Browsing by Subject "Embolization"

Now showing 1 - 6 of 6
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    Characterization of outcomes and practices utilized in the management of internal carotid artery injury not requiring definitive endovascular management
    (Wiley, 2021-07-17) London, Nyall R., Jr.; AlQahtani, Abdulaziz; Barbosa, Siani; Castelnuovo, Paolo; Locatelli, Davide; Stamm, Aldo; Cohen-Gadol, Aaron A.; Elbosraty, Hussam; Casiano, Roy; Morcos, Jacques; Pasquini, Ernesto; Frank, Georgio; Mazzatenta, Diego; Barkhoudarian, Garni; Griffiths, Chester; Kelly, Daniel; Georgalas, Christos; Janakiram, Trichy N.; Nicolai, Piero; Prevedello, Daniel M.; Carrau, Ricardo L.; Neurological Surgery, School of Medicine
    Background: After internal carotid artery (ICA) injury during endoscopic skull base surgery, the majority of patients undergo ICA embolization or stenting to treat active extravasation or pseudoaneurysm development. However, management practices when embolization or stenting is not required have not been well described. The objective of this study was to determine how patients with ICA injury but no embolization, stenting, or ligation do long-term and ascertain the reconstruction methods utilized. Methods: Twenty-nine cases of ICA injury were identified in an international multi-institutional retrospective review. Of these, we identified six cases that were not treated with embolization, stenting, or ICA sacrifice. Information was available for five cases. Results: A muscle patch was used in the immediate repair of each case. A nasoseptal flap was used in one case. Prefabricated nasal tampons were used in all cases. Nasal packing was initially left in for a median of 7 days prior to removal. The initial muscle patch was reinforced with a second muscle graft in one case. One case demonstrated ICA bleeding at the time of packing removal and was repacked an additional week. Follow-up for each of these cases was at least 2 years. No cases of subsequent carotid rupture were found and none of these cases ultimately underwent endovascular stenting. Radiation or proton therapy has not been subsequently used in any of these patients. Conclusions: This study details the reconstruction, lessons learned, and long-term follow-up for five cases of ICA injury not treated with embolization, stenting, or ligation.
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    Management of Incidental Peripheral Pulmonary Arterial Aneurysm by Interventional Radiology
    (Cureus, 2021-08-20) Nasra, Karim; Kiros, Neud; Diebes, Anthony; Raole, Deep; Osher, Matthew; Radiology and Imaging Sciences, School of Medicine
    A peripheral pulmonary arterial aneurysm (PAA) is an abnormal dilatation of the distal pulmonary artery consisting of all three vessel wall layers (the intima, media, and adventitia). It is a rare, potentially life-threatening entity. There is no defined standard for an abnormal amount of dilation of the distal pulmonary vasculature, however, the most common criteria used is a diameter greater than 1.5 times the upper limit of a normal or proximal portion. Despite the rarity of peripheral PAAs, the ability to recognize and diagnose them is important for both radiologists and clinicians. Early recognition is needed because of the high mortality associated with rupture. Consistent guidelines still need to be developed to help clinicians determine when intervention is appropriate. In the interim, endovascular coil embolization has become a mainstay of treatment due to its minimally invasive nature and lower risk of complications when compared to open surgical approaches.
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    Outcomes of Patent Foramen Ovale Transcatheter Closure: Should a Short Aortic Rim Preclude Closure?
