bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.
“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.
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.
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.