CE-MRA (K=-0.04) were unable to detect pathological vessel compared to DSA, without difference in accuracy (P=0.68). For parent artery occlusion detection, agreement with DSA was substantial for 3D-TOF-MRA (K=0.64) and moderate for CE-MRA (K=0.45), with similar good diagnostic accuracies (P=1). After stent-assisted coiling treatment, 3D-TOF-MRA and CE-MRA demonstrated good accuracy to detect aneurysm remnant (but tended to overestimation). Although CE-MRA agreement with DSA was better, there was no statistical difference between 3D-TOF-MRA and CE-MRA accuracies. Both MRAs were unable to provide a precise evaluation of in-stent status but could detect parent vessel occlusion. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Selective transarterial embolization with n-butyl-2-cyanoacrylate for the treatment of arterial hemorrhage after third molar extraction.

PubMed

Sagara, Yoshiko; Kiyosue, Hiro; Tanoue, Shuichi; Shimada, Ryuichi; Hongo, Norio; Kohno, Tatsuyuki; Kawano, Kenji; Mori, Hiromu

2013-06-01

Comprehensive reports concerning selective embolization for arterial bleeding from third molar removal have not been published. We analyzed cases of arterial bleeding from third molar extraction that required transarterial embolization, and we demonstrate representative cases. Five consecutive patients (three men and two women, aged 24 to 37 years) who underwent transarterial embolization at our institution were included in this study. Four of them showed postoperative bleeding after lower third molar removal, and one suffered bleeding after upper third molar extraction. The period of time from extraction to embolization varied from 5 h to 5 weeks. Angiography revealed pseudoaneurysms at the inferior alveolar artery in four cases and at the superior alveolar artery in one case. The pseudoaneurysms were selectively embolized using 25-33 % n-butyl-2-cyanoacrylate (NBCA)-lipiodol. All of the cases showed good results angiographically and clinically. Transit hypoesthesia at the region of the mental nerve was observed in one patient. Selective transarterial embolization is an effective technique for arterial bleeding from third molar removal when it is difficult to obtain hemostasis by dental procedures. Injection of NBCA can be useful when the alveolar artery is too small to embolize with coils.

Double Coaxial Microcatheter Technique for Glue Embolization of Renal Arteriovenous Malformations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uchikawa, Yoko, E-mail: jauchikawa@gmail.com; Mori, Kensaku, E-mail: moriken@md.tsukuba.ac.jp; Shiigai, Masanari, E-mail: m-41gai@yahoo.co.jp

PurposeTo demonstrate the technical benefit of the double coaxial microcatheter technique for embolization of renal arteriovenous malformations (AVMs) with n-butyl cyanoacrylate and iodized oil (glue).Materials and MethodsSix consecutive patients (1 man and 5 women; mean age 61 years; range 44–77 years) with renal AVMs were included. Five patients had hematuria, and one had a risk of heart failure due to a large intrarenal arteriovenous shunt. All patients underwent transarterial embolization using glue and the double coaxial microcatheter technique with outer 2.6F and inner 1.9F microcatheters. After glue injection, the inner microcatheter was retracted, while the outer microcatheter was retained. We assessed themore » complications and clinical outcomes of this technique.ResultsTechnical success was achieved in all patients. In 9 sessions, 34 feeding arteries were embolized with glue using the double coaxial microcatheter technique, 1 was embolized with glue using a single microcatheter, and 2 were embolized with coils. The double coaxial microcatheter technique was useful for selecting small tortuous feeding arteries, preventing glue reflux to the proximal arteries, and approaching multiple feeding arteries without complete retraction of the microcatheters. As a minor complication, glue migrated into the venous system in four patients without any sequelae. In all patients, favorable clinical outcomes, including hematuria cessation in five patients and improvement of the large intrarenal arteriovenous shunt in one patient, were obtained without deterioration of renal function.ConclusionGlue embolization with the double coaxial microcatheter technique was useful for treating renal AVMs with multiple tortuous feeding arteries.« less

Balloon Blocking Technique (BBT) for Superselective Catheterization of Inaccessible Arteries with Conventional and Modified Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp, E-mail: mori-h33@xa2.so-net.ne.jp; Takeuchi, Yoshito, E-mail: yotake62@qg8.so-net.ne.jp; Ito, Takaaki, E-mail: takaaki@koto.kpu-m.ac.jp

2016-06-15

PurposeThe purpose of the study was to retrospectively evaluate the efficacy and safety of the balloon blocking technique (BBT).Materials and MethodsThe BBT was performed in six patients (all males, mean 73.5 years) in whom superselective catheterization for transcatheter arterial embolization by the conventional microcatheter techniques had failed due to anatomical difficulty, including targeted arteries originating steeply or hooked from parent arteries. All BBT procedures were performed using Seldinger’s transfemoral method. Occlusive balloons were deployed and inflated at the distal side of the target artery branching site in the parent artery via transfemoral access. A microcatheter was delivered from a 5-F cathetermore » via another femoral access and was advanced over the microguidewire into the target artery, under balloon blockage of advancement of the microguidewire into non-target branches. After the balloon catheter was deflated and withdrawn, optimal interventions were performed through the microcatheter.ResultsAfter success of accessing the targeted artery by BBT, optimal interventions were accomplished in all patients with no complications other than vasovagal hypotension, which responded to nominal therapy.ConclusionThe BBT may be useful in superselective catheterization of inaccessible arteries due to anatomical difficulties.« less

GREAT-a randomized controlled trial comparing HydroSoft/HydroFrame and bare platinum coils for endovascular aneurysm treatment: procedural safety and core-lab-assessedangiographic results.

PubMed

Taschner, Christian A; Chapot, René; Costalat, Vincent; Machi, Paolo; Courthéoux, Patrick; Barreau, Xavier; Berge, Jérôme; Pierot, Laurent; Kadziolka, Kryzsztof; Jean, Betty; Blanc, Raphaël; Biondi, Alessandra; Brunel, Hervé; Gallas, Sophie; Berlis, Ansgar; Herbreteau, Denis; Berkefeld, Joachim; Urbach, Horst; El Shikh, Samer; Fiehler, Jens; Desal, Hubert; Graf, Erika; Bonafé, Alain

2016-08-01

Hybrid hydrogel-platinum coils (HydroCoil) have proven effective for endovascular aneurysm treatment. To overcome technical limitations (coil stiffness, time restriction for placement), a second generation of softer hydrogel coils has been brought to clinical practice (HydroSoft, HydroFrame). We report on procedural safety and core-lab-assessed angiographic results from an open-label multicenter randomized controlled trial. Web-based randomization occurred in 15 medical centers in France and seven in Germany between coil embolization with second-generation hydrogel coils and treatment with any bare platinum coil. Assist devices could be used as clinically required. Primary endpoint is a composite outcome including major aneurysm recurrence and poor clinical outcome at 18 months follow-up. Five hundred thirteen patients were randomized (hydrogel n = 256, bare platinum n = 257). Twenty patients were excluded for missing informed consent and nine patients for treatment related criteria. Four hundred eighty-four patients were analyzed as randomized (hydrogel n = 243, bare platinum n = 241). Two hundred eight had ruptured aneurysms (43 %). Prespecified procedural complications occurred in 58 subjects (hydrogel n = 28, bare platinum n = 30, p = 0.77). The 14-day mortality rate was 2.1 % in both arms of the study. The median calculated packing densities for aneurysms assigned to hydrogel and bare platinum were 39 and 31 % respectively (p < 0.001). No statistically significant differences were found between arms in the post procedural angiographic occlusion rate (p = 0.8). Second-generation hydrogel coils can be used in a wide spectrum of aneurysms with a risk profile equivalent to bare platinum. Packing density was significantly higher in aneurysms treated with hydrogel coils. http://www.germanctr.de , DRKS00003132.

Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

PubMed Central

Stensaeth, Knut Haakon; Sovik, Edmund; Haig, Ingrid Natasha Ylva; Skomedal, Erna; Jorgensen, Arve

2017-01-01

Background Severe postpartum hemorrhage occurs in 1/1000 women giving birth. This condition is often dramatic and may be life threatening. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has in recent years been introduced as a novel treatment for hemorrhagic shock. We present a series of fluoroscopy-free REBOA for controlling life threatening postpartum hemorrhage. Methods In 2008 an ‘aortic occlusion kit’ was assembled and used in three Norwegian university hospitals. The on-call interventional radiologist (IR) was to be contacted with a response time < 30 minutes in case of life threatening PPH. Demographics and characteristics were noted from the medical records. Results This retrospective study includes 36 patients treated with fluoroscopy-free REBOA for controlling severe postpartum hemorrhage in the years 2008–2015. The REBOA success rate was 100% and no patients died from REBOA related complications. Uterine artery embolization was performed in 17 (47%) patients and a hysterectomy in 16 (44%) patients. A short (11cm) introducer length was strongly associated with iliac artery thrombus formation (ρ = 0.50, P = 0.002). In addition, there was a strong negative correlation between uterine artery embolization and hysterectomy (ρ = -0.50, P = 0.002). Conclusions Our Norwegian experience indicates the clinical safety and feasibility of REBOA in life threatening PPH. Also, REBOA can be used in an emergency situation without the use of fluoroscopy with a high degree of technical success. It is important that safety implementation of REBOA is established, especially through limited aortic balloon occlusion time and a thorough balloon deflation regime. PMID:28355242

Application of chitosan-covered gauze in combination with intrauterine balloon tamponade for postpartum hemorrhage treatment - Case report of a novel "uterine sandwich" approach.

PubMed

Seidel, Vera; Braun, Thorsten; Weizsäcker, Katharina; Henrich, Wolfgang

2018-05-26

Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death worldwide. Fertility preserving second stage interventions following uterotonic medications may include compression sutures, uterine balloon tamponade and ligation or embolization of arteries. We present a case of PPH where a novel "uterine sandwich" approach (combination of chitosan-covered gauze with intrauterine balloon tamponade) was effectively used to stop further blood loss and prevented more invasive second stage interventions. Furthermore, we present the ultrasonographic image of chitosan-covered gauze in the uterine cavity. Chitosan-covered gauze and intrauterine balloon tamponade are complementary in their mechanism of work, the balloon reducing blood flow into the uterus and the chitosan-covered gauze enhancing the coagulation. This novel "uterine sandwich" approach can be a useful method for fertility preserving management of PPH. Copyright © 2018. Published by Elsevier Ltd.

Balloon-Occluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention.

PubMed

Kishino, Mitsuhiro; Nakaminato, Shuichiro; Kitazume, Yoshio; Miyasaka, Naoyuki; Kudo, Toshifumi; Saida, Yukihisa; Tateishi, Ukihide

2018-07-01

The usefulness of carbon dioxide (CO 2 ) gas digital subtraction angiography (DSA) has been reported for patients with renal insufficiency and allergy to iodinated contrast agents. However, CO 2 gas cannot replace the iodinated contrast agent in all cases owing to some disadvantages. We describe balloon-occluded CO 2 DSA (B-CO 2 DSA) as an improved CO 2 DSA procedure for interventions in the internal iliac artery (IIA) region and compare the quality of images obtained using conventional CO 2 DSA and B-CO 2 DSA. B-CO 2 DSA-guided embolization was performed for one case of genital bleeding with an acute anaphylactic reaction to the iodinated contrast agent and for three cases of type II endoleaks after endovascular abdominal aortic aneurysm repair with renal dysfunction. A 9-mm occlusion balloon catheter was placed just after the orifice of the IIA. Then, 10-15 ml of CO 2 gas was injected manually via the catheter with and without balloon occlusion. The quality of sequential digital subtraction angiograms was analyzed based on a scoring criterion. In all four cases, image quality was improved with B-CO 2 DSA; the poor quality of images without balloon occlusion was because of reflux of the CO 2 gas. B-CO 2 DSA improves the image quality of CO 2 DSA in the IIA region and is useful for vascular intervention. Level IV.

