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1.
Henrik Behrend Vilijam Zdravkovic Johannes M. Giesinger Karlmeinrad Giesinger 《Knee surgery, sports traumatology, arthroscopy》2017,25(5):1454-1460
Purpose
To measure joint awareness in patients who have undergone anterior cruciate ligament (ACL) reconstruction and to investigate medium- and long-term results of the procedure.Methods
All patients who had undergone ACL reconstruction with the same arthroscopic surgical technique at our institution between 2011 and 2014 (medium-term follow-up group (Group I)) or between 2000 and 2005 (long-term follow-up group (Group II)) were considered for inclusion in the study. A group of healthy controls were recruited to obtain reference values for the FJS-12 (Forgotten Joint Score-12). Propensity score matching was applied to improve comparability of patients and healthy controls in terms of sex and age.Results
Fifty-eight patients of the Group I (mean follow-up 31.5 (SD13.4) months, range 12–54), 57 patients of the Group II (mean follow-up 139 (SD15.2) months, range 120–179), and the healthy control samples (100 individuals) were analysed. Significantly lower FJS-12 was found in both groups (Group I: 71.6 and Group II: 70.1), compared to the two matched control groups (88.1 and 90.0).Conclusions
The concept of joint awareness was successfully applied to evaluate medium- and long-term results of ACL reconstruction. The clinical relevance of this study is that it extends the construct of joint awareness as a patient-reported outcome parameter to ACL reconstruction surgery.Level of evidence
Level III.2.
Stevo Duvnjak Pernille Ravn Anders Green Poul Erik Andersen 《Cardiovascular and interventional radiology》2016,39(2):204-209
Purpose
This study was designed to evaluate the long-term clinical outcome and frequency of reinterventions in patients with uterine fibroids treated with embolization at a single center using polyvinyl alcohol microparticles.Methods
The study included all patients with symptomatic uterine fibroids treated with uterine fibroid embolization (UFE) with spherical (s-PVA) and nonspherical (ns-PVA) polyvinyl alcohol microparticles during the period January 2001 to January 2011. Clinical success and secondary interventions were examined. Hospital records were reviewed during follow-up, and symptom-specific questionnaires were sent to all patients.Results
In total, 515 patients were treated with UFE and 350 patients (67 %) were available for long-term clinical follow-up. Median time of follow-up was 93 (range 76–120.2) months. Eighty-five patients (72 %) had no reinterventions during follow-up in the group embolized with ns-PVA compared with 134 patients (58 %) treated with s-PVA. Thirty-three patients (28 %) underwent secondary interventions in the ns-PVA group compared with 98 patients (42 %) in s-PVA group (χ 2 test, p < 0.01).Conclusions
Spherical PVA particles 500–700 µm showed high reintervention rate at long-term follow-up, and almost one quarter of the patients underwent secondary interventions, suggesting that this type of particle is inappropriate for UFE.3.
Purpose
The purpose of the study was to report the outcomes and late toxicities in patients younger than 60 years of age with long-term follow-up treated with low dose rate (LDR) brachytherapy for localized prostate cancer.Methods
Between January 2000 and December 2009, 270 consecutive patients were treated with favourable localized prostate cancer; the median follow-up was 111 months (range 21–206). All patients received one implant of LDR brachytherapy. Toxicity was reported according to the Common Toxicity Criteria for Adverse Events, Version 4.0 (CTAE v4.02) by the National Cancer Institute.Results
The overall survival according to Kaplan–Meier estimates was 99 (±1%) at 17 years. The 17-year rate for failure in tumour-free survival (TFS) was 97% (±1%), whereas for biochemical control it was 95% (±1%) at 17 years, 97% (±1%) of patients being free of local recurrence. No intraoperative or perioperative complications occurred. Acute genitourinary (GU) grade II toxicity was 4% at 12 months. No other chronic toxicity was observed after treatment. At 6 months, 94% of patients reported no change in bowel function.Conclusions
LDR brachytherapy provides patients younger than 60 years of age with low and intermediate-risk prostate cancer excellent outcomes and has a low risk of significant long-term GU or gastrointestinal morbidity.4.
