bluuebunny/crossref_metadata_2025_split huggingface dataset:
Living Kidney Donors’ Information Needs and Preferences
Authors: Traino Heather M. , Nonterah Camilla W. , Gupta Gaurav , Mincemoyer Jodi 
Published: January 2017

Introduction: Past research suggests the information exchanged from transplant centers to potential living kidney donors is, in many cases, suboptimal. The purpose of this study was to assess donors’ perceptions of the information provided while considering living donation. Methods: Semistructured telephone interviews conducted with 81 past living donors seen at 1 mid-Atlantic transplant center assessed the extent to which living kidney donors deemed Centers for Medicare and Medicaid Services (CMS)-mandated information useful to making a decision about donation and to which more information was or would have been desired before donating. Understanding of and satisfaction with the information was also assessed. Results: Participants were primarily white (67.9%), females (67.9%), with an average age of 57.8 years. Perceived usefulness ranged from a mean of 3.1 for the confidentiality of the transplant center’s communication to 4.1 for postoperative care and short-term medical risks of donation. Donors of minority descent as well as those with more education and less income found the information provided most useful. Few donors desired additional information about the right to opt out of (8.6%) or decline (13.6%) donation; however, most wanted more information regarding the risk of being refused health, disability and/or life insurance after donating (77.8%), and insurance coverage for future health problems (66.7%). Discussion: This study revealed limited usefulness of certain CMS-mandated topics and a desire for additional information about donation. Efforts to standardize the informed consent process should incorporate donors’ perspectives as to the specific topics, quantity of information, and the mode of communication found most useful when considering living donation.
Postoperative Intracranial Thrombolysis and Angioplasty
Authors: Levrier O. , Stordeur J.M. , Bruder N. , Manera L. , Bouillot P. , Raybaud C.H. 
Published: January 2017

The case study involves a patient presenting middle cerebral artery thrombosis, related to a severe vasospasm following subarachnoid hemorrhage due to aneurysm rupture. The patient was treated initially by surgical clipping of the left middle cerebral artery aneurysm. After surgery, the neurological status of the patient was normal. Six days later, the patient presented right hemiplegia and aphasia that were related to the proximal left middle cerebral artery thrombosis. Despite recent open-skull surgery, in situ thrombolysis using urokinase and antiplatelet antibodies (abciximab) was performed. The thrombosed artery was reopened and a severe vasospasm was observed. The vasospasm was treated by transluminal angioplasty. No intracranial hemorrhage was noted after thrombolysis and angioplasty, whereas subcutaneous hemorrhage around the scalp incision was observed. The patient recovered from motor and language impairment. The only long-term symptom was a mild dysorthographia. Balance of risk/benefit is discussed for such aggressive thrombolytic therapy. In this particular case, effectiveness and uneventful use of abciximab was demonstrated despite very recent brain surgery that was considered a formal contra-indication for the use of such a powerful thrombolytic drug. Vessel thrombosis is an exceptional complication of cerebral vasospasm. In the early hours, intra-arterial thrombolysis may be considered, but recent intracranial surgery is usually an exclusion criterion to performing thrombolysis. We report the case of a patient who underwent thrombolysis and angioplasty in the postoperative period to treat this complication of vasospasm.
Endovascular Treatment of a Distal Aneurysm of the Superior Cerebellar Artery by Intra-Aneurysmal Injection of Glue
Authors: Leonardi M. , Simonetti L. , Andreoli A. 
Published: January 2017

Aneurysms in the distal cerebellar arteries are rare events. They are associated with a poor prognosis, as surgery or embolisation with Guglielmi detachable coils (GDCs) is very difficult. The ability to treat them surgically depends on the location of the aneurysm, but surgery is considered difficult and is associated with a high morbidity/mortality rate. Embolisation with GDCs may be difficult or impossible because of the distal location of the aneurysm or the unfavourable ratio between the size of the aneurysm and the size of the parent vessel. We report our experience in one case treated with intra-aneurysmal injection of glue. The aneurysm, located in the distal right superior cerebellar artery, was catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysmal sac. The treatment resulted in total occlusion of the aneurysm with preservation of the parent artery.
Utility of Balloon-Assisted Guglielmi Detachable Coiling in the Treatment of Cerebral Aneurysms
Authors: Mangiafico S. , Cellerini M. , Villa G. , Nistri M. , Pandolfo C. , Ammannati F. , Mennonna P. , Giordano GP 
Published: January 2017