Dense Accumulation of Lipiodol Emulsion in Hepatocellular Carcinoma Nodule during Selective Balloon-occluded Transarterial Chemoembolization: Measurement of Balloon-occluded Arterial Stump Pressure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Irie, Toshiyuki, E-mail: toshiyuki.irie.rq@hitachi.com; Kuramochi, Masashi, E-mail: masashi.kuramochi.sh@hitachi.com; Takahashi, Nobuyuki, E-mail: nbyktakahashiodn@yahoo.co.jp

2013-06-15

Purpose. To reveal the mechanism of dense accumulation of lipiodol emulsion (LE) in hepatocellular carcinoma (HCC) during selective balloon-occluded transarterial chemoembolization (B-TACE). Methods. Balloon-occluded arterial stump pressure (BOASP) at the embolization portion was measured during selective B-TACE for 43 nodules in 42 patients. Fluoroscopy and digital subtraction angiography were prospectively observed during selective B-TACE to note whether dense LE accumulation in HCC occurred. The LE concentration ratio of HCC to embolized liver parenchyma (LECHL ratio) was also calculated for each treatment on the basis of the computed tomographic scan obtained immediately after selective B-TACE. The relationships between degree of LEmore » accumulation and the BOASP, as well as the LECHL ratio, were analyzed. Results. Arterial flow beyond the catheter tip was maintained even after balloon inflation. In 39 of 43 treatments, LE inflow into the nontumorous liver parenchyma ceased immediately after LE droplets were filled in arteries of the nontumorous liver parenchyma while LE inflow into the HCC nodule continued (group 1). More dense LE accumulation in HCC nodule was obtained in these 39 treatments. In four treatments, LE inflow both into the nontumorous liver parenchyma and into the HCC nodule continued, and no dense LE accumulation in HCC nodule was observed (group 2). In these four treatments, thick anastomotic vessels with collateral artery were noted. The BOASP in group 1 was (mean {+-} SD) 33.8 {+-} 12.8 mmHg (range 13-64 mmHg) and that in group 2 was 92.3 {+-} 7.4 mmHg (range 83-100 mmHg). There was a statistically significant difference in BOASP between groups (p = 0.00004, Welch's t test). The LECHL ratio in group 1 was 18.3 {+-} 13.9 (range 2.9-54.2) and that in group 2 was 2.6 {+-} 1.1 (range 1.7-4.2). There was a statistically significant difference in the LECHL ratio between the groups (p = 0.000034, Welch's t test). Conclusion. Selective B

Type II Endoleak After Endovascular Repair of Abdominal Aortic Aneurysm: Effectiveness of Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nevala, Terhi, E-mail: Terhi.Nevala@ppshp.f; Biancari, Fausto; Manninen, Hannu

2010-04-15

The purpose of this study was to report our experience in treating type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. Two hundred eighteen patients underwent EVAR with a Zenith stent-graft from January 2000 to December 2005. During a follow-up period of 4.5 {+-} 2.3 years, solely type II endoleak was detected in 47 patients (22%), and 14 of them underwent secondary interventions to correct this condition. Ten patients had transarterial embolization, and four patients had translumbar/transabdominal embolization. The embolization materials used were coils, thrombin, gelatin, Onyx (ethylene-vinyl alcohol copolymer), and glue. Disappearance of the endoleak withoutmore » enlargement of the aneurysm sac after the first secondary intervention was achieved in only five of these patients (5/13). One patient without surveillance imaging was excluded from analyses of clinical success. After additional interventions in four patients and the spontaneous disappearance of type II endoleak in two patients, overall clinical success was achieved in eight patients (8/12). One patient did not have surveillance imaging after the second secondary intervention. Clinical success after the first secondary intervention was achieved in two patients (2/9) in the transarterial embolization group and three patients (3/4) in the translumbar embolization group. The results of secondary interventions for type II endoleak are unsatisfactory. Although the small number of patients included in this study prevents reliable comparisons between groups, the results seem to favor direct translumbar embolization in comparison to transarterial embolization.« less

Snare-assisted anterograde balloon mitral and aortic valvotomy using Inoue balloon catheter.

PubMed

Krishnan, Mangalath N; Syamkumar, M D; Sajeev, C G; Venugopal, K; Johnson, Francis; Vinaykumar, D; Velayudhan, C C; Jayakumar, T G

2007-01-02

We performed concurrent antegrade mitral and aortic valvotomy using Inoue dilatation catheter in 3 cases of combined rheumatic mitral and aortic stenosis. Following mitral valvotomy by standard procedure, aortic valve was crossed with the help of a floatation catheter. Stiff long length guide wire was fixed in descending aorta using a snare. Inoue catheter was threaded over the wire across the aortic valve and aortic valvotomy completed. Mitral valve area increased from mean 1 cm2 to 2 cm2; aortic gradient dropped from mean of 97 mm to 36 mm. Concurrent anterograde balloon mitral and aortic valvotomy may be effective and safe.

Posttraumatic carotid cavernous fistula that presented as seizure and focal neurological deficits with symptom resolution after therapeutic coil embolization.

PubMed

Klevtsova, Ekaterina; Nguyen-Min, Caroline; Lalani, Tania; Carlan, Stephen James; Madruga, Mario

2015-02-01

A posttraumatic carotid cavernous fistula can remain unrecognized and ultimately present with symptoms characteristic for a middle cerebral artery stroke. Progressive neurologic deterioration can occur until the condition is diagnosed and treated. If unrecognized and untreated, permanent damage may result. A 46-year-old white man with the history of a motor vehicle crash 6 months prior presented with complaints of acute onset of expressive aphasia and seizure-like activity for 3 days. On presentation, the patient was noted to have moderate proptosis and chemosis of the left eye. Magnetic resonance imaging of the brain showed an arteriovenous fistula arising from the anterolateral precavernous left internal carotid artery. This was directly communicating with the adjacent cortical veins along the medial aspect of the left temporal lobe, resulting in venous congestion in the left frontal opercular region, the left insula, and subinsular tracks. The patient underwent an intracranial coil embolization of a left carotid cavernous fistula. No complications were encountered, and the patient had near-complete resolution of neurologic deficits and left eye proptosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although posttraumatic carotid cavernous fistula is a rare condition, it is important to be aware of this entity because immediate diagnosis and treatment may improve outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

On the feasibility of closed-loop control of intra-aortic balloon pumping

NASA Technical Reports Server (NTRS)

Clark, J. W., Jr.; Bourland, H. M.; Kane, G. R.

1973-01-01

A closed-loop control scheme for the control of intra-aortic balloon pumping has been developed and tested in dog experiments. A performance index reflecting the general objectives of balloon-assist pumping is developed and a modified steepest ascent control algorithm is utilized for the selection of a proper operating point for the balloon during its pumping cycle. This paper attempts to indicate the feasibility of closed-loop control of balloon pumping, and particularly its flexibility in achieving both diastolic augmentation of mean aortic pressure and control of the level of end-diastolic pressure (EDP) an important factor in reducing heart work.

Double balloon protection during carotid artery stenting for vulnerable carotid stenosis reduces the incidence of new brain lesions.

PubMed

Nakazaki, Masahito; Nonaka, Tadashi; Takahashi, Akira; Yonemasu, Yasuyuki; Nomura, Tatsufumi; Onda, Toshiyuki; Honda, Osamu; Hashimoto, Yuji; Ohnishi, Hirofumi; Sasaki, Masanori; Daibo, Masahiko; Honmou, Osamu

2016-07-01

The use of distal filter protection alone is associated with a high risk of ischemic complications when vulnerable carotid stenosis is treated by carotid artery stenting (CAS). Double balloon protection, a combination of distal balloon protection and proximal balloon occlusion, can be utilized. We assessed the outcome and complications of the double balloon protection method for vulnerable carotid stenosis. Among 130 patients who underwent CAS from 2009 to 2014, we enrolled the following patients: those whose target lesion was vulnerable as evaluated by MRI, i.e., a signal ratio of plaque to posterior cervical muscle on T1-weighted images before CAS of ≥1.5, and those who underwent diffusion-weighted imaging (DWI) studies within 48 h after the procedure. Ninety patients were enrolled. We investigated DWI findings of the double balloon protection group compared with those of the simple distal balloon protection and distal filter protection groups. Sixty-four patients (71 %) underwent double balloon protection, 15 patients (17 %) simple distal balloon protection, and 11 patients (12 %) distal filter protection. Symptomatic embolic complications and new lesions on DWI after CAS were significantly less common in patients undergoing double balloon protection compared to distal balloon protection or distal filter protection (0 % vs. 20 %, 9 %, P < 0.01, and 30 % vs. 67 %, 82 %, P < 0.01, respectively). Logistic regression analysis also identified the odds ratio of double balloon protection for new lesions on DWI after CAS of 0.23 (95 % confidence interval: 0.07-0.70, P < 0.01) compared to simple distal protections. In the patients who underwent CAS for vulnerable carotid stenosis, double balloon protection was an independent significant factor associated with a reduction in the risk of new lesions on DWI after the procedure compared to conventional distal protections.

A novel balloon colonoscope detects significantly more simulated polyps than a standard colonoscope in a colon model.

PubMed

Hasan, Nazia; Gross, Seth A; Gralnek, Ian M; Pochapin, Mark; Kiesslich, Ralf; Halpern, Zamir

2014-12-01

Although standard colonoscopy is considered the optimal test to detect adenomas, it can have a significant adenoma miss rate. A major contributing factor to high miss rates is the inability to visualize adenomas behind haustral folds and at anatomic flexures. To compare the diagnostic yield of balloon-assisted colonoscopy versus standard colonoscopy in the detection of simulated polyps in a colon model. Prospective, cohort study. International gastroenterology meeting. A colon model composed of elastic material, which mimics the flexible structure of haustral folds, allowing for dynamic responses to balloon inflation, with embedded simulated colon polyps (n = 12 silicone "polyps"). Fifty gastroenterologists were recruited to identify simulated colon polyps in a colon model, first using standard colonoscopy immediately followed by balloon-assisted colonoscopy. Detection of simulated polyps. The median polyp detection rate for all simulated polyps was significantly higher with balloon-assisted as compared with standard colonoscopy (91.7% vs 45.8%, respectively; P < .0001). The significantly higher simulated polyp detection rate with balloon-assisted versus standard colonoscopy was notable both for non-obscured polyps (100.0% vs 75.0%; P < .0001) and obscured polyps (88.0% vs 25.0%; P < .0001). Non-randomized design, use of a colon model, and simulated colon polyps. As compared with standard colonoscopy, balloon-assisted colonoscopy detected significantly more obscured and non-obscured simulated polyps in a colon model. Clinical studies in human participants are being pursued to further evaluate this new colonoscopic technology. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Coronary and peripheral stenting in aorto-ostial protruding stents: The balloon assisted access to protruding stent technique.

PubMed

Helmy, Tarek A; Sanchez, Carlos E; Bailey, Steven R

2016-03-01

Treatment of aorto-ostial in-stent restenosis lesions represents a challenge for interventional cardiologists. Excessive protrusion of the stent into the aorta may lead to multiple technical problems, such as difficult catheter reengagement of the vessel ostium or inability to re-wire through the stent lumen in repeat interventions. We describe a balloon assisted access to protruding stent technique in cases where conventional coaxial engagement of an aorto-ostial protruding stent with the guide catheter or passage of the guide wire through the true lumen is not feasible. This technique is applicable both in coronary and peripheral arteries. © 2015 Wiley Periodicals, Inc.

Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation.

PubMed

Kim, Joohyun; Lee, Jang-Bo; Cho, Tai-Hyoung; Hur, Junseok W

2017-05-01

Onyx embolization is one of the standard treatments for brain arteriovenous malformations (AVMs) and is a promising method for spinal AVMs as well. Its advantages have been emphasized, and few complications have been reported with Onyx embolization in spinal AVMs. Here, we report an incidental anterior spinal artery (ASA) occlusion due to Onyx reflux during embolization of a spinal type II AVM. A 15-year-old boy presented with weakness in both upper and lower extremities. Magnetic resonance imaging and spinal angiogram revealed a spinal type II AVM with two feeders including the right vertebral artery (VA) and the right deep cervical artery. Onyx embolization was performed gradually from the VA to the deep cervical artery and an unexpected Onyx reflux to the ASA was observed during the latter stage deep cervical artery embolization. Post-operative quadriplegia and low cranial nerves (CN) dysfunction were observed. Rehabilitation treatment was performed and the patient showed marked improvement of neurologic deterioration at 1-year follow-up. Onyx is an effective treatment choice for spinal AVMs. However, due to the small vasculature of the spine compared to the brain, the nidus is rapidly packed with a small amount of Onyx, which allows Onyx reflux to unexpected vessels. Extreme caution is required and dual-lumen balloon catheter could be considered for Onyx embolization in spinal AVMs treatment.

Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net

This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up ofmore » 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.« less

Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling.

PubMed

McCracken, D Jay; Lovasik, Brendan P; McCracken, Courtney E; Caplan, Justin M; Turan, Nefize; Nogueira, Raul G; Cawley, C Michael; Dion, Jacques E; Tamargo, Rafael J; Barrow, Daniel L; Pradilla, Gustavo

2015-12-01

Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment. To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms. Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status. For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01). Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment. EUH, Emory University HospitalIQR, interquartile rangeJHU, Johns Hopkins UniversitymRS, modified Rankin ScaleONP, oculomotor nerve palsyPCoA, posterior communicating arterySAH, subarachnoid hemorrhage.

Ballooning Then...and Ballooning Now.

ERIC Educational Resources Information Center

Journal of Aerospace Education, 1978

1978-01-01

Describes the history of hot-air balloon travel, starting with its French origins and continuing through to the 1978 national championship. An address for Balloon Federation of America membership is included. (MA)

Hybrid approach to surgical correction of tetralogy of Fallot in all patients with functioning Blalock Taussig shunts.