Purpose
Long-term data on aneurysm treatment with flow-diverting stents are still sparse, and follow-up protocols differ widely between institutions. We present long-term results, with a focus on the usefulness of contrast-enhanced MR angiography (ceMRA).Materials and Methods
Interventions and follow-up imaging of patients with aneurysms treated by flow-diverting stents (“Pipeline,” “Silk” and “FRED” models) without additional coiling were analyzed. All MRI scans included dedicated two-phase ceMRA. Aneurysm occlusion rates, size of the aneurysmal sac and complications were evaluated on MRI and digital subtraction angiography (DSA), where available. The ability of ceMRA to depict aneurysm occlusion and stent patency was graded on a three-point scale.Results
Twenty-five patients with 102 MRI scans were included. The median duration of follow-up was 830 days. Aneurysm occlusion rates were 52% at 3 months (10 of 19 patients), 72% at 6 months (18/25) and 84% overall (21/25). Shrinkage of the aneurysmal sac was found in 19 patients (76%) and in 12 cases to <50% of the original size (48%). CeMRA assessability of aneurysmal occlusion was graded as good in all cases. When compared to DSA (18 cases), ceMRA had a sensitivity of 100% and specificity of 91% regarding aneurysm remnant detection. Assessability of the stent lumen varied and was limited in most cases.Conclusions
Flow-diverter treatment achieves high occlusion rates and can cause major aneurysm shrinkage. CeMRA is highly valuable regarding imaging of the aneurysmal sac. There are limitations regarding the assessability of the stent lumen on ceMRA.Level of Evidence
Level 4, Case Series.5.
Introduction
The Leo stent was the first retrievable stent for endovascular treatment of intracranial aneurysms (IAs). We report our experience with this device with emphasis on very long-term follow-up.Methods
This study was approved by authors’ ethical committee. A retrospective review of our prospectively maintained database identified all patients treated for a saccular IA with this stent in our institution. Technical issues and immediate and long-term outcomes (at least 12 months) were evaluated.Results
Between 2004 and 2015, 50 patients with 52 IAs were identified. In two patients, the stent could not safely be placed (failure rate = 3.8%). Among 48 treated patients with 50 IAs, there were 44 women and 4 men (mean age, 53 years). Mean aneurysm diameter was 7.2 mm. All IAs but six were wide-necked. There was no immediate morbidity or mortality. Anatomical results included 76% complete occlusions, 22% neck remnants, and 2% incomplete occlusions. Mean follow-up was 50.2 months (range, 12–139 months). Two patients had delayed TIAs but long-term morbidity rate remained = 0%. At follow-up, occlusion was stable in 68% IAs, showed thrombosis in 12%, and recanalization in 20% IAs. Complementary treatment was required in 8% IAs. Final results showed 70% complete occlusions, 24% neck remnants, and 6% incomplete occlusions. Asymptomatic stent occlusion and significant stenosis occurred in one and two cases, respectively.Conclusion
The Leo stent is safe and effective for treatment of wide-necked saccular IAs. Very long-term results show high rates of adequate and stable occlusion. Moreover, the stent is well tolerated.6.
Eisaku Yoden Takayuki Nose Yuki Otani Shuuji Asahi Iwao Tsukiyama Takushi Dokiya Toshiaki Saeki Ichirou Fukuda Hiroshi Sekine Naoto Shikama Yu Kumazaki Takao Takahashi Ken Yoshida Tadayuki Kotsuma Norikazu Masuda Kazutaka Nakashima Taisei Matsumura Shino Nakagawa Seiji Tachiiri Yoshio Moriguchi Jun Itami Masahiko Oguchi 《Japanese journal of radiology》2017,35(7):381-388
Purpose
We conducted a multi-institutional prospective study on accelerated partial breast irradiation (APBI) using interstitial brachytherapy. The clinical results over a minimum follow-up period of 30 months are presented here.Materials and methods
Forty-six patients with breast cancer were treated with breast-conserving surgery and postoperative APBI. After confirmation of negative surgical margins and negative lymph nodes, a high-dose-rate brachytherapy protocol of 36 Gy/6 fractions was carried out. All clinical data were prospectively collected using the Common Terminology Criteria for Adverse Events ver. 3.0.Results
No recurrence was observed. Cumulative rates of grade 2 or higher late sequelae were 25% for fibrosis, 2% for fractures, 9% for pain, and 9% for soft tissue necrosis. Rates of excellent or good cosmetic results as assessed by the physician and patient were 93 and 89% at the 12-month follow-up and 76 and 74% at the 30-month follow-up, respectively. Large volumes of resected tissue in small breasts were associated with fibrosis of grade 2 or higher.Conclusion
APBI in Japanese women provides satisfactory clinical results except for cosmetic outcomes. There is some difficulty with the assessment of fibrosis and cosmetic outcomes, especially in patients with small breasts.Clinical Trial Registration Number
UMIN000001677.7.
