bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Management of Cerebral Arteriovenous Malformations. Present Role of Interventional Neuroradiology
Authors: Viñuela F. , Duckwiler G. , Jahan R. , Murayama Y.
Published: January 2017

This chapter summarizes the authors' experience in the endovascular therapy of cerebral arteriovenous malformations (AVMs). This clinical series includes 660 patients treated from 1980 to 2005.

The first 148 patients were treated at University Hospital, in London, Ontario Canada, in association with Drs. Allan Fox, Dave Pelz, John Girvin and Charles Drake. The next 512 patients were treated at UCLA Medical Center, Los Angeles, California in association with Drs. Gary Duckwiler, Reza Jahan, Jacques Dion, Pierre Gobin, Neil Martin and John Frazee.

Only patients treated with superselective endovascular/intraoperative catheterization and embolization of avm arterial feeders were included. Cerebral arteriovenous malformations treated by non-selective injection of beads in ICA or vertebral arteries were excluded.

Modern neuroimaging modalities associated to the anatomical, topographic and functional evaluations of cerebral avms such as brain CT and CTA, MRI, MRA and functional MRI are all utilized at UCLA Medical Center. They have become essential in the therapeutic management of avms closely related to cerebral eloquent areas (figure 1).
Endovascular treatment of cerebral arteriovenous malformations with emphasis on the curative role of embolisation
Authors: Valavanis A. , Pangalu A. , Tanaka M.
Published: January 2017

Valavanis A, Pangalu A, Tanaka M. Endovascular treatment of cerebral arteriovenous malformations with emphasis on the curative rule of embolisation. Schweiz Arch Neurol Psychiatr 2004;155:341–7.
Ectatic and Occlusive Diseases of the Venous Drainage System of Cerebral Arteriovenous Malformations (AVMs) -with Emphasis on Spectacular Shrinking Neurological Deficits after Embolization
Authors: Goto K.
Published: January 2017

During reviewing cases with AVM, the author noticed that stenotic and occlusive changes of the draining veins are commonly seen in high flow cerebral AVMs. However, little attention has been paid to these venous diseases until ectatic veins, generated in the upstream of the venous system, cause mass effect to the surrounding structures, or redistribution and shunting toward regional veins became insufficient after they are markedly overloaded or occluded. Cases with such venous abnormality are clinically important because of the possibility of dramatic improvement of neurological deficits after embolization of AVMs.

Following presenting treatment results of 177 AVM case, the author is going to present five cases with abnormality in the Galenic venous system and two cases with abnormality in cortical veins associating with high flow cerebral AVMs. Consideration will be made on symptomatology and pathophysiologic mechanism of venous abnormalities associating with high flow cerebral AVMs.
3T MRI — 3D DSA Fusion Technique on Posterior Cerebral Artery Dissecting Aneurysm: Understanding a Potential Pathophysiologic Mechanism
Authors: Chong W.K.W. , Lee S.K. , terBrugge K.G.
Published: January 2017

We aimed to show the anatomical relationship between a dissecting aneurysm of the posterior cerebral artery (PCA) and tentorial free edge to understand the pathophysiologic mechanism. A 52-year-old woman with a history of head trauma presented with dizziness and numbness in her left fingers. 3D DSA showed a dissecting aneurysm of the right P2-P3 segment of PCA.

The fusion of 3D DSA and 3T MRI was performed at the dedicated workstation using three pairs of landmarks including the ICA termination, MCA bifurcation and A1-A2 junction of the right ACA. Fusion of 3D DSA and 3T MRI clearly demonstrated the dissected segment of PCA crossed the tentorial free edge twice.

The fusion images support the direct trauma hypothesis of dissecting aneurysm of the P2-P3 segment of PCA. This novel imaging technique shows future potential to be used to understand the anatomical relationships between various vascular lesions and surrounding structures.
History of Endovascular Endosaccular Occlusion of Brain Aneurysms: 1965–1990
Authors: Guglielmi G.
Published: January 2017

A concise historical review of the endovascular, endosaccular treatment of intracranial aneurysms is reported. The transition from detachable balloons to detachable coils is described. The development of microcatheters for intracranial endovascular navigation is also reported.
Traumatic Cerebral Aneurysm Associated with a Contralateral Traumatic Carotid Cavernous Fistula
Authors: Fuse A. , Yokota H. , Kominami S. , Yamamoto Y.
Published: January 2017

This report documents the management of a traumatic carotid aneurysm (TCA) with a traumatic carotid-cavernous fistula (T-CCF) of the contralateral internal carotid artery (ICA) following a closed head injury. A 38-year-old man presented with severe traumatic subarachnoid hemorrhage and pneumocephalus due to a severe head injury.

Four months after the accident, the patient presented with clinical symptoms of exophthalmos and retroorbital bruit. Cerebral angiography showed a TCA of the IC-PC region, which coexisted with a contralateral T-CCF. Both lesions were successfully managed with an endovascular treatment using coils to isolate a fistula from the ICA, and direct surgical trapping of the intracranial ICA to eliminate a TCA.

