bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceived Barriers and Facilitators to Physical Activity in Kidney Transplant Recipients
Authors: Sánchez Zoila V. , Cashion Ann K. , Cowan Patricia A. , Jacob Susan R. , Wicks Mona N. , Velasquez-Mieyer Pedro
Published: January 2017

Background

Relatively few transplant recipients participate in regular physical activity. There is a paucity of information regarding barriers and facilitators to physical activity in kidney transplant recipients.

Objective

To investigate factors that transplant recipients perceive as barriers and facilitators to physical activity and whether these barriers and facilitators differ on the basis of transplant patients' reported level of physical activity. Method—Using a descriptive, cross-sectional design, a convenience sample of 100 kidney transplant recipients provided survey data on a physical activity questionnaire on their current levels of physical activity and determinants that influence participation in physical activity.

Results

The “rarely/never” (32%) physical activity group reported more frequent barriers and the “often” (20%) group reported the least. Overall, perceived facilitators were reported most frequently by the “often” (80%) physical activity group and least by the “rarely/never” (67%) group.

Conclusions

Motivational interventions should focus on diminishing perceived barriers in the less physically active transplant recipients and enhancing perception of health-related facilitators. Nurses should be innovative in customizing interventions, recommending structured physical activity programs, and encouraging less structured, enjoyable ways to increase activities that expend energy. Interventions with achievable outcomes and realistic expectations are more acceptable to patients.
Hepatic Iron Content and the Risk of Staphylococcus Aureus Bacteremia in Liver Transplant Recipients
Authors: Singh Nina , Wannstedt Cheryl , Keyes Lois , Mayher Debra , Tickerhoof Lisa , Akoad Mohamed , Wagener Marilyn M. , Frye Roy , Cacciarelli Thomas V.
Published: January 2017

Iron is a critical nutrient source and contributes to staphylococcal pathogenesis. We assessed the role of hepatic explant iron overload as a risk factor for Staphylococcus aureus bacteremia in liver transplant recipients. Seven of 13 cases with S aureus bacteremia (53.8%) had hepatic explant iron concentrations that exceeded normal limits (grade ≥ 2). Length of posttransplant intensive care unit stay ( P = .013) and hepatocellular carcinoma as underlying liver disease ( P = .04), but not hepatic explant iron concentration, correlated with a higher risk of S aureus bacteremia after transplantation. However, noncarriers (patients without S aureus nasal carriage) who developed S aureus bacteremia were more likely to have high hepatic iron content; 4 of 7 (57%) noncarriers with high-grade iron content developed S aureus bacteremia but no noncarriers with low-grade iron content did ( P = .07). All noncarriers who became infected had high iron content (grade ≥ 2) of the hepatic explant. A readily quantifiable assessment of hepatic iron at the time of transplantation can potentially identify patients without carriage who may be at risk for early S aureus bacteremia.
Nursing and Transplant Coordination: A Call for Clarity
Authors: McNatt Gwen E.
Published: January 2017

Organ transplantation is a complex and highly regulated field. This review focuses on the role of nurses and transplant coordinators in solid organ transplantation, excluding both inpatient staff nursing and procurement activities. The literature describes a robust and autonomous transplant coordinator role; a key member of the multidisciplinary transplant team. Transplant coordinators facilitate patient care throughout all phases of transplantation. However, a lack of consensus on licensure and educational preparation of these important practitioners was evident from the review of literature. Synthesis of the data suggests that the role of transplant coordinator is not distinct but a description of a wide variety of functions, duties, and tasks that require varying levels of licensure and educational preparation. Greater clarity for both practitioners and consumers could be achieved by creating certification levels similar to nephrology nurses. As no transplant-specific staffing models or benchmarks were discovered, rigorous research regarding optimal staffing patterns is also recommended.
Effects of Hyperglycemia on the Development of New-Onset Diabetes after Liver Transplantation
Authors: Anderson April L. , Lewis Daniel A. , Steinke Douglas T. , Ranjan Dinesh , Smith Kelly M. , Clifford Timothy M.
Published: January 2017

Context

New-onset diabetes after transplantation (NODAT) has been associated with cardiovascular and thrombotic complications, acute rejection, and infection in transplant recipients. NODAT in kidney transplantation is well described; however, data are lacking in liver transplant recipients.

Objective

To evaluate the incidence of new-onset diabetes within 6 months postoperatively in adult liver transplant recipients.

Design, Participants, Setting, and Interventions

Patients who underwent a liver transplantation at our institution between January 2004 and December 2005 were retrospectively evaluated. NODAT was defined according to the diagnostic criteria of the American Diabetes Association/World Health Organization, persistent hyperglycemia (serum glucose ≥200 mg/dL occurring 2 weeks after initial steroid induction and persisting for more than 2 weeks), or the need for hypoglycemic agents upon discharge.

Main Outcomes

Incidence of NODAT within 6 months after transplantation in patients with poor glycemic control within the first 2 weeks after transplantation, acute rejection episodes, infections, hospital readmissions, and cardiovascular and thrombotic events.

Results

Forty-five patients were evaluated. Within the first 6 months after transplantation, NODAT developed in 11 (24%). Acute rejection, infection, hospital readmissions, cardiovascular events, and thrombotic events did not differ between the groups.

