bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Preemptive Transplant Education to Increase Living Donation Rates: Reaching Patients Earlier in Their Disease Adjustment Process
Authors: Hays Rebecca , Waterman Amy D.
Published: January 2017

Patients who receive a preemptive kidney transplant before starting dialysis avoid the medical complications related to dialysis and have the highest graft success and lowest mortality rates. Because only 2.5% of incident patients receive kidney transplants preemptively, improved psychosocial education may assist more patients in accessing preemptive transplant. This article outlines (1) unique psychosocial issues affecting patients with chronic kidney disease stage 4 (glomerular filtration rates >20 mL/min per 1.73 m2) and (2) how an educational program about preemptive living donor transplant should be designed and administered to increase access to this treatment option. Early referral patients may be overwhelmed in coping with and learning about their disease and, therefore, not ready to make a treatment decision, or they may be highly motivated to obtain a transplant to avoid dialysis and return to a normal life. An education program that defines the quality-of-life and health benefits possible with early transplant is outlined. The program is focused on minimizing the disruption of starting 2 treatment techniques and maximizing early transplant health, graft survival, employability, and retention of insurance coverage. Once the benefits of preemptive living donor transplant are outlined, educators can focus on demystifying the living donor evaluation process and assisting interested patients in planning how to find a living donor. To reach all patients, especially racial minorities, education about preemptive transplant should be available in primary-care physicians' and community nephrologists' offices, at dialysis centers, and through other kidney organizations.
Adapting Teaching Styles to Accommodate Learning Preferences for Effective Hospital Development
Authors: Eshleman Kelly Y.
Published: January 2017

Hospital development professionals in organ procurement organizations engage in many roles in the hospital. The important role of educator requires making the most of each teaching opportunity by understanding the characteristics of the learning audience and applying proven principles of adult educational design, with a focus on collaborative learning and variety in presentation techniques. The goal is to provide effective education, enabling hospital staff to transfer this learning to the job setting, with the outcome of facilitating a supportive process that saves lives through organ donation.
Medication Adherence in Successful Kidney Transplant Recipients
Authors: Ruppar Todd M. , Russell Cynthia L.
Published: January 2017

Objective

To explore the medication-taking behavior of successful kidney transplant recipients and determine what behaviors were common among this group.

Methods

Open-ended interviews were conducted by telephone with 19 individuals who had successfully maintained a transplanted kidney for 25 years or more. Data were coded by using a grounded theory approach to explore patterns of phenomena, common descriptions, and relationships.

Results

Four themes emerged as participants described the behaviors they developed to adhere successfully to the immunosuppressive medication required for maintaining their transplanted kidneys. The themes were reminder methods, obtaining medications, maintaining routines, and problem-solving strategies. Kidney transplant recipients identified the importance of developing and maintaining medication-taking skills and routines on medication adherence. Problem-solving abilities were also valuable during times of disruption of normal routines.

Conclusions

Interventions focusing on medication-taking skills, habit formation, and resources for problem solving may improve immunosuppressive medication adherence and clinical outcomes in kidney transplant recipients.
Relationship of Exposure to Organ Donation Information to Attitudes, Beliefs, and Donation Decisions of Next of Kin
Authors: Rodrigue James R. , Cornell Danielle L. , Howard Richard J.
Published: January 2017

Context

Public education campaigns about organ donation are common, but their association to actual attitudes, beliefs, and decisions about organ donation among family members of donation-eligible individuals is unknown.

Objective

To examine the sources of organ donation information identified by donor and nondonor families who participated in a large-scale study to examine factors that influence organ donation decisions.

Design

Semistructured telephone survey conducted after a passive recruitment strategy.

Setting and Participants

Participants were 285 next of kin of donor-eligible individuals (147 donors, 138 nondonors) from one organ procurement organization.

Results

Most (85.6%) of next of kin were exposed to at least 1 source of donation information that was important to them, although the types of donation information they were exposed to varied widely. White and educated adults were more likely to have been exposed to more donation information than had minorities and persons with less education. Favorable attitudes and beliefs about organ donation, donor designation, and sharing donation intentions with others were all associated with more exposure to different types of donation information. Donation consent was more likely when next of kin had been exposed to more donation information in the months preceding the family member's death.

Conclusions

When examined in the context of other recent research, these findings argue for continued development and implementation of public education campaigns for organ donation, with an emphasis on repeated exposure over time.
Role Development of Nurse Practitioners and Physician Assistants in Liver Transplantation
Authors: Chaney Amanda J. , Harnois Denise M. , Musto Kaitlyn R. , Nguyen Justin H.
Published: January 2017

Background:

Nurse practitioners (NPs) and physician assistants (PAs) are increasingly utilized in health care. However, their roles in liver transplantation (LT) have not been investigated.

Materials and Methods:

In this study, we reviewed the employment and development of NPs and PAs and their impact on our deceased-donor LT (DDLT) program.

