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[Interventional neuroradiology: current options].

Modern interventional neuroradiology has a leading role in the treatment of ischemic and hemorrhagic stroke, and it provides more and more important treatment options for degenerative diseases of the vertebral column and the management of correlated pain. During the last decades interventional neuroradiology has played a primary role in the treatment of intracranial berry aneurysms due to the continuous technical improvements. Ongoing studies proved superiority of mechanical stent-thrombectomy in acute proximal occlusion of cerebral arteries. Less invasive neurointerventional methods, such as

[Last updates about amniotic fluid embolism and a case report].

Amniotic fluid embolism (AFE) is a rare complication of pregnancy, which, in France, is the second leading cause of maternal mortality. It results from the passage of amniotic fluid into the maternal circulation, but mechanisms leading to clinical signs are not yet clearly identified. After a literature review, we report on the case of a 34 years old patient occurred during labor. Laboratory tests were performed during acute phase to diagnose coagulopathy and to monitor vital parameters. Further laboratory tests were conducted to support the diagnosis: cytology, study of insulin-like growth fa

Comparison of techniques for stent assisted coil embolization of aneurysms.

INTRODUCTION: Stent assisted coiling (SAC) of aneurysms has been adopted with potential mechanical, hemodynamic and biologic properties imparting an advantage over coil embolization alone. The purpose of this investigation is to compare the various techniques of SAC at a single institution with regards to clinical, technical and angiographic complications and success. METHODS: Patients who underwent SAC between 2003 and 2010 were identified. Clinical charts, procedures, angiographic and non-invasive radiological images were analyzed to determine the anatomical and procedural details and adver

Cerebral protection devices reduce periprocedural strokes during carotid angioplasty and stenting: a systematic review of the current literature.

PURPOSE: To compare through a systematic review of published literature the stroke outcomes in protected and unprotected carotid artery stenting (CAS). METHODS: PubMed and Cochrane electronic databases were queried to identify peer-reviewed publications from 1995 to 2007 meeting our pre-defined criteria for inclusion (English language, human only, at least 20 patients reported) and exclusion (procedures performed for the treatment of total occlusion, dissection, or aneurysmal disease; urgently performed procedures; use of covered stents; access other than transfemoral). Information was collec

[Animal models of cerebral ischemia--testing therapeutic strategies in vivo].

Acute cerebral ischemia is one of the leading causes of mortality and chronic disability worldwide. Animal models of focal (stroke-type) and global (cardiac arrest-type) ischemia have been established to investigate the morphological, functional and molecular consequences and to design therapeutic strategies for the improvement of ischemic injury. Despite highly beneficial effects in experimental studies, most human clinical trials were disappointing, suggesting inefficacies in the design and/or translation of animal experiments. In this review the pathophysiologically relevant specifics of is

Paradoxical emboli in children and young adults: role of atrial septal defect and patent foramen ovale device closure.

OBJECTIVE: To describe a multicenter experience with patent foramen ovale (PFO) and atrial septal defect (ASD) device closure for presumed paradoxical emboli in children and young adults (<35 years old). PATIENTS AND METHODS: Medical records were reviewed of patients who had device closure of an ASD or PFO, who were younger than 35 years, and who had a history of presumed paradoxical embolus between January 1999 and August 2005 at Mayo Clinic, Rochester, Minn, University of Parma, Parma, Italy, and Loyola University Medical Center, Maywood, Ill. RESULTS: Forty-five patients fulfilled the inc

Systemic Embolic Events in Atrial Fibrillation: An Individual Patient Data Meta-analysis of 71 683 Participants Randomized to NOAC Versus Warfarin.

BACKGROUND: Systemic embolic events (SEEs) are a serious but underrecognized complication of atrial fibrillation. Although non-vitamin K antagonist oral anticoagulants prevent ischemic stroke (IS), their efficacy in SEE and the clinical characteristics of patients who experience SEE remain poorly understood. METHODS: We analyzed individual patient data from 4 pivotal randomized trials enrolling patients between 2005 and 2010 comparing non-vitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation. We characterized the incidence, clinical features, management, and outcomes

[Treatment of carotid stenosis: carotid surgery or stent? In favor of operation].

BACKGROUND: According to international studies (ACAS, NASCET, ECST, ACST) the discussion concerning the indication for an operative treatment of carotid artery stenosis which lasted over years, may be regarded as completed. The impressive results showed that the operative treatment is of less risk for the patient than the natural history. But is this conclusion also true for carotid artery stenting? Comparative studies are running, but are not completed yet. The treatment of carotid stenosis by operative or interventional means is controversial, since conflicting conclusions have been drawn fr

Technical advances in total aortic arch replacement.

BACKGROUND: We compared the effects of using hypothermic circulatory arrest (HCA) alone, HCA combined with selective cerebral perfusion (SCP), and use of SCP with a trifurcated graft (T) on outcome after aortic arch repair. METHODS: One hundred fifty patients, median age 66 years (range, 27 to 85), underwent total arch replacement between 1988 and 2002; 75 were female. We retrospectively compared the results of three patient groups roughly comparable with regard to preoperative risk factors: 45 patients using HCA beginning in 1988; 67 patients using HCA/SCP beginning in 1994; and 38 patients

Arterial shear rate determines the structure and mechanical properties of whole-blood clots.