E. K. Song Pranav R. Agrawal S. K. Kim H. Y. Seo J. K. Seon 《Knee surgery, sports traumatology, arthroscopy》2016,24(11):3381-3386
Purpose
Well balanced knees with good alignment are essential for a well-functioning TKA with long survival of its implants. This prospective randomized study comparing navigation-assisted TKA and conventional TKA reported the clinical and radiological outcomes at a follow-up of 9 years. The purpose of this study was to compare the clinical and radiological outcomes for patients who underwent navigation-assisted TKA or conventional TKA after long-term follow-up.Methods
A total of 80 patients (88 knees) were available for physical and radiological examination 9 years after TKA. Clinical outcomes were evaluated using HSS, WOMAC, and KS function and pain scores. And radiological outcomes of the component loosening and its survivorship during 9-year follow-up were also evaluated.Results
There were no significant differences in the field of clinical outcomes between the two groups. In terms of radiological outcomes, the navigation group had fewer alignment outliers (7.3 vs 20 %, p = 0.006). Although the clinical outcomes showed no differences between the two groups, the survival rate was slightly better in the navigation group than in the conventional group without statistical significance (best-case scenario 100 vs 95.3 %, n.s., worst-case scenario 95.6 vs 88.4 %, n.s.).Conclusion
Navigation-assisted TKA produced better alignment outcomes and better survival rates than conventional instruments although some of the differences were not statistically significant.Level of evidence
I.8.
Stefan Roest Hendrik J. Boiten Ron T. van Domburg Roelf Valkema Arend F. L. Schinkel 《Journal of nuclear cardiology》2018,25(1):63-71
Background
Dobutamine stress myocardial perfusion imaging (MPI) is a useful alternative for the evaluation of coronary artery disease (CAD) in elderly patients who are unable to perform an exercise stress test. However, data on the long-term prognostic value of stress MPI in elderly patients are lacking. Therefore, this study evaluated the long-term prognostic value of dobutamine stress MPI in elderly patients unable to perform an exercise test.Methods
The study population consisted of 247 elderly patients (mean age 71 ± 5 years) who underwent dobutamine stress single-photon emission computed tomography (SPECT) MPI. An abnormal SPECT study was defined as the presence of fixed and/or reversible perfusion defects. A summed stress score (SSS) was obtained to estimate the extent and severity of perfusion defects. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction (MI).Results
During a median follow-up of 14 years (range 12-16), 168 (68%) patients died (all-cause mortality), of which 56 (23%) were due to cardiac causes. Nonfatal MI occurred in 19 (8%) patients. Kaplan-Meier survival curves showed that MPI provided optimal risk stratification in patients with normal and abnormal MPI. Multivariable analysis identified an abnormal MPI as a strong significant predictor of all-cause mortality and cardiac events. A multivariable analysis also revealed that a reversible defect and SSS were strong long-term predictors of cardiac mortality and hard cardiac events.Conclusion
Dobutamine stress 99mTc-tetrofosmin SPECT provides incremental prognostic information for the prediction of long-term cardiovascular outcomes in elderly patients, unable to perform exercise testing. Dobutamine stress MPI is useful in risk classifying elderly patients.9.
Narayanan Thulasidasan Srividhiya Sriskandakumar Shahzad Ilyas Tarun Sabharwal 《Cardiovascular and interventional radiology》2016,39(12):1759-1764
Purpose
Percutaneous transcatheter embolization is currently the preferred treatment for ruptured or enlarging renal angiomyolipoma (AML), although the optimum choice of embolic material has not yet been established. We present mid- to long-term outcomes following embolization of AMLs with Onyx.Materials and Methods
Ten AMLs in seven patients (including two with tuberous sclerosis) were embolized with Onyx. Patients were followed-up clinically, with tumour size and renal function measured pre- and post-procedure.Results
Mean pre-treatment AML size was 63.4 mm (range 42–100). Mean clinical follow-up was 431.4 days (range 153–986) and imaging follow-up 284.2 days (range 30–741). There was no haemorrhage from treated lesions within the follow-up period. Of patients who had cross-sectional imaging pre- and post-procedure, mean decrease in AML size of 22 mm was seen after Onyx embolization (p = 0.0058, 95 % CI 9.13–34.87). No significant difference between serum creatinine was seen pre- and post-procedure (p = 0.54, 95 % CI 8.63–4.85).Conclusions
Onyx embolization of renal AMLs is effective in the medium to long term, with theoretical benefits in safety and durability of result.10.