Conclusion

Elevated fasting levels of blood glucose during the first 2 weeks after liver transplantation may be associated with an increased incidence of NODAT and may have predictive value. More studies are needed to determine the effects of recognition and treatment of hyperglycemia in recent transplant recipients.
Development of a Survey to Identify Barriers to Living Donation in Kidney Transplant Candidates
Authors: Barnieh Lianne , McLaughlin Kevin , Manns Braden , Klarenbach Scott , Yilmaz Serdar , Hemmelgarn Brenda ,   for the Alberta Kidney Disease Network
Published: January 2017

Background

Kidney transplantation from living donors, compared with deceased donors, has improved health care outcomes for patients with end-stage renal disease; however, less than 40% of transplants come from living donors. Numerous barriers may impede the identification of, and transplantation from, living donors.

Objective

To develop and validate a survey to identify barriers that transplant candidates may encounter when seeking a living donor for kidney transplantation.

Methods

The survey was developed in 3 phases: item identification by using persons with a stake in the process to identify key components; survey refinement, including assessment of content and face validity; and assessment of test-retest reliability by using the kappa coefficient and percent agreement for each of the scaled response items.

Results

The final survey contained 10 items with a Likert scale response and 5 open-ended questions. Expert nephrologists in the field confirmed face validity and content validity of the survey. The overall kappa coefficient for the scale was 0.76, reflecting excellent agreement, with an overall percent agreement of 88.7%.

Conclusion

We developed a survey to identify barriers that kidney transplant candidates may experience when seeking a living donor, which demonstrated content and face validity as well as reproducibility. This survey can by used by end-stage renal disease programs to identify barriers in candidates seeking a transplant. The results of the survey can be used to develop interventions to overcome such barriers with an ultimate goal of increasing rates of living kidney donation.
Family, Friends, and Faith: How Organ Donor Families Heal
Authors: Stouder Donald B. , Schmid Adam , Ross Sharon S. , Ross Larry G. , Stocks Lisa
Published: January 2017

Context

Understanding how organ donors' families recover from their grief can help organ procurement organizations improve consent rates and increase the number of deceased donor organs available for transplant.

Objective

To determine what helps the loved ones of deceased organ donors heal from their grief and loss, and to better understand families' needs during the consent process as a way of improving overall consent rates for organ donation.

Design, Setting, and Participants

Written survey of all organ and tissue donors' families in the San Diego and Imperial County (California) service area during 2006 and 2007.

Main Outcome Measures

Responses to the 20-question survey addressing factors that help healing from grief, as well as contextual information about the families' experience at the hospital and the consent process.

Results

Most respondents (84%) indicated that family support was the most helpful thing in dealing with their grief, followed by the support of friends (74%) and religious and cultural beliefs (37%). Most (75%) indicated that they agreed to donation so that something positive could result from their loss. Most respondents (93%) felt that they were given enough information to make an informed decision about donation, and 6% indicated that the donation process interfered with funeral or memorial arrangements. More than 95% understood that their loved one had died before they were approached for consent. Consistent with previous studies, 12% said they still had unanswered questions about aspects of donation, and 15% of respondents indicated that the discussion about organ donation added more emotional stress to their overall experience.
Kidney Donation and Transplantation in Eurotransplant 2006–2007: Minimizing Discard Rates by Using a Rescue Allocation Policy
Authors: Vinkers Maurits T. , Smits Jacqueline M. , Tieken Ineke C. , de Boer Jan , Ysebaert Dirk , Rahmel Axel O.
Published: January 2017

Context

All organ exchange organizations are challenged to maximize the utilization rate of all donors.

Objective

To investigate the benefit of a rescue allocation policy and to study the impact of donor factors on the risk of kidney discard.

Design and Setting

All 4057 donors with kidneys offered for allocation to Eurotransplant between 2006 and 2007 were included. Allocation was patient-oriented, based on a point-score system including recipient and donor factors. If an organ offer was rejected 5 times for medical reasons, allocation was switched to rescue allocation (ie, the organ was then offered in a center-oriented way). A logistic regression model was built to test whether donor factors were predictors of rescue allocation or kidney discard.

Results

Rescue allocation was used for 665 donors (16.4%); within this group, transplant rate was 54.3%, resulting in a donor discard rate of 304 donors (7.5% of total study group). The multivariate model showed that rescue allocation was used significantly more for kidneys from child donors and donors with a high creatinine level. Moreover, testing positive for hepatitis B surface antigen or antibody to hepatitis C virus was associated with an increased probability of rescue allocation. Kidney discard was significantly associated with donation after cardiac death, donor age, serum creatinine level, history of diabetes, and history of hepatitis.

Conclusions

Rescue allocation is effective in lowering donor discard rates. Even with rescue allocation, several donor factors were significantly associated with a higher discard rate. Use of liberal donor criteria and a rescue allocation policy can reduce kidney discards and thus shorten the waiting list for kidney transplantation.
Endovascular Treatment for Intracranial Aneurysms
Authors: Sonobe M.
Published: January 2017

Concerning to the embolization for the intracranial aneurysms, the underlying theme of the discussion is presented with our experiences.
Treatment for Giant Aneurysms in the Cavernous Portion of the Internal Carotid Artery Using Detachable Coils
Authors: Kai Y. , Hamada J. , Mizuno T. , Todaka T. , Morioka M. , Ushio Y.
Published: January 2017

We report 7 patients with symptomatic giant aneurysms in the cavernous portion of the internal carotid artery (ICA) who were treated by trapping the ICA on either side of the aneurysmal orifice using detachable coils. In all 7 patients the ICA was sacrificed; 5 patients subsequently underwent bypass surgery (STA-MCA bypass, n = 4; high-flow bypass, n = 1), the other 2 patients did not. In 6 patients, there were no post-treatment embolic episodes; one patient who had been treated by proximal occlusion of the ICA developed transient ischemia due to an intra-aneurysmal thrombus. Cranial nerve palsies were markedly improved in all patients.