Balloon-assisted Guglielmi detachable coiling (BAGDC) is a new technical option developed to allow endovascular treatment of wide-necked aneurysms. Aim of the following work is to report a single center experience of BADGC of aneurysms with assessment of its efficacy and safety. BAGDC of wide-necked aneurysms (SNR close to 1) was retrospectively evaluated in 37 patients (28 females, nine males, mean age: 56.6 yrs, range: 27–81 yrs) who underwent the procedure between january 1999 and january 2002 for a total of 45 procedures on 41 aneurysms. Twenty-nine patients presented with SAH from an acutely ruptured aneurysm. In two patients BAGDC failed whereas 35 patients successfully underwent BADGC (39 aneurysms). Twenty-nine patients (31 aneurysms) were available for angiographic follow-up (mean: 10 mo, range: 3–24 mo). At the last angiographic follow-up 29/33 aneurysms (87%) resulted stable and occluded (22 aneurysms with dense and seven with loose packing of the sac and the neck), two aneurysms showed regrowth, one aneurysm showed a neck remnant and another one a sac and neck remnant. Complications directly related to the procedure occurred in five patients (three perforations, one thromboembolism, one femoral AV) with a mortality and morbility rate of 2.7 and 5.4 respectively. BAGDC is a promising adjunct to treatment of wide-necked aneurysms broadening the spectrum of indications for endovascular treament of challenging aneurysms.
Glubran 2: A New Acrylic Glue for Neuroradiological Endovascular Use
Authors: Leonardi M. , Barbara C. , Simonetti L. , Giardino R. , Aldini N. Nicoli , Fini M. , Martini L. , Masetti L. , Joechler M. , Roncaroli F. 
Published: January 2017

A new acrylic glue, Glubran 2, is now available on the European market. It bears the CE mark with several surgical indications and the specific indication for neuroradiological endovascular use. Despite this approval, to our knowledge its use is still limited to surgery and no injections have been made in human patients. This study was designed to evaluate the behavior of Glubran 2 in endovascular injection in a simulation of brain AVM. Six sheep were operated on opening a fistula between the right common carotid artery and the jugular vein. This fistula modifies blood flow in the skull base rete mirabilis, which then functions as an AVM. In two sheep, the rete mirabilis was occluded by injection of 1.5 ml of Histoacryl diluted 1:1 and 1:3 with Lipiodol. In two sheep, the rete was embolized by injection of 1.5 ml of Glubran 2 diluted 1:1 with Lipiodol. The last two sheep were embolized by injection of Glubran 2 diluted 1:3 with Lipiodol. The procedures were documented by DSA angiographic acquisitions and by fluoroscopic VHS. The sheep were killed immediately after the procedures and the rete mirabilis isolated for histologic examination. Embolization was obtained with both kinds of glue. Glubran 2 diffuses in a very similar way to Histoacryl with an apparently more complete diffusion. Reflux in the ascending pharyngeal artery showed that Glubran 2 tended not to produce bubbles but diffused more homogeneously. The subjective conclusion of this work is that Glubran 2 can be used in endovascular embolizations. Before approaching brain AVMs, a further study will investigate embolization of the external carotid territory.
Rebleeding and Ischemia after Acute Endovascular Treatment of Ruptured Dissecting Subarachnoid Vertebral Artery Aneurysms
Authors: Mangiafico S. , Padolecchia R. , Cellerini M. , Puglioli M. , Villa G. , Nistri M. 
Published: January 2017

Dissection aneurysms of the vertebral artery represent 3.2% of all cerebral aneurysms and 28% of intracranial dissection aneurysms. Dissection of the vertebral artery in its intracranial segment (V4) usually causes a subarachnoid hemorrhage (SAH) from subadventiatial extension of the vessel wall hematoma. Rarely (one case in seven), the symptomatology is characterized by brain stem ischemia from the vertebral artery and/or postero-inferior cerebellar artery occlusive dissection. The high rebleeding (18–33% with a 10+/-5 day interval between the first and the second bleeding) and mortality (>45%) rates 1, 13 of this disease prompt emergency treatment usually consisting in endovascular coiling of the dissection aneurysm and/or the dissected segment of the parent vessel. Herein we report our experience in endovascular coiling of acutely ruptured dissecting aneurysms of the vertebral artery dissection in V4 segment. We focus the discussion on the risk of rebleeding and the ischemic complications that my occur after endovascular or surgical treatment.
Three-Year Retrospective Study of Complications Arising during Interventional Procedures
Authors: Leonardi M. , Cenni P. , Spagnoli M. , Simonetti L. , Raffi L. , Agati R. 
Published: January 2017