Post-operative angiography revealed a good cross-flow through the anterior communicating artery from the contralateral ICA, which was completely obliterated by the T-CCF. No additional surgical or endovascular procedure for traumatic vascular injuries was required. The patient remained asymptomatic during the clinical follow-up period of 24 months. The goal of traumatic carotid injuries is the selective elimination of the vascular pathologic injury with asymptomatic state, using direct surgery and/or an endovascular treatment.
Venous Anatomy of the Sphenoparietal Sinus: Evaluation by MR Imaging
Authors: Takahashi S. , Sakuma I. , Otani T. , Yasuda K. , Tomura N. , Watarai J. , Yanagisawa T. , Mizoi K.
Published: January 2017

The termination of the superficial middle cerebral vein (SMCV) has been described as entering or being partially equivalent to the venous sinus coursing under the lesser sphenoid wing, which has classically been called the sphenoparietal sinus. However, the recent literature reports that the SMCV is not connected to the sphenoparietal sinus. In this study, the venous anatomy was evaluated to clarify the anatomy of the sphenoparietal sinus and the termination of the SMCV. Magnetic resonance imaging (MRI) was performed on 1.5-T superconductive units using a three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) sequence with fat suppression in a total of 48 sides of 24 patients. Coronal source images and reconstructed axial images were displayed on the Advantage Window Console, and connections to the cavernous sinus were then evaluated for the venous sinus coursing under the lesser sphenoid wing (hereafter called the sinus of the lesser sphenoid wing), the middle meningeal vein, and the SMCV.

The following findings were observed bilaterally in all patients. The sinus of the lesser sphenoid wing was connected medially with the cavernous sinus and laterally with the anterior branch of the middle meningeal vein near the pterion.

The anterior branch of the middle meningeal vein entered the bony canal laterally above the junction with the sinus of the lesser sphenoid wing and coursed along the inner table of the skull or emerged into the diploic vein, indicating its parietal portion. Although the termination of the SMCV had several patterns, the SMCV was not connected with the sinus of the lesser sphenoid wing in any of the patients. The sphenoparietal sinus is considered to consist of the sinus of the lesser sphenoid wing and the parietal portion of the anterior branch of the middle meningeal vein; these were identified as venous structures distinct to the SMCV.
Selective Transvenous Coil Embolization of Dural Arteriovenous Fistula
Authors: Yoshioka T. , Kitagawa N. , Yokoyama H. , Nagata I.
Published: January 2017

We herein report three cases of dural arteriovenous fistula (DAVF) in which the venous outlet immediately adjacent to the fistula was selectively embolized. Case 1: A 69-year-old man presented with a subarachnoid hemorrhage (SAH). Angiography demonstrated a DAVF in the left superior petrous sinus. Case 2: A 59-year-old woman presented with dizziness. Angiography demonstrated a DAVF adjacent to great vein of Galen. The DAVF drained through the great vein of Galen with retrograde leptomeningeal venous drainage (RLVD). The basal vein of Rosenthal was enhanced from the great vein of Galen. Case 3: A 51-year-old man presented with an occipital seizure. Angiography demonstrated a DAVF adjacent to the left side of the superior sagittal sinus with RLVD. All three cases were successfully treated by the selective embolization of the venous outlet immediately adjacent to the fistula. Therefore, selective embolization preserved normal venous return.
Result of Neck Clipping and Coil Embolization as a Treatment for Unruptured Aneurysm
Authors: Iwamuro Y. , Nakahara I. , Higashi T. , Iwaasa M. , Watanabe Y. , Tsunetoshi K. , Munemitsu T. , Taha M.
Published: January 2017

The report of the International Subarachnoid Aneurysm Trial (ISAT) study showed that coil embolization was superior to neck clipping as a treatment for subarachnoid hemorrhage (SAH) 1. Recently, some results of treatments for unruptured aneurysm via coil embolization and neck clipping have been reported2,3. We compared the results of coil embolization and neck clipping in our institute. Generally better outcomes were obtained by endovascular surgery than by neck clipping. Postoperative ischemic strokes occurred in one case (1.8%) as a major stroke and in three cases (5.6%) as a minor stroke among coil-treated cases, and in two cases(2.6%) as a major stroke, and in seven cases(9.0%) as a minor stroke among neck clipping cases.

Other complications after these treatments were six cases of subdural effusion/hematoma, four cases of infection, two cases of epidural hematoma, one abducens nerve palsy, one hydrocephalus, and one acute myocardial infarction among 78 neck clipping cases, and two subcutaneous hematoma, one pseudoaneurysm at the puncture points, one direct carotid-cavernous fistula among 54 coil-treated cases. Four coil-treated cases, in which introduction of microcatheters to the aneurysm was impossible, were treated completely by neck clipping after endovascular treatments. In terms of modified Rankin Scale(mRS) three months after treatments, while mRS 3 was noted in only one case in the endovascular treatment group, there were one case of mRS 3, two cases of mRS 4, and two cases of mRS 5 in the neck clipping group. Duration of hospitalization averaged 11.9 days in the endovascular group and 24.1 days in the neck clipping group. The results of endosaccular enbolizations as treatment of the unruptured aneurysm seems to be better than neck clipping. However, not all cases of unruptured aneurysms can be treated by coil embolization due to the width of aneurysmal neck and relation of the aneurysm to parent arteries. Therefore, surgeons should also be able to perform neck clipping as an alternative modality.
Revascularization Procedure Mainly by Suction Thrombectomy for Acute Cervical Carotid Occlusion
Authors: Yano T. , Sakai N. , Yamagami H. , Kanefuji K. , Kobayashi J. , Adachi H. , Ueno Y. , Kunieda T. , Morizane A. , Osaka N. , Kajikawa R. , Sakai C. , Kikuchi H.
Published: January 2017