ICA trapping using detachable coils was a highly successful treatment method in these patients. We found the detachable coils effective and easy to use in the trapping methods applied in this series of 7 patients.
Transvenous Detachable Coil Embolization of Direct & High-Flow Carotid-Cavernous Fistula Alternative of Transarterial Detachable Balloon Embolization
Authors: Nishizawa T. , Terada K. , Matsuyama N.
Published: January 2017

We encountered 8 cases of high-flow and direct carotid cavernous fistula (CCF) since 1994. Four patients were treated with transarterial fistula occlusions using detachable balloons before 1997. Complete obliteration of CCFs with preservation of internal carotid artery (ICA) were achieved in all 4 cases using each one balloon. Three cases were approached to the fistulas via the percutaneous transfemoral approach, but one aged patient needed a direct carotid puncture because of her tortuous vessels.

Meanwhile, transvenous embolizations with detachable coils (DCs); Guglielmi detachable coil (GDC), interlocking detachable coil (IDC) and fibered platinum coil were attempted in four cases after 1997; in 2 cases after failure of transarterial approach and in 2 as initial form of treatment.

All 4 cases were successfully approached to the cavernous sinuses (CS) through the inferior petorosal sinus (IPS). At first we intended to block dangerous outflow points for the superior ophthalmic vein (SOV), cortical venous reflux (CVR) and contra-lateral CS. And then obliteration of the fistulas were performed with tight packing of GDCs covering the outside of the ICA. At this time, the arteriovenous shunts were disappeared abruptly, so we finished all procedure without occlusion of IPS. We compared the two methods and concluded that the transvenous embolizaton with DCs is an useful alternative of transarterial detachable balloon therapy of high flow CCF, especially when transarterial approach is difficult or proper balloons are not available.
A Grading System for Intracranial Arteriovenous Malformations Applicable to Endovascular Procedures
Authors: Sheikh B. , Nakahara I. , El-Naggar A. , Nagata I. , Kikuchi H.
Published: January 2017

A grading system was designed by the first author (B.S.) specifically to predict the difficulty of endovascular obliteration of an intracranial arteriovenous malformation based on the feeding arterial characteristics, and the venous drainage system.

We have retrospectively reviewed our cases of intracranial arteriovenous malformation, with special interest in those underwent endovascular embolization. The grading of the AVM was by either our new proposed system or by a surgically oriented grading system. Both systems were compared from the endovascular point of view. Using the present proposed grading system intracranial arteriovenous malformation may range from grade I to grade V. The difficulty of the endovascular embolization correlated well with the new grading system, while in most cases it did not reflect the degree of difficulty of the procedure when a pure surgical grading system was used. This newly designed grading system has a better prediction value to the difficulty of performing endovascular embolization than does other grading systems.
The Strategy for Internal Carotid Stenosis with Thrombus
Authors: Masuo O. , Terada T. , Tsuura M. , Matsumoto H. , Okada H. , Oura Y. , Nakamura Y. , Kido T. , Nakai K. , Itakura T.
Published: January 2017

We report 3 cases of internal carotid artery (ICA) stenosis with thrombus. The initial symptom is transient ischemic attack (TIA) in 1 case, and cerebral infarction due to artery-to-artery embolism in 2 cases. We started anticoagulation and antiplatelet therapy after the angiography on admission in all cases. Carotid endarterectomy (CEA) was performed in 1 case after confirming the disappearance of the thrombus 1 month after the initial attack, although small cerebral embolic infarction happened during this period. In the other cases, percutaneous transluminal angioplasty (PTA) and stenting was performed using the protective technique about 2 weeks after the initial attack without embolic complication. Postoperative angiography showed sufficient dilatation. It seemed that PTA/stenting using the protection system was one of the alternatives for ICA stenosis with thrombus.
Symptoms, Vascular Anatomy and Endovascular Treatment of Spinal Cord Arteriovenous Malformations
Authors: Niimi Y. , Berenstein A. , Setton A. , Pryor J.
Published: January 2017