Results:

We found a safe and efficient way to utilize NPs and PAs in a DDLT program. Since the beginning of our program, Model of End-Stage Liver Disease (MELD) scores have increased significantly, suggesting patients are sicker at the time of transplant, and wait times of patients have become longer. With the incorporation of NPs and PAs, we found that length of stay (LOS) was not affected. The overall median warm ischemic time did not increase. Outcomes of LT for both patient and graft survival actually improved and remain at or above the expected values. These results collectively support the usefulness and validity of NPs and PAs in a DDLT program.

Conclusion:

We have determined that surgical and medical NPs and PAs are essential for optimal patient outcomes. They facilitate a better learning experience for residents and fellows on their transplant rotations. Further investigations to assess the roles of these providers and their impact on the education of residents and fellows in transplantation are warranted. Further transplant hepatology education programs and/or fellowships are recommended to assist in the education and professional development of transplant NPs and PAs.
A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients
Authors: Gordon Elisa J. , Feinglass Joe , Carney Paula , Vera Karina , Olivero Maria , Black Anne , O’Connor Kate Grubbs , Baumgart Jessica MacLean , Caicedo Juan Carlos
Published: January 2017

Background:

Hispanic dialysis patients often encounter barriers to learning about living kidney donation and transplantation. Effective culturally targeted interventions to increase knowledge are lacking. We developed a culturally targeted educational website to enhance informed treatment decision making for end-stage kidney disease.

Methods:

A pretest/posttest intervention study was conducted among adult Hispanic patients undergoing dialysis at 5 dialysis centers in Chicago, Illinois. Surveys included a 31-item, multiple-choice pretest/posttest of knowledge about kidney transplantation and living donation, attitudes about the website, Internet use, and demographics. The intervention entailed viewing 3 of 6 website sections for a total of 30 minutes. The pretest/posttest was administered immediately before and after the intervention. Participants completed a second posttest via telephone 3 weeks thereafter to assess knowledge retention, attitudes, and use of the website.

Results:

Sixty-three patients participated (96% participation rate). Website exposure was associated with a mean 17.1% same day knowledge score increase between pretest and posttest ( P < .001). At 3 weeks, participants’ knowledge scores remained 11.7% above pretest ( P < .001). The greatest knowledge gain from pretest to 3-week follow-up occurred in the Treatment Options ( P < .0001) and Cultural Beliefs and Myths ( P < .0001) website sections. Most participants (95%) “agreed” or “strongly agreed” that they would recommend the website to other Hispanics.

Conclusions:

Web-based education for patients undergoing dialysis can effectively increase Hispanics’ knowledge about transplantation and living kidney donation. Study limitations include small sample size and single geographic region study. Dialysis facilities could enable website access as a method of satisfying policy requirements to provide education about kidney transplantation.
Cultural Sensitivity and Challenges in Management of the Transgender Patient With ESRD in Transplantation
Authors: Hoch Deborah Ann , Bulman Maya , McMahon Dorn W.
Published: January 2017

Transgender patients with end-stage renal disease (ESRD) present with specific challenges during the transplant evaluation, perioperative management, and postoperative phase of care. Demographic information, health-care records, chosen name, and gender identity along with documentation of specific health-care needs can become a challenge when gender assigned at birth is incongruent with the patients gender identity. Medical care involves addressing the end-organ disease as well as addressing those aspects of care specific to the transgender patient. This review article provides information on defining transgender, the impact of ESRD, and transgender in the transplant process and considerations in the throughout phases of care. Current recommendations for management of this unique population are provided.
New-Onset Diabetes After Kidney Transplantation and Pretransplant Hypomagnesemia
Authors: Sinangil Ayse , Celik Vedat , Barlas Soykan , Sakaci Tamer , Koc Yener , Basturk Taner , Akin Emin Baris , Ecder Tevfik
Published: January 2017

Aim:

Hypomagnesemia is a frequent finding in kidney transplant patients and plays a causal role in insulin resistance and diabetes. The aim of this study was to investigate whether the pretransplant magnesium (Mg) level is a risk factor for the development of new-onset diabetes after kidney transplantation (NODAT) and the presence of relationship between pretransplant hypomagnesemia and the development period of NODAT.

Methods:

Four hundred and nineteen nondiabetic renal transplant recipients were evaluated retrospectively. The patients were divided into NODAT and non-NODAT groups. The time of diagnosis of patients with NODAT was divided into 0 to 3, 3 to 6, 6 to 12 months, and after 12 months. Patients’ characteristics and pretransplant Mg levels in NODAT were compared with non-NODAT, and it was investigated whether pretransplant hypomagnesemia was a risk factor for the development of NODAT.

Results:

Totally 70 (16.6%) patients (36 female [F], mean age 51.7 ± 8.2 years) were diagnosed with NODAT. Three hundred and forty-nine patients (115 F, mean age 43.2 ± 12.5 years) did not have NODAT. Pretransplant mean Mg level was 1.97 ± 0.40 mg/dL in patients with NODAT, while it was 2.5 ± 0.45 mg/dL in non-NODAT patients ( P < .001). Serum Mg level was found to be similar in subgroups according to the development period of NODAT ( P = .07). When patients were stratified according to quartiles of Mg level, the frequency of NODAT was significantly higher in patients in the lower quartile (Mg < 2.1 mg/dL; P < .001). Older age, high body mass index, and low pretransplant serum Mg levels were established as risk factors for developing NODAT. According to the quartile of Mg level, the risk of developing NODAT was highest in the lowest quartile.