Michele Vasso Chiara Del Regno Katia Corona Rocco D’Apolito Alfredo Schiavone Panni 《Knee surgery, sports traumatology, arthroscopy》2016,24(10):3100-3105
Purpose
The purpose of this study was to determine the long-term outcome in patients who underwent two-stage reimplantation with an articulated spacer following a chronic periprosthetic knee infection. The hypothesis was that the use of an articulated spacer provides significant improvement of clinical results and knee functionality through a long follow-up period, and therefore a durable revision TKA.Methods
Forty-six consecutive patients (46 knees) who underwent two-stage reimplantation with an articulated spacer for a chronic periprosthetic knee infection were retrospectively analysed. An articulated cement spacer, moulded in surgery room, was implanted in all cases. Patients were followed for a median period of 12 (range 6–16) years, and no patients were lost to follow-up. Patients were assessed preoperatively and postoperatively through the IKS knee and function scores and ROM.Results
Two-stage reimplantation was successful in controlling the infection in 91.3 % of patients. In the 42 patients with a successful two-stage revision, the median IKS knee and function scores were 36 (range 16–56) points and 25 (range 15–35) points, respectively, before the operation, and 76 (range 52–94) points and 70 (range 55–90) points (p < 0.001) at the last follow-up. The median ROM increased from 80 (range 60–110) degrees preoperatively to 115 (range 100–128) degrees (p < 0.01) at the last follow-up.Conclusions
Two-stage septic revision with an articulated cement spacer provided a significant long-term improvement of preoperative clinical and functional knee scores and therefore a durable revision TKA.Level of evidence
Retrospective case series, Level IV.11.
Purpose
To report the 3-year results of the MAJESTIC first-in-human study of the Eluvia Drug-Eluting Vascular Stent System for treating femoropopliteal artery lesions.Methods
The prospective, single-arm, multicenter clinical trial enrolled 57 patients with symptomatic lower limb ischemia (Rutherford category 2, 3, or 4) and lesions in the superficial femoral artery or proximal popliteal artery. Mean lesion length was 70.8 ± 28.1 mm, and 46% of lesions were occluded. Efficacy measures at 2 years included primary patency, defined as duplex ultrasound peak systolic velocity ratio of ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Safety monitoring through 3 years included adverse events and TLR.Results
Primary patency was estimated as 83.5% (Kaplan–Meier analysis) at 24 months, and 90.6% (48/53) of patients maintained an improvement in Rutherford class. At 36 months, the Kaplan–Meier estimate of freedom from TLR was 85.3%. No stent fractures were identified, and no major target limb amputations occurred.Conclusion
MAJESTIC results demonstrated long-term treatment durability among patients whose femoropopliteal arteries were treated with the paclitaxel-eluting Eluvia stent.Level of Evidence
Level 2b, cohort study12.
Ji Hyun Youk Eun-Kyung Kim Min Jung Kim Jin Young Kwak Eun Ju Son 《European radiology》2010,20(4):782-789
Objectives
To determine the false-negative rate and to evaluate the clinical, radiologic or histologic features of false-negative results at ultrasound (US)-guided 14-gauge core needle biopsy (CNB).Methods
A total of 3,724 masses from 3,308 women who had undergone US-guided 14-gauge CNB and who had a rebiopsy or at least 2 years’ follow-up were included. The histology of CNB was correlated with the rebiopsy or long-term imaging follow-up. In cases of missed cancer, the time interval between CNB and rebiopsy, the reasons for rebiopsy, and the procedural or lesion characteristics were analysed.Results
Of 1,706 benign CNBs, 50 additional malignancies were found at excision (false-negative rate, 2.5% of 1,982 with a final diagnosis of malignancy). Of 50 false negatives, 41 were found immediately of which 28 had rebiopsy because of imaging-histological discordance. Regarding the frequency of malignancy according to the reasons for rebiopsy, suspicious imaging finding (24%) showed significantly higher frequency than suspicious clinical findings or request (1%). Regarding the characteristics except invasiveness, no significant differences in false-negative rates were found.Conclusions
Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential.13.