PubMed

Sivakumar, Kothandam; Krishnan, Prasad; Pieris, Rajeeva; Francis, Edwin

2007-08-01

In total surgical correction of tetralogy of Fallot (TOF) with functioning Blalock Taussig shunts (BTS), shunt take down increased surgical time, bleeding, and might injure phrenic and recurrent laryngeal nerve and thoracic duct. A routine hybrid approach using transcatheter BTS closure immediately before total surgical correction of TOF in all patients might reduce these problems. We analyze the safety and feasibility of this approach. Transcatheter BTS closure was achieved using single or multiple stainless steel embolization coils, Amplatzer vascular plugs, or duct occluders. When coils were released without control by bioptome forceps, coil migration in larger shunts was prevented by proximal or distal balloon occlusion. This routine hybrid strategy was followed in 22 consecutive patients aged 1-13 years over 4-year-period and 21 procedures were successful. Among the 16 patients attempted with coils, 13 had successful closure, 2 needed Amplatzer duct occluder devices, and 1 sent for surgical shunt takedown due to acute angulation of the shunt. New Amplatzer vascular plugs were used in six patients. Bioptome was used in six patients and proximal or distal balloon occlusion of flow was used in three patients. Four patients had closure of associated aortopulmonary or chest wall collaterals. Hybrid approach using routine transcatheter closure of all BTS immediately before surgical correction of TOF shunts with coils/plugs/devices is safe, feasible, and reproducible. Copyright (c) 2007 Wiley-Liss, Inc.

In vitro study of near-wall flow in a cerebral aneurysm model with and without coils.

PubMed

Goubergrits, L; Thamsen, B; Berthe, A; Poethke, J; Kertzscher, U; Affeld, K; Petz, C; Hege, H-C; Hoch, H; Spuler, A

2010-09-01

Coil embolization procedures change the flow conditions in the cerebral aneurysm and, therefore, in the near-wall region. Knowledge of these flow changes may be helpful to optimize therapy. The goal of this study was to investigate the effect of the coil-packing attenuation on the near-wall flow and its variability due to differences in the coil structure. An enlarged transparent model of an ACA aneurysm was fabricated on the basis of CT angiography. The near-wall flow was visualized by using a recently proposed technique called Wall-PIV. Coil-packing attenuation of 10%, 15%, and 20% were investigated and compared with an aneurysmal flow without coils. Then the flow variability due to the coil introduction was analyzed in 10 experiments by using a packing attenuation of 15%. A small packing attenuation of 10% already alters the near-wall flow significantly in a large part of the aneurysmal sac. These flow changes are characterized by a slow flow with short (interrupted) path lines. An increased packing attenuation expands the wall area exposed to the altered flow conditions. This area, however, depends on the coil position and/or on the 3D coil structure in the aneurysm. To our knowledge, this is the first time the near-wall flow changes caused by coils in an aneurysm model have been visualized. It can be concluded that future hydrodynamic studies of coil therapy should include an investigation of the coil structure in addition to the coil-packing attenuation.

Celiac trunk embolization, as a means of elongating short distal descending thoracic aortic aneurysm necks, prior to endovascular aortic repair.

PubMed

Belenky, Alexander; Haddad, Menashe; Idov, Igor; Knizhnik, Michael; Litvin, Sergey; Bachar, Gil N; Atar, Eli

2009-09-01

The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization -- only if the superior and inferior mesenteric arteries are patent -- is a good and safe way to elongate the neck and enable EVAR.

Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair

DOE Office of Scientific and Technical Information (OSTI.GOV)

Belenky, Alexander; Haddad, Menashe; Idov, Igor

2009-09-15

The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first yearmore » and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization-only if the superior and inferior mesenteric arteries are patent-is a good and safe way to elongate the neck and enable EVAR.« less

Molecular clamp mechanism of substrate binding by hydrophobic coiled-coil residues of the archaeal chaperone prefoldin

PubMed Central

Lundin, Victor F.; Stirling, Peter C.; Gomez-Reino, Juan; Mwenifumbo, Jill C.; Obst, Jennifer M.; Valpuesta, José M.; Leroux, Michel R.

2004-01-01

Prefoldin (PFD) is a jellyfish-shaped molecular chaperone that has been proposed to play a general role in de novo protein folding in archaea and is known to assist the biogenesis of actins, tubulins, and potentially other proteins in eukaryotes. Using point mutants, chimeras, and intradomain swap variants, we show that the six coiledcoil tentacles of archaeal PFD act in concert to bind and stabilize nonnative proteins near the opening of the cavity they form. Importantly, the interaction between chaperone and substrate depends on the mostly buried interhelical hydrophobic residues of the coiled coils. We also show by electron microscopy that the tentacles can undergo an en bloc movement to accommodate an unfolded substrate. Our data reveal how archael PFD uses its unique architecture and intrinsic coiled-coil properties to interact with nonnative polypeptides. PMID:15070724

Application of a novel metal artifact correction algorithm in flat-panel CT after coil embolization of brain aneurysms: intraindividual comparison.

PubMed

Buhk, J-H; Groth, M; Sehner, S; Fiehler, J; Schmidt, N O; Grzyska, U

2013-09-01

To evaluate a novel algorithm for correcting beam hardening artifacts caused by metal implants in computed tomography performed on a C-arm angiography system equipped with a flat panel (FP-CT). 16 datasets of cerebral FP-CT acquisitions after coil embolization of brain aneurysms in the context of acute subarachnoid hemorrhage have been reconstructed by applying a soft tissue kernel with and without a novel reconstruction filter for metal artifact correction. Image reading was performed in multiplanar reformations (MPR) in average mode on a dedicated radiological workplace in comparison to the preinterventional native multisection CT (MS-CT) scan serving as the anatomic gold standard. Two independent radiologists performed image scoring following a defined scale in direct comparison of the image data with and without artifact correction. For statistical analysis, a random intercept model was calculated. The inter-rater agreement was very high (ICC = 86.3 %). The soft tissue image quality and visualization of the CSF spaces at the level of the implants was substantially improved. The additional metal artifact correction algorithm did not induce impairment of the subjective image quality in any other brain regions. Adding metal artifact correction to FP-CT in an acute postinterventional setting helps to visualize the close vicinity of the aneurysm at a generally consistent image quality. © Georg Thieme Verlag KG Stuttgart · New York.

Utility of the balloon-overtube-assisted modified over-the-wire stenting technique to treat post-sleeve gastrectomy complications.

PubMed

Ponte, Ana; Pinho, Rolando; Proença, Luísa; Silva, Joana; Rodrigues, Jaime; Sousa, Mafalda; Silva, João Carlos; Carvalho, João

2017-06-16

To describe a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy in post-sleeve gastrectomy (SG) complications. Between January 2010 and December 2015, all patients submitted to an endoscopic stenting procedure to treat a post-SG stenosis or leakage were retrospectively collected. Procedures from patients in which the stent was deployed using the balloon-overtube-assisted modified over-the-wire (OTW) stenting technique were described. The technical success, corresponding to proper placement of the stent in the stomach resulting in exclusion of the SG leak or the stenosis, was evaluated. Complications related to stenting were also reported. Five procedures were included to treat 2 staple line leaks and 3 stenoses. Two types of stents were used, including a fully covered self-expandable metal stent designed for the SG anatomy (Hanarostent, ECBB-30-240-090; M.I. Tech, Co., Ltd, Seoul, South Korea) in 4 procedures and a biodegradable stent (BD stent 019-10A-25/20/25-080, SX-ELLA, Hradec Kralove, Czech Republic) in the remaining procedure. In all cases, an overtube was advanced with the endoscope through the SG to the duodenum. After placement of the guidewire and removal of the endoscope, the stent was easily advanced through the overtube. The overtube was pulled back and the stent was successfully deployed under fluoroscopic guidance. Technical success was achieved in all patients. The adoption of a modified technique of deployment of OTW stents using an overtube may represent an effective option in the approach of SG complications.

Utility of the balloon-overtube-assisted modified over-the-wire stenting technique to treat post-sleeve gastrectomy complications

PubMed Central

Ponte, Ana; Pinho, Rolando; Proença, Luísa; Silva, Joana; Rodrigues, Jaime; Sousa, Mafalda; Silva, João Carlos; Carvalho, João

2017-01-01

AIM To describe a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy in post-sleeve gastrectomy (SG) complications. METHODS Between January 2010 and December 2015, all patients submitted to an endoscopic stenting procedure to treat a post-SG stenosis or leakage were retrospectively collected. Procedures from patients in which the stent was deployed using the balloon-overtube-assisted modified over-the-wire (OTW) stenting technique were described. The technical success, corresponding to proper placement of the stent in the stomach resulting in exclusion of the SG leak or the stenosis, was evaluated. Complications related to stenting were also reported. RESULTS Five procedures were included to treat 2 staple line leaks and 3 stenoses. Two types of stents were used, including a fully covered self-expandable metal stent designed for the SG anatomy (Hanarostent, ECBB-30-240-090; M.I. Tech, Co., Ltd, Seoul, South Korea) in 4 procedures and a biodegradable stent (BD stent 019-10A-25/20/25-080, SX-ELLA, Hradec Kralove, Czech Republic) in the remaining procedure. In all cases, an overtube was advanced with the endoscope through the SG to the duodenum. After placement of the guidewire and removal of the endoscope, the stent was easily advanced through the overtube. The overtube was pulled back and the stent was successfully deployed under fluoroscopic guidance. Technical success was achieved in all patients. CONCLUSION The adoption of a modified technique of deployment of OTW stents using an overtube may represent an effective option in the approach of SG complications. PMID:28690770

Early outcomes of empiric embolization of tumor-related gastrointestinal hemorrhage in patients with advanced malignancy.

PubMed

Tandberg, Daniel J; Smith, Tony P; Suhocki, Paul V; Pabon-Ramos, Waleska; Nelson, Rendon C; Desai, Svetang; Branch, Stanley; Kim, Charles Y

2012-11-01

To report short-term results of empiric transcatheter embolization for patients with advanced malignancy and gastrointestinal (GI) hemorrhage directly from a tumor invading the GI tract wall. Between 2005 and 2011, 37 mesenteric angiograms were obtained in 26 patients with advanced malignancy (20 men, six women; mean age, 56.2 y) with endoscopically confirmed symptomatic GI hemorrhage from a tumor invading the GI tract wall. Angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as absence of signs and symptoms of hemorrhage for at least 30 day following embolization. Active extravasation was demonstrated in three cases. Angiographic abnormalities related to a GI tract tumor were identified on 35 of 37 angiograms, including tumor neovascularity (n = 21), tumor enhancement (n = 24), and luminal irregularity (n = 5). In the absence of active extravasation, empiric embolization with particles and/or coils was performed in 25 procedures. Cessation of hemorrhage (ie, clinical success) occurred more frequently when empiric embolization was performed (17 of 25 procedures; 68%) than when embolization was not performed (two of nine; 22%; P = .03). Empiric embolization resulted in clinical success in 10 of 11 patients with acute GI bleeding (91%), compared with seven of 14 patients (50%) with chronic GI bleeding (P = .04). No ischemic complications were encountered. In patients with advanced malignancy, in the absence of active extravasation, empiric transcatheter arterial embolization for treatment of GI hemorrhage from a direct tumor source demonstrated a 68% short-term success rate, without any ischemic complications. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

Percutaneous intraportal application of adipose tissue-derived mesenchymal stem cells using a balloon occlusion catheter in a porcine model of liver fibrosis.

PubMed

Avritscher, Rony; Abdelsalam, Mohamed E; Javadi, Sanaz; Ensor, Joe; Wallace, Michael J; Alt, Eckhard; Madoff, David C; Vykoukal, Jody V

2013-12-01

To investigate the safety and effectiveness of a novel endovascular approach for therapeutic cell delivery using a balloon occlusion catheter in a large animal model of liver fibrosis. Transcatheter arterial embolization with ethiodized oil (Ethiodol) and ethanol was used to induce liver damage in 11 pigs. Mesenchymal stem cells (MSCs) were harvested from adipose tissue and engineered to express green fluorescent protein (GFP). A balloon occlusion catheter was positioned in the bilateral first-order portal vein branches 2 weeks after embolization to allow intraportal application of MSCs in six experimental animals. MSCs were allowed to dwell for 10 minutes using prolonged balloon inflation. Five control animals received a sham injection of normal saline in a similar fashion. Hepatic venous pressure gradient (HVPG) was measured immediately before necropsy. Specimens from all accessible lobes were obtained with ultrasound-guided percutaneous 18-gauge biopsy 2 hours after cell application. All animals were euthanized within 4 weeks. Fluorescent microscopy was used to assess the presence and distribution of cells. Liver injury and fibrosis were successfully induced in all animals. MSCs (6-10 × 10(7)) were successfully delivered into the portal vein in the six experimental animals. Cell application was not associated with vascular complications. HVPG showed no instances of portal hypertension. GFP-expressing MSCs were visualized in biopsy specimens and were distributed primarily within the sinusoidal spaces; however, 4 weeks after implantation, MSCs could not be identified in histologic specimens. A percutaneous endovascular approach for cell delivery using a balloon occlusion catheter proved safe for intraportal MSC application in a large animal model of liver fibrosis. © 2013 SIR Published by SIR All rights reserved.

Computational fluid dynamics (CFD) using porous media modeling predicts recurrence after coiling of cerebral aneurysms.

