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Predictors of recanalization after endovascular treatment of posterior circulation aneurysms

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Wiśniewski K., Tomasik B., Bobeff E. J., Stefańczyk L., Jaskólski D. J.
Polish Journal of Surgery
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2017
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vol. 89(6)
7-11
EN
Introduction. Posterior circulation aneurysms account for approximately 30% of all intracranial aneurysms, and their rupture often causes aneurysmal subarachnoid hemorrhage (aSAH). Because surgical treatment of posterior circulation aneurysms is difficult, endovascular treatment is commonly indicated. However, simple coil embolization is associated with a high rate of recanalization. Our goal was to investigate morphometric aneurysmal features assessed on pre-embolization computed tomography angiography (CTA) as predictors of recanalization in patients with posterior circulation aneurysms. Material and Methods. We retrospectively analyzed data of 24 patients who underwent coil embolization due to rupture of saccular posterior circulation aneurysms. The morphometric features of aneurysms were measured based on pre-embolization 3D-CTA-aneurysm models, and aneurysmal size and volume were measured on digital subtraction angiography (DSA) images. The effectiveness of initial endovascular treatment was determined visually with the modified Raymond Roy classification directly after embolization and on follow-up DSAs. Recanalization was diagnosed when, compared to the primary embolization aneurysm appearance, compaction and filling of the aneurysm occurred. Statistical analysis was performed with Statistica 13.1 software. Results. Higher maximal aneurysm height perpendicular to the aneurysmal neck was associated with a greater aneurysm recanalization risk (12.12±5.13mm vs. 7.41±3.97mm, p=0.039), and this relationship remained significant after adjustment for patient’s age, sex and aneurysm localization (OR=1.26, 95%CI: 1.01-1.60, p=0.047). Maximal aneurysm height perpendicular to the aneurysmal neck distinguished well between recanalized and non-recanalized aneurysms (AUC=0.755, 95%CI: 0.521- 0.989, p=0.033). Conclusions. Predictors of aneurysm recanalization can help choose best endovascular treatment strategies, which could reduce complication rates.
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STROKE FOLLOWING PERIPHERAL ARTERIO VENIUS MALFORMATION ALCOHOL EMBOLIZATION – SHOULD WE LOOK FOR PERSISTED FORAMEN OVALE IN ADVANCE?

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Błaż M., Ostrowska M., Zasada J., Maciąg R., Komar M., Michalski M., Trystuła M.
Acta Neuropsychologica
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2022
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vol. 20(1)
81-85
EN
Stroke due to paradoxical embolism can be a complication of certain peripheral venous procedures in patients with coexisting patent foramen ovale. There is an established link between venous sclerotherapy and stroke, however there are no known reports of this complication following peripheral arteriovenous embolization.We present a case of a 36-year- old woman who experienced symptoms of disorientation and apraxia following a hypoxic event during percutaneous alcohol embolization of a large arteriovenous malformation in her right gluteal region. An MRI scan revealed multiple foci of restricted diffusion in both cerebral hemispheres corresponding to acute ischemic stroke lesions. As the subsequent work-up revealed patent foramen ovale, we speculate on the pathomechanism of stroke and conclude with a recommendation to screen for patent foramen ovale in patients undergoing peripheral venous procedures including arteriovenous malformation embolization.
3
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Efficacy Evaluation Of Bio Trombina ® 400 In Mini Mall Y Invasive Treatment of Complications (Pseudoaneurysms), After Venipuncture for Diagnostic Purposes. Authors’ Own Experience – Case Study of 38 Patients

100%
Iłżecki M., Zubilewicz T., Przywara S., Wojtak A., Kęsik J. J., Olejniczak-Nowakowska M., Terlecki P.
Polish Journal of Surgery
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2015
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vol. 86
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issue 8
359-363
EN
Common use of venipuncture on upper and lower limbs for diagnostic purposes (such as coronarography or arteriography), and also during the course of treatment (angioplasty), very often bares a complication in the form of pseudoaneurysms. According to various reports, the incidence of pseudoaneurysms ranges from 0.005% to 0.5% of all vascular procedures requiring arterial cannulation (Common Femoral Artery, Brachial Artery, Radial Artery). The use of Bio Trombina® 400 in the embolization of pseudoaneurysms allows minimally invasive and effective treatment. The aim of the study was to evaluate the efficacy of pseudoaneurysm embolization with the use of Trombina 400, authors’ own experience. Material and methods. In the years 2011 - 2013, the authors of this study performed 38 vascular interventional procedures involving pseudoaneurysms as complications of venipuncture in upper and lower limbs for diagnostic and treatment purposes. All procedures involved the direct injection of thrombin into the chamber of the pseudoaneurysm under the guidance of USG Doppler (6.2 MHz linear head). 34 cases presented single chamber pseudoaneurysms while 4 cases involved multi- chamber pseudoaneurysms, which required several thrombin reinjections (Bio Trombina® 400) into each of the chambers. Pseudoaneurysm maximum size of 4 cm was set as an inclusion criterion for the embolization procedure. Furthermore, all pseudoaneurysms with a significantly wide tract in transverse dimensions were treated as an exclusion criterion because of high risk of the peripheral arteries embolization. Results. Initial success was observed in 36 patients (94.73%) in the first day after the procedure, 1 patient (2.63%) underwent thrombin reinjection procedure in the second day after the first embolization. Another patient (2.63%) underwent an open procedure in which the Common Femoral Artery was accessed, the clot evacuated, and CFA was sutured with continuous suture Prolene 6-0. Conclusions. 1. Embolization of pseudoaneurysms with USG Doppler-guided thrombin injection is an effective course of treatment for complications of cannulation. 2. The safety of pseudoaneurysm embolization depends on a surgeon’s experience. It is also crucial to keep in mind the inclusion and exclusion criteria for this type of procedure (the size of a pseudoaneurysm, the width of its base). 3. Furthermore, its cost effectiveness and short hospitalization period make pseudoaneurysm embolization an effective and valuable alternative to the classic approach.
4
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Dental use of cone beam computed tomography in pediatric embolized arteriovenous maxillofacial malformation

88%
Olszewski R., Theys S.
Nemesis. Negative Effects in Medical Sciences Oral and Maxillofacial Surgery
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2021
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vol. 20
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issue 1
1-20
EN
Objective: Pediatric facial arteriovenous malformations (AVMs) are rare but can cause potentially fatal hemorrhages during dental procedures and oral surgery. In this article we present a systematic review of the medical open access literature on pediatric facial AVM. Case report: We illustrate our purpose with clinical dental use of cone beam computed tomography (CBCT) in pediatric embolized facial AVM to define the presence and the position of the right upper impacted canine. Conclusions: We advocate the use of CBCT as additional imaging tool in the follow-up of pediatric dentomaxillofacial AVM, and for depiction of dentoalveolar structures that are inaccessible by conventional dental radiography.
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