BACKGROUND: Arterial thrombosis arises under high shear conditions and is a leading cause of ischemic stroke and myocardial infarction. The local hemodynamic environment during the formation of the thrombus influences its final composition, which in turn influences its mechanical characteristics and the associated risk of embolization. However, how arterial shear rates determine the local mechanical properties, structure, and composition of clots remains poorly understood. OBJECTIVES: This study investigated how physiological and pathologic arterial shear rates shape blood clot composition, f

Coronary Embolism in Atrial Fibrillation: A Distinct High-Risk Phenotype With Residual Thromboembolic Risk Despite Anticoagulation.

BACKGROUND: Coronary embolism (CE) is an underrecognized cause of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). Dedicated management guidelines are lacking because of limited evidence. METHODS: This retrospective cohort study leveraged routinely collected electronic health records and regional death registry data from a tertiary hospital in China (2014-2023). Among 4777 patients with AMI, CE was diagnosed using a 3-stage validation process: modified Shibata criteria, blinded angiographic core laboratory assessment, and final adjudication. Patients were categoriz

Cerebral Metastasis From Recurrent Atrial Myxoma: A Case Report.

BACKGROUND Atrial myxomas are benign cardiac tumors that can embolize and cause arterio-occlusive complications associated with substantial morbidity and mortality. Recurrence after surgical resection is uncommon, and distant metastasis is exceedingly rare. We describe a young patient who concomitantly experienced 2 rare and serious manifestations of atrial myxoma: tumor recurrence after many years and cerebral metastasis. CASE REPORT A 33-year-old man with a history of left atrial myxoma resection at age 19 presented with sudden onset of right facial paresthesia and right arm weakness. Brain

Endovascular Treatment for False Lumen Expansion Due to a Gutter Leak After Total Arch Replacement Using the Fenestrated Frozen Elephant Trunk Technique: A Case Report.

Acute aortic dissection is a life-threatening condition that requires urgent surgical intervention. The frozen elephant trunk (FET) technique, including the use of the J Graft Frozenix®, is an effective strategy for managing complex aortic pathologies. Approaches for left subclavian artery LSA reconstruction are a critical component of complex aortic arch procedures, such as total arch replacement or thoracic endovascular aortic repair (TEVAR), designed to prevent stroke, spinal cord ischemia, and left arm claudication. Approaches generally fall into the following three categories: in situ rec

Thrombosis in Neuromuscular Medicine: Current Evidence, Unmet Needs, and Future Directions.

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is an important but under-recognised complication in neuromuscular diseases. In adults, emerging epidemiological data suggests increased VTE occurrence in conditions such as Amyotrophic Lateral Sclerosis, myotonic dystrophy, myasthenia gravis, inflammatory neuropathies, inflammatory myopathies, and POEMS syndrome. This heightened risk reflects not only disease-related immobility but also disorder-specific biological mechanisms, including inflammation, endothelial dysfunction and cardiomyopathy-related stasis.

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… The risk of embolic stroke appears to be correlated primarily with dilated cardiomyopathy and low ejection fraction, and less dependent on the presence of atrial fibrillation or a detected intracardiac thrombus [ 58 ]. … This predisposes to embolic strokes, which can be the initial manifestation in some patients [ 123 ]. …

Intravascular Ultrasound Findings in Acute and Chronic Deep Vein Thrombosis of the Lower Extremities.

Deep vein thrombosis (DVT) of the lower extremities, as part of venous thromboembolism disorder, is the third leading cause of acute cardiovascular syndrome after heart attack and stroke. It can result in disability due to pulmonary embolism (PE) and post-thrombotic syndrome (PTS), particularly in cases where the thrombosis extends to the iliofemoral veins. Anticoagulation therapy is effective in preventing thrombus propagation and embolism but may not be sufficient for thrombus degradation and venous patency restoration. Up to 50% of patients with iliofemoral DVT develop PTS, mainly due to ve

Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms.

BACKGROUND: Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. OBJECTIVE: To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. METHODS: This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to man

Increased cardiovascular disease risk among adolescents and young adults with gastric cancer.

BACKGROUND: Previous studies have investigated cardiovascular disease (CVD) risks in cancer patients, but there is limited knowledge concerning the CVD risk in adult and young adolescent (AYA) survivors of gastric cancer. OBJECTIVES: This study aims to investigate the incidence of CVD in AYA gastric cancer survivors, analyzing it by treatment type and identifying associated risk factors. METHODS: We conducted a retrospective cohort study using Korean National Health Insurance Service data collected from 2006 to 2019. Propensity score matching (1:3, caliper < 0.1) was performed using the vari

Catastrophic complications following microvascular free tissue transfer: A 10-year review of NSQIP data.

INTRODUCTION: There is an absence of literature regarding the risks of catastrophic medical outcomes (CMOs) such as stroke, cardiac arrest, and pulmonary embolism in microvascular free tissue transfer. This study aims to determine the CMO and mortality rates, as well as risk factors, associated with microvascular reconstruction of the head and neck, extremity, and breast. METHODS: This study uses data from the American College of Surgeons National Surgical Quality Improvement Program. Cases of microvascular free tissue transfer from 2012 to 2021 were analyzed to assess the 30-day rates of CMO