PubMed

Umeda, Yasuyuki; Ishida, Fujimaro; Tsuji, Masanori; Furukawa, Kazuhiro; Shiba, Masato; Yasuda, Ryuta; Toma, Naoki; Sakaida, Hiroshi; Suzuki, Hidenori

2017-01-01

This study aimed to predict recurrence after coil embolization of unruptured cerebral aneurysms with computational fluid dynamics (CFD) using porous media modeling (porous media CFD). A total of 37 unruptured cerebral aneurysms treated with coiling were analyzed using follow-up angiograms, simulated CFD prior to coiling (control CFD), and porous media CFD. Coiled aneurysms were classified into stable or recurrence groups according to follow-up angiogram findings. Morphological parameters, coil packing density, and hemodynamic variables were evaluated for their correlations with aneurysmal recurrence. We also calculated residual flow volumes (RFVs), a novel hemodynamic parameter used to quantify the residual aneurysm volume after simulated coiling, which has a mean fluid domain > 1.0 cm/s. Follow-up angiograms showed 24 aneurysms in the stable group and 13 in the recurrence group. Mann-Whitney U test demonstrated that maximum size, dome volume, neck width, neck area, and coil packing density were significantly different between the two groups (P < 0.05). Among the hemodynamic parameters, aneurysms in the recurrence group had significantly larger inflow and outflow areas in the control CFD and larger RFVs in the porous media CFD. Multivariate logistic regression analyses demonstrated that RFV was the only independently significant factor (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = 0.016). The study findings suggest that RFV collected under porous media modeling predicts the recurrence of coiled aneurysms.

Egress door opening assister

DOEpatents

Allison, Thomas L.

2015-10-06

A door opening spring assistance apparatus is set forth that will automatically apply a door opening assistance force using a combination of rods and coil springs. The release of the rods by the coil springs reduces the force required to set the door in motion.

α/β coiled coils

PubMed Central

Hartmann, Marcus D; Mendler, Claudia T; Bassler, Jens; Karamichali, Ioanna; Ridderbusch, Oswin; Lupas, Andrei N; Hernandez Alvarez, Birte

2016-01-01

Coiled coils are the best-understood protein fold, as their backbone structure can uniquely be described by parametric equations. This level of understanding has allowed their manipulation in unprecedented detail. They do not seem a likely source of surprises, yet we describe here the unexpected formation of a new type of fiber by the simple insertion of two or six residues into the underlying heptad repeat of a parallel, trimeric coiled coil. These insertions strain the supercoil to the breaking point, causing the local formation of short β-strands, which move the path of the chain by 120° around the trimer axis. The result is an α/β coiled coil, which retains only one backbone hydrogen bond per repeat unit from the parent coiled coil. Our results show that a substantially novel backbone structure is possible within the allowed regions of the Ramachandran space with only minor mutations to a known fold. DOI: http://dx.doi.org/10.7554/eLife.11861.001 PMID:26771248

Feasibility of Using Intravascular Ultrasonography for Assessment of Giant Cavernous Aneurysm after Endovascular Treatment: A Technical Report

PubMed Central

Majidi, Shahram; Grigoryan, Mikayel; Tekle, Wondwossen G; Watanabe, Masaki; Qureshi, Adnan I

2012-01-01

Introduction Intravascular ultrasonography (IVUS) has been shown as a valuable adjunct imaging tool during endovascular procedures but its value in detection of any recurrence during follow up after endovascular coil embolization of large and giant intracranial aneurysms is not reported. Methods A 41 years old man who had been treated using stent assisted coil embolization for cavernous segment aneurysm of the left internal carotid artery underwent 60 month angiographic follow up. Concurrently, IVUS catheter was advanced under fluoroscopic guidance inside the cavernous portion of the left internal carotid artery. Then IVUS images were used to visualize the stent, coil loops, and aneurysm neck. Results The angiographic images were limited because of superimposition of the aneurysm on the parent vessel in all projections. IVUS images demonstrated that the stent was patent along its whole length and there was no sign of stent deformity or in-stent thrombosis. Loops of the coil were visualized as hyperechoic signals inside the aneurysm and there was no sign of herniated loops of coil inside the stent. Conclusion In this case report, we observed that adjunct use of IVUS can provide valuable information not ascertained by angiography during follow up assessment of coil embolized aneurysm. PMID:22737259

Percutaneous Direct Needle Puncture and Transcatheter N-butyl Cyanoacrylate Injection Techniques for the Embolization of Pseudoaneurysms and Aneurysms of Arteries Supplying the Hepato-pancreato-biliary System and Gastrointestinal Tract

PubMed Central

Yadav, Rajanikant R; Boruah, Deb K; Bhattacharyya, Vishwaroop; Prasad, Raghunandan; Kumar, Sheo; Saraswat, V A; Kapoor, V K; Saxena, Rajan

2016-01-01

Aims: The aim of this study was to evaluate the safety and clinical efficacy of percutaneous direct needle puncture and transcatheter N-butyl cyanoacrylate (NBCA) injection techniques for the embolization of pseudoaneurysms and aneurysms of arteries supplying the hepato-pancreato-biliary (HPB) system and gastrointestinal (GI) tract. Subjects and Methods: A hospital-based cross-sectional retrospective study was conducted, where the study group comprised 11 patients with pseudoaneurysms/aneurysms of arteries supplying the HPB system and GI tract presenting to a tertiary care center from January 2015 to June 2016. Four patients (36.4%) underwent percutaneous direct needle puncture of pseudoaneurysms with NBCA injection, 3 patients (27.3%) underwent transcatheter embolization with NBCA as sole embolic agent, and in 4 patients (36.4%), transcatheter NBCA injection was done along with coil embolization. Results: This retrospective study comprised 11 patients (8 males and 3 females) with mean age of 35.8 years ± 1.6 (standard deviation [SD]). The mean volume of NBCA: ethiodized oil (lipiodol) mixture injected by percutaneous direct needle puncture was 0.62 ml ± 0.25 (SD) (range = 0.5–1 ml), and by transcatheter injection, it was 0.62 ml ± 0.37 (SD) (range = 0.3–1.4 ml). Embolization with NBCA was technically and clinically successful in all patients (100%). No recurrence of bleeding or recurrence of pseudoaneurysm/aneurysm was noted in our study. Conclusions: Percutaneous direct needle puncture of visceral artery pseudoaneurysms and NBCA glue injection and transcatheter NBCA injection for embolization of visceral artery pseudoaneurysms and aneurysms are cost-effective techniques that can be used when coil embolization is not feasible or has failed. PMID:28123838

Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

PubMed Central

Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea

2016-01-01

Purpose To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. Materials and Methods From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. Results All technical and clinical success–i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control–was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12–32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Conclusion Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding. PMID:27189294

Fat embolism syndrome

PubMed Central

George, Jacob; George, Reeba; Dixit, R.; Gupta, R. C.; Gupta, N.

2013-01-01

Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good. PMID:23661916

Long term follow-up of bifurcation aneurysms treated with braided stent assisted coiling and complex T- and Y- stent constructs.

PubMed

Cheung, Nicholas K; Chiu, Albert Hy; Cheung, Andrew; Wenderoth, Jason D

2018-06-01

Stent assisted coil embolization (SACE) of bifurcation aneurysms is challenging. Heterogeneous results have been achieved to date, but largely for laser cut stents. While braided stents offer multiple technical advantages, their long term efficacy has yet to be validated. To report the first long term 18 month results for the durability of bifurcation aneurysms treated with braided stents. Over a 4 year period, 59 consecutive patients with 60 bifurcation aneurysms underwent elective braided SACE across three Australian neurovascular centers. 17 of these aneurysms underwent T- or Y-shaped stent constructs. All patients had immediate, 6 month and 18 month clinical and radiological follow-up. Radiological assessment was made on modified Raymond-Roy occlusion scores while clinical assessment was based on the modified Rankin Scale. Subgroup analysis of 17 aneurysms treated with multi-stent constructs was conducted. 6 month follow-up data were available for 59 aneurysms and 18 month follow-up data for 58 aneurysms. Satisfactory aneurysm occlusion was achieved in 97% at inception and at 6 months, and 98% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Similar satisfactory results were achieved with the multi-stent construct cohort. Intraprocedural thromboembolic events were recorded in 5% and delayed events in 2%. Technical complications were found in 5%. All complication rate was 13%. Braided SACE was safe, efficacious, and durable at the long term 18 month follow-up, including for multi-stent constructs. Preliminary results indicate favorable clinical and radiological outcomes compared with laser cut stents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Coagulation abnormalities in pediatric and adult patients after sclerotherapy or embolization of vascular anomalies.

PubMed

Mason, K P; Neufeld, E J; Karian, V E; Zurakowski, D; Koka, B V; Burrows, P E

2001-12-01

The purpose of our study was to examine the coagulation status in patients with vascular anomalies who had undergone sclerotherapy or embolization. Ours was a prospective pilot study of 29 patients who had undergone sclerotherapy or embolization of large vascular anomalies. Fibrinogen, platelet, and d-dimer levels and prothrombin time were obtained before, immediately after, and on the day after the procedure. Five patients with venous malformations had positive d-dimer levels before the procedure. A subgroup analysis revealed a relationship between the type of agent used and the change in coagulation status. Specifically, a positive relationship was found between the use of dehydrated alcohol or sodium tetradecyl sulfate and a disruption in coagulation profiles as evidenced by a decrease in platelets and fibrinogen, an increase in prothrombin time, and a conversion from negative to positive d-dimers. In contrast, sclerotherapy or embolization with cyanoacrylic, polyvinyl alcohol foam particles, or platinum microcoils was not associated with coagulation disturbances. The coagulation disturbances that occur in response to dehydrated alcohol or sodium tetradecyl sulfate sclerotherapy or embolization could compromise the patient's clotting ability. Patients who receive dehydrated alcohol or sodium tetradecyl sulfate during a preoperative sclerotherapy or embolization may experience coagulation disturbances that could increase the risk of bleeding, thrombosis, or hematoma. This patient population may benefit from the use of glue, foam, or coils as a substitute for dehydrated alcohol or sodium tetradecyl sulfate.

Is side-viewing endoscope assisted balloon dilatation better for corrosive gastric outlet obstruction?

PubMed

Katiyar, Prashant; Nijhawan, Sandeep; Saradava, Vimal; Nagaich, Neeraj; Gupta, Gaurav; Mathur, Amit; Nepalia, Subhash

2013-11-01

Endoscopic balloon dilatation (EBD) is an effective therapy for caustic-induced gastric outlet obstruction (GOO). Gaining access to the stricture site is the most important step. It is sometimes difficult to negotiate a balloon through the stricture with a front-viewing endoscope due to deformed anatomy of stomach. To overcome this technical difficulty, a side-viewing endoscope can be used. There is limited data regarding the use of side-viewing endoscopes in EBD. We here report on the short-term efficacy and safety of EBD in caustic-induced GOO. In technically difficult cases, a side-viewing endoscope was used for EBD and its efficacy and safety were assessed. The study included 25 patients with caustic-induced GOO. Patients underwent EBD using a through-the-scope balloon. Initial balloon dilatation was performed with a front-viewing endoscope. A side-viewing endoscope was used where negotiation across the stricture failed with a front-viewing endoscope. Dilatation was started at 8 mm diameter and was performed at 1-week intervals. The end point of dilatation was 15 mm diameter. In 18 patients successful balloon dilatation was possible with a front-viewing endoscope. A side-viewing endoscope was used in six patients as negotiation across the stricture was not possible with a front-viewing endoscope. In all six patients negotiation across the stricture followed by successful dilatation was successful with a side-viewing endoscope. Of the 25 patients included in this study, 24 (96%) achieved procedural success (18 with a front-viewing endoscope and 6 with a side-viewing endoscope) in 3-9 sessions. Our results show that EBD is a safe and effective option for caustic-induced GOO and in difficult cases a side-viewing endoscope can be used to achieve technical success.

Computational fluid dynamics (CFD) using porous media modeling predicts recurrence after coiling of cerebral aneurysms

PubMed Central

Ishida, Fujimaro; Tsuji, Masanori; Furukawa, Kazuhiro; Shiba, Masato; Yasuda, Ryuta; Toma, Naoki; Sakaida, Hiroshi; Suzuki, Hidenori

2017-01-01

Objective This study aimed to predict recurrence after coil embolization of unruptured cerebral aneurysms with computational fluid dynamics (CFD) using porous media modeling (porous media CFD). Method A total of 37 unruptured cerebral aneurysms treated with coiling were analyzed using follow-up angiograms, simulated CFD prior to coiling (control CFD), and porous media CFD. Coiled aneurysms were classified into stable or recurrence groups according to follow-up angiogram findings. Morphological parameters, coil packing density, and hemodynamic variables were evaluated for their correlations with aneurysmal recurrence. We also calculated residual flow volumes (RFVs), a novel hemodynamic parameter used to quantify the residual aneurysm volume after simulated coiling, which has a mean fluid domain > 1.0 cm/s. Result Follow-up angiograms showed 24 aneurysms in the stable group and 13 in the recurrence group. Mann-Whitney U test demonstrated that maximum size, dome volume, neck width, neck area, and coil packing density were significantly different between the two groups (P < 0.05). Among the hemodynamic parameters, aneurysms in the recurrence group had significantly larger inflow and outflow areas in the control CFD and larger RFVs in the porous media CFD. Multivariate logistic regression analyses demonstrated that RFV was the only independently significant factor (odds ratio, 1.06; 95% confidence interval, 1.01–1.11; P = 0.016). Conclusion The study findings suggest that RFV collected under porous media modeling predicts the recurrence of coiled aneurysms. PMID:29284057

Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.

Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day ratesmore » and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.« less

Fat embolism syndrome.

PubMed

Stein, Paul D; Yaekoub, Abdo Y; Matta, Fadi; Kleerekoper, Michael

2008-12-01

To assess the incidence and risk factors for fat embolism syndrome. Data from the National Hospital Discharge Survey (NHDS) were analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. From 1979 through 2005 among 928,324,000 patients discharged from short-stay hospitals in the United States, 41,000 (0.004%) had fat embolism syndrome. Among 21,538,000 patients with an isolated fracture of the femur (any site), tibia, fibula, pelvis, ribs, humerus, radius, or ulna, 25,000 (0.12%) developed fat embolism syndrome. Patients with multiple fractures of the femur (excluding neck) more often had fat embolism syndrome than those with isolated fractures (1.29% versus 0.54%). The incidence of fat embolism syndrome was lower with isolated fractures of the tibia or fibula (0.30%) and even lower with isolated fractures of the neck of the femur (0.06%). The incidence of fat embolism was too low to calculate with isolated fractures of the pelvis, ribs, humerus, radius, or ulna. Nonorthopedic conditions rarely, if ever, were accompanied by fat embolism syndrome. The fat embolism syndrome was more frequent in men (relative risk 5.71). Children, aged 0 to 9 years rarely had fat embolism syndrome. The fat embolism syndrome most commonly affected patients aged 10 to 39 years. The incidence of the fat embolism syndrome depends on the bone involved, whether fractures are isolated or multiple, the age of the patient and the gender. It rarely occurs as a result of medical conditions.

Initial Clinical Experience with an Endoluminal Spiral Prosthesis for Treating Complicated Venous Thrombosis and Preventing Pulmonary Embolism

PubMed Central

Jakob, H.; Oelert, H.; Schmiedt, W.; Teusch, P.; Iversen, S.; Hake, U.; Schild, H.; Maass, D.

1989-01-01

Fourteen patients with complicated venous thrombosis or recurrent pulmonary embolism were treated by implantation of an endoluminal spiral prosthesis subsequent to balloon angioplasty, surgical thrombectomy or embolectomy, a combination of these, or, in 2 cases, no other treatment. The patients were divided into 2 groups, based on their primary diagnosis and the purpose of the prosthesis. Group I included 8 patients with extensive iliofemoral or caval thrombosis, caused by congenital caval stenosis (1 case) or extravascular compression or retraction (7 cases); 7 of these patients had had previous operations, and the remaining patient had undergone thrombolysis, which failed. The current treatment consisted of balloon angioplasty and surgical thrombectomy or embolectomy, and implantation of an endoluminal spiral stent to prevent elastic recoil of the vessel. In 4 cases, an arteriovenous fistula was constructed and was taken down 3 months later; in 1 additional patient, a bilateral arteriovenous fistula was created. Group II comprised 6 patients with recurrent pulmonary embolism (4 cases), massive pulmonary embolism (1 case), or paradoxical bilateral carotid artery embolism (1 case). Four of these patients underwent surgical thrombectomy or embolectomy, while 2 had no treatment other than filter implantation. All 6 underwent transluminal implantation of a helix caval filter (a modification of the endoluminal spiral stent). All but 1 implantation was accomplished by means of either a transfemoral or a transjugular cutdown; the remaining implantation was performed transatrially after a pulmonary embolectomy. The only device-related complication was a retroperitoneal hematoma in Group I, resulting from perforation of the inferior vena cava by the guidewire during device implantation. This complication necessitated an emergency laparotomy and takedown of the arteriovenous fistula, which resulted in rethrombosis of the left iliofemoral vein. The other 7 stented veins were

Physiologically-relevant measurements of flow through coils and stents: towards improved modeling of endovascular treatment of intracranial aneurysms

NASA Astrophysics Data System (ADS)

Barbour, Michael; Levitt, Michael; Geindreau, Christian; Rolland Du Roscoat, Sabine; Johnson, Luke; Chivukula, Keshav; Aliseda, Alberto

2016-11-01

The hemodynamic environment in cerebral aneurysms undergoing flow-diverting stent (FDS) or coil embolization treatment plays a critical role in long-term outcomes. Standard modeling approaches to endovascular coils and FDS simplify the complex geometry into a homogenous porous volume or surface through the addition of a Darcy-Brinkman pressure loss term in the momentum equation. The inertial and viscous loss coefficients are typically derived from published in vitro studies of pressure loss across FDS and coils placed in a straight tube, where the only fluid path is across the treatment - an unrealistic representation of treatment apposition in vivo. The pressure drop across FDS and coils in side branch aneurysms located on curved parent vessels is measured. Using PIV, the velocity at the aneurysm neck plane is reconstructed and used to determine loss coefficients for better models of endovascular coils or FDS that account for physiological placement and vessel curvature. These improved models are incorporated into CFD simulations and validated against in vitro model PIV velocity, as well as compared to microCT-based coil/stent-resolving CFD simulations of patient-specific treated aneurysm flow.

Distal Embolization After Stenting of the Vertebral Artery: Diffusion-Weighted Magnetic Resonance Imaging Findings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Canyigit, Murat; Arat, Anil; Cil, Barbaros E.

2007-04-15

Purpose. We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure. Methods. Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32-76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure. Results. On seven of the 16 postprocedural diffusion-weightedmore » MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities. Conclusion. Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection

Use of a latest-generation vascular plug for peripheral vascular embolization with use of a diagnostic catheter: preliminary clinical experience.

PubMed

Mordasini, Pasquale; Szucs-Farkas, Zsolt; Do, Do-Dai; Gralla, Jan; Kettenbach, Joachim; Hoppe, Hanno

2010-08-01

The latest-generation Amplatzer vascular plug (AVP), the AVP 4, is designed for embolization of smaller vessels without a sheath or guiding catheter. This study evaluated the AVP 4 in peripheral vascular embolization. Embolization with the AVP 4 was attempted in 13 patients (11 men) for trauma (n = 7) and other indications (n = 6). Technical success rate, vascular bed, size of catheter, and number and size of AVP 4 devices were recorded. Embolization with the AVP 4 was successful in 10 of 13 patients (77%). In trauma patients (n = 7), embolization of the splenic artery (n = 4), lumbar artery (n = 2), and superior gluteal artery (n = 1) was performed. In other patients, preoperative embolization of the right portal vein (n = 1), a gastric varix after transjugular intrahepatic portosystemic shunt creation (n = 1), an aneurysm of the internal iliac artery (n = 1), and inferior mesenteric artery (IMA) embolization before aneurysm repair (n = 2) was performed. Sizes of the AVP 4 were 4 mm (n = 6), 6 mm (n = 5), and 8 mm (n = 1). In all patients, 4- and 5-F catheters with a 0.038-inch minimum inner lumen were used. In one patient, IMA embolization was attempted via a femoral approach but was unsuccessful as a result of repeated catheter tip dislocation because of acute angle; coils were used instead. Peripheral embolization with the AVP 4 was successful in the majority of patients. Future comparative study is necessary to evaluate this device's benefits over other embolization materials such as earlier-generation AVPs or microcoils. Copyright (c) 2010 SIR. Published by Elsevier Inc. All rights reserved.

Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery.

PubMed

De Koning, Michael; Moreels, Tom G

2016-08-22

Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Balloon-assisted enteroscopy allows therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in these patients, avoiding rescue surgery. The objective of the current study is to compare success and complication rate of double-balloon (DBE) and single-balloon enteroscope (SBE) to perform ERCP in Roux-en-Y patients. Seventy three Roux-en-Y patients with suspected biliary tract pathology underwent balloon-assisted enteroscopy in a tertiary-care center. Retrospective analysis of 95 consecutive therapeutic ERCP procedures was performed to define and compare success and complication rate of DBE and SBE. Male-female ratio was 28/45 with a mean age of 58 ± 2 years. 30 (32 %) procedures were performed with DBE and 65 (68 %) with SBE. Overall ERCP success rate was 73 % for DBE and 75 % for SBE (P = 0.831). Failure was due to inability to reach or cannulate the intact papilla or bilioenteric anastomosis. Success rate was significantly higher when performed at the bilioenteric anastomosis (80 % success in 56 procedures) or at the intact papilla in short-limb Roux-en-Y (80 % in 15 procedures) as compared to the intact papilla in long-limb (58 % in 24 procedures; P = 0.040). Adverse event rates were 10 % (DBE) and 8 % (SBE) (P = 0.707) and mostly dealt with conservatively. ERCP after Roux-en-Y altered small bowel anatomy is feasible and safe using both DBE and SBE. Both techniques are equally competent with high success rates and acceptable adverse events rates. ERCP at the level of the intact papilla in long limb Roux-en-Y is less successful as compared to short-limb or bilioenteric anastomosis.

Japanese Balloon Program

NASA Astrophysics Data System (ADS)

Yoshida, Tetsuya; Fuke, Hideyuki; Shoji, Yasuhiro; Iijima, Issei; Izutsu, Naoki; Kato, Yoichi; Matsuzaka, Yukihiko; Mizuta, Eiichi; Sato, Takatoshi; Tamura, Keisuke; Saito, Yoshitaka; Kakehashi, Yuya

2012-07-01

Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency conducts domestic balloon campaigns at Taiki Aerospace Research Field (TARF) in Hokkaido since 2008. The ballooning at TARF becomes stable after four year operation. Because the field faces to the Pacific Ocean, heavy balloons and payloads can be launched safely using a very unique sliding launcher. Recoveries at the inshore along the Tokachi coast can be done very quickly and smoothly. Unfortunately, flight opportunities are recently limited due to unfriendly weather condition. Unstable Jet stream also prevents us to have so-called `boomerang flight' to achieve long flight duration more than several hours. Six balloon-borne experiments were carried out in 2010 and 2011. Three of them were demonstrations of challenges of space engineering, two were in-situ atmospheric observation, and one was the technical flight of new high-resolution γ-ray telescope. In addition to these flights, we carried out two launches for next generation balloons: one for Tawara-shaped superpressure balloon and the other for ultra-thin high-altitude balloon. In this paper, recent activities of the Japanese scientific balloon program will be introduced. On-going development of the balloon system will also be presented.

Nonhuman primate models of focal cerebral ischemia

PubMed Central

Fan, Jingjing; Li, Yi; Fu, Xinyu; Li, Lijuan; Hao, Xiaoting; Li, Shasha

2017-01-01

Rodents have been widely used in the production of cerebral ischemia models. However, successful therapies have been proven on experimental rodent stroke model, and they have often failed to be effective when tested clinically. Therefore, nonhuman primates were recommended as the ideal alternatives, owing to their similarities with the human cerebrovascular system, brain metabolism, grey to white matter ratio and even their rich behavioral repertoire. The present review is a thorough summary of ten methods that establish nonhuman primate models of focal cerebral ischemia; electrocoagulation, endothelin-1-induced occlusion, microvascular clip occlusion, autologous blood clot embolization, balloon inflation, microcatheter embolization, coil embolization, surgical suture embolization, suture, and photochemical induction methods. This review addresses the advantages and disadvantages of each method, as well as precautions for each model, compared nonhuman primates with rodents, different species of nonhuman primates and different modeling methods. Finally it discusses various factors that need to be considered when modelling and the method of evaluation after modelling. These are critical for understanding their respective strengths and weaknesses and underlie the selection of the optimum model. PMID:28400817

Transcatheter Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rautio, Riitta, E-mail: riitta.rautio@tyks.fi; Haapanen, Arto

2007-04-15

Our aim was to treat a clinically silent renal artery aneurysm. The patient was a 76-year-old man with elevated prostate-specific antigen and prostata biopsies with a gradus II-III adenocarcinoma who was incidentally found to have an aneurysm in his right renal artery. We performed a successful transcatheter embolization of the aneurysm using ethylene vinyl alcohol copolymer (Onyx). To avoid migration of the liquid material into the parent artery, a balloon was inflated in the orifice of the neck of the aneurysm while the liquid was injected. Five-month follow-up computed tomography (CT) imaging confirmed total occlusion of the aneurysm.

Clinical Results and Problems of Percutaneous Transluminal Angioplasty and Stenting for Extracranial Internal Carotid Stenoses

PubMed Central

Tsuura, M.; Terada, T.; Masuo, O.; Matsumoto, H.; Itakura, T.; Hyoutani, G.; Nakamura, Y.; Moriwaki, H.; Hayashi, S.