In many cases, the prognosis for acute cervical carotid artery occlusion is poor. However, a standard treatment for the acute stage is not yet established. We report here the results of eight consecutive patients (mean age 71.5 years old) in which revascularization mainly by suction thrombectomy was performed under proximal protection during the acute phase. The occlusion sites were the intracranial internal carotid artery in five patients, tandem lesions of the internal carotid origin and intracranial vessel in two patients, and the common carotid artery in one patient. In addition, the subjects who received the treatment had an extent of infarction in MRI/DWI that was 1/3 or less of the internal carotid artery territory. The mean time from the onset to treatment commencement was 7.25 hours (2–28 hours). For the endovascular treatment, a guiding catheter with a balloon was used for proximal protection of the carotid artery. Revascularization was performed mainly by suction thrombectomy, and if a stenosed lesion was observed, PTA/stenting was added. Local fibrinolysis was not performed in combination with the above procedure. The treatment results were complete recanalization in three patients and partial recanalization in three patients. However, recanalization was not achieved in two patients. No hyperfusion syndrome or hemorrhagic infarction was observed postoperatively. All four patients in whom thrombi were successfully aspirated had occlusions proximal to the ophthalmic artery branch. In three of these four patients, complete recanalization was achieved. The revascularization procedure using suction thrombectomy under proximal protection was considered effective against the acute cervical carotid occlusions, in particular, those proximal to the ophthalmic artery branch.
Preliminary Report on the Thrombogenic Properties of Tantalum-GDC Coils An Experimental Study
Authors: Guglielmi G.
Published: January 2017

In order to overcome the possibility of re-canalization and compaction with Platinum GDC coils Tantalum coils were placed in three aneurysms in swine. Comparative coiling was done on the other side in each animal with platinum GDC.

More stable thrombus was observed on the aneurysms coiled with Tantalum GDC.
Endovascular Management of Posterior Cerebral Artery Aneurysms
Authors: Zhao Z.-W. , Deng J.-P. , Gao L. , Gao G.-D.
Published: January 2017

The purposes of this study were to evaluate the efficacy and safety of the endovascular management of posterior cerebral artery aneurysms and compare the efficacy and safety of selective aneurysmal coiling and parent artery occlusion.

We reviewed all cases with cerebral aneurysms and attention was paid to the patients with posterior cerebral artery aneurysms. Among 550 aneurysms, eight aneurysms in eight patients were located on the posterior cerebral artery, three of which presented with SAH, whereas five presented with different degrees of headache. Seven were located at the P2 segment and one at the P3 segment. One was a giant serpentine aneurysm, two were giant sac aneurysms, two were large and three were small.

All aneurysms were successfully treated, five with selective aneurysmal coiling and three with parent artery occlusion. Two patients presenting with headache with giant aneurysms had suffered an aggravated headache for two weeks which then resolved. Others had an uneventful recovery. All patients were followed from 12 months to 56 months. Four selective aneurysmal coiling aneurysms received digital subtraction angiography, two of which needed another treatment and one was treated with parent artery occlusion, one of which recanalized slightly and one of which had further thrombosis. No rebleeding or any other symptom occurred.

Whether selective aneurysmal coiling or parent artery occlusion was performed, endovascular management of PCA aneurysms was a safe and effective method. Under some conditions, parent artery occlusion was better than selective aneurysmal coiling.
Endovascular Treatment of a High-Flow Direct Traumatic Carotid Cavernous Fistula with a Two Year Follow-up
Authors: Fang C.
Published: January 2017

Endovascular treatment of high-flow direct traumatic carotid cavernous fistula (CCF) carries many difficulties. One of them is that carotid dissection may be associated with pseudo-aneurysm formation even when the CCF can be successfully embolized by detachable balloons. This article details a unique technique of treating pseudo-aneurysm by obstructing the lumen with preservation of the parent artery.

The case presented here involves a 50-year-old man with a history of severe trauma. The angiography revealed that his bilateral high-flow carotid cavernous fistula was successfully embolized by detachable balloons and control digital subtraction angiography at the end of the procedure demonstrated the fistula closed and the internal carotid artery preserved. But two months later, a pseudo-aneurysm formed in the right internal carotid artery. Under endovascular treatment along with other techniques including coils, stent-assisted and covered stent, the pseudo-aneurysm was excluded with preserved ICA. Two years later, the fistula and pseudo-aneurysm both disappeared quietly without patent foreign body reaction in the parent arterial wall.
Paediatric Dissecting Aneurysm of the Posterior Cerebral Artery
Authors: Bradač G.B. , Peretta P. , Stura G. , Ragazzi P. , Gaglini P.P. , Bergui M.
Published: January 2017

Aneurysms in children are rare. We describe a large spontaneous dissecting aneurysm of the posterior cerebral artery. The clinical presentation was characterized by headache as the sole symptom due to a mass effect leading to hydrocephalus. Acute treatment with a temporary ventricular shunt was followed by occlusion of the aneurysm via an endovascular approach leading to a complete recovery of the patient.
Subarachnoid Hemorrhage with Cerebral Vein Thrombosis and Aneurysmal Disease: A Treatment Conundrum
Authors: Davagnanam I. , Brew S.
Published: January 2017