Conclusion:

Pretransplant hypomagnesemia is an independent risk factor of NODAT. Therefore, it is necessary to closely monitor the Mg levels in the posttransplant period.
Self-Reported Employment Status and Social Participation After Successful Kidney Transplantation
Authors: Parajuli Sandesh , Singh Jagmeet , Sandal Shaifali , Liebman Scott E. , Demme Richard A.
Published: January 2017

Introduction:

Kidney transplantation (KTX) is considered the treatment of choice for most individuals with end-stage kidney disease. The purpose of this study was to assess the employment status and social participation after successful KTX.

Methods:

This was a retrospective cross-sectional study. Eligible participants were patients who received a transplant ≥1 year ago and who were previously on hemodialysis (HD) for ≥1 year. Two hundred individuals participated in this study.

Results:

A significant number (93.5%) of patients reported they were working prior to HD versus 35% while on HD. Only 14% reported receiving disability benefits prior to HD versus 75% receiving disability while on HD. Comparing transplant recipients with pre-HD patients, 35.5% versus 93.5% reported working, and 74.5% versus 14% reported receiving disability benefits, respectively. After transplant, patients were more likely to join recreational clubs, travel frequently, and participate in recreational/religious activities and social events than when they were on HD.

Conclusion:

Posttransplant, these individuals are more likely to participate in social and leisure activities, but the majority did not resume employment and continued to receive disability payments. Future studies could explore barriers to employment in patients who underwent successful transplantation and the causes and factors as to why these individuals continue to receive disability benefits.
Behavioral Factors Contributing to Older Adults Falling in Public Places
Authors: Clemson Lindy , Manor Debra , Fitzgerald Maureen H.
Published: January 2017

Activity recall, in-depth interviews, and reenactment of the fall were used to elucidate the behavior patterns, actions, and habits that contribute to older adults falling in public places. The aim was to improve older adults' capacity to understand behavioral risks associated with falls and develop safe adaptive strategies so they can play an active role in minimizing falls and maintaining meaningful activity. Ten major themes were identified: not attending to the route ahead, lack of familiarity, pace, mobility behaviors, environmental influences, eyesight behaviors, health factors affecting physical abilities, lack of confidence, overexertion, and unnoticed environmental hazards. The findings add to knowledge about the extent and nature of behavioral factors that contribute to falls in public places and provide guidelines for some specific areas of focus for falls prevention. A recommendation is that fall prevention interventions with older adults employ strategies that actively engage them in critical reflective thinking.
The Activity Card Sort: A Factor Analysis
Authors: Sachs Dalia , Josman Naomi
Published: January 2017

This study was conducted to examine the utility of the Activity Card Sort (ACS) as a unique assessment tool for measuring adult human occupation and level of activity. Factor analysis was used to determine whether the picture items of the ACS empirically cluster into four categories of human occupations (instrumental activities, low-demand leisure activities, high-demand leisure activities, and social activities), as well as to compare young and elderly people's classifications of activities on the ACS instrument. The study sample consisted of 184 participants who were divided into two groups (53 students and 131 elderly people). Factor analysis revealed five factors for student activities and four factors for elderly people's activities. The analysis of variance revealed that students were involved primarily in leisure activities and secondarily in independent activities of daily living (IADL), whereas elderly people were mostly involved in IADL. Pearson correlations showed the five student categories to be distinctive, whereas substantial overlapping among categories was obtained for elderly people. The use of the ACS as an important research instrument may serve to advance our understanding of the categorization of human occupations among different age groups by identifying underlying dimensions of occupational performance and assessing intensity of involvement in different occupational categories. In addition, this instrument highlights the interaction between occupational performance, person factors (various age and gender groups), and environment factors (e.g., culture).
3D Rotational Angiography: Recent Experience in the Evaluation of Cerebral Aneurysms for Treatment
Authors: Ishihara S. , Ross I.B. , Piotin M. , Weill A. , Aerts H. , Moret J.
Published: January 2017

Three dimensional (3D) reconstruction techniques providing volume rendered 3D images from rotational angiography data now exist. We report the design and early experience with one such system. 237 aneurysms were studied. Information was obtained on the morphology of the aneurysm itself and the vascular architecture in and around the aneurysm. 218 (92%) aneurysms went on to have endovascular treatment.

The 3D images provided valuable information on aneurysmal anatomy, including relationships with the parent and adjacent vessels. This technique allowed fast and safe decision-making regarding the feasibility of endovascular or surgical treatment and provided useful information for performing the chosen treatment.
Timing of ICAM-I Expression in a Canine Model of Post-Haemorrhagic Cerebral Vasospasm
Authors: Abruzzo T. , Shengelaia G.G. , Cloft H.J. , Thaxton G. , Dudley P. , Tong F. , Dion J.E.
Published: January 2017

Temporal alterations in endothelial intercellular adhesion molecule I (ICAM-I) expression during the course of post-haemorrhagic cerebral vasospasm (PHCV) are correlated with angiographic and histologic changes in the canine basilar artery.