2001-01-01

Summary 110 patients with extracranial ICA stenosis were treated by PTA or stenting. In 21 of 55 cases of only PTA and in 40 of 55 cases of stenting, we used our blocking balloon systems to prevent distal embolism. The morbidity and the mortality rates were 5.4% and 0%, respectively. There was only one embolic complication in cases of PTA or stenting where blocking balloon systems were used. In contrast, distal embolism occurred in 3 of 34 cases of PTA without blocking balloon systems (one symptomatic case) and in 4 of 15 cases of stenting without blocking balloon systems (3 symptomatic cases). Our blocking balloon catheter system is a useful device to reduce the risk of symptomatic distal embolism. PMID:20663375

Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report.

PubMed

Takeuchi, Nobuhiro; Nomura, Yusuke

2014-01-09

Renal arteriovenous fistula (RAVF) is a comparatively rare malformation. Here, we report a case of ruptured RAVF that was successfully treated by catheter embolization. An 89-year-old female was transferred to our institution with massive gross hematuria in March 2011. Plain abdominal computed tomography (CT) revealed dilated left renal pelvis with high-density contents. Hematoma was suspected. Subsequent plain abdominal magnetic resonance imaging revealed left hydronephrosis and blood retention in the dilated left renal pelvis. No renal or ureteral cancer was evident. Hematuria was conservatively treated using hemostatic agents but hematuria persisted. Repeated urinary cytology revealed no malignant cells. On day 9, the patient went into septic and/or hemorrhagic shock. Fluid and catecholamine infusion, blood transfusion, and antibacterial drugs were rapidly initiated, and the patient's general condition gradually improved. Contrast-enhanced abdominal CT revealed marked expansion of the hematoma in the renal pelvis and microaneurysms in the segmental arteries of the left kidney. Inflammation improved, and a left double-J stent was inserted. Selective renal angiography revealed RAVF with microaneurysms in the left segmental arteries; therefore, catheter embolization using metallic coils was performed, which resolved hematuria. We report a case of ruptured renal arteriovenous malformation, which was successfully treated by catheter embolization.

An unusual complication of a "blind" femoral embolectomy.

PubMed

Karkos, Christos D; Karamanos, Dimitrios G; Papadimitriou, Dimitrios N; Demiropoulos, Filippos; Zambas, Neophytos; Gerassimidis, Thomas S

2010-08-01

Iatrogenic pseudoaneurysms after femoral embolectomy are unusual and have been described in the peroneal, posterior tibial, and popliteal arteries. We present an unusual case of such a pseudoaneurysm originating from a medial superior genicular collateral vessel that was coming off the proximal popliteal artery at an acute angle. It is likely that the embolectomy catheter had accidentally entered this branch, which ruptured when the balloon was inflated. Transcatheter coil embolization resulted in successful thrombosis of the pseudoaneurysm. Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Endolymphatic Ethiodized Oil Intranodal Lymphangiography and Cyanoacrylate Glue Embolization for the Treatment of Postoperative Lymphatic Leak After Robot-Assisted Laparoscopic Pelvic Resection.

PubMed

Hill, Hannah; Srinivasa, Ravi N; Gemmete, Joseph J; Hage, Anthony; Bundy, Jacob; Chick, Jeffrey Forris Beecham

2018-01-01

Purpose: To report the approach, technical success, clinical outcomes, complications, and follow-up of ethiodized oil intranodal lymphangiography with cyanoacrylate glue embolization for the treatment of lymphatic leak after robot-assisted laparoscopic pelvic resection. Materials and Methods: Four men with mean age 68.7 ± 14.3 years were treated with ethiodized oil intranodal lymphangiography with cyanoacrylate embolization for postoperative lymphatic leak. Patients underwent either (1) cystoprostatectomy with ileal conduit and bilateral extensive pelvic lymph node dissection for muscle-invasive urothelial carcinoma and presented with postoperative lymphatic ascites ( n  = 2) or (2) prostatectomy with bilateral standard pelvic lymph node dissection for prostate carcinoma and presented with postoperative pelvic lymphoceles ( n  = 2). Intranodal lymphangiography and embolization procedural details, technical success, clinical outcomes, and follow-up were recorded. Results: In four patients, a total of six ethiodized oil intranodal lymphangiograms were performed, two procedures being repeated interventions. Inguinal lymph node catheterization and ethiodized oil lymphangiography was technically effective in all procedures. A mean of 5.2 ± 2.0 mL of ethiodized oil was used for lymphatic opacification. Cyanoacrylate was diluted to 24.2% with ethiodized oil and 0.44 mL of cyanoacrylate was instilled during first time interventions. On repeat procedures, cyanoacrylate was diluted to 51.7%, and 0.52 mL was instilled. The primary clinical success rate was 50% ( n  = 2/4). Clinical success was achieved in all patients after two interventions ( n  = 4; 100%). No complications were reported at mean follow-up of 134.7 ± 79.2 days (range: 59-248 days). Conclusion: Ethiodized oil intranodal lymphangiography with direct cyanoacrylate glue embolization is a minimally invasive treatment option for lymphatic leak after pelvic resection.

Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

PubMed Central

Osoegawa, Takashi; Motomura, Yasuaki; Akahoshi, Kazuya; Higuchi, Naomi; Tanaka, Yoshimasa; Hisano, Terumasa; Itaba, Souichi; Gibo, Junya; Yamada, Mariko; Kubokawa, Masaru; Sumida, Yorinobu; Akiho, Hirotada; Ihara, Eikichi; Nakamura, Kazuhiko

2012-01-01

AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth II gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing, selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth II reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth II reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting

Preoperative catheter spinal angiography and embolization of cervical spinal tumors: Outcomes from a single center

PubMed Central

Leng, Lewis Z; Kimball, David; Marcus, Joshua; Knopman, Jared; Laufer, Ilya; Bilsky, Mark; Gobin, Y Pierre

2016-01-01

Objective The existing literature regarding preoperative cervical spinal tumor embolization is sparse, with few discussions on the indications, risks, and best techniques. We present our experience with the preoperative endovascular management of hypervascular cervical spinal tumors. Methods We performed a retrospective review of all patients who underwent preoperative spinal angiography (regardless of whether tumor embolization was performed) at our institution (from 2002 to 2012) for primary and metastatic cervical spinal tumors. Tumor vascularity was graded from 0 (tumor blush equal to the normal adjacent vertebral body) to 3 (intense tumor blush with arteriovenous shunting). Tumors were considered “hypervascular” if they had a tumor vascular grade from 1 to 3. Embolic materials included particles, liquid embolics, and detachable coils. The main embolization technique was superselective catheterization of an arterial tumor feeder followed by injection of embolic material. This technique could be used alone or supplemented with occlusion of dangerous anastomoses of the vertebral artery as needed to prevent inadvertent embolization of the vertebrobasilar system. In cases when superselective catheterization of the tumoral feeder was not feasible, embolization was performed from a proximal catheter position after occlusion of branches supplying areas other than the tumor (“flow diversion”). Results A total of 47 patients with 49 cervical spinal tumors were included in this study. Of the 49 total tumors, 41 demonstrated increased vascularity (vascularity score > 0). The most common tumor pathology in our series was renal cell carcinoma (RCC) (N = 16; 32.7% of all tumors) followed by thyroid carcinoma (N = 7; 14.3% of all tumors). Tumor embolization was undertaken in 25 hypervascular tumors resulting in complete, near-complete, and partial embolization in 36.0% (N = 9), 44.0% (N = 11), and 20.0% (N = 5) of embolized tumors, respectively

Spiral assisted ERCP is equivalent to single balloon assisted ERCP in patients with Roux-en-Y anatomy.

PubMed

Lennon, Anne Marie; Kapoor, Sumit; Khashab, Mouen; Corless, Erin; Amateau, Stuart; Dunbar, Kerry; Chandrasekhara, Vinay; Singh, Vikesh; Okolo, Patrick I

2012-05-01

Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with Roux-en-Y anatomy. Augmented enteroscopy allows deep insertion into the small bowel and can be useful in patients with Roux-en-Y anatomy. The aim of this study was to compare single balloon assisted ERCP (SBE-ERCP) and spiral assisted ERCP (SE-ERCP) in patients with Roux-en-Y anatomy in terms of diagnostic and therapeutic yield, procedure time, and complications. This is a retrospective cohort study of consecutive patients with Roux-en-Y anatomy who underwent SBE-ERCP or SE-ERCP between October 2007 and March 2011. Diagnostic yield was defined as successful duct cannulation. Therapeutic yield was defined as the ability to successfully carry out endoscopic therapy in those cannulated. Procedure time and complications were assessed. Thirty-four consecutive patients with Roux-en-Y anatomy underwent 54 ERCP procedures. The overall diagnostic yield was 44.4% with no significant difference between the diagnostic yield of SBE-ERCP (48.3%) and SE-ERCP (40%). The diagnostic yield was lower in patients with gastric by-pass (38.9%) compared with other types of Roux-en-Y anatomy (47.2%) but this was not statistically significant (P = 0.772). The overall therapeutic yield was 93.8%, with a therapeutic yield of 100% for SBE-ERCP and 87.5% for SE-ERCP (P = 1.0). There was one perforation during SBE-ERCP, giving a complication rate of 3.5%. The mean procedure time did not differ between the two techniques. Diagnostic and therapeutic yields are similar with SBE-ERCP and SE-ERCP in patients with Roux-en-Y anatomy with no significant difference in procedure time or complication rates.

Intraoperative direct puncture and embolization (IOPE) using a glue material for spinal cord arteriovenous fistula: a case report.

PubMed

Shin, Hong Kyung; Suh, Dae Chul; Jeon, Sang Ryong

2015-05-01

Spinal arteriovenous fistula (AVF) is treated by embolization or surgery. However, transarterial embolization or surgery is difficult in rare cases when the fistula site is very complicated to access especially as in fistular nidus supplied by posterior and anterior spinal artery. We present the case which was treated with intraoperative direct puncture and embolization (IOPE) using glue material, since the usual transarterial or transvenous neurointerventional approach was difficult to embolize the AVF. A 36-year-old woman presented with progressive leg weakness and pain after a 20-year history of lower back pain. She had pelvic and spinal AVF combined with arteriovenous malformation (AVM). Despite prior treatment of the pelvic lesion with radiotherapy and coil embolization, the spinal lesion persisted and caused repeated subarachnoid hemorrhages. A spinal angiogram revealed a tortuous and long feeder of the AVF which had growing venous sac, as well as AVM. Two embolization trials failed because of the long tortuosity and associated anterior spinal artery. Four months later, drastic leg weakness and pain occurred, and IOPE was performed using a glue material. The subsequent recovery of the patient was rapid. One month later, the use of a strong opioid could be discontinued, and the patient could walk with aid. A follow-up spinal angiogram revealed that the venous sac of the AVF had disappeared. In spinal AVF which is not feasible to access by usual intervention approach and to dissect surgically, IOPE with glue material can be considered for the treatment.

Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Subhani, Aqeel, E-mail: drsubhani07@gmail.com

Objective: This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.Study designEighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed. Results: The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %)more » were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery. Conclusions: Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.« less

Balloons and Science Kit.

ERIC Educational Resources Information Center

Balloon Council, Washington, DC.

This document provides background information on balloons including: (1) the history of balloons; (2) balloon manufacturing; (3) biodegradability; (4) the fate of latex balloons; and (5) the effect of balloons on the rainforest and sea mammals. Also included as part of this instructional kit are four fun experiments that allow students to…

Genome-Wide Identification of Arabidopsis Coiled-Coil Proteins and Establishment of the ARABI-COIL Database1

PubMed Central

Rose, Annkatrin; Manikantan, Sankaraganesh; Schraegle, Shannon J.; Maloy, Michael A.; Stahlberg, Eric A.; Meier, Iris

2004-01-01

Increasing evidence demonstrates the importance of long coiled-coil proteins for the spatial organization of cellular processes. Although several protein classes with long coiled-coil domains have been studied in animals and yeast, our knowledge about plant long coiled-coil proteins is very limited. The repeat nature of the coiled-coil sequence motif often prevents the simple identification of homologs of animal coiled-coil proteins by generic sequence similarity searches. As a consequence, counterparts of many animal proteins with long coiled-coil domains, like lamins, golgins, or microtubule organization center components, have not been identified yet in plants. Here, all Arabidopsis proteins predicted to contain long stretches of coiled-coil domains were identified by applying the algorithm MultiCoil to a genome-wide screen. A searchable protein database, ARABI-COIL (http://www.coiled-coil.org/arabidopsis), was established that integrates information on number, size, and position of predicted coiled-coil domains with subcellular localization signals, transmembrane domains, and available functional annotations. ARABI-COIL serves as a tool to sort and browse Arabidopsis long coiled-coil proteins to facilitate the identification and selection of candidate proteins of potential interest for specific research areas. Using the database, candidate proteins were identified for Arabidopsis membrane-bound, nuclear, and organellar long coiled-coil proteins. PMID:15020757

Liquid Embolic Agents for Endovascular Embolization: Evaluation of an Established (Onyx) and a Novel (PHIL) Embolic Agent in an In Vitro AVM Model.