Seong Hwan Kim Jung-Won Lim Young-Bong Ko Min-Gu Song Han-Jun Lee 《Knee surgery, sports traumatology, arthroscopy》2016,24(11):3466-3473
Purpose
The purpose of this study was to compare the midterm outcomes between fixed and mobile ultra-congruent (UC) bearings in total knee arthroplasty (TKA).Methods
This is a retrospective matched-pairs case–control study of patients who underwent primary navigation-assisted TKA with a minimum 5-year follow-up. A total of 182 cases involved the fixed UC bearing system as Group 1 and 101 cases involved mobile UC bearing system group as Group 2. After 1:1 matching, 73 knees in each group were enrolled. Clinical and radiographic outcomes were evaluated.Results
The overall survival was 143 of 146 cases (97.9 %) at final follow-up, and 72 of 73 cases (96.3 %) in Group 1 and 71 of 73 cases (95.8 %) in Group 2 at final follow-up based on an endpoint of revision surgery. The reasons of revision TKA were periprosthetic fracture in Group 1, infection and bearing dislocation in Group 2. There was no statistical difference in Hospital for Special Surgery (HSS) scores, Knee Society Scores (KSS), WOMAC index score evaluations between groups.Conclusions
This study demonstrated that the fixed-bearing UC prosthesis could provide satisfactory performance compared with that of the mobile-bearing UC prosthesis with minimum 5-year follow-up. The fixed-bearing UC prosthesis could be considered in navigation-assisted TKA with theoretical advantages of UC design.Level of evidence
IV.14.
Objectives
To assess the efficacy of bisphosphonate therapy on bone pain in patients with osteoid osteoma (OO) (main objective), and to describe bisphosphonate-induced changes in nidus mineralisation and regional bone-marrow oedema (BMO).Methods
A prospective, observational study was conducted from 2011 to 2014. Patients with risk factors for complications of percutaneous or surgical ablation or recurrence after ablation, were offered once monthly intravenous bisphosphonate treatment until significant pain alleviation was achieved.Results
We included 23 patients. The first two patients received pamidronate and the next 21 zoledronic acid (mean, 2.95 infusions per patient). Bisphosphonate therapy was successful in 19 patients (83%), whose mean pain visual analogue scale score decreased by 76.7%; this pain-relieving effect persisted in 17 patients (74%) with a mean follow-up time of 36 months. Computed tomography (CT) demonstrated a mean nidus density increase of 177.7% (p = 0.001). By magnetic resonance imaging (MRI), mean decreases were 38.4% for BMO surface area and 30.3% for signal intensity (p = 0.001 and p = 0.000, respectively).Conclusions
In 17/23 patients with painful OO managed conservatively with bisphosphonates, long-term final success was achieved. Bisphosphonates may accelerate the spontaneous healing of OO.Key points
? 19/23 patients with OO managed with bisphosphonates experienced significant pain relief ? Pain relief was sustained in 17/23 patients, mean follow-up of 36 months ? CT demonstrated a significant increase in nidus mineralisation ? MRI demonstrated a significant decrease in bone marrow oedema ? Bisphosphonate therapy may accelerate the spontaneous healing of OO15.
Joicemar Tarouco Amaro Gustavo Gonçalves Arliani Diego Costa Astur Pedro Debieux Camila Cohen Kaleka Moises Cohen 《Knee surgery, sports traumatology, arthroscopy》2017,25(6):1692-1696
Purpose
Until now, there are no definitive conclusions regarding functional differences related to middle- and long-term everyday activities and patient pain following implantation of mobile- and fixed-platform tibial prostheses. The aim of this study was to determine whether there are middle-term differences in knee function and pain in patients undergoing fixed- and mobile-bearing total knee arthroplasty (TKA).Methods
Eligible patients were randomized into two groups: the first group received TKA implantation with a fixed tibial platform (group A); the second group received TKA with a mobile tibial platform (group B). Patients were followed up (2 years), and their symptoms and limitations in daily living activities were evaluated using the Knee Outcome Survey—Activities of Daily Living Scale (ADLS), in addition to pain evaluation assessed using the pain visual analogue scale (VAS).Results
There were no significant differences in function and symptoms in the ADLS and VAS between the study groups.Conclusion
The type of platform used in TKA (fixed vs. mobile) does not change the symptoms, function or pain of patients 2 years post-surgery. Although mobile TKAs may have better short-term results, at medium- and long-term follow-up they do not present important clinical differences compared with fixed-platform TKAs. This information is important so that surgeons can choose the most suitable implant for each patient.Level of evidence
Randomized clinical trial, Level I.16.
Aim
This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.Methods
Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.Results
Several large-scale trials on moderate hypofractionation with single doses from 2.4–3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2–3 years.Conclusion
Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.17.
