bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver Transplantation in Italy: Analysis of Risk Factors Associated with Graft Outcome
Authors: Quintieri Francesca , Pugliese Orsola , Mattucci Dino Alberto , Taioli Emanuela , Venettoni Sante , Costa Alessandro Nanni 
Published: January 2017

Objective To analyze the graft outcome after liver transplantation in Italy in the years 1995 to 2000. Methods We performed a longitudinal study with follow-up at 3 months, 1 year, 3 years, and 5 years on 1987 liver grafts. The effect of several variables on graft survival was also analyzed. Results Several variables affect graft survival: Donor and recipient older age, gender mismatching, prolonged cold ischemia time, acute hepatic necrosis, and retransplantation are reported to significantly affect liver graft survival. Donors older than 60 years show a relative risk of 1.59 (95% CI, 1.23–2.05) compared with donors with an age between 19 and 60 years; recipients older than 50 years show a relative risk of 1.29 (95% CI, 1.04–1.60) compared with recipients aged 19 to 50 years. A cold ischemia time of 12 hours or longer doubled the risk of failure (relative risk = 2.01, 95% CI, 1.36–2.96) compared with a cold ischemia time of less than 6 hours. Conclusions The results show that the overall quality of liver transplantation in Italy is satisfying and comparable to the outcome reported by international registries. Follow-up studies on large numbers of liver transplants are useful to define predictors of outcome, and subsequently modify the criteria for organ allocation.
Endovascular Management of Intradural Berry Aneurysms
Authors: Fuse A. , Rodesch G. , Alvarez H. , Lasjaunias P. 
Published: January 2017

Endovascular management of intracranial arterial aneurysms (AA) is well described and performed by many teams. The aim of this work is to review a series of consecutive cases treated in our institution and to compare to the data available in the literature. 225 AA were seen in Bicêtre between 1993 and 1998 in 203 patients. 201 of them (in 180 patients) were treated by our group. The endovascular treatment, its indications, results and complications have been reviewed and studied. The clinical follow-up of the patients has been evaluated. A female dominance was noted (64.5%) with a mean age of patients of 44.3 years. 65.6% of patients were treated in the acute phase after intracranial haemorrhage, 72% of them being Hunt and Hess grade 1 or 2. Most of these AA (73.6%) were located in the anterior circulation. In 86.1% of cases the AA was smaller than 10 mm. 85.6% of the AA needed only one session of endovascular therapy. No mortality occurred in the group of unruptured AA. Overall management mortality was 11% in ruptured AA (3.5% in HH1–2, 30.3% in HH3–5). Technical or transient complications occured in 11.6% of cases, but permanent morbidity was seen in 3.1% of cases. Control angiograms were performed 3 months and one year after therapy. In doubtful cases a control at 6 months was also performed. 100% occlusion rate was noted in 60.8% of cases; 22.8% of AA were occluded between 90–99%, and 13.3% between 80–90%. Only 3.1% of AA had an occlusion rate of less than 80%. One patient with a ruptured basilar tip AA which was partially coiled regrew and rebled three months after. The patient declined the recommended complementary surgery. Clinical follow up of patients with ruptured AA treated by embolisation shows satisfactory results with 8., 5% of GOS 1–2, 3.4% of GOS 3–4, and 11% of GOS 5 (mortality). Overpacking of the AA may not be necessary to protect patients from (re)bleeds over time. The related technical risks and increased costs of dense overpacking do not seem justified. Secondary thrombosis of the ruptured AA after coiling is more often seen than coil compaction. Analysis of the AA architecture and recognition of false aneurysms are mandatory in order to obtain good clinico-morphological logical results.
Evaluation of the Stability of Intracranial Aneurysms Occluded with Guglielmi Detachable Coils
Authors: Tamatani S. , Ito Y. , Koike T. , Abe H. , Kumagai T. , Takeuchi S. , Tanaka R. 
Published: January 2017