This retrospective study aimed to assess the percentage of complications arising in our daily practice of interventional procedures, comparing our findings with those of leading international reference centers and accepted guidelines for endovascular treatment. During the three-year period considered (2000–2002), we performed 246 interventional procedures, divided into seven different pathological conditions: aneurysms, brain AVMs dural and carotid cavernous fistulae, spine-spinal cord tumours, head-neck tumours, carotid stenosis and thrombolysis. Aneurysmal disease accounted for 45% of all endovascular procedures. In conclusion, four periprocedural complications arose in the course of 246 procedures resulting in one death and three cases of permanent neurological deficit (2%).
Hereditary Haemorrhagic Telangiectasia Cerebrospinal Localization in Adults and Children
Authors: Mahadevan J. , Ozanne A. , Yoshida Y. , Weon YC , Alvarez H. , Rodesch G. , Lasjaunias P. 
Published: January 2017

Cerebral arteriovenous malformations (CAVM) can be associated with Hereditary Haemorrhagic Telangiectasia (HHT), adominantly inherited vascular disorder with variable penetrance and expressivity. The presentation and angiographic features were analysed retrospectively. The purpose is to point to special groups of AVM patients within the overall CAVMs and to discuss the issue of screening. We reviewed 34 cases of HHT -related CAVM from the data bank in Bicêtre from 1985–2003. In Spinal cor d AVM (SCAVM) there were 194 patients with 5 HHT. HHT was diagnosed when at least two criteria were met; cutaneous telangiectasia, epistaxis, visceral AVMs, angiographic findings of AVF and first degree family history. Intracranial haemorrhage was the presenting symptom in 8.8% and the risk of haemorrhage in the natural history was 0.7% per year. The commonest angiographic features in adults are nidus (81.8%) and multiplicity (45.5%), while in the paediatric group venous ectasia and giant pouches (91.3%), AVF (69.6%) and multiplicity (52.2%). In spinal cor d lesions macrofistulas are demonstrated in 83% of HHT with no multiplicity. HHT-related CAVMs present as multiple lesions, cortical in location, micro AVMs or AVF. HHT in SCAVM is expressed as single macro AVF, especially in the paediatric group. AVF in children are highly suggestive of HHT. We do not recommend screening in HHT adult patients for CAVM, while in the paediatric population, screening could be recommended at six months of age for cerebrospinal localization. These patients should be screened for Pulmonary AVF, which needs to be treated in priority.
Local Hyperthermia Enhances Thrombosis in Aneurysms Containing Platinum Coils
Authors: Suzuki O. , Miyachi S. , Okamoto T. , Ito A. , Shinkai M. , Honda H. , Kobayashi T. , Negoro M. , Yoshida J. 
Published: January 2017

Despite recent technical advances in embolization of cerebral aneurysms with platinum coils, some aneurysms eventually resulted in incomplete packing with remnant neck or dome filling. Such a situation with a remaining inflow zone may pose a risk of rupture and subsequent regrowth. Metals characteristically generate heat under high-frequency alternating magnetic fields (AMF). We used this property to induce local hyperthermia and promote thrombogenesis in incompletely packed aneurysms. Glass model aneurysms packed with coils were subjected to AMF to investigate the correlation between weight of platinum and temperature elevation and the correlation between flow rates of water through the model and temperature elevation. Next, activated coagulation time (ACT) of blood obtained from dogs was studied at various temperatures. Finally, side-wall aneurysms created in the canine carotid artery using a venous patch were packed with platinum coils. Change in temperature and angiographic changes were investigated after AMF application. In the glass model, the weight of platinum was correlated with elevation of temperature, and a negative logarithmic correlation was evident between flow rate and elevation of temperature. Elevation of blood sample temperature tended to shorten ACT. In canine carotid aneurysms, elevation of intra-aneurysmal temperature was confirmed and sufficient elevation of temperature was found to promote angiographically evident thrombogenesis of the remnant space after AMF application. Local hyperthermia may be useful in completing luminal obliteration of aneurysms after coil embolization. It may particularly useful for ruptured aneurysms to prevent the early rerupture.
Experimental Determination of Minimal Stimulation Current and Period for Electrical Thrombosis in Dogs
Authors: Suzuki S. , Kurata A. , Ohmomo T. , Oka H. , Nakayama S. , Hirayama H. , Yasui Y. , Fujii K. 
Published: January 2017