Coexisting cerebral vein thrombosis and aneurysmal disease in the setting of acute subarachnoid hemorrhage is rare. We present the case of a 62 year-old woman presenting to our institution with an episode of collapse with a transient loss of consciousness with a 24 hour history of occipital headache. Imaging demonstrated extensive basal cisternal, intraventricular and cortical subarachnoid hemorrhage. Digital subtraction angiography and magnetic resonance imaging confirmed the presence of an aneurysm in the proximity of the right posterior communicating artery as well as thrombosis of the right anastomotic vein of Labbe. The patient underwent endovascular coil embolization to exclude the aneurysm and post-treatment anticoagulation. Despite a SAH rebleed with reversal of the anticoagulation, the patient subsequently made an unremarkable recovery with no neurological deficit.
Current Status and Future Direction of Interventional Neuroradiology, the Official Journal of the World Federation of Interventional and Therapeutic Neuroradiology
Authors: Kim J.K. , Yang S.H. , Young P.S. , Suh D.C.
Published: January 2017

Interventional Neuroradiology (INR) is an international journal devoted to a highly sub-specialized field with international editorial board members and a representative journal through which the specialty of neurointervention has continuously evolved, especially through the efforts and passion of Professor Pierre Lasjaunias. Articles in INR are submitted by authors in many countries worldwide and are peer reviewed by international referees. Considering that interventional neuroradiology is the highly specialized field that INR pursues, the impact factor or the Eigenfactor score of INR is still very low partly because the LinkOut services, including PubMed, are not yet provided in a sufficiently open way. Ethical research standards should also be emphasized in INR.
Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management
Authors: Pan J. W. , Zhou H.J. , Zhan R.Y. , Wan S. , Yan M. , Fan W.J. , Wu Z.X. , Zheng S.S.
Published: January 2017

Onyx is increasingly used in endovascular therapy of intracranial arteriovenous malformations (AVMs). However, the embolic effect and post-embolization management are still under discussion. We report our experience in the treatment of supratentorial brain arteriovenous malformations (SBAVMs) with Onyx and discuss post-embolic management.

From June 2006 to July 2008, 20 patients with SBAVM were embolized with Onyx. There were 14 men and six women ranging from 14 to 64 years of age (mean 38.3 years). Initial symptoms included spontaneous hemorrhage (n=12), headaches (n=4), seizure (n=3) and incidentally disclosed after head trauma (n=1). After the endovascular procedure, all had subsequent treatment (follow-up angiogram, stereotactic radiosurgery or microsurgery) according to the obliteration degree.

At angiography, seven patients (35%, 7/20) were completely obliterated (over 95% closure) after embolization while one suffered a small subarachnoid hemorrhage without permanent clinical sequelae. Four patients (20%, 4/20) were subtotally obliterated (over 80% closure), one patient who suffered severe cerebral edema after embolization underwent decompressive craniectomy, two patients had additional radiosurgery and one patient had follow-up angiogram. Nine patients (45%, 9/20) were partially obliterated (20–80% closure), five patients had additional surgery, two patients had additional radiosurgery and two patients had follow-up angiogram (one patient had intraventricular hemorrhage three months after embolization). Of all 20 AVMs, an average of 2.2 ml Onyx was used per patient and average volume reduction was 80% (range, 30%–99%).

Onyx is suitable for embolization of SBAVMs because of its diffuse controllable properties. We suggest clinical follow-up after complete obliteration, additional radiosurgery or angiographic follow-up after subtotal obliteration and additional surgery after partially obliteration. More cases with long-term follow-up are needed to evaluate the long-term prognosis of our post-embolization management.
Treatment and Outcome of Intracranial Hemorrhage after Carotid Artery Stenting
Authors: Xu Y. , Wanga Y. , Feng L. , Miao Z. , Ling F.
Published: January 2017

Intracranial hemorrhage following carotid artery stenting (CAS) is a rare but potentially devastating complication. The present study reviewed intracranial hemorrhage cases from patients undergoing CAS in ten years to find the methods to rescue patients from this fatal complication.

Patients with postoperative intracranial hemorrhage following CAS were retrospectively selected, and clinical features, treatments and outcomes were studied.

Ten patients with intracranial hemorrhage were identified. The mean onset time of hemorrhage was 6.1 ± 7.1 h. Intracerebral hemorrhage occurred in eight patients and SAH in two patients. The patients were treated by stopping anti-platelet and anticoagulant for at least three days, and surgical drainage of the hematoma/ventricle drainage or conservative treatment. Six patients survived, two had left moderate paralysis, four had a good recovery at four week follow-up, and four patients died. No patients underwent thrombosis in stent after withdrawing of antiplatelet and anticoagulant.

Intracranial hemorrhage after CAS occurs usually in a few hours and leads to catastrophic results. Once patients have intracranial hemorrhage, good neurocritical care may help to save them. Stopping antiplatelet and anticoagulant for at least three days may avoid thrombosis in the stenting site.
Y-Crossing of Braided Stents with Stents and Flow Diverters Does Not Cause Significant Stenosis in Bench-Top Studies
Authors: Makoyeva Alina , Darsaut Tim E. , Salazkin Igor , Raymond Jean
Published: January 2017

Y-stent placement to treat bifurcation aneurysms requires the second device to cross the confines of the first stent, with concerns regarding the formation of stenosis of the second device at the site of crossing.

Various braided stents and flow diverters (FDs) were deployed to cross through a high porosity braided stent, in a Y configuration, with the ends of the devices inserted in plastic tubes of various diameters, leaving the mid-portion free to expand. The ensuing constructs were photographed, paying attention to the degree of stenosis, if any, created where the second device crosses the first stent. Experiments were repeated selecting different zones of the first stent as the site of crossing for the second device, different tube diameters, and changing the angle of the bifurcation.