Angiography was performed in six dogs to obtain baseline measurements of basilar artery diameter. In three dogs subarachnoid haemorrhage (SAH) was created by performing percutaneous puncture of the cisterna magna, and replacing 7 ml of cerebrospinal fluid with 7 ml of arterial blood. The remaining three dogs were used as controls. Daily angiography was performed on all dogs to determine the percent reduction in basilar artery diameter (%RBAD). One dog from each group was sacrificed after 24 hours. The remaining two dogs in each group were sacrificed after 48 hours. Each basilar artery was perfusion fixed and subjected to histologic, and immunohistochemical analysis.

In the SAH group, the average %RBAD was 4 (+/- 3) at 24 hours, and 36 (+/- 1) at 48 hours. In the control group, the average %RBAD was — 1 (+/- 1) at 24 hours, and 0 (+/- 2) at 48 hours. Endothelial edema and endothelial expression of ICAM-I were found at 24 hours. At 48 hours post-SAH there was widespread endothelial desquamation, but no evidence of ICAM-I expression. In the control group, histology was normal and no ICAM-I expression was found at 24 or 48 hours.

The results suggest that a brief window of therapeutic efficacy exists during the first postictal 24 hours where ICAM-I antagonists may be useful in suppressing the pathogenesis of PHCV.
Palliative Embolisation of Brain Arteriovenous Malformations Presenting with Progressive Neurological Deficit
Authors: Al-Yamany M. , terBrugge K. G. , Willinsky R. , Montanera W. , Tymianski M. , Wallace M.C.
Published: January 2017

Large arteriovenous malformations (AVMs) located in eloquent areas of the brain are generally considered incurable because of the high morbidity and mortality associated with their treatment. When these patients develop a progressive neurological deficit they in time often become severely disabled. This report presents the results of palliative embolisation in this subgroup of patients.

Analysis of our data-base of 714 patients with known brain AVMs revealed 17 patients who presented with progressive neurological deficit and who underwent palliative embolisation as the therapeutic modality of choice for management of their AVM. One patient was excluded due to lack of follow-up and two were excluded because they later received radiation therapy. Following embolisation 43% had improvement of their neurological deficit, 50% stabilized and 7% continued to deteriorate and these clinical results persisted for an average of more than 2 years follow-up.

Transient neurological morbidity associated with embolisation treatment was 7% and there was no permanent morbidity and no mortality.

Palliative embolisation of brain AVMs presenting with progressive neurological deficits arrested deterioration in more than 90% of patients and was associated with low morbidity and no mortality.
The Accuracy of Plain Skull X-ray Examination as a Predictor of Recanalization following Guglielmi Detachable Coil Embolisation in the Treatment of Cerebral Aneurysms
Authors: Hwang G.J. , Berenstein A. , Niimi Y. , Setton A. , Pryor J. , Baltsavias G. , Albert R. , Hartman J.
Published: January 2017

We evaluated the accuracy of plain skull x-ray series as an imaging modality for the follow-up of cerebral aneurysm recanalization after Guglielmi Detachable Coil (GDC) embolisation.

We retrospectively reviewed of 100 consecutive follow-up angiograms and skull x-ray examinations in 78 patients harboring 82 aneurysms and in whom 85 procedures were performed. Angiography was performed between 1 and 54 months (mean: 10.8 months) after embolisation. The skull series (AP, lateral and Towne's projections) were taken at the time of follow-up angiography. Each follow-up angiogram and skull series were compared to the immediate post-coiling, correlating presence or absence of coil compaction on the skull series and recanalization of the aneurysm at angiography.

In 97 (97%) examinations, skull x-ray findings correlated with the angiographic findings. In three cases, skull x-ray examination suggested compaction when no recanalization was seen angiographically; in these three cases, the aneurysms were small and found to be more thrombosed than baseline. In no case did angiographic recanalization occur in the absence of compaction on skull series. These findings yield 100% sensitivity, 95% specificity, 93% positive predictive value, 100% negative predictive value and 97% accuracy. The location, size, configuration and neck/dome ratio of the aneurysm were not related to the correlation between angiography and skull x-ray exam.

Skull x-ray series is a safe, accurate, and cost-effective mode of follow-up for patients with GDC-treated aneurysms. The possibility of it replacing angiography still requires a more comparative skull x-ray modality in follow-up studies.
Stenting for Abrupt Closure of the Intracranial Vertebral Artery Complicating Balloon Angioplasty
Authors: Hatano T. , Tsukahara T. , Araki K.
Published: January 2017