Endovascular surgery has been proposed as an alternative treatment for cerebral aneurysms. However, for wide neck and large sized lesions it is very difficult to obtain complete occlusion and tissue organization. The present study was conducted to examine the efficacy of electrical thrombosis for cerebral aneurysms and parent arterial occlusions using Interlocking Detachable Coils (IDCs), focusing on the minimum current volume and stimulation time required for stable electrical thrombosis formation. We used ten mixed-breed adult dogs (in the study body weights 9–12 kg; males: 5, females: 5). Guiding catheter sand microcatheters were introduced into both sides of the distal external carotid artery (ECA) and placed at the same level. To prevent migration, IDCs (4 mm × 12 cm) were placed in the ECA without being detached. After confirming no vessel occlusion, we applied a positive current (2–6 mA) to the coil on one side and performed angiography every ten minutes to observe whether vessel occlusion with electrothrombosis had occurred. It was determined that to achieve complete occlusion of the external carotid arteries in mixed-breed dogs, a minimum stimulation current of 4mA and a minimum stimulation time of ten to 20 minutes are required.
Heparin or Local Thrombolysis in the Management of Cerebral Venous Sinus Thrombosis?
Authors: Anand S. , Siddhartha W. , Karnad D.R. , Shrivastava M. , Ghatge S. , Limaye U.S. 
Published: January 2017

Patients with acute cerebral venous sinus thrombosis treated with Heparin or in situ thrombolysis in our department were evaluated in an attempt to rationalize treatment with heparin or thrombolysis. 279 patients with angiographically proven acute cerebral venous sinus thrombosis were included in the study. Patients were classified into mild and severe clinical grade. The study was divided into three phases. Phase I included 27 patients treated with systemic heparin. Phase II included 72 patients, 30 in severe grade and 42 in mild. 26 were thrombolysed with 14 in severe and 12 in mild grade. Phase III included 180 patients treated according to a defined protocol. 133 were in mild grade and 47 in severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild grade and 40 in severe. 113 patients were treated with systemic heparin. Following acute management all were anticoagulated for six months. The baseline characteristics were found to be same in all three phases. On comparison of outcome in Phase III with Phase 1 the likelihood ratio was found to be statistically significant in favor of Phase III (p < 0.0001). The likelihood ratio was found to be statistically significant in mild and severe clinical grade in favor of thrombolysis in Phase III (p 0.039 in mild and p 0.00001 in Severe clinical grade). This ratio was insignificant (p = 0.716) for intracranial bleed; however, local puncture site bleeding was found to be significant in the thrombolysed group (0.00005).
Coil Embolization Training Using a Rabbit Saccular Aneurysm Model
Authors: Tsumoto T. , Terada T. , Yamaga H. , Itakura T. 
Published: January 2017

We developed a rabbit saccular aneurysm model for coil embolization training. Elastase-induced aneurysms were created successfully in about 80% of the rabbits. The aneurysms were usually broad in the neck and lengthy. At the 28th postoperative day, the aneurysms were about 1.5 times larger in both width and height than they had been at the 14th day. All aneurysms were successfully embolized with 18-sized electrically detachable (ED) platinum coils. After embolization, almost all aneurysms had a neck remnant. In conclusion, this model is useful not only for learning the technique of coil embolization but also for testing new embolic materials. The rabbit aneurysm model proved to be an efficacious training modality for endovascular coil embolization.
Result of Neck Clipping and Coil Embolization as a Treatment for Subarachnoid Haemorrhage
Authors: Iwamuro Y. , Nakahara I. , Higashi T. , Watanabe Y. , Oku T. , Hirata E. 
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 haemorrhage (SAH) 1. We compared the results of coil embolization and neck clipping in our institute. Generally better outcomes were obtained by endovascular surgery than neck clipping. Symptomatic vasospasm and symptomatic hydrocephalus occurred less frequently in coil embolization than neck clipping. Because not all cases of SAH can be treated by coil embolization due to the width of aneurysmal neck and relation of the aneurysm to parent arteries, we should also be able to perform neck clipping as another modality.
Coil Embolization Combined with Stenting for a Giant Basilar Trunk Aneurysm
Authors: Nakamura M. , Fujita A. , Kohmura E. 
Published: January 2017