Crossing the first stent did not cause the second stent to become significantly stenosed in any case. Crossing through the transition or expansion zone of the first device had no influence on results. Different bifurcation angles had no influence on the occurrence of stenosis.

Y-stent placement to treat arterial bifurcations using braided self-expanding stents and FDs does not lead to significant stenosis in bench-top studies.
Spinal Cord Infarction is an Unusual Complication of Intracranial Neuroendovascular Intervention
Authors: Matsubara Noriaki , Miyachi Shigeru , Okamaoto Takeshi , Izumi Takashi , Asai Takumi , Yamanouchi Takashi , Ota Keisuke , Oda Keiko , Wakabayashi Toshihiko
Published: January 2017

Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention. The authors report on two cases involving spinal cord infarction after endovascular coil embolization for large basilar-tip aneurysms. Each aneurysm was sufficiently embolized by the stent/balloon combination-assisted technique or double catheter technique. However, postoperatively, patients presented neurological symptoms without cranial nerve manifestation. MRI revealed multiple infarctions at the cervical spinal cord. In both cases, larger-sized guiding catheters were used for an adjunctive technique. Therefore, guiding catheters had been wedged in the vertebral artery (VA). The wedge of the VA and flow restriction may have caused thromboemboli and/or hemodynamic insufficiency of the spinal branches from the VA (radiculomedullary artery), resulting in spinal cord infarction. Spinal cord infarction should be taken into consideration as a complication of endovascular intervention for lesions of the posterior circulation.
Endovascular Therapy in Hyperacute Ischaemic Stroke: History and Current Status
Authors: Mortimer Alex M. , Bradley Marcus D. , Renowden Shelley A.
Published: January 2017

This is a literature review on to the use of endovascular therapy in hyperacute ischaemic stroke secondary to large vessel occlusion (LVO). The prognosis for LVO is generally poor and the efficacy of intravenous tissue plasminogen activator (IV TPA) in the treatment of this subtype of stroke is questionable. It is well documented that recanalisation is associated with improved outcomes but IV TPA has limited efficacy in LVO recanalisation and the complication rates are higher for IV TPA in this stroke subset.

Improved recanalisation rates have been demonstrated with intra-arterial TPA and first and second generation mechanical techniques but the rate of favourable outcome has not overtly mirrored this improvement.

Several controversial trials using these early techniques have recently been published but fail to reflect modern practice which centres on the use of stent-retriever technology. This has been proven to be superior to older techniques. Not only are recanalisation rates higher, but the speed of recanalisation is greater and clinical results are improved.

Multiple observational studies demonstrate consistently high rates of LVO recanalisation; TICI 2b/3 in the order of 65–95% and, rates of favourable outcome (mRS 0–2) in the order of 55% (42.5–77%) in clinically moderate to severe stroke with complicating symptomatic haemorrhage in the order of 1.5–15%.

A major factor determining outcome is time to treatment but success has been demonstrated using these devices with bridging therapy, after IV TPA failure or as a stand-alone treatment.
The Guglielmi Detachable Coil in the Treatment of Arteriovenous Fistulae
Authors: Evans A.J. , Jensen M.E. , Mathis J.M. , Dion J.E.
Published: January 2017

This report describes the use of the Guglielmi Detachable Coil (GDC) (Target Therapeutics, Fremont CA) in the treatment of cervicocerebral arteriovenous fistulae. From March, 1993 to May 1995 we used GDCs in an IRB approved protocol as part of the endovascular treatment of 11 patients with arteriovenous fistulae of internal carotid, external carotid, or vertebral vessels.

The patient population included four patients with dural arteriovenous fistulae, three patients with direct carotid cavernous fistulae, three patients with vein of Galen malformations, and one patient with a vertebral artery - vertebral vein fistula.

In six of the 11 patients the AVF were completely occluded. Fistula occlusion occurred in two patients immediately, in three patients in a delayed fashion (three days to nine months) and in one patient the fistula was closed immediately, reopened spontaneously, and then reoccluded at a second procedure 17 months later. In five patients the fistula was incompletely occluded (20–95%).

In all cases but one the coils were used in conjunction with another embolic agent. In this small series of patients we found that GDCs generally could be deposited predictably at the desired site, and that they could be observed prior to detachment to help ensure that the coil was in a secure position, decreasing the chances of unintended passage into the venous outlet.

Although they rarely proved thrombogenic enough to stop the fistula, GDCs can slow the flow in a fistula, allowing other, more thrombogenic embolic agents to be deposited with a decreased risk of distal embolisation.

In conclusion, we found GDCs to be a useful tool in the treatment of AV fistulae. In combination with other embolic agents, this device can aid in the safe, effective closure of these lesions.
The Natural History and Management of Intracranial Dural Arteriovenous Fistulae
Authors: Davies M.A. , ter Brugge K. , Willinsky R. , Wallace M.C.
Published: January 2017

The natural history of aggressive intracranial dural arteriovenous fistulae (ICDAVF) is unknown. Despite this, the recently proposed classification scheme of Borden et al (Borden*) has the potential to predict aggressive lesion behavior after presentation for any lesion, but has so far been untested.