The purpose of this study is to evaluate the long-term stability of embolized aneurysms using the volume embolization rate (VER). One hundred and six aneurysms in 96 patients who were treated with Guglielmi detachable coils were selected for this study. Follow-up angiography was performed at six or more months after initial treatment. Every aneurysm was packed as densely as possible, however, the percentage of stability varied according to the size of the aneurysm or the size of the aneurysm neck. The percentage of stable aneurysm was 82% (56/68) in small aneurysms with small necks, 68% (13/19) in small aneurysms with wide necks and 42% (8/19) in large aneurysms. The mean VER of embolized aneurysms in each size was 30%, 22% and 17%, respectively. There was a correlation between the percentage of stable aneurysms and the mean VER. On the other hand, there seemed to be a difference of VER for the stability of embolized aneurysms between ruptured aneurysms and unruptured ones. In small aneurysms with small necks, the stability of embolized aneurysms in ruptured ones was obtained only when the VER was greater than 30%, whereas it was found in unruptured ones even though the VER was less than 20%. In conclusion, the long-term stability of embolized aneurysms was obtained in small-sized aneurysms, especially small neck aneurysms, and unruptured ones. The VER is a good, objective index to predict the long-term stability of embolized aneurysms.
Treatment of Dissecting Vertebral Aneurysm
Authors: Kai Y. , Hamada J. , Morioka M. , Todaka T. , Mizuno T. , Ushio Y. 
Published: January 2017

We report 17 patients with dissecting aneurysm of the vertebral artery (VA) who were treated by direct surgery (n=8) or interventional surgery (n=9). Eight patients presented with subarachnoid hemorrhage (SAH) and nine with ischemia. Ten patients were treated by trapping of the aneurysm that was occlusion of the VA on both sides of aneurysm (direct surgery, n=2; interventional surgery, n=8). The other seven patients were treated by ligation of the VA proximal to the aneurysm (direct surgery, n=6; interventional surgery, n=1). Two patients underwent transposition of the posterior inferior cerebellar artery (PICA). In 15 patients, there were no major complications. Two patients who had been treated by proximal occlusion of the VA developed rebleeding and ischemia due to persistent retrograde filling of the dissecting site. We suggest that angiographic evidence of retrograde filling of the dissecting site should have been considered as an indication for trapping. Trapping of VA dissecting aneurysms is easier and safer by interventional surgery than by direct surgery.
Intracranial Haemorrhage Probably Due to an Angiographically Occult AVM after Carotid Stenting
Authors: Berker M. , Ulus A. , Palaoglu S. , Soylemezoglu F. , Ay H. , Cekirge S. 
Published: January 2017

Angiographically occult vascular malformations refer to cerebrovascular malformations that are not demonstrable on technically satisfactory cerebral angiography. Authors herein present a very unusual intracranial bleeding complication related to an angiographically occult vascular malformation after extracranial carotid artery stenting procedure. A 52-year-old male patient admitted to the hospital with 2 episodes of amaurosis fugax in the left eye. Cervical carotid angiography and bilateral carotid Doppler ultrasonography revealed a 98% stenosis of the left internal carotid artery just distal to the bifurcation. Post-stenting control cervical carotid angiography revealed neither any residual stenosis nor a developmental venous anomaly. The patient developed left pupil dilatation with loss of consciousness two hours after the neurovascular intervention. Emergent cranial CT showed acute subdural haematoma, intracerebral and subarachnoid haemorrhage with massive midline shift. He underwent an emergent craniotomy with left temporal lobectomy. Abnormal cortical vascular structures with prominent engorgement were remarkable over the posterior temporal cortex. Histopathological studies confirmed the diagnosis of an occult AVM Classically, these lesions are not visualized with angiography. Our patient's cerebral angiography and MR investigations were all normal. To our knowledge this is the first case in literature in which intracranial haemorrhage (acute subdural haematoma, intracerebral haematoma, SAH) occurred due to hyperperfusion of angiographically occult vascular malformation.
Temporary Hidden Aneurysms during Pregnancy
Authors: Cho C. S. , Kim Y. J. , Cho K. T. , Lee S. K. , Park B. J. , Cho M. K. 
Published: January 2017