We report a case of stenting for abrupt closure of the intracranial vertebral artery complicating balloon angioplasty. A 58-year-old man with symptomatic restenosis of the intracranial vertebral artery underwent balloon angioplasty, which was complicated by acute occlusion due to wall dissection. The acute occlusion of the lesion was completely recanalized by implanting a balloon-expandable stent designed for the coronary artery. Follow-up angiography 15 months after stenting did not show severe restenosis and the patient's symptoms disappeared after stenting. This therapeutic option may be useful as a means to bail out from acute occlusion of the intracranial artery caused by endovascular procedures.
Retrieval of Malpositioned, Dislocated or Fractured Guglielmi Detachable Coils from Intracranial Vessels
Authors: Lampmann L.E.H. , Sluzewski M. , Van Rooij W.J.J.
Published: January 2017

Endovascular treatment of intracranial vascular disorders has become common practice, especially treatment of aneurysms with detachable coils. Detachable coils can be utilized with high success rates but technical complications such as misplacement and displacement of coils and/or fractures may occur. We describe our experience with retrieval of coil material utilizing the Lasso retriever (Balt, Montmorency, France) in seven patients.
Endovascular Treatment of Berry Intracranial Aneurysms Using a New Detachable Coil System
Authors: Tournade A. , Riquelme C. , Musacchio M. , Mont'Alverne F.
Published: January 2017

We aimed to assess and to demonstrate the efficiency of a new mechanical system in the endovascular treatment of berry intracranial aneurysms.

From September 1999 to October 2000, 38 patients with 40 aneurysms experienced selective embolization using Detach Coils (DCS® — Cook). They were 12 men and 26 women, aged 26 to 77 years, mean age 53.4. The clinical status of patients was graded by Hunt and Hess scale: Stage 0:8 — stage I:3 — Stage II: 11 — Stage III: 11 — Stage IV: 2 — Stage V: 3. The localization of aneurysms was as follows: internal carotid artery: 11; sylvian artery: 10; anterior communicating artery: 5; anterior cerebral artery A1-A2: 5; intra-cavernous carotid artery: 1; basilar trunk: 5; PICA: 2; posterior cerebral artery: 1. The size of the aneurysms ranged from 2 to 40 mm. For embolization of aneurysms, we utilized 242 coils (mean number 6.05). The shape and size of coils varied as follows: longest J 6.25 — shortest J 4–3 — longest S 10–20 — shortest S 2–2.

The mean time of procedure was 43 minutes (max 180 minutes — min 7 minutes). We did not have any technical complications during the procedure and no immediate rebleeding occurred. Initial follow-up of the patients showed angiographic full occlusion.

Detach Coils appear to be a very precise, reliable and rapid system, with high stability during coil detachment (in very small or very giant aneurysms) in the embolization of intracranial aneurysms, with an interesting aspect concerning the low cost of this new mechanical device.
Importance of the over the Wire Occlusion Balloon Catheter Designed for Intracranial Use
Authors: Weill A. , Marotta T. , Redekop G.
Published: January 2017

The over the wire occlusion balloon catheter is a new interventional neuroradiology tool. We present two cases where this system was crucial for the management. In the first case it allowed us to perform an occlusion test before closing in safe conditions a M2 fusiform aneurysm. In the second case, it allowed us to control a subarachnoid bleeding after endovascular perforation of a normal left P1 segment. We believe that all interventional neuroradiologists should be familiar and comfortable with the systems available.
Spontaneous Healing and Complete Disappearance of a Giant Basilar Tip Aneurysm in a Child
Authors: Luo C.B. , Chen Y.L. , Hsu S.W. , Alvarez H. , Rodesch G. , Lasjaunias P.
Published: January 2017

We report a rare case of spontaneous total thrombosis of a giant basilar tip aneurysm resulting in compression of the brainstem, diagnosed in a two-year-old child who presented with neurological deficits and third cranial nerve impairment. After conservative treatment, the giant aneurysm was completely thrombosed and the clinical symptoms were remarkably improved. MRI demonstrated dramatic shrinkage and ultimately complete disappearance of the giant aneurysm at seven month follow-up.
Growth and Spontaneous Regression of a Middle Cerebral Artery Aneurysm after Surgical Clipping
Authors: Tan C.B. , Rodesh G. , Lasjaunias P.
Published: January 2017

We present a case of growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. A 36-year-old woman who presented with grade II subarachnoid haemorrhage was found to have a right middle cerebral artery aneurysm. The aneurysm was surgically clipped in view of the morphology of the aneurysm. Second clipping was performed four months later as there was re-growth of the neck of the aneurysm. Again re-growth of the aneurysm was noted five months after the second clipping.

As further clipping of the aneurysm would be difficult, external and internal carotid arteries bypass was the treatment option but unfortunately, the by-pass operation was unsuccessful. Interestingly, angiogram performed after the bypass surgery revealed partial thrombosis and decreasing size of the aneurysm. Complete obliteration of the aneurysm was noted without further intervention one month after the failed by-pass surgery.
Endovascular and Surgical Management of Multiple Intradural Aneurysms
Authors: Porter P.J. , Mazighi M. , Rodesch G. , Alvarez H. , Aghakhani N. , David Ph , Lasjaunias P.
Published: January 2017