In addition, they discuss a new but logical treatment strategy for aggressive ICDAVF based on the elimination of retrograde leptomeningeal venous drainage (RLVD). Our similar philosophy and substantial experience with these lesions, provides a unique opportunity to test these hypotheses.

A cohort of 46 Borden* grade II and III ICDAVF was selected from a series of 102 ICDAVF seen at a single institution between 1984 and 1995. Patients with these lesions, presumed to have an aggressive course were all offered treatment. Conservative therapy was chosen by 14 (30%) patients, 22 (47%) had surgery, and 20 (43%) had embolisation either as sole treatment or prior to surgery. During the follow-up period (249 lesion months) for the conservatively treated group, four (29%) patients died. Excluding presentation, these patients were observed to have interval rates of intracranial hemorrhage (ICH), non haemorrhagic neurological deficit (NHND), and mortality, of 19.2%, 10.9%, and 19.3% / lesion year respectively.

The 11 patients who had embolisation alone were followed for a total of 344 months after treatment. All nine patients who had lesion obliteration, or subtotal obliteration with elimination of RLVD, as confirmed by angiography, experienced improvement or complete clinical recovery. Two patients had subtotal obliteration without elimination of RLVD. One died from interval ICH and the other experienced a delayed NHND.

Twenty-five surgical operations were performed on 23 ICDAVF in 22 patients. Resection of the ICDAVF was performed in 9 patients, and 16 patients were treated with surgical disconnection alone. Complications occurred in 3/9 (33%) patients who had their lesions resected and none of the disconnected group. Failure to achieve angiographic obliteration of RLVD in 2 patients treated with resection was associated with an adverse outcome in both cases (death, and interval NHND). All 16 (100%) of the disconnected group were shown to have undergone angiographic obliteration with excellent clinical outcome.

Untreated, Borden* grade II and III ICDAVF have a poor natural history. Also, persistence of RLVD after inadequate treatment results in adverse outcomes. Embolisation usually improves the safety of surgical access and may lead to obliteration on its own in some cases. For the aggressive ICDAVF, surgery is required in most cases, and our data confirm that surgical disconnection alone results in cure of all Borden* grade III ICDAVF, and in grade II lesions, if not cure, conversion to a benign grade I lesion.
Treatment of an Arteriovenous Shunt Draining into a Venous Angioma by Selective Embolisation
Authors: Akai T. , Kuwayama N. , Kubo M. , Endo S. , Takaku A.
Published: January 2017

We treated a 62-year-old woman who suffered from intraventricular haemorrhage. Angiography revealed an arteriovenous shunt draining into a venous angioma. She was successfully treated by obliteration of the arteriovenous shunt with transarterial embolisation.

Angiography performed after embolisation demonstrated that the persisting venous angioma served as the draning vein for normal middle cerebral artery perfusion.

We believe that selective arterial occlusion with preservation of the venous component is the best treatment for this type of mixed vascular malformation.
The Immunology of Gluten Sensitivity beyond the Intestinal Tract
Authors: Vojdani A. , O'Bryan T. , Kellermann G.H.
Published: January 2017

Celiac disease and gluten-sensitive enteropathy are terms that have been used to refer to a disease process affecting the small bowel. However, evidence has been accumulated in literature demonstrating that gluten sensitivity or celiac disease can exist even in the absence of enteropathy, but affecting many organs. Based on overwhelming evidence, immunological pathogenesis has been demonstrated in the joint, the heart, thyroid, bone, and, in particular, the brain cerebellum and neuronal synapsin I. When blood samples of patients with celiac disease are tested against gliadin and different tissue antigens, in addition to gliadin antibody, a significant percentage of them exhibit elevation in antibodies against transglutaminase, heat shock protein, collagen, thyroid, myosin, endothelial cell, bone antigen (transglutaminase), myelin basic protein, cerebellar and synapsin. This elevation of autoantibodies in patients with celiac disease may result in neuroimmune disorders. In fact, in comparison to the general population, the incidence of various autoimmune disorders, including gluten ataxia, is increased up to 30-fold in patients with celiac disease. Therefore, immune evaluation of patients with gluten sensitivity or celiac disease, in addition to gliadin and transglutaminase, should include antibody measurement against thyroglobulin, thyroid peroxidase, heat shock protein, bone transglutaminase, myelin basic protein, cerebellar peptide and synapsin. This novel laboratory approach to gluten sensitivity and autoimmunity may enable clinicians to detect markers of autoimmune diseases. Early identification of gluten sensitive and celiac disease patients and implementation of a gluten-free diet may result in significant improvement and control of associated diseases.
Complement C3 Genotyping of Slow and Fast Variants by Real Time PCR-High Resolution Melting
Authors: Valero-Hervás D.M. , Morales P. , Castro M.J. , Varela P. , Castillo-Rama M. , Moreno E. , Meneu J.C. , Mora-Díaz S. , Talayero P. , Paz-Artal E.
Published: January 2017