The purpose of this study is to evaluate the symptoms, anatomy and efficacy of embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of 108 SCAVMs consisting of 38 pediatric and 70 adult cases. They included 81 nidus (26 pediatric) and 27 fistulous (12 pediatric) AVMs. Hemorrhage occurred in 74% of pediatric and 62% of adult cases with multiple hemorrhages in 54% of pediatric and 42% of adult cases. Fistulous AVMs hemorrhaged more frequently in children than adults (75% vs. 13%). 75 cases were treated with embolization alone, 10 with surgery and embolization, 2 with embolization following radiation and 12 with surgery alone. 9 patients received no treatment. In 79 of 87 embolized patients, acrylic was utilized either alone (49) or in combination (30) with other materials. Embolization was attempted 156 times in 93 patients. Complete obliteration by embolization was obtained in 17 cases. If complete obliteration was not possible, partial targeted embolization was performed, aiming at dangerous anatomic structures such as aneurysms. During the follow-up period (mean: 34 months), hemorrhage was observed in only 2 cases. Although technical complications such as dissection or vasospasm occurred on 19 occasions, only 4 resulted in aggravation of neurological symptoms. Of the 21 sessions in which worsening of symptoms occurred after embolization, 10 resulted in permanent deficits and eight of these occurred prior to 1990. SCAVMs have a poor functional prognosis due to frequent hemorrhage if untreated. Embolization with acrylic is feasible as the first choice of treatment. Provocative test and electrophysiological monitoring have improved safety. Partial targeted embolization is effective in preventing hemorrhage.
Treatment of Intramedullary Arteriovenous Malformations of the Spinal Cord
Authors: Ushikoshi S. , Hida K. , Kikuchi Y. , Iwasaki Y. , Miyasaka K. , Abe H.
Published: January 2017

We retrospectively reviewed our treatment results for spinal intramedullary arteriovenous malformations (AVMs). Fifteen consecutive patients were included in this syudy.

Five patient underwent particulate embolization. Surgery was performed in ten patients (including two patient who were treated embolization initially). Five patients, at the beginning of our experience, underwent radical excision of the nidus via the posterior myelotomy. Recent five patients underwent interruption of the feeding pedicles on the surface of the spinal cord. Especially when arteriovenous fistulas (AVFs) or aneurysms were demonstrated, accurate obliteration of them were performed. Four patients, including two with residual AVM after the surgery, underwent irradiation therapy.

Anatomically, four AVMs disappeared completely and the other 11 patients have a residual lesions after the treatment. Clinically, three patients improved, six remained unchanged, and six worsened. The causes of neurological deterioration after the treatment were technical complication of embolization in one patient and surgical manipulation in five. There was no patient who experienced hemorrhage during the follow-up period ranged from 6 months to 17 years, with a mean of 7.5 years.

In conclusion, particulate embolization should be considered as the first choice of treatment if feasible. Surgical treatment is indicated for the dangerous anatomical features such as AVFs or aneurysms.
Measurement of the Intracranial Arterial Wedge Pressure in Cases of Acute Cerebral Arterial Occlusion to Determine the Indication of Intraarterial Thrombolytic Therapy
Authors: Terada T. , Tsuura M. , Matsumoto H. , Masuo O. , Hyotani G. , Ryujin Y. , Kamei I. , Itakura T
Published: January 2017

Wedge pressure of the occluded major cerebral artery (distal pressure beyond the occlusion) was measured to estimate the residual cerebral blood flow in thirteen patients with acute ischemic stroke. There existed the relationship that patients with higher wedge pressure tolerated longer ischemic insults than those with lower wedge pressure. Wedge pressure is measured with minimum time loss before starting thrombolytic therapy and may be a good indicator to estimate the brain tissue reversibility.
Endovascular Surgery for Internal Carotid Stenoses
Authors: Terada T. , Tsuura M. , Matsumoto H. , Masuo O. , Yamaga H. , Moriwaki H. , Hyotani G. , Kamei I. , Nakamura Y. , Kido T. , Nakai K. , Itakura T.
Published: January 2017

This paper will overview our results of endovascular therapy (PTA or stenting) for cervical ICA stenosis and discuss the advantages and disadvantages of each treatment. 60 cases with 62 lesions were treated with PTA 68 times, while 36 cases with 37 lesions were treated with stenting 37 times. A total of 99 lesions were treated with PTA or stenting 105 times. In the PTA group arterial stenosis improved from 76.4% to 21%. In the stent group the stenosis improved from 82.3% to 8.3%. The morbidity rate was 2/60 (3.3%) in PTA group, although two cases had minor neurological deficits, while in stent treated group, morbidity rate was 1/36 (2.8%), although it showed one major neurological deficit. Mortality was 0% in each group. The restenosis rate in PTA group was 15/58 (26%), while it was 0/20 (0%) in stent treated group. Stenting brings significant reduction of stenosis and reduces the rate of restenosis compared to PTA. However, stenting has its own disadvantages such as hypotension and distal kinks when deployed in tortuous ICA stenosis.
Endovascular Coil Occlusion of Intracranial Aneurysms Assisted by a Novel Self-Expandable Nitinol Microstent (Neuroform)
Authors: Henkes H. , Bose A. , Felber S. , Miloslavski E. , Berg-Dammer E. , Kühne D.
Published: January 2017

Endovascular treatment of wide neck intracranial aneurysms is technically difficult and leads to less favorable treatment results and long term outcome. We participated in a multicenter prospective study to evaluate the safety and performance of a new self-expandable nitinol micro stent (Neuroform) in stent assisted coil occlusion of wide neck intracranial aneurysms. Eighteen patients were enrolled in the study in a single center. The anatomy of the target aneurysm and the parent vessel, technical details of the procedure, device functionality, anatomic and clinical results were evaluated. All enrolled aneurysms were either wide necked or showed an unfavorable neck-to-fundus ratio. In 16 out of 18 patients the Neuroform device allowed stent assisted coil occlusion of the aneurysm. The occlusion rate was 95% in eight patients and 100% in eight patients. The two failures were both due to anatomic reasons. Flexibility of the stent, behavior during deployment and subsequent ability to retain coils within the aneurysmal sac were considered as good as or better than the properties of previous balloon expandable stents. No device-related adverse events were encountered. Procedure-related clinical complications occurred in seven patients but caused no severe permanent neurological deficit. The Neuroform neurovascular stenting system is a safe and effective adjunct for the stent-assisted coil occlusion of wide necked intracranial aneurysms. The major advantages of this device are its self-expanding property and very high flexibility which allows safe navigation, easy sizing, as well as accurate positioning of the stent while providing sufficient bridging of the aneurysm neck for subsequent coil placement.
Intraarterial Thrombolysis for Thromboemboli Associated with Endovascular Aneurysm Coiling
Authors: Koebbe C.J. , Horowitz M.B. , Levy E.I. , Dutton K. , Jungries C.C. , Purdy P.D.
Published: January 2017