There are a number of reports on cerebral aneurysmal ruptures during pregnancy. Although the cerebral aneurysmal rupture is quite rare during pregnancy, it leads to a high maternal mortality; which gives rise to a clinical significance. We have encountered a number of multiple cerebral aneurysms during pregnancy, and the ruptured cases were successfully treated with the coiling procedures. The coiling is found to be a good treatment method for ruptured aneurysms during pregnancy. The cerebral angiogram is the gold standard diagnostic method for detecting cerebral aneurysms. However, 1.8–20% of the cases are reported to be false negative in initial angiography, and only up to 20% can be diagnosed even with the additional angiographies. A special attention for a hidden aneurysm should also be required while managing the patients.
Brain AVM Embolization with Onyx®: Analysis of Treatment in 34 Patients
Authors: Leonardi M. , Simonetti L. , Cenni P. , Raffi L. 
Published: January 2017

The endovascular approach to arteriovenous malformations (AVM) using different embolizing agents is a well-established treatment option. This report assesses the results of our experience using a non “glueing” embolic material available for several years, commercially known as Onyx®. We used Onyx to treat 34 consecutive patients in the last four years. All patients were treated in the same department by the same neuroradiological team, with a strictly repetitive technical strategy and procedural protocol. All our patients presented AVMs with Spetzler Grade 3 or more, because in our Institution Grade 1 or 2 AVMs are directly treated by surgical approach. We adopt a multidisciplinary treatment approach (embolization, surgery, radiotherapy) by which embolization is construed as work in progress offering definitive treatment of AVMs without severe risks. Embolization is mainly undertaken as the first step before surgery, to reduce flow and size of the AVM by a “targeted” technique. In addition to reducing lesion size, endovascular treatment aims to seal off AVM areas anatomically or haemodynamically complex for surgical treatment. Occasionally, the reduction in size allows a radiosurgical approach. Embolization seldom results in a definitive cure of AVMs. At the end of multimodal approach, we obtained the complete and definitive cure of AVM in 21/34 patients (two complete obliteration with interventional technique, 19 in combination with surgery); to these were added 5/34 patients who received radiosurgical therapy. No major complications arose during endovascular treatment. One patient had transitory (36 hour) impaired right arm pronation. The CT scan disclosed an asymptomatic mild SAH in the left sylvian fissure but no ischaemic areas. One patient still in treatment died from fatal rebleeding (the clinical onset had been with haemorrhage two weeks before the session) 12 days after the embolization. Excellent or good clinical outcome was obtained in 23/26 patients who completed the therapeutic protocol. Outcome was conditioned by focal symptoms present on admission in three patients due to haemorrhagic onset, but only one patient presented a severe disability on discharge. In our view, the main problem of Onyx is that the apparently easier approach will probably lead to a wider diffusion of these procedures. AVMs are extremely difficult and dangerous to treat: this is not affected by the quality of the embolizing agents used and must be kept in mind at all times.
Temporary Balloon Occlusion during Giant Aneurysm Surgery
Authors: Petralia B. , Skrap M. 
Published: January 2017

We propose this combined balloon occlusion and surgical technique to treat selected patients with large-giant aneurysms not suitable for a pure endovascular or surgical approach. After an occlusion test a non detachable balloon catheter is positioned deflated proximally to the neck of the aneurysm under general anesthesia. The patient is then moved to the neurosurgical room. During the intervention the balloon is inflated and deflated when necessary to allow better surgical control of the aneurysmal sac. With this approach we achieve complete aneurysm occlusion and shorten the surgery time. Since January 2003 we have treated 13 giant aneurysms (ten paraclinoid and three vertebrobasilar) without significant complications related to balloon assistance and a good outcome in all patients.
Additional Rescue Stent Placement for Stabilization of a Prolapsed Coil during Stent-Assisted Coil Embolization of a Wide-Neck Intracranial Aneurysm
Authors: Sourour N. , Góngora-Rivera F. , Biondi A. 
Published: January 2017