Patients with multiple intradural aneurysms present unique clinical challenges, particularly when presenting with subarachnoid haemorrhage. This study was undertaken to retrospectively review the management of such patients treated at a single institution. Consecutive patients with multiple intradural aneurysms managed at our institution between 1993 and 1999 were studied. The 122 patients had a total of 305 aneurysms. In most patients presenting with subarachnoid haemorrhage, the aneurysm responsible for the bleed could be identified with a fair degree of certainty, as confirmed by subsequent surgical and autopsy findings. Irregularity of the aneurysm (false sac or polylobulation) was the most useful criterion for making this determination. Failure to recognize all aneurysms on the original angiogram remained an uncommon but clinically important problem. Posterior inferior cerebellar and anterior communicating artery aneurysm locations were disproportionately more likely, and para-ophthalmic less likely, to be responsible for the subarachnoid haemorrhage. There was a trend for patients with uncertainty regarding the site of bleeding to have all aneurysms treated, and for cure to be obtained in a shorter time. Surgical and endovascular complication rates and patient outcomes were not dissimilar from what one would expect for single aneurysm patients. During follow-up, we observed a haemorrhage rate from unruptured aneurysms of 1.1% per patient-year of observation, and a de novo aneurysm formation rate of 0.76% of patients per year.

In conclusion, we feel that although patients with multiple intradural aneurysms have more complex management issues than those with single aneurysms, good outcomes can be achieved with appropriate use of endovascular and/or surgical therapy. The goal in the acute setting following subarachnoid haemorrhage is recognition of all aneurysms and urgent treatment of the one responsible for the haemorrhage. When there is uncertainty, more than one aneurysm may need to be treated. Decisions on subsequent treatment of remaining unruptured aneurysms must be individualized.
Revascularization Using an Extracorporeal Pump for the Treatment of Cerebral Embolism in the Acute Stage
Authors: Sonobe M. , Nakai Y. , Matsumaru Y. , Sugita K.
Published: January 2017

Object. For patients with cerebral embolism, we are using an extracorporeal pump to revascularize the more peripheral brain tissues far from the thrombus, proceeding the microcatheter beyond the thrombus, and dissolving the thrombus during a satisfactory time as required.

Methods. As the critical cerebral blood flow is thought to be below 30 ml/100g/min, in the case of middle cerebral artery occlusion at the M1 portion, over 15ml/min. of arterial blood is necessary to protect the brain tissue from irreversible change. One thousand and eight hundred mmHg (about 2 atoms) of pump pressure is necessary to send 15ml/min. of blood through the microcatheter (110 cm, FastTrucker 18, Boston). It was confirmed by laboratory and clinical data that hemolysis of the pump action is not sufficient to aggravate kidney function.

Conclusion. This method enables the protection of brain tissues from irreversible change after cerebral embolism, and extends the time sufficiently for thrombolysis.
Supraclinoid Internal Carotid Arterial Aneurysm Presenting as a Suprasellar Mass-Like Lesion in a Child
Authors: Suh D. Chul , Alvarez H. , Rose C. Sainte , Lasjaunias P.
Published: January 2017

We present the case of a two-year and seven-month-old boy with a partially-thrombosed giant lobulated aneurysm in the supraclinoid portion of the internal carotid artery. He presented with several months of symptoms of progressive frontal headache and visual loss. CT revealed a large lobulated suprasellar mass lesion mimicking a craniopharyngioma. After the aneurysm was successfully obliterated by an endovascular procedure, regression of the giant aneurysm was confirmed on followed-up MRI. The differential diagnosis, possible etiologies, and the endovascular technique for pediatric patient will be discussed.
Encephalocraniocutaneous Lipomatosis Syndrome in a Child: Association with Multiple High Flow Cerebral Arteriovenous Fistulae
Authors: Batista LL , Mahadevan J. , Sachet M. , Husson B. , Rasmussen J. , Alvarez H. , Lasjaunias P.
Published: January 2017

We describe the case of a three-year-old Danish boy born at term by Cesarean due to cardiac insufficiency in the last trimestre of intra-uterine life for which he is being treated with cardiac drugs. At birth, he was noted to have bilateral ocular malformations on the upper eyelids, and diffuse scalp lipoma and alopecia. Due to the retarded growth (score-3D) he had a MRI and angiography which demonstrated a high flow fistula on the basilar tip artery and another one on the MCA branch treated by endovascluar approach. Intracranial arachnoid cysts, dysplastic cortex, ventricular enlargement and lipoma were noted too, establishing the diagnosis of Encephalocraniocutaneous Lipomatosis Syndrome, a rare disease, especially in bilateral presentation. To our knowledge this is the first observation of ECCL associated with intracranial pial arteriovenous fistulas.
Anterior Choroidal Artery Variant and Acute Embolic Stroke
Authors: Komiyama M. , Morikawa T. , Ishiguro T. , Matsusaka Y. , Yasui T.
Published: January 2017

The anterior choroidal artery has the cortical branches to the temporal, parietal, and occipital lobes in the early embryological stage, which later become the posterior cerebral artery distal to the posterior communicating artery (P2-4). Acute embolic stroke occurred in a 57-year-old man with an anterior choroidal artery having such a persistent embryonic branch to the temporal lobe. Recognition of this embryological form of the anterior choroidal artery is clinically important in acute cerebral ischaemia because the cerebral region between the territories supplied by the middle cerebral artery and the anterior choroidal artery is shown on carotid angiography as an avascular area, which could be misunderstood as a region of the acute ischaemia.
Natural History and Treatment Modalities of Symptomatic Bilateral Middle Cerebral Artery Stenosis
Authors: Zhongrong M. , Feng L. , Shengmao L. , Fengshui Z. , Hongqi Z. , Moli W. , Yang H.
Published: January 2017

To assess the natural history, pathogenesis, and treatment modalities of symptomatic bilateral middle cerebral artery stenosis, we retrospectively evaluated a consecutive series of patients for their medical history, anamnesis, and our treatment protocol.