With the rapidly developing applications of GDC endovascular aneurysm embolization, the recognition and treatment of potential intra-procedural complications is crucial to reducing the morbidity and mortality of this procedure. Thromboembolic complications occur with an incidence of 2–11% with endovascular aneurysm coiling. We describe five cases in which the intraarterial use of thrombolytics was applied to disrupt a fresh clot and recanalize the occluded vessels with variable angiographic and clinical success.

Five cases are presented in which thromboembolic complications occurred during or shortly after GDC endovascular aneurysm occlusion. The complication was recognized while depositing coils in two cases, on post-embolization angiogram in one, and a few hours following embolization in two cases in which a new neurologic deficit developed in the ICU.

In those cases recognized while the microcatheter was near the aneurysm site, immediate thrombolysis was performed at the site of occlusion. The patients who developed a new neurologic deficit were returned to the endovascular suite and the site of occlusion was noted to be distal to the coiled aneurysm. Clot disruption was performed with the microcatheter before delivering intraarterial thrombolytics.

Thromboembolic complications of GDC aneurysm embolization are fortunately rare and can be managed with delivery of thrombolytic therapy at the site of occlusion. Intraarterial thrombolysis of fresh clot caused by GDC aneurysm occlusion can successfully open the occluded vessels but not without serious risk of hemorrhage.
Catheter-Directed Intra-Arterial Abciximab Administration for Acute Thrombotic Occlusions during Neurointerventional Procedures
Authors: Duncan I.C. , Fourie P.A.
Published: January 2017

Abciximab is one of a new class of platelet aggregation inhibitors that has to date been used mainly in the management of acute coronary ischaemic syndromes or during cardiac intervention for the prevention and treatment of acute vessel occlusion during and after angioplasty or stent placement. More recently, it has begun to play a similar role in neurointerventional work. Its administration during acute stent or vessel occlusions has usually been via systemic intravenous infusion. We describe five cases of acute vessel occlusion during neurointerventional procedures where the abciximab bolus was administered intra-arterially at or close to the site of the occlusion, with rapid complete visual dissolution of the thrombus in four cases and partial dissolution in one, resulting in two patients with no neurological deficits, one with no further neurological deterioration, one with a mild residual thumb paresis and one with a severe neurological deficit.
PC-Based 3D Reconstruction of MR Angiography in Evaluation of Intracranial Aneurysms
Authors: Park S.-W. , Han M.H. , Cha S.H. , Kwon B.J. , Kim K.-H. , Kwon O-K. , Baik S.K. , Chang K.-H.
Published: January 2017

In this study, we present our experiences of personal computer-based 3D reconstructions of MRA for pre-treatment planning and post-treatment follow-up for cerebral aneurysms. Twenty-nine ruptured or unruptured intracranial aneurysm patients with 36 intracranial aneurysms, who underwent embolization and pretreatment and/or follow up 3D MRA were included in this study. All 29 patients were examined by DSA and MRA before (18 patients, 24 aneurysms) and/or after embolization (16 patients, 17 aneurysms). The MRA source images were transported to a personal computer in DICOM format for viewing, post-processing, and 3D reconstruction. DSA and PC based SSD 3D MRA equally well demonstrated most aneurysms before embolization (17 patients, 22 aneurysms). The depiction of aneurysm morphology, neck evaluation and branch vessel interpretation were much easier on 3D MRA, which has the ability to manipulate images in real time. When the vascular anatomy was complicated by another vascular system, the anterior or posterior circulations were separately reconstructed easily by using PC based reconstruction software. The 3D MRA also well demonstrated post-embolization recurrence or remnant aneurysmal cavities. In one giant aneurysm, the 3D MRA was unable to show the entire aneurysmal sac due to a blood flow saturation effect, but this was resolved by additional contrast material injection. PC-based 3D MRA proved to be a useful tool for the pretreatment planning of embolization procedures and for follow up after treatment in the case of cerebral aneurysms.
Early Intracerebral Hemorrhage Complicating the Successful Occlusion of a Carotid-Cavernous Fistula
Authors: Cloft H.J. , Tong F.C. , Joseph G.J. , Dion J.E. , Barrow D.L.
Published: January 2017

A 74-year-old woman with a direct carotid-cavernous fistula secondary to aneurysm rupture was treated by endovascular balloon occlusion of the fistula. Two days later, she suffered an intracerebral hemorrhage ipsilateral to the treated carotid cavernous fistula, perhaps due to normal perfusion pressure breakthrough.