Mats Ryttlefors Torsten Danfors Francesco Latini Anders Montelius Erik Blomquist Olafur Gudjonsson 《European journal of nuclear medicine and molecular imaging》2016,43(8):1432-1443
Purpose
To determine if 11C-l-methionine PET is a useful tool in the evaluation of the long-term effect of proton beam treatment in patients with meningioma remnant.Methods
Included in the study were 19 patients (4 men, 15 women) with intracranial meningioma remnants who received hypofractionated high-energy proton beam treatment. Patients were examined with 11C-l-methionine PET and MRI prior to treatment and after 6 months, and 1, 2, 3, 5, 7 and 10 years. Temporal changes in methionine uptake ratio, meningioma volume, meningioma regrowth and clinical symptoms throughout the follow-up period were evaluated.Results
In 17 patients the tumour volume was unchanged throughout the follow-up. The methionine uptake ratio on PET decreased over the years in most patients. In two patients the tumour remnant showed progression on MRI. In these patients, prior to the volume increase on MRI, the methionine uptake ratio increased. One patient experienced transient clinical symptoms and showed radiological evidence of a radiation-induced reaction close to the irradiated field.Conclusion
Proton beam treatment is a safe and effective treatment for achieving long-term growth arrest in meningioma remnants. Follow-up with 11C-l-methionine PET may be a valuable adjunct to, but not a replacement for, standard radiological follow-up.18.
Objective
To assess the feasibility, efficacy, and safety of agitation thrombolysis and catheter-directed thrombolysis (AT–CDT) in the treatment of normotensive patients with acute pulmonary thromboembolism (PTE).Methods
A total of 37 consecutive patients of normotensive PTE were treated by AT–CDT between October 2011 and January 2016. Clinical outcomes and mortality were evaluated after the treatment, and follow-up was carried out after hospital discharge.Results
AT–CDT was technically successful in 93.7% (36/37) patients, with one case died from respiratory failure during procedure. The clinical success rate was 91.9% (34/37), one patient died from intracranial hemorrhage 9 days after agitation, and one case showed no improvement. A total of 83.8% (31/37) cases were clinical cured and 8.1% (3/37) cases were relieved during hospitalization. Three cases died of respiratory failure caused by PTE, and two cases died of diseases unrelated to PTE (lung carcinoma/hemoptysis) during a 20–1524 days of follow-up.Conclusion
AT–CDT may be a feasible, effective, and safe treatment for normotensive patients with acute PTE.19.
Purpose
Wide-neck bifurcation intracranial aneurysms (WNBA) with a branch incorporated in the aneurysm base remain difficult to treat by embolization. We aim to report our long-term follow-up of stent-assisted coiling (SAC) in this subgroup of patients.Methods
This study was approved by our local ethical committee. A retrospective review of our prospectively maintained database identified all patients treated in our institution by SAC for a WNBA with a branch incorporated in the aneurysm base. Technical issues, immediate, long-term outcomes were evaluated.Results
Between 2007 and 2015, 49 patients with 53 intracranial aneurysms (IAs) (52 unruptured, 1 ruptured) were identified and successfully treated. No morbidity/mortality occurred. The incorporated branch was preserved in all patients but one who was treated during a vasospasm phase. At the first 6-month imaging control, the branch was patent. Immediate occlusion was near-complete in 11/53 aneurysms (20.8%), neck remnant in 20/53 aneurysms (37.7%), and incomplete in 22/53 aneurysms (41.5%). Available imaging follow-up of 47 IAs, ranging from 3 to 84 months (mean 26 months ± 19.6 months), showed 27 progressive thrombosis (57.4%), 17 stable occlusions (36.2%), 1 minor recanalization (2.1%), and 2 significant recanalizations that were retreated (4.3%). The latest imaging control showed 30 near-complete occlusions (63.8%), 13 neck remnants (27.7%), and 4 incomplete occlusions (8.5%).Conclusion
Stent-assisted coiling is safe and effective for the treatment of WNBA with a branch incorporated in the aneurysm base. Despite poor immediate anatomical results, long-term follow-up shows a high rate of progressive thrombosis achieving adequate and stable occlusion in most patients.20.
Anna M. Sailer Patricia J. Nelemans Camille van Berlo Ozan Yazar Michiel W. de Haan Dominik Fleischmann Geert Willem H. Schurink 《European radiology》2016,26(6):1613-1619