    (Elsevier, 2023-03-22) Stefanescu Schmidt, Ada C.; Abrahamyan, Lusine; Muthuppalaniappan, Annamalar; Gorocica Romero, Ricardo; Ephrem, Georges; Everett, Karl; Lee, Douglas S.; Osten, Mark; Benson, Leland N.; Horlick, Eric M.; Medicine, School of Medicine
    Background: The risk of erosion of an atrial septal closure device, in particular the Amplatzer Septal Occluder, has been described as higher in patients with a short aortic rim. Similar concern has been applied to patent foramen ovale (PFO) closure devices, but there are only rare reported cases of erosion. It may be that smaller devices are chosen due to fear of device erosion in PFO patients when this is not necessarily an issue. Objectives: The authors aimed to assess outcomes after PFO closure with the Amplatzer PFO device in patients with a short (<9 mm) aortic rim. Methods: We performed a retrospective analysis of PFO closure for any indication, between 2006 and 2017 at a quaternary center. Preprocedural transesophageal echocardiographic parameters including the aortic rim were remeasured. Long-term outcomes were obtained by linkage to provincial administrative databases. Results: Over the study period, 324 patients underwent PFO closure with the Amplatzer PFO device, with a mean age of 49.8 years; 61% had a short aortic rim (<9 mm). The most common indication was cryptogenic stroke (72%); those with longer aortic distance were more likely to have a non-stroke indication for closure, diabetes (15% vs 6.5%, P = 0.04), and heart failure (15.7% vs 4%, P < 0.001). Over a median 7 years of follow-up, there were no cases of device erosion or embolization requiring cardiac surgery. Conclusions: In a large cohort with long-term administrative follow-up (1,394 patient-years), implantation of an Amplatzer PFO device was performed safely even in patients with a short aortic rim.
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    Spontaneous Splenic Rupture in Atypical Pneumonia From Mycoplasma Infection
    (Cureus, 2021-07-30) Nasra, Karim; Raole, Deep; Kiros, Neud M.; Loomis, Alexander; Rinker, Eric; Radiology and Imaging Sciences, School of Medicine
    Splenic rupture is a potentially life-threatening condition, often associated with chest or abdominal trauma. Atraumatic splenic rupture (ASR) is quite rare. When reported, it is usually attributed to underlying pathological conditions such as malignant neoplastic disorders, viral infections, or inflammatory processes. Here, we report a case of ASR in a patient that was attributed to Mycoplasma pneumoniae infection. This was supported by the diagnosis of atypical pneumonia secondary to M. pneumoniae, presence of multiple pseudoaneurysms in the spleen, and presence of cold agglutinins indicating an inflammatory state likely due to systemic vasculitis. Additionally, the lack of recent trauma further corroborated the mycoplasma infection as the driving force behind the splenic rupture.
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    The Use of a Pipeline Embolization Device for Treatment of a Ruptured Dissecting Middle Cerebral Artery M3/M4 Aneurysm: Challenges and Technical Considerations
    (Korean Society of Interventional Neuroradiology, 2022) Berwanger, Robert P.; Hoover, Madeline C.; Scott, John A.; DeNardo, Andrew J.; Amuluru, Krishna; Payner, Troy D.; Kulwin, Charles G.; Sahlein, Daniel H.; Neurological Surgery, School of Medicine
    Prompt, effective treatment is necessary following aneurysmal subarachnoid hemorrhage to prevent recurrent rupture, which is thought to double mortality. Atypical ruptured aneurysms, such as blister or dissecting pseudoaneurysms, or those that are unusually distal in the middle cerebral artery (MCA) are challenging to treat with either open or endovascular options, though the pipeline embolization device (PED) has shown promise in multiple case series. We present a case of a ruptured dissecting pseudoaneurysm in the distal MCA (distal M3/proximal M4) prefrontal division in an healthy young patient (<60 years) successfully treated with a PED. The PED was chosen both as the only vessel sparing option in the young patient as well as for its potential as a vessel sacrifice tool if the pseudoaneurysm was felt to be incompletely treated, which in this case was not necessary-though would have leveraged the thrombogenicity of the device as a therapeutic advantage.
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    To embolize or not to embolize: that is the question for arteriovenous malformations
    (American Association of Neurological Surgeons, 2021-01-01) Baskaya, Mustafa K.; Richardson, Angela M.; Neurological Surgery, School of Medicine