Normal perfusion pressure breakthrough has been described as a cause of hemorrhage following treatment of arteriovenous malformations and carotid stenosis. We report an unusual case of therapeutic endovascular occlusion of a direct carotid-cavernous fistula complicated by hemorrhage presumably caused by normal pressure perfusion breakthrough.
New Devices Designed to Improve the Long-Term Results of Endovascular Treatment of Intracranial Aneurysms
Authors: Raymond J. , Leblanc P. , Chagnon M. , Gévry G. , Collet J.-P. , Guilbert F. , Weill A. , Roy D.
Published: January 2017

Endovascular coiling can improve the outcome of patients with ruptured intracranial aneurysms, but angiographic recurrences are frequent compared to surgical clipping. New coils or devices have been introduced to improve long-term results of endovascular treatment but none have been the object of a valid clinical trial. We have proposed a multicentric randomized double-blind study comparing radioactive and standard coil occlusion of aneurysms.

The purpose of this article is to review issues that are specific to the design of clinical trials to assess embolic agents that could improve the long-term efficacy of endovascular treatment of intracranial aneurysms.

The proposed trial is a randomized, multi-center, prospective, controlled trial comparing the new generation coils to standard platinum coils. Blinding, if at all possible, is preferable to minimize bias, at least for follow-up angiographic studies that should cover a period of 18 months. All patients with an intracranial aneurysm eligible for endovascular treatment would be proposed to participate. The study would enrol approximately 500 patients equally divided between the two groups, recruited within two years, to demonstrate a decrease in the recurrence rate, the primary outcome measure, from 20% to 10%.

Secondary outcome measures should assure that complications, initial clinical and angiographic results remain unchanged. Independent data safety and monitoring committees are crucial to the credibility of trials and to ensure scientific rigor and objectivity.

The scientific demonstration of an improved long-term efficacy, without significant compromise regarding safety, is mandatory before considering the widespread use of a new embolic device for the endovascular treatment of aneurysms.
A New Sclerosing Agent in the Treatment of Venous Malformations
Authors: Sannier K. , Dompmartin A. , Théron J. , Labbé D. , Barrellier M.T. , Leroyer R. , Touré P. , Leroy D.
Published: January 2017

Absolute ethanol is the most effective agent in the treatment of venous malformation (VM) although it is quite risky to use because of the danger of diffusion beyond the target. To reduce this risk, we have developed an alcoholic sclerosing solution that is less diffusible.

The viscosity of absolute ethanol was enhanced with monographic ethyl-cellulose at a concentration of 5.88% ie 0.75 g in 15 ml of absolute ethanol 95%. 23 patients with VM located on the buttock (1), hand (2), leg (1) and face (19) were treated. A mean volume of 1.99 ml of the solution was injected directly into the VM. Each patient had an average of 2.8 procedures. Sixteen patients were done under general anaesthesia and seven with local anaesthesia.

Evaluation was performed by the patient, the dermatologist of the treating multidisciplinary team and a dermatological group not involved in the treatment of the patients. Patients were evaluated after a mean delay of 24.52 months. Evaluation of the cosmetic result was made with a five point scale and the global result with a three point scale. VM pain was evaluated by the patients with a Visual Analogue Scale.

The aesthetic results were graded as satisfactory (> 3) for the patient and the dermatologist of the multidisciplinary team. However the results were not as good with the independent dermatological group evaluation. The pain was signifcantly less important after the treatment (p << 0.001). Among the 23 patients, the local adverse events were nine necrosis with or without ethylcellulose fistula followed by only two surgical procedures. There were no systemic adverse events. Sclerotherapy of VM is usually performed with absolute ethanol or ethibloc. The main advantage of our sclerosing mixture is that it expands like a balloon when injected slowly in a aqueous media. Because of the important increase in viscosity the volume of injected solution is much lower than ethanol alone and the risk of systemic reactions is lower. Contrary to ethibloc, post-sclerosing surgery is not necessary because sub-cutaneous ethylcellulose disappears secondarily.
Use of Neuroform Stent in a Patient with Acute Stroke Caused by Spontaneous Petrous Segment Internal Carotid Artery Dissection
Authors: Mitra D. , Herwadkar A. , Gholkar A.
Published: January 2017

Neuroform stents have been recently introduced for treatment of broad-necked intracranial aneurysms. Several studies have demonstrated the feasibility of deployment of Neuroform stents (Boston Scientific Target, USA) in intracranial circulation. We report a case of a patient presenting with acute stroke due to occlusive petrous segment internal carotid artery dissection who was treated with a Neuroform stent.
“Duplicated” or “Multiple” Cervical Internal Carotid and Vertebral Arteries from Fenestration, Duplication and Vasa Vasorum to Segmental Rete
Authors: Chng S.M. , Alvarez H. , Marsot-Dupuch K. , Mercier P. , Lasjaunias P.
Published: January 2017

The appearance of multiple cervical arteries may be due to a variety of anatomic situations. Arterial fenestrations and duplications have different anatomic origins, with distinct appearances on angiography. They are associated with incomplete segmental development.