Treatment included transluminal angioplasty, bypass surgery and/or conservative antiplatelet therapy for prevention of the stroke attack and vessel reconstruction. Indications, feasibility, effectiveness, and complications of treatment are also discussed.

A series of 19 patients with symptomatic bilateral middle cerebral artery (MCA) stenosis were treated consecutively from 1998 to 2002. Medical history, anamnesis, and treatment protocol were reviewed and evaluated retrospectively, Of these 19 patients, six (six vessels, 31.57%) were treated by balloon (two vessels) or stent-assistant angioplasty (four vessels), four (four vessels, 21.05%) were treated by bypass surgery, 18 vessels plus ten vessels occluded before treatment (47.37%) were conservatively treated by antiplatelet agents. 24 vessels (12 patients) were followed from three months to four years by angiography (nine cases), TCD (12 cases), or MRA (five cases).

A total of 38 vessels were involved (19 vessels), of which ten vessels (10/38, 26.31%) had occluded before coming to our hospital. Three patients (3/19, 15.78%) had a history of hypertension, five had a history of smoking. The mean age of these 19 patients was 33 yrs (24 ∼ 42 yrs), with a slight male preponderance (males/females = 13/6). Initial clinical presentations were TIAs (14/19, 73.68%) and minor stroke (5/19, 26.32%), symptoms attacked alternatively for five patients (5/38, 13.16%). Seven vessels (7/28, 25%) occluded within one to three years, of which three occluded asymptomatically, four acutely occluded vessels accompanied acute stroke. Nine vessels (9/28, 32.14%) were treated by conservative antiplatelet agents and one treated by bypass surgery had related recurrent TIAs. Vessels treated by angioplasty (balloon or stent) remained patent and free of symptoms.

The stenosed bilateral MCA may occlude within one to three years without intervention. The pathogenesis of this special disease is unclear, it may be genetic or due to asymptomatic infection.

The results showed that earlier appropriate treatment can resolve the clinical symptoms and somehow change the natural history of this disease. Conservative medical therapy cannot prevent further stroke attack. Collaterals are very important for these special patients.
MTI (Dendron) Variable Detachable Coils
Authors: Thammaroj J. , Jayakrishnan V. , Lamin S. , Jenkins S. , Teasdale E. , Bhattacharya J.
Published: January 2017

We present our initial clinical experience of Dendron Variable Detachable System (VDS) coils, now Sapphire VDS from MTI, in the endovascular treatment of cerebral aneurysms. VDS coils, uniquely, can be detached at variable points along their length, allowing placement of as much or as little as desired of the coil within the aneurysm. Our ten patients formed part of a multicentre feasibility study. VDS coils were successfully deployed in all but one aneurysm. The electrolytic detachment mechanism with practice is both simple to use and reliable. The coils are however slightly stiffer than standard coils limiting their use in small aneurysms. This remains a technology in evolution.
MR Perfusion Imaging in a Case of a Vein of Galen Malformation with Secondary Capillary Angioectasia
Authors: Weon Y.-C. , Ducreux D. , Alvarez H. , Lasjaunias P.
Published: January 2017

Vein of Galen Aneurysmal Malformations (VAGMs) are uncommon vascular malformations associated with dilatation of the vein of Galen embryonic forerunner with single or multiple direct arteriovenous fistulas within its wall without direct reflux into normal cerebral veins. We describe a patient with a late neurological onset presenting a classic VGAM complicated by secondary thalamic capillary angioectasia imaged with MR perfusion. In our patient, abnormal MR perfusion parameters were not seen on conventional MRI; they probably reflect underlying venous hypertension. They were located in areas involved in motor neurological deficit.
Endovascular Treatment of a Dural Arteriovenous Fistula of the Transverse Sinus by Recanalisation, Angioplasty and Stent Deployment
Authors: Weber W. , Kis B. , Esser J. , Berlit P. , Kühne D.
Published: January 2017

We report the endovascular treatment of a 40-year-old woman with bilaterally thrombosed transverse sinuses and a dural arteriovenous fistula (DAVF) causing cortical venous reflux by recanalization, angioplasty and stent deployment of the occluded sinus segment followed by occlusion of the DAVF by stent deployment in the fistulous segment. By recanalization of the occluded sinus we re-established normal anterograde venous drainage and eliminated the venous hypertension and cortical venous reflux. After the procedure, the patient was treated with aspirin and clopidogrel for three months. A follow-up examination showed total occlusion of the DAVF, patency of the sinus and a complete resolution of the clinical symptoms.
3D Micrus Coil “Cage” in Wide-Necked Aneurysms
Authors: Leonardi M. , Simonetti L. , Cenni P. , Raffi L.
Published: January 2017

We aimed to verify that Micrus 3D microcoils can be used as first coils in the treatment of saccular wide-necked aneurysms to provide stable protection to the neck by keeping the coil mesh inside the aneurysm.