We report a case of a 55-year-old man carrying two unruptured internal carotid artery (ICA) wide-neck aneurysms. In the same session, the smaller aneurysm was treated by coils using the remodeling technique and the large aneurysm was treated by stent-assisted coil embolization. During the stent-assisted procedure for the large aneurysm, the microcatheter tip moved from the aneurysm into the parent artery causing a prolapse of some coil loops into the vessel lumen. The distal part of the coil was tangled within the stent's struts, therefore, in order to introduce the entire coil, an attempt was made to withdraw the prolapsed loops of the coil within the microcatheter and concomitantly repositioning the microcatheter into the residual aneurysm neck through the stent struts. However this maneuver was unsuccessful. An attempt to retrieve gently the coil also failed and the coil prematurely detached. For maintaining the patency of the arterial lumen and to reduce the embolic risk, a second stent was used to pin the free coil loops. The rescue stent was positioned within the coil loops and its deployment allowed a circumferential expansion of some loops around the stent perimeter while other loops were flattened against the wall of the artery. The parent artery remained patent at one-year follow-up angiographic study. No clinical complications were observed.
Treatment of Cerebral Aneurysms: Surgical Clipping and Coil Embolization
Authors: Kaku Y. , Watarai H. , Kokuzawa J. , Tanaka T. , Andoh T. 
Published: January 2017

The present series provides a balanced overview of the treatment of aneurysms in surgical clipping and coil embolization. Between January 2004 and March 2006, 76 consecutive patients with cerebral aneurysms underwent endovascular embolization and/or surgical clipping. Of these, 42 patients suffered an aneurysmal subarachnoid hemorrhage (SAH), while the remaining 34 patients had nonruptured cerebral aneurysms. Of the 23 surgically treated patients, 17 (73.9%) achieved a favorable outcome. Of the 19 patients who underwent endovascular embolization, 12 (63.2%) achieved a favorable outcome. Three patients (15.8%) who underwent endovascular embolization needed to undergo re-treatments, while no re-treatment was needed in the surgically treated patients. Of the 34 nonruptured aneurysms, 12 (35.3%) were treated using surgical clipping, while 22 (64.7%) underwent endovascular embolization. The complication rates of the two treatment modalities demonstrated no significant difference. A combined microsurgical-endovascular team approach is thus considered to provide the most effective means to achieve favorable outcomes for patients with cerebral aneurysms.
Evaluation of Carotid Artery Plaque Using IVUS Virtual Histology
Authors: Tamakawa N. , Sakai H. , Nishimura Y. 
Published: January 2017

Currently carotid artery stenting (CAS) as well as carotid endoarterectomy (CEA) have become widely accepted forms of treatment for carotid artery stenosis, although complications associated with distal embolism remain problematic. Therefore it is important to have an accurate understanding of the properties of carotid plaque before undertaking CAS in order to ensure the safety of such a therapeutic treatment. This study was undertaken to determine the efficacy of using IVUS Virtual Histology TM (VH-IVUS) to evaluate the pathological properties of plaque contained within carotid artery stenosis. VH-IVUS was performed for six cases undergoing CAS during the period of July to December, 2005. VH-IVUS displays plaque composition under four color mappings of fibrous, fibro-fatty, calcification and necrotic core, being able to offer detailed tissue characterization of soft to hard plaque components. Plaque evaluation by VH-IVUS is both reproducible and objective, and is considered to be an effective method for evaluating the risk complications associated with CAS.
Stenting for Chronic Total Occlusion of the Proximal Subclavian Artery
Authors: Sakai C. , Sakai N. , Kuroiwa T. , Ishihara H. , Adachi H. , Morizane A. , Yano T. , Kajikawa R. , Yamagami H. , Kobayashi J. , Kondo K. , Kikuchi H. 
Published: January 2017

We report the results of 26 patients who underwent stent deployment for chronic total occlusion of proximal subclavian artery. From January 1998 to October 2005, 26 patients (18 male; mean age, 62.7 years, range 22 to 83 years), 28 lesions, underwent 29 procedures of stenting for chronic total occlusion of the proximal subclavian artery. Twenty-three patients had symptoms of claudication in their arm, no patients had subclavian steal syndrome. A brachial approach was used in 21 procedures, a femoral approach was used in five procedures, and combined femoral-brachial approach was required in three procedures. Primary stent deployment was success in 24 lesions (85.7%), and secondary procedure was success in one patient, totally 25 lesions (89.3%) were successfully treated by stenting. Procedure related complication occurred in four cases, including stent migration without symptoms in two procedures, hemianopsia on next day in a case, and TIA on unclear reason in one case. Permanent morbidity rate is 3.4% in procedure. Target lesion re-treatment required in three lesions, caused by subacute thrombosis, in-stent-restenosis, and dissection of the vessel by stent edge. The cases of subacute thrombosis and in-stent-restenosis were treated by re-PTA, and the case of dissection was treated by additional stenting. Secondary patency was 100%. We conclude that stenting for chronic total occlusion of subclavian arteries appears feasible and safe.
Incidence of Ischemic Complications after Endovascular Treatment for Ruptured Dissecting Vertebral Artery Aneurysms
Authors: Kudo T. , Iihara K. , Satow T. , Murao K. , Miyamoto S. 
Published: January 2017