“Slow” and “Fast” C3 complement variants (C3S and C3F) result from a g.304C>G polymorphism that changes arginine to glycine at position 102. C3 variants are associated with complement-mediated diseases and outcome in transplantation. In this work C3 genotyping is achieved by a Real Time PCR - High Resolution Melting (RT-PCR-HRM) optimized method. In an analysis of 49 subjects, 10.2% were C3FF, 36.7% were C3SF and 53.1% were C3SS. Allelic frequencies (70% for C3S and 30% for C3F) were in Hardy-Weinberg equilibrium and similar to those published previously. When comparing RT-PCR-HRM with the currently used Tetraprimer-Amplification Refractory Mutation System PCR (T-ARMS-PCR), coincidence was 93.8%. The procedure shown here includes a single primer pair and low DNA amount per reaction. Detection of C3 variants by RT-PCR-HRM is accurate, easy, fast and low cost, and it may be the method of choice for C3 genotyping.
Balkan Endemic Nephropathy Risk Associates to the hs1.2 Ig Enhancer Polymorphism
Authors: Frezza D. , Serone E. , Lolli S. , Cianci R. , D'Addabbo P. , Mattioli C. , Giambra V. , Pavlovic N. , Djordjevic V. , Kostic S. , Pandolfi F. , Kostic E.
Published: January 2017

Balkan Endemic Nephropathy (BEN) is a kidney degenerative disease with a high incidence in the valleys of the Danube and tributary rivers. Many studies describe it as a multifactorial disease. Environmental as well immuno-inflammatory and genetic cofactors have been suggested to trigger the onset of the disease. Recently, high levels of C-reactive protein were demonstrated in BEN patients. We performed this study to evaluate the possible correlation of BEN with the polymorphism of the Ig heavy chain 3'Regulatory Region enhancer hsl.2 that is related to changes of consensus for trans activators binding within the DNA sequence and probably consequently autoimmune and inflammatory diseases. Therefore, we studied three cohorts: 1) 111 control subjects, 2) 95 BEN patients in dialysis therapy and 3) 133 components of a large family “J” in the same geographical area. The allelic frequencies of hsl.2 of BEN patients and family “J” components had similar decrease frequency of allele *1 and increase of allele *2 in respect to the controls. This trend suggests the association of allele *1 as a protective and allele *2 as a risk component for the disease. The presence of a consensus sequence for NF-Kb in the allele *2 may link the polymorphism to the inflammatory activity of BEN. This study supports the presence of an inflammatory pathway in BEN through the involvement of polymorphic enhancer hsl.2 influencing differently binding complexes and consequently the 3D structure of 3' Regulatory Region of IgH. Our work is the first study that clearly links BEN to a gene involved in the regulation of immune response.
Isolation of Staphylococcus Aureus and Progression of Periodontal Lesions in Aggressive Periodontitis
Authors: Passariello C. , Lucchese A. , Virga A. , Pera F. , Gigola P.
Published: January 2017

This work evaluates whether isolation and toxicity of subgingival Staphylococcus aureus strains correlate with progression of periodontal lesions and whether isolates are characterized by a specific genomic background. The study involved 165 subjects affected by generalized aggressive periodontitis. Three sets of samples of supragingival and subgingival plaque were obtained at 45-day intervals from active and non-active sites, to detect S. aureus. Susceptibility to antibiotics, the presence of 17 genes, genomic restriction profiles and multilocus sequence typing (MLST) were performed to characterize all isolates. S. aureus was detected in 37.6% of the subjects. Subgingival colonization rates were 66.1% and 12.9% for active and non-active sites, respectively ( P<0.01). Supragingival and subgingival isolates were shown to be distinct by molecular genotyping and DNA fingerprint analysis. MLST showed that isolates were not genetically related and no sequence type was predominant in any of the two locations. These data demonstrate that S. aureus is associated with the progression of aggressive periodontitis and that a specific set of characters is necessary for the bacterium to colonize subgingival sites. Comparative analysis of genomic structure and genetic-related data suggest that the periodontal environment could promote genetic evolution of strains.
Synchronous Onset of Secondary Raynaud's Phenomenon in Monozygotic Twins
Authors: Riccio A. , Sangiolo M.G. , Tarantino G.
Published: January 2017

The heritability of primary Raynaud's phenomenon has been reported in previous works. In this paper we describe the simultaneous onset of Raynaud's phenomenon, rapidly evolved in acrocyanosis and diagnosed as secondary Raynaud's phenomenon, observed in monozygotic twins. This case supports the role of genetic factors in the pathogenesis of such disorder. Moreover, the singular synchronism of its appearance is discussed.
Retrospective Study on 205 Fixtures Inserted in Upper Jaw
Authors: Fanali S. , Lopez M. A. , Bassp M. Andreasi , Confalone L. , De Oliveira D. Pedreira , Carinci F.
Published: January 2017

The rehabilitation of the edentulous maxilla is a relatively common clinical problem and to submerge dental implants during the healing period is a major prerequisite to obtain implant osseointegration. It is believed that micromovement of implants, due to functional forces at the bone-implant interface during wound healing, could induce the formation of fibrous tissue rather than bone, leading to a clinical failure. In addition, the coverage of an implant is also thought necessary to prevent infection and epithelial down-growth. Usually, the second surgical procedure was performed after three months in the mandible and six months in the maxilla. Since no report is available on a new type of implants, a retrospective study was performed on fixtures inserted in upper jaw. A total of 205 two-piece implants (FMD srl, Rome, Italy) were inserted in maxilla, 111 in female and 94 in males. The median age was 59 ± 10 (min-max 24–80 years). Twenty four diabetic patients were enrolled, 141 had periodontal disease and 96 were smokers. Two surgeons performed operation. Fixtures were placed in 6 totally edentulous patient, 9 single missing teeth and 190 partially edentulous subjects. Twenty one implants were placed in post-extraction sockets; GBR was performed onto 26 fixtures and 3 were immediately loaded. There were 109 single crowns, 96 implants bearing 2 or greater bridges. Two implants were lost, survival rate = 99.02%. Among the studies variables immediate loaded implants on single tooth rehabilitations (p=0.03) have a worse clinical outcome. Then peri-implant bone resorption (i.e. delta IA J) was used to investigate SCR. Among the remaining 203 implants, 20 fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 89.13). Statistical analysis demonstrated that diabetes (p=0.001) and periodontal disease (p=0.047) had a worse outcome. In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.
Wide Diameter Implants: Analysis of a Case Series
Authors: Confalone L. , Lopez M. A. , Bassi M. Andreasi , Fanali S. , Candotto V. , Carinci F.
Published: January 2017