The vasa vasorum of the internal carotid artery are rarely seen unless enlarged in pathological situations. They represent a peculiar segmental, in-situ, collateral circulation. Retes, on the other hand, correspond to a more complex reconstitution of an early segmental regression. Careful analysis of each of these features is required to choose the best appropriate terminology. The purpose of this paper is to report illustrative cases to enhance the distinctive features of each disposition.
Endovascular Treatment of Basilar Artery Dissection by Stent Deployment
Authors: Leonardi M. , Raffi L. , Simonetti L. , Cenni P.
Published: January 2017

We describe a 44 year-old woman with dissection of the distal third of the basilar artery presenting with subarachnoid haemorrhage. She was treated with a Neuroform stent (Boston Scientific), the first stent designed for intracranial navigation and recently approved by the FDA to treat wide-necked cerebral aneurysms and allow reconstruction of the internal lumen. In our patient, the dissection involved the origin of the anterosuperior cerebellar artery and the origin of the right posterior cerebral artery. The stent was positioned without complications during or after the procedure. Intra and periprocedural thrombolytic therapy was given followed by an antiaggregant (100 mg Aspirin) for a year after treatment. Subsequent angio-MR and angiographic monitoring disclosed resolution of the dissection and normalization of the basilar artery lumen. She currently lives a controlled but normal life.
Multidetector CT-Guided Lumbar Puncture in Patients with Cancer
Authors: Debnam J.M. , Schellingerhout D. , Kumar A.J. , Ketonen L. , Shah K. , Hamberg L.M. , Hunter G.J.
Published: January 2017

Lumbar puncture can be performed for therapeutic purposes, to instill intrathecal chemotherapy for leptomeningeal cancer treatment or prophylaxis. This technique is generally performed blindly or under fluoroscopic guidance. However, in certain situations, lumbar puncture using multidetector CT (MDCT)-guided imaging may be beneficial, when other options have been exhausted or depending on the requirements of the performing radiologist's institution. The purpose of this article is to describe the technique and to evaluate outcomes of MDCT-guided lumber puncture for diagnostic and therapeutic purposes in patients with cancer. We conclude that MDCT-guided lumbar puncture is an effective and safe guiding modality for thecal sac access in patients with cancer, particularly where other methods of intrathecal access have failed.
Use of Dyna-CT Angiography in Neuroendovascular Decision-Making
Authors: Namba K. , Niimi Y. , Song J.K. , Berenstein A.
Published: January 2017

A successful neuroendovascular procedure depends on accurate anatomical understanding of a target vessel in relation to surrounding anatomical structures or endovascular devices, such as coils and stents. During an endovascular procedure, with conventional or three dimensional (3D) rotational angiography, this type of information is extremely difficult to obtain in a timely manner. To overcome this drawback, a DynaCT was combined with low dose contrast injection to create CT angiography (CTA)-like images (DynaCTA). The images obtained were similar to those of conventional CTA but with better quality in analyzing vessels to surrounding anatomical structures and endovascular devices while the patient was on the table. The authors present three illustrative cases in which information added by the DynaCTA helped improve understanding of anatomy, and affected our clinical decision-making. Although better quality images may be obtained by other imaging modalities or careful angiographic interpretations, DynaCTA can be an easy and effective rescue technique worth keeping in mind in clarifying the relation of a vessel to surrounding anatomy.
Early Rebleeding of Small Anterior Communicating Artery Aneurysm with Presumed Extrusion of Coil Loop to outside the Aneurysmal Wall during Endovascular Treatment
Authors: Pyun HW , Hyun DK , Lee DH , Park SW , Lim MK
Published: January 2017

Although endovascular treatment has been proved to be as effective as surgical clipping in the prevention of rebleeding of ruptured aneurysm, early rebleeding after coil embolization has seldom been reported. We experienced early re-hemorrhage in two patients of ruptured small anterior communicating artery aneurysms of complete treatment with coil-embolization initially. In both cases what interested us was not early rebleeding itself but how the presumed extrusion of the first part of coil loop beyond aneurysmal wall developed. However, there was no evidence of intraprocedural rupture and moreover complete occlusion with only one or two coils was obtained. Our two patients underwent successful second treatment. We discovered the presumed extruded first part of the coil loop initially was located inside the enlarged aneurysmal sac in retreatment stage.

In case of coil embolization of ruptured small anterior communicating aneurysm, the phenomenon we experienced with no evidence of intraprocedural rupture in spite of obvious extrusion of coil loop beyond the aneurysmal wall can be a sign of necessity for early follow-up study including plain radiography to track the change in the presumed extruded coil loop.
Endovascular Treatment of Basilar Artery Aneurysms Associated with Distal Fenestration
Authors: Juszkat R. , Nowak S. , Moskal J. , Kociemba W. , Zarzecka A.
Published: January 2017

Segmental non-fusion of the basilar artery results from failed fusion of the neural arteries and from regression of the bridging arteries that connect the longitudinal arteries.

This condition is associated with aneurysm formation in 7% of cases. Distally unfused arteries with associated aneurysms are very rare. We report on a case of successful endovascular treatment of an aneurysm of the distally unfused basilar trunk.
Dissecting Aneurysm at the Proximal Anterior Cerebral Artery Treated by Parent Artery Occlusion
Authors: Lv M. , Lv X. , Li Y. , Jiang C. , Jiang P. , Wu Z.
Published: January 2017

Aneurysms of the A1 segment of the anterior cerebral artery (ACA) are rare. We described the first documented endovascular treatment of an A1 portion dissecting aneurysm by parent artery occlusion. A 43-year-old man patient presented with subarachnoid hemorrhage. Cerebral angiography demonstrated a dissecting aneurysm of the left anterior cerebral artery (ACA) at A1 portion. Because of the dissecting nature of the A1 portion aneurysm, a 2.5×15-mm Neuroform stent was placed in the left A1 portion. However, regrowth of the aneurysm was found on the three month follow-up angiogram, so the aneurysm and the left A1 portion of ACA were occluded completely.
Effects of Ozone on Sciatic Nerve in Rat
Authors: Lin Q. , Chen H. , Lu C. , Wang B. , Zhang Y. , He X. , Yu B.
Published: January 2017