We analyzed the incidence of ischemic complications after internal trapping for ruptured VA dissecting aneurysms. Between April 2001 and August 2005, nine cases of ruptured VA dissecting aneurysms, five in women, “proximal” or distal (distal type) to the origin of the PICA, were treated by internal trapping in the acute stage after SAH. There were four cases of proximal type and five of distal type. The demographics of the patients were reviewed in the medical charts and radiological findings were evaluated by neuroradiologists. The dissected site was completely obliterated and PICA was preserved in all cases. Follow-up angiography performed five to 19 days after treatment revealed complete obliteration of the aneurysm and patency of the PICA. The incidence of perioprocedural ischemic complications for the PICA-distal type (75%) was higher than that for the PICA-proximal type (20%). Here we retrospectively analyzed and discussed the incidence and mechanisms of ischemic complications.
Emergency Stenting of an Acute Internal Carotid Artery Occlusion from Spontaneous Dissection
Authors: Leong S. , Abbas S. , Galvin L. , Moroney J , Brennan P. , Thornton J. 
Published: January 2017

Internal carotid artery (ICA) dissection is an important cause of stroke in the younger population. Carotid stenting with or without angioplasty is usually the preferred treatment for symptomatic patients who have failed medical therapy. We report a case of a symptomatic internal carotid artery dissection at the petrous segment of the ICA initially treated conservatively with anticoagulation and antiplatlet agents. Due to early clinical deterioration from near complete carotid occlusion without adequate cross over flow, the patient underwent emergency stenting of the ICA. Post procedure angiography demonstrated no residual stenosis of the ICA. The patient progressively improved and at six months follow-up, the patient had no further symptoms, a normal neurological examination and improvement in the imaging findings. The successful clinical result in our case of ICA stenting for dissection as a ‘hemispheric rescue’ contributes to the growing literature of endovascular management of carotid dissection. The excellent mid term follow-up confirms the efficacy of this treatment for a dominant ICA.
Morphological Study of Aneurysms at the Junction of the Superior Cerebellar Artery
Authors: Iizuka H. , Miyachi S. , Ohshima T. , Izumi T. , Tsurumi A. , Yoshida J. 
Published: January 2017

Superior cerebellar artery (SCA) aneurysms sometimes involve the origin of the SCA making treatment difficult. We focused on the morphological characteristics of SCA aneurysms and adjacent vascular structures to apply clinical decision-making for the treatment strategy. Sixty-nine SCA aneurysms, including 34 ruptured and 35 unruptured ones, had been treated for over 12 years. Multiple aneurysms were associated in 30 patients. The pattern of the neck position of aneurysms was classified into three types: Type A: no SCA-involved type; Type B: half involved type with SCA originating from the aneurysmal neck; Type C: pure SCA aneurysm with all the neck mounting on SCA. Morphological and clinical analysis was done between ruptured and unruptured aneurysms and among the three types. There was no difference in patient profile between ruptured and unruptured aneurysms. The angle formed by the posterior cerebral artery and SCA on the aneurysm side was obtuse in 62 (90%) patients. From the morphological point of view the SCA-involved type (types B + C) was significantly more prevalent in ruptured aneurysms (77%). Bleb formation was particular in ruptured aneurysms. As for the treatment, the risk of SCA occlusion and incomplete and attempted operation was particularly high in cases with SCA-involved type. Although SCA aneurysms may grow due to the hemodynamic stress at the opened bifurcation between the PCA and SCA, the neck shifting to the origin of SCA, particularly in ruptured lesions, may suggest some other etiological mechanism. SCA-involved type aneurysms had a high treatment risk of SCA occlusion and tended to incomplete treatment to avoid such ischemic complications.