In the last decade the use of wide diameter implants (WDI, i.e. diameter > 3.75 mm) has increased especially in posterior jaws because it is generally accepted that WDI: 1- improve the ability of posterior implants to tolerate occlusal forces, 2- create a wider base for proper prosthesis, and 3- avoid placing two standard-size implants (SSI = 3.75 mm) at one site to obtain a double-root prosthetic tooth. Since no report is available on a new type of implants, a retrospective study was performed. A total of 124 two-piece implants (FMD srl, Rome, Italy) were inserted, 56 in female and 68 in males. The median age was 59 ± 12 (min-max 28–75 years). Implants were inserted 59 in the maxilla and 65 in the mandible; they replaced 7 incisors, 4 cuspids, 23 premolars and 90 molars. One implant was lost, survival rate = 99.20%. Among the studies variables immediate loaded implants (p=0.05) and upper jaw (p=0.005) have a statistically significant worse outcome. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Among the remaining 123 implants, 2 fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 97.54). Statistical analysis demonstrated that single crown have a higher peri-implant crestal bone resorption if compared with bridge supported by 2 or more implants (p=0.03). In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.
Reliability of Short Implants in Oral Rehabilitation
Authors: Bassi M. Andreasi , Lopez M. A. , Confalone L. , Fanali S. , Candotto V. , Carinci F.
Published: January 2017

Implant prostheses are often used to restore partially or completely edentulous patients but limited bone height, especially in the posterior mandible, may restrict the use of dental implants. Short implants (i.e. x ≤ 10 mm) may be selected in these situations. They have several advantages: 1 - restricting the need for sophisticated and expensive surgical procedures like sinus lifting, bone grafting and mandibular nerve transposition, 2 - placing short-span dentures and 3 - avoiding cantilevers in the posterior sextants. The limited surface area of SIs, conversely, can be a potential disadvantage as it has less resistance to occlusal forces. Since no report is available on a new type of implants, a retrospective study was performed. A total of 148 short (i.e x ≤ 10 mm) two-piece implants (FMD srl, Rome, Italy) were inserted, 91 in female and 57 in males. The median age was 58 ± 12 (min-max 25–80 years). Implants were inserted 68 in the maxilla and 80 in the mandible. One implant was lost, survival rate = 98.52%. Among the studies variables post-extractive implants on single tooth rehabilitations (p=0.043) was the only significant variable. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Among the remaining 147 implants, 18 fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 87.75). Statistical analysis demonstrated that only diabetes has a negative impact on peri-implant crestal bone resorption (p=0.016). In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.
Titanium Disk Surfaces Modulate Dental Implants Osseointegration
Authors: Lopez M. , Bassi M. Andreasi , Confalone L. , Fanali S. , Candotto V. , Cura F. , Carinci F.
Published: January 2017

Titanium and titanium alloys are widely used as implant materials due to their excellent biocompatibility and mechanical properties. The aim of this work is to compare five different titanium layers in order to investigate which one had a greater osteoconductive power using Human Osteoblasts (HObs) culture for seven days on these surfaces. The expression levels of some bone-related genes (ALPL, COL1A1, COL3A1, SPP1, RUNX2 and SPARC) were analyzed using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). Results obtained in this study demonstrate that titanium disks can lead to osteoblast differentiation and extracellular matrix deposition and mineralization by the activation of different osteoblast genes in relation to the specific type of surface treatment.
Effects of 17ß-Estradiol on the Acute Necrotizing Pancreatitis after Onset in Rats
Authors: Alhan E. , Cinel A. , Türkyilmaz S. , Erçin C. , Kural B.V. , Usta A.
Published: January 2017

The aim of this study was to investigate the influence of 17ß-estradiol (E2) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. Rats were divided into six groups as sham + saline, sham + single dose E2 (SDE2), sham + multiple dose E2 (MDE2), ANP + saline, ANP + SDE2, and ANP + MDE2. ANP in rats was induced by glycodeoxycholic acid. The extent of acinar cell injury, mortality, systemic cardiorespiratory variables, functional capillary density (FCD), renal/hepatic functions, and changes in some enzyme markers for pancreatic and lung tissue were investigated during ANP in rats. The induction of ANP resulted in a significant increase in the mortality rate, pancreatic necrosis, and serum activity of amylase, alanine aminotransferase (ALT), interleukin (IL)-6, lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, serum concentration of urea, and tissue activity of myeloperoxidase (MPO) and malondialdehyde (MDA) in the pancreas and lung, and a significant decrease in concentrations of calcium, blood pressure, urine output, p02, and functional capillary density (FCD). The use of E2 did not alter these changes. E2 demonstrated no effect on the course of ANP in rats. Therefore, it has no value in the treatment during acute pancreatitis.