PubMed

Vollherbst, D F; Sommer, C M; Ulfert, C; Pfaff, J; Bendszus, M; Möhlenbruch, M A

2017-07-01

Embolization plays a key role in the treatment of arteriovenous malformations. The aim of this study was to evaluate an established (Onyx) and a novel (precipitating hydrophobic injectable liquid [PHIL]) liquid embolic agent in an in vitro AVM model. An AVM model was integrated into a circuit system. The artificial nidus (subdivided into 28 honeycomb-like sections) was embolized with Onyx 18 (group Onyx; n = 8) or PHIL 25 (group PHIL; n = 8) with different pause times between the injections (30 and 60 seconds, n = 4 per study group) by using a 1.3F microcatheter. Procedure times, number of injections, embolization success (defined as the number of filled sections of the artificial nidus), volume of embolic agent, and frequency and extent of reflux and draining vein embolization were assessed. Embolization success was comparable between Onyx and PHIL. Shorter pause times resulted in a significantly higher embolization success for PHIL (median embolization score, 28 versus 18; P = .011). Compared with Onyx, lower volumes of PHIL were required for the same extent of embolization (median volume per section of the artificial nidus, 15.5 versus 3.6 μL; P < .001). While the embolization success was comparable for Onyx and PHIL, pause time had a considerable effect on the embolization success in an in vitro AVM model. Compared with Onyx, lower volumes of PHIL were required for the same extent of embolization. © 2017 by American Journal of Neuroradiology.

Gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery successfully treated with coil embolization: a case report and review of the literature.

PubMed

Namikawa, Masashi; Kakizaki, Satoru; Takakusaki, Satoshi; Saito, Shuichi; Yata, Yutaka; Mori, Masatomo

2011-12-01

Endoscopic hemostasis is a useful treatment modality for gastric ulcer bleeding. However, it is sometimes difficult to achieve hemostasis in cases with arterial bleeding, especially those complicated with vascular abnormalities. We describe a case with gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery. A 50-year-old female was admitted to our hospital with dizziness and tarry stools. Upper gastrointestinal endoscopy revealed bleeding from a gastric ulcer, and endoscopic hemostasis by endoscopic clipping was carried out. Computed tomography and abdominal angiography revealed the variant left gastric artery running below the gastric ulcer. In spite of endoscopic hemostasis and medication, re-bleeding from the gastric ulcer occurred. A transcatheter coil embolization for the variant left gastric artery was performed and successfully achieved hemostasis. This case was accompanied by congenital absence of the splenic artery, which is an extremely rare condition. We herein describe this rare case and review previously reported cases.

Molecular basis of coiled-coil oligomerization-state specificity.

PubMed

Ciani, Barbara; Bjelic, Saša; Honnappa, Srinivas; Jawhari, Hatim; Jaussi, Rolf; Payapilly, Aishwarya; Jowitt, Thomas; Steinmetz, Michel O; Kammerer, Richard A

2010-11-16

Coiled coils are extensively and successfully used nowadays to rationally design multistranded structures for applications, including basic research, biotechnology, nanotechnology, materials science, and medicine. The wide range of applications as well as the important functions these structures play in almost all biological processes highlight the need for a detailed understanding of the factors that control coiled-coil folding and oligomerization. Here, we address the important and unresolved question why the presence of particular oligomerization-state determinants within a coiled coil does frequently not correlate with its topology. We found an unexpected, general link between coiled-coil oligomerization-state specificity and trigger sequences, elements that are indispensable for coiled-coil formation. By using the archetype coiled-coil domain of the yeast transcriptional activator GCN4 as a model system, we show that well-established trimer-specific oligomerization-state determinants switch the peptide's topology from a dimer to a trimer only when inserted into the trigger sequence. We successfully confirmed our results in two other, unrelated coiled-coil dimers, ATF1 and cortexillin-1. We furthermore show that multiple topology determinants can coexist in the same trigger sequence, revealing a delicate balance of the resulting oligomerization state by position-dependent forces. Our experimental results should significantly improve the prediction of the oligomerization state of coiled coils. They therefore should have major implications for the rational design of coiled coils and consequently many applications using these popular oligomerization domains.

Recent Developments in Balloon Support Instrumentation at TIFR Balloon Facility, Hyderabad.

NASA Astrophysics Data System (ADS)

Vasudevan, Rajagopalan

2012-07-01

The Balloon Facility of Tata Institute of Fundamental Research has been conducting stratospheric balloon flights regularly for various experiments in Space Astronomy and Atmospheric Sciences. A continuous improvement in Balloon flight Support instrumentation by the Control Instrumentation Group to keep in space with the growing complexities of the scientific payloads have contributed to the total success of balloon flights conducted recently. Recent improvements in display of Balloon position during balloon flight by showing on real time the balloon GPS position against Google TM maps is of immense help in selecting the right spot for payload landing and safe recovery . For further speeding up the payload recovery process, a new GPS-GSM payload system has been developed which gives SMS of the payload position information to the recovery team on their cell phones. On parallel footing, a new GPS- VHF system has been developed using GPS and Radio Modems for Balloon Tracking and also for obtaining the payload impact point. On the Telecommand side, a single board Telecommand/ Timer weighing less than 2 Kg has been specially developed for use in the mesosphere balloon test flight. The interference on the existing Short Range Telemetry System has been eliminated by introducing a Band Pass Filter and LNA in the Receiving system of the modules, thereby enhancing its reliability. In this paper , we present the details of the above mentioned developments.

GHOST balloons around Antarctica

NASA Technical Reports Server (NTRS)

Stearns, Charles R.

1988-01-01

The GHOST balloon position as a function of time data shows that the atmospheric circulation around the Antarctic Continent at the 100 mb and 200 mb levels is complex. The GHOST balloons supposedly follow the horizontal trajectory of the air at the balloon level. The position of GHOST balloon 98Q for a three month period in 1968 is shown. The balloon moved to within 2 deg of the South Pole on 1 October 1968 and then by 9 December 1968 was 35 deg from the South Pole and close to its position on 1 September 1968. The balloon generally moved from west to east but on two occasions moved in the opposite direction for a few days. The latitude of GHOST balloons 98Q and 149Z which was at 200 mb is given. Both balloons tended to get closer to the South Pole in September and October. Other GHOST balloons at the same pressure and time period may not indicate similar behavior.

Rupture during coiling of intracranial aneurysms: Predictors and clinical outcome.

PubMed

Kocur, Damian; Przybyłko, Nikodem; Bażowski, Piotr; Baron, Jan

2018-02-01

The intraprocedural aneurysm rupture (IPR) is one of the most feared adverse effect associated with the coil embolization therapy. The aim of the study was to identify predisposing factors for IPR, as well as to define patient groups with worse clinical outcome following IPR. From February 2008 to March 2015, 273 consecutive patients were treated at our institution via endovascular coil embolization. Patient medical records were reviewed with emphasis on procedure description, potential risk factors and clinical outcomes related to IPR. The IPR occurred in 14 (5.13%) cases. Multivariate logistic regression models were used to determine independent predictors of IPR. Clinical outcome was analyzed using the Glasgow Outcome Scale (GOS). Multivariate analysis showed that aneurysm location at posterior communicating artery is an independent risk factor for IPR (p = 0.035; OR 3.5; 95%CI 1.09-11.26). The frequencies of favorable disability (GOS 4-5), severe disability (GOS 2-3), and mortality (GOS 1) between patients with IPR and without IPR were significantly different in the general study population (p < 0.001, p < 0.001 and p = 0.023, respectively) and in patients with previously unruptured aneurysms (p < 0.001, p = 0.006 and p = 0.003, respectively) but not in patients with previously ruptured aneurysms (p = 0.187, p = 0.089 and p = 1.0, respectively). Posterior communicating artery aneurysm location is an independent predictor for IPR. IPR is associated with a significant clinical deterioration in a subgroup of patients with previously unruptured aneurysms, but not in patients with ruptured aneurysms. Copyright © 2018 Elsevier B.V. All rights reserved.

The structure of the GemC1 coiled coil and its interaction with the Geminin family of coiled-coil proteins

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caillat, Christophe; Fish, Alexander; Pefani, Dafni-Eleftheria

The GemC1 coiled-coil structure has subtle differences compared with its homologues Geminin and Idas. Co-expression experiments in cells and biophysical stability analysis of the Geminin-family coiled coils suggest that the GemC1 coiled coil alone is unstable. GemC1, together with Idas and Geminin, an important regulator of DNA-replication licensing and differentiation decisions, constitute a superfamily sharing a homologous central coiled-coil domain. To better understand this family of proteins, the crystal structure of a GemC1 coiled-coil domain variant engineered for better solubility was determined to 2.2 Å resolution. GemC1 shows a less typical coiled coil compared with the Geminin homodimer and themore » Geminin–Idas heterodimer structures. It is also shown that both in vitro and in cells GemC1 interacts with Geminin through its coiled-coil domain, forming a heterodimer that is more stable that the GemC1 homodimer. Comparative analysis of the thermal stability of all of the possible superfamily complexes, using circular dichroism to follow the unfolding of the entire helix of the coiled coil, or intrinsic tryptophan fluorescence of a unique conserved N-terminal tryptophan, shows that the unfolding of the coiled coil is likely to take place from the C-terminus towards the N-terminus. It is also shown that homodimers show a single-state unfolding, while heterodimers show a two-state unfolding, suggesting that the dimer first falls apart and the helices then unfold according to the stability of each protein. The findings argue that Geminin-family members form homodimers and heterodimers between them, and this ability is likely to be important for modulating their function in cycling and differentiating cells.« less

[Paradoxical brain embolism mediated through a pulmonary arteriovenous malformation with hereditary hemorrhagic telangiectasia in a Japanese patient].

PubMed

Takeda, June; Todo, Kenichi; Yamamoto, Shiro; Yamagami, Hiroshi; Kawamoto, Michi; Kohara, Nobuo

2012-01-01

We report a case of paradoxical brain embolism mediated through a pulmonary arteriovenous malformation (PAVM) with hereditary hemorrhagic telangiectasia (HHT). A 25-year-old right handed man was admitted to our hospital after sudden headache and visual field abnormality. In neurologic examinations, he had left superior-quadrantanopsia. Laboratory findings showed iron deficiency anemia. Diffusion weighted images disclosed a high-signal-intensity area in the right occipito-temporal lobe, and intraarterial digital subtraction cerebral angiography revealed occlusion of the right posterior cerebral artery. Transesophageal echocardiography revealed continuous right-to-left shunt. We confirmed his history of spontaneous recurrent epistaxis and the first-degree relatives with epistaxis or PAVM. A contrast enhanced CT scan of the chest revealed a PAVM. The diagnosis of paradoxical brain embolism mediated through the PAVM with HHT was, thus, established. The PAVM was occluded by using embolization coils successfully. In Asian countries, the prevalence of PAVM with HHT is thought to be lower than in European countries. We should carefully take medical and family histories, especially epistaxis, in a young stroke patient.

Experimental measurement of coil-rod-coil block copolymer tracer diffusion through entangled coil homopolymers

PubMed Central

Wang, Muzhou; Timachova, Ksenia; Olsen, Bradley D.

2014-01-01

The diffusion of coil-rod-coil triblock copolymers in entangled coil homopolymers is experimentally measured and demonstrated to be significantly slower than rod or coil homopolymers of the same molecular weight. A model coil-rod-coil triblock was prepared by expressing rodlike alanine-rich α-helical polypeptides in E. coli and conjugating coillike poly(ethylene oxide) (PEO) to both ends to form coil-rod-coil triblock copolymers. Tracer diffusion through entangled PEO homopolymer melts was measured using forced Rayleigh scattering at various rod lengths, coil molecular weights, and coil homopolymer concentrations. For rod lengths, L, that are close to the entanglementh length, a, the ratio between triblock diffusivity and coil homopolymer diffusivity decreases monotonically and is only a function of L/a, in quantitative agreement with previous simulation results. For large rod lengths, diffusion follows an arm retraction scaling, which is also consistent with previous theoretical predictions. These experimental results support the key predictions of theory and simulation, suggesting that the mismatch in curvature between rod and coil entanglement tubes leads to the observed diffusional slowing. PMID:25484454

A periodic table of coiled-coil protein structures.

PubMed

Moutevelis, Efrosini; Woolfson, Derek N

2009-01-23

Coiled coils are protein structure domains with two or more alpha-helices packed together via interlacing of side chains known as knob-into-hole packing. We analysed and classified a large set of coiled-coil structures using a combination of automated and manual methods. This led to a systematic classification that we termed a "periodic table of coiled coils," which we have made available at http://coiledcoils.chm.bris.ac.uk/ccplus/search/periodic_table. In this table, coiled-coil assemblies are arranged in columns with increasing numbers of alpha-helices and in rows of increased complexity. The table provides a framework for understanding possibilities in and limits on coiled-coil structures and a basis for future prediction, engineering and design studies.

Recanalization after successful occlusion by transcatheter arterial embolization with N-butyl cyanoacrylate for traumatic splenic artery injury.