This study evaluated the influence of ozone on rat sciatic nerve structure and function. Thirty Wistar rats were randomly divided into six groups (n = 5). In groups I to IV, 1ml of ozone (O3) 10 μg/ml, 30 μg/ml, 50 μg/ml, 80μg/ml was injected at the junction of gluteus maximus margin and lateral edge of the long head of biceps femoris respectively, in group V, 1 ml of pure O2 was injected at the same point, and group V had puncture without any injection. Ozone was manufactured by an ozone generator (Ozone Line Co, Italy).

The rats were investigated by both gross measurement and behavioral changes. One day, one week and three weeks after injection, rat hindlimb footprints were measured and the sciatic nerve function index (SFI) was calculated, and after three weeks, all right sciatic nerves were exposed under anesthesia. Near neural stimulation of the rat sciatic nerve was calculated and nerve conduction velocity, latency and maximum amplitude recorded. Animals were sacrificed for pathology, and ipsilateral triceps surae were taken for wet weight. No serious behavioral abnormalities were observed in any animal. SFI comparison in the various times and various groups showed no significant differences (p<0.05), and nerve conduction velocity, latency and maximum amplitude difference amongst the groups was not significant (p<0.05). There were no abnormalities in peripheral nerves pathologically after injection. Our initial study suggests that ozone concentrations from 10 μg/ml to 80 μg/ml injected around rat's peripheral nerve will not cause serious sequelae or serious damage to the structure and function of peripheral nerve. This finding provides evidence of the safety of ozone injected around the peripheral nerve.
Treatment of Vertebral Artery Origin Stenosis with a Pharos Stent Device: A Single Center Experience
Authors: Broussalis E. , Kunz A.B. , Luthringshausen G. , Klein S. , McCoy M.R. , Trinka E. , Killer-Oberpfalzer M.
Published: January 2017

Atherosclerotic stenosis of vertebral artery (VA) origin exceeding 70% severity accounts for one third of all vertebrobasilar strokes. For a period of one year the results of endovascular treatment of VA stenosis with the new Pharos stent device were assessed.

Twenty-two patients with symptomatic VA stenosis were treated with the Pharos stent. Clinical status and stenosis grade were documented before treatment and 24 hours, one, three and twelve months after treatment via ultrasound and magnetic resonance tomography.

All procedures proved to be technically successful without the occurrence of intra-procedural complications. During the observation period of more than one year, 55% of patients were documented with a mean stenosis degree of 60%: two (10%) of these patients showed a residual stenosis after angioplasty and nine patients (45%) an in-stent restenosis, whereas only two patients were documented with a hemodynamically relevant in-stent restenosis of 80%. These two patients were retreated with balloon dilatation. None of the patients showed neurological deterioration or new abnormalities at magnetic resonance tomography examination. Neither VA occlusion nor restenosis of the contralateral VA negatively affected the clinical outcome. An in-stent restenosis was developed by more female than male patients.

VA origin stenting with the Pharos stent device is an effective treatment of stenosis. The good clinical results compared to the high restenosis rates have to be examined in further studies. Pin particular, it has to be determined whether the Pharos stent allows the vessel time for collateralization, whether double antiplatelet treatment prevents recurrent cerebrovascular events or whether merely the low restenosis degree is causative for the clinical outcome.
Acute Endovascular Treatment (< 48 Hours) of Uncoilable Ruptured Aneurysms at Non-Branching Sites Using Silk Flow-Diverting Devices
Authors: Causin F. , Pascarella R. , Pavesi G. , Marasco R. , Zambon G. , Battaglia R. , Munari M.
Published: January 2017

A blood blister-like (BBL) or dissecting aneurysm should be carefully considered if located at a non-branching site of the supra-clinoid internal carotid artery (ICA). Several surgical and endovascular treatment methods have been proposed but they all carry a relatively high risk of morbidity and mortality.

This study evaluated the effectiveness of a novel Silk flow-diverting device (SFD) placed in the early acute stage.

Three patients presenting with acute subarachnoid haemorrhage caused by small blisterlike aneurysms of the carotid siphon were treated within 48 hours after admission by placement of SFDs. More than one device was placed to cover the lesion. None of the patients were premedicated and started anti-platelet therapy during the procedure. All aneurysms were successfully occluded.

A good outcome was observed in two out of three treated patients. No thromboembolic or haemorrhagic event occurred during or after the procedures, or during follow-up (6–14 months). SFD prevented rebleeding and the use of these devices could be proposed as an option to treat fragile uncoilable BBL aneurysms, even in the early acute phase without anti-platelet premedication. Larger studies and long-terms results are necessary.
Cervical Epidural Arteriovenous Fistula Presenting with Radiculopathy: Transvenous Embolization Using Onyx
Authors: Dabus G. , Nimmagadda A. , Russell E.J.
Published: January 2017

We present an uncommon case of cervical epidural arteriovenous fistula presenting with radiculopathy that was successfully treated with transvenous embolization using Onyx.