We selected 22 wide-necked aneurysms and calculated the ratio between sac diameter and neck width which was close to unity. The aneurysms were treated by endovascular approach using Micrus 3D (Spherical) microcoils as first coils. The coils proved stable during placement and detachment and compatible with both GDC and Micrus coils used for filling and packing. The endovascular procedure was suspended in only two out of 22 aneurysms selected for treatment. Aneurysm bleeding occurred in two endovascular procedures but was controlled. No complications were encountered in the remaining 18 patients treated. The percentage of technical failures has been reduced since the adoption of 3D Micrus microcoils in our practice.
Bilobed Wide Neck Posterior Cerebral Artery Aneurysm Associated with Fusiform Basilar Aneurysm, Subarachnoid Hemorrhage and Chronic Renal Failure
Authors: Koan Tan Siauw
Published: January 2017

A 56 year-old woman presented with a ruptured bilobed wide neck aneurysm of the P2 segment of the PCA, atherosclerotic fusiform basilar artery aneurysm, subarachnoid bleeding with negative CT scan and chronic renal failure. She was managed by a cooperative approach involving neurosurgeons, neuroradiologist, neurointensivist, emergency room physicians, nurses and technicians.

She underwent operation by proximal clipping for the aneurysm of the PCA. Postoperative neurological deficits include homonymous hemianopsia and ipsilateral third nerve palsy. The operation was performed through asubtemporal approach. At surgery, the aneurysm was located in the distal of the P2 segment of PCA, bilobed up and down, no definitive neck with small distal branches, and was treated by proximal clipping of the PCA aneurysm. The fusiform basilar artery aneurysm was severely atherosclerotic and left untouched.

This is a rare case which required a high index of suspicion to detect subarachnoid bleeding from ruptured posterior fossa aneurysm, accurate prediction of the site of bleeding and the location of aneurysm location by conventional angiogram, MRI and MRA, and careful planned surgical strategy with the right approach for the P2 segment of the PCA aneurysm, complicated post operative care with airway management, triple H therapy, nutrition, additional measures and multiple hemodialysis.
Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection
Authors: Szajner M. , Obszaska K. , Nestorowicz A. , Szczerbo-Trojanowska M.
Published: January 2017

Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n-BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.
Endovascular Treatment of Traumatic Intracranial Aneurysm in an Infant
Authors: Kim B. , Lee S.-K. , terBrugge K.G.
Published: January 2017

Traumatic intracranial aneurysms in children are rare and mostly related to skull fracture or rapid decelerating closed head injury. We report the case of an infant who developed intracranial aneurysm after minor head trauma and managed by endovascular treatment.

A seven-month-old infant presented with delayed intracranial hemorrhage following minor head trauma. Cerebral angiography disclosed a multilobulated fusiform aneurysm involving the right anterior cerebral artery (ACA) distal to the anterior communicating artery. Endovascular treatment of the aneurysm was performed and the infant made an excellent recovery during six months clinical and radiological follow-up.

Delayed presentation of intracranial hemorrhage with acute deterioration in the infant after head trauma warrants angiography for proper diagnosis and management of the traumatic aneurysm, which has a high mortality rate after rupture and rebleeding. Endovascular treatment of traumatic aneurysm is feasible in infants, and occlusion of distal intracranial arterial aneurysms can be safely and precisely achieved using current coil technology.
Presurgical Embolization of Spinal Tumours Using Glubran 2 Acrylic Glue
Authors: Raffi L. , Simonetti L. , Cenni P. , Bandiera S. , Gasbarrini A. , Boriani S. , Leonardi M.
Published: January 2017

This study aimed to define the indications, technique and results of presurgical embolization of spinal tumours using Glubran 2 acrylic glue. Embolization was performed prior to surgery in eight patients with benign tumours and 11 patients with malignant lesions. The main embolization agent used was Glubran 2, a new acrylic glue with the EC mark, suitable for permanent embolization of the pathological circulation of primary and secondary spinal tumours.

All the procedures were technically feasible and achieved partial or complete embolization of the vascularized lesion without periprocedural complications. Glubran 2 proved easy to use with excellent intravascular penetration achieving permanent embolization. The degree of presurgical embolization in terms of surgical field haemostasis was correlated with the degree of vascular occlusion achieved.
Endovascular Treatment of Giant P1/P2 Aneurysm by Direct Puncture of the Vertebral Artery
Authors: Szajner M. , Obsza_Ska K. , Nestorowicz A. , Szczerbo-Trojanowska M. , Trojanowski T.
Published: January 2017

Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative.

The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach.

According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.