PubMed

Ishikawa, Masaki; Kakizawa, Hideaki; Yamasaki, Wataru; Date, Syuji; Hieda, Masashi; Kajiwara, Kenji; Awai, Kazuo

2011-12-01

A 70-year-old male with advanced pancreatic cancer went into shock after sustaining a traumatic abdominal injury. Computed tomography (CT) showed a hematoma with extravasation around the pancreas and hemorrhagic ascites. After direct catheterization failed due to angiospasm, the ruptured splenic artery was successfully occluded by transcatheter arterial embolization (TAE) using an N-butyl cyanoacrylate (NBCA)-lipiodol mixture and the patient recovered from shock without complications. A follow-up CT obtained 20 days later showed a recurrent splenic artery pseudoaneurysm without extravasation. A repeat angiogram demonstrated recanalization of the splenic artery and pseudoaneurysm via antegrade. We embolized the recanalized pseudoaneurysm using metallic coils for isolation. Our experience indicates that adequate concentration and volume of the NBCA-lipiodol mixture should be considered depending on the vascular spasm in a patient with hypovolemic shock.

Removal of large hydatid cysts with balloon-assisted modification of Dowling's method: technical report.

PubMed

Ulutas, Murat; Cinar, Kadir; Secer, Mehmet

2015-07-01

Delivery of hydatid cysts, especially large ones, without rupture is very important and there is still no 100% successful method. After the hydatid cyst was reached, starting near the surface working around the cyst toward the base, a Foley probe was advanced and, in the region of desired dissection, the balloon of the Foley probe was inflated, and adhesion bands were freed to allow dissection. We believe our balloon-aided dissection technique is a method that increases the chances of delivering hydatid cysts, with no calcification and secondary infection, without rupture.

Ballooning Comes of Age: Make Your Own Balloon.

ERIC Educational Resources Information Center

Eckford, Jim

1983-01-01

Provides instructions for building a working model of a hot-air balloon, offering suggestions for a successful flight. Indicates that children can be involved in the projects, for example, by filling in colors in the panels of a balloon drawing. (JN)

Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center.

PubMed

Soh, Jae Seung; Yang, Dong-Hoon; Lee, Sang Soo; Lee, Seohyun; Bae, Jungho; Byeon, Jeong-Sik; Myung, Seung-Jae; Yang, Suk-Kyun

2015-09-01

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

AIAA Educator Academy: The Space Weather Balloon Module

NASA Astrophysics Data System (ADS)

Longmier, B.; Henriquez, E.; Bering, E. A.; Slagle, E.

2013-12-01

Educator Academy is a K-12 STEM curriculum developed by the STEM K-12 Outreach Committee of the American Institute of Aeronautics and Astronautics (AIAA). Consisting of three independent curriculum modules, K-12 students participate in inquiry-based science and engineering challenges to improve critical thinking skills and enhance problem solving skills. The Space Weather Balloon Curriculum Module is designed for students in grades 9-12. Throughout this module, students learn and refine physics concepts as well as experimental research skills. Students participate in project-based learning that is experimental in nature. Students are engaged with the world around them as they collaborate to launch a high altitude balloon equipped with HD cameras.The program leaders launch high altitude weather balloons in collaboration with schools and students to teach physics concepts, experimental research skills, and to make space exploration accessible to students. A weather balloon lifts a specially designed payload package that is composed of HD cameras, GPS tracking devices, and other science equipment. The payload is constructed and attached to the balloon by the students with low-cost materials. The balloon and payload are launched with FAA clearance from a site chosen based on wind patterns and predicted landing locations. The balloon ascends over 2 hours to a maximum altitude of 100,000 feet where it bursts and allows the payload to slowly descend using a built-in parachute. The payload is located using the GPS device. In April 2012, the Space Weather Balloon team conducted a prototype field campaign near Fairbanks Alaska, sending several student-built experiments to an altitude of 30km, underneath several strong auroral displays. To better assist teachers in implementing one or more of these Curriculum Modules, teacher workshops are held to give teachers a hands-on look at how this curriculum is used in the classroom. And, to provide further support, teachers are each

Purposeful creation of a pneumothorax and chest tube placement to facilitate CT-guided coil localization of lung nodules before video-assisted thoracoscopic surgical wedge resection.

PubMed

Iqbal, Shams I; Molgaard, Christopher; Williamson, Christina; Flacke, Sebastian

2014-07-01

To evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)-guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection. From May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42-76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications. There were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5-35 mm), and average size was 13 mm (range, 7-30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions. Pneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Energy from solar balloons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grena, Roberto

2010-04-15

Solar balloons are hot air balloons in which the air is heated directly by the sun, by means of a black absorber. The lift force of a tethered solar balloon can be used to produce energy by activating a generator during the ascending motion of the balloon. The hot air is then discharged when the balloon reaches a predefined maximum height. A preliminary study is presented, along with an efficiency estimation and some considerations on possible realistic configurations. (author)

Buried polar residues in coiled-coil interfaces.

PubMed

Akey, D L; Malashkevich, V N; Kim, P S

2001-05-29

Coiled coils, estimated to constitute 3-5% of the encoded residues in most genomes, are characterized by a heptad repeat, (abcdefg)(n), where the buried a and d positions form the interface between multiple alpha-helices. Although generally hydrophobic, a substantial fraction ( approximately 20%) of these a- and d-position residues are polar or charged. We constructed variants of the well-characterized coiled coil GCN4-p1 with a single polar residue (Asn, Gln, Ser, or Thr) at either an a or a d position. The stability and oligomeric specificity of each variant were measured, and crystal structures of coiled-coil trimers with threonine or serine at either an a or a d position were determined. The structures show how single polar residues in the interface affect not only local packing, but also overall coiled-coil geometry as seen by changes in the Crick supercoil parameters and core cavity volumes.

Comparison of endorectal coil and nonendorectal coil T2W and diffusion-weighted MRI at 3 Tesla for localizing prostate cancer: correlation with whole-mount histopathology.

PubMed

Turkbey, Baris; Merino, Maria J; Gallardo, Elma Carvajal; Shah, Vijay; Aras, Omer; Bernardo, Marcelino; Mena, Esther; Daar, Dagane; Rastinehad, Ardeshir R; Linehan, W Marston; Wood, Bradford J; Pinto, Peter A; Choyke, Peter L

2014-06-01

To compare utility of T2-weighted (T2W) MRI and diffusion-weighted MRI (DWI-MRI) obtained with and without an endorectal coil at 3 Tesla (T) for localizing prostate cancer. This Institutional Review Board-approved study included 20 patients (median prostate-specific antigen, 8.4 ng/mL). Patients underwent consecutive prostate MRIs at 3T, first with a surface coil alone, then with combination of surface, endorectal coils (dual coil) followed by robotic assisted radical prostatectomy. Lesions were mapped at time of acquisition on dual-coil T2W, DWI-MRI. To avoid bias, 6 months later nonendorectal coil T2W, DWI-MRI were mapped. Both MRI evaluations were performed by two readers blinded to pathology with differences resolved by consensus. A lesion-based correlation with whole-mount histopathology was performed. At histopathology 51 cancer foci were present ranging in size from 2 to 60 mm. The sensitivity of the endorectal dual-coil, nonendorectal coil MRIs were 0.76, 0.45, respectively. PPVs for endorectal dual-coil, nonendorectal coil MRI were 0.80, 0.64, respectively. Mean size of detected lesions with nonendorectal coil MRI were larger than those detected by dual-coil MRI (22 mm versus 17.4 mm). Dual-coil prostate MRI detected more cancer foci than nonendorectal coil MRI. While nonendorectal coil MRI is an attractive alternative, physicians performing prostate MRI should be aware of its limitations. Copyright © 2013 Wiley Periodicals, Inc.

GBNV encoded movement protein (NSm) remodels ER network via C-terminal coiled coil domain

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singh, Pratibha; Savithri, H.S., E-mail: bchss@biochem.iisc.ernet.in

interacts with NP via its N-terminal unfolded region and the NSm–NP complex could in turn interact with the ER membrane via the C-terminal coiled coil domain of NSm to form vesicles that are targeted to PD and there by assist the cell to cell movement of the viral genome complex. - Highlights: • GBNV NSm localizes to plasmodesmata via the C-terminal coiled coil domain. • GBNV NSm interacts with endoplasmic reticulum network and remodels it to vesicles. • The C-terminal coiled domain alone is responsible for vesicle formation. • The N-terminal unfolded region of NSm is involved in the re-localization of NP to PD.« less

Transcatheter Embolization of Type I Endoleaks Associated With Endovascular Abdominal Aortic Aneurysm Repair Using Ethylene Vinyl Alcohol Copolymer.

PubMed

Graif, Assaf; Vance, Ansar Z; Garcia, Mark J; Lie, Kevin T; McGarry, Michael K; Leung, Daniel A

2017-01-01

To evaluate the feasibility, safety, and outcome of transcatheter embolization using ethylene vinyl alcohol copolymer (EVOH) of type I endoleaks associated with endovascular abdominal aortic aneurysm repair. Retrospective chart review was performed to identify 8 consecutive patients who had undergone EVOH embolization for type I endoleaks between 2012 and 2015. The primary approach used to access the endoleak was the perigraft technique, where the endoleak itself is catheterized at the anastomotic site. Six type Ia and 2 type Ib endoleaks were treated. In 2 patients, a direct transabdominal approach was used to access the endoleak because it was inaccessible via the perigraft approach. Coils were used in addition to EVOH in 5 cases. Residual endoleak was noted in 1 case, whereas 2 patients developed a recurrent type I endoleak during follow-up. No EVOH complications were observed. The 5 remaining patients demonstrated freedom from endoleak and reintervention at a mean follow-up of 6.9 months. Type I endoleaks can be safely and effectively treated by embolotherapy with EVOH. Larger endoleaks resulting from grossly undersized endografts appear to be unsuitable for EVOH embolization.

Radical resection of a Shamblin type III carotid body tumour without cerebro-neurological deficit: Improved technique with preoperative embolization and carotid stenting.

PubMed

Ong, H S; Fan, X D; Ji, T

2014-12-01

The surgical resection of a large unfavourable Shamblin type III carotid body tumour (CBT) can be very challenging technically, with many potential significant complications. Preoperative embolization aids in shrinking the lesion, reducing intraoperative blood loss, and improving visualization of the surgical field. Preoperative internal carotid artery (ICA) stenting aids in reinforcing the arterial wall, thereby providing a better dissection plane. A woman presented to our institution with a large right-sided CBT. Failure of the preoperative temporary balloon occlusion (TBO) test emphasized the importance of intraoperative preservation of the ipsilateral ICA. A combination of both preoperative embolization and carotid stenting allowed a less hazardous radical resection of the CBT. An almost bloodless surgical field permitted meticulous dissection, hence reducing the risk of intraoperative vascular and nerve injury. Embolization and carotid stenting prior to surgical resection should be considered in cases with bilateral CBT or a skull base orientated high CBT, and for those with intracranial extension and patients who have failed the TBO test. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Single balloon versus double balloon bipedicular kyphoplasty: a systematic review and meta-analysis.

PubMed

Jing, Zehao; Dong, Jianli; Li, Zhengwei; Nan, Feng

2018-06-19

Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy. In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model. Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs. This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive. These slides can be retrieved under Electronic Supplementary Material.

Transcatheter treatment of life-threatening lower gastrointestinal bleeding due to advanced pelvic malignancy.

PubMed

Spinosa, D J; Angle, J F; McGraw, J K; Maurer, E J; Hagspiel, K D; Matsumoto, A H

1998-01-01

We present two patients with life-threatening, massive, lower gastrointestinal (GI) bleeding and locally advanced cervical carcinoma. Selective pelvic arteriography demonstrated that the site of bleeding originated from a pseudoaneurysm of the right internal iliac artery with fistulous communication to the sigmoid colon in one patient and from the left internal iliac artery into the rectum in the second patient. Transcatheter embolotherapy was then performed using balloon occlusion in one patient and coil embolization in the second patient. The iliac arteries should also be evaluated in patients with pelvic cancer who present with lower GI bleeding.

Dynamic allostery of protein alpha helical coiled-coils

PubMed Central

Hawkins, Rhoda J; McLeish, Tom C.B

2005-01-01

Alpha helical coiled-coils appear in many important allosteric proteins such as the dynein molecular motor and bacteria chemotaxis transmembrane receptors. As a mechanism for transmitting the information of ligand binding to a distant site across an allosteric protein, an alternative to conformational change in the mean static structure is an induced change in the pattern of the internal dynamics of the protein. We explore how ligand binding may change the intramolecular vibrational free energy of a coiled-coil, using parameterized coarse-grained models, treating the case of dynein in detail. The models predict that coupling of slide, bend and twist modes of the coiled-coil transmits an allosteric free energy of ∼2kBT, consistent with experimental results. A further prediction is a quantitative increase in the effective stiffness of the coiled-coil without any change in inherent flexibility of the individual helices. The model provides a possible and experimentally testable mechanism for transmission of information through the alpha helical coiled-coil of dynein. PMID:16849225

Predicting helix orientation for coiled-coil dimers

PubMed Central

Apgar, James R.; Gutwin, Karl N.; Keating, Amy E.

2008-01-01