A 52-year-old male presented with left oculomotor nerve palsy. Angiograms revealed a giant basilar trunk aneurysm with a maximum diameter of 32 mm and a wide neck of 18 mm, located between the superior cerebellar artery and the anterior inferior cerebellar artery and without opacification of posterior communicating arteries. Intra-aneurysmal embolization of the dome was followed by deployment of a 24mm-long coronary balloon-expandable stent across the neck of the aneurysm. Additional coil embolization of the aneurysmal neck produced good clinical and angiographic results.
The Platinum Ball
Authors: Ozawa H. , Kurata A. , Suzuki S. , Fujii K. , Kan S. 
Published: January 2017

Polyvinyl alcohol (PVA) particles have been widely used as an embolic material for endovascular treatment of vascular enriched tumors, especially for meningiomas. However, there are disadvantages with their use due to the fact that they are radiolucent, with a very irregular shape and a tendency for self-adhesion. With alternative organic liquids there is also a possibility of toxicity. We have therefore developed a new embolic material, platinum balls, which feature radioopacity, a relatively well-defined oval shape, multi-pitted and indented surfaces on electron microscopy and a lower tendency for self-adhesion Based on positive findings in experimental studies, embolization of meningiomas was conducted with platinum balls in 27 patients and the results compared with findings for a matched group previously treated with PVA particles. Total volume of blood transfused during surgery was comparable in the two cases, although a tendency for lower values was noted with the platinum balls, and outcome was equally positive.
Endovascular Therapy Followed by Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations
Authors: Arai Y. , Handa Y. , Ishii H. , Ueda Y. , Uno H. , Nakajima T. , Hirose S. , Kubota T. 
Published: January 2017

Pre-radiosurgical embolization was carried out using cyanoacrylate in seven of 13 patients with cerebral arteriovenous malformations (AVMs) treated by stereotactic radiosurgery (SRS) with a linear accelerator (LINAC). The aim of embolization before SRS was the reduction of AVM volume and/or the elimination of vascular structures bearing an increased risk of haemorrhage. Staged-volume SRS was also performed in two patients because of residual irregular shaped nidus of AVMs even after the embolizations. Complete obliteration of the AVM nidus on angiogram was presented in five patients with embolizations (including one with staged-volume SRS) and in three of six patients with SRS alone, during follow-up periods after radiosurgery. No patients experienced haemorrhagic events after SRS. Although transient neurological symptoms were observed after embolizations in two patients, no permanent neurological deficits were presented in all patients with SRS. Pre-radiosurgical embolization may allow the effective influence on irradiation therapy in relatively large AVMs and promote more frequent obliteration in more small sized AVMs compared to those with SRS alone. However, further study must be needed to determine whether staged-volume SRS provides a high rate of AVM obliteration and its safeness.
The Stenting to Internal Carotid Artery Stenosis (ICS) in Petrous Portion
Authors: Hayashi K. , Seyama H. , Yamada N. , Murao K. , Iihara K. , Takahashi J.C. , Nakajima N. , Sayama T. , Morimoto M. , Mori H. , Yamamoto M. , Hishikawa T. , Nonaka Y. , Ayabe J. , Kikuchi T. , Hyuga M. , Ookawa M. , Kudo T. , Miyamoto S. 
Published: January 2017

In the safety stenting, it is important to get to know the characteristics of a plaque. In petrous carotid artery stenosis, it is difficult to know the characteristics of the plaque. We paid our attention to the MPRAGE (Magnetization Prepared Rapid Acquisition with Gradient Echo) method on high resolving power MRI. By the MPRAGE method, low intensity was observed in these lesions of all cases. This result suggested that the plaque in petrous portion was a fibrous plaque. This method is useful to get to know the characteristics of a plaque in petrous portion before endovascular treatment.