Endovascular treatment of anterior choroidal artery aneurysms

BACKGROUND AND PURPOSE: Ischemic stroke is the most common complication after surgical clipping of anterior choroidal artery (AChA) aneurysms, and the reported morbidity-mortality rates vary from 5% to 50%. We report the findings in a series of 18 consecutive patients who underwent endovascular treatment (EVT) for an AChA berry aneurysm. METHODS: In this retrospective study, the aneurysms were defined according to their size and position, the presence of a concomitant arteriovenous malformation (AVM), the mode of presentation. The patients were clinically assessed before and after the EVT, as well as at each angiographic follow-up. RESULTS: All were small-sized aneurysms, with greater diameters ranging from 2 to 8 mm (mean, 4 mm), arising from the supraclinoid internal carotid artery close to the origin of the AChA. Two were AVM-associated aneurysms. Fourteen patients (14/18 [78%]) presented with subarachnoid hemorrhage. All aneurysms were selectively embolized with coils. There was one (1/18 [5.5%]) treatment-related death due to aneurysm perforation. Another patient (1/18 [5.5%]) developed a transient controlateral hemiparesis. Fourteen patients (14/18 [78%]) were followed up clinically and angiographically for 3-32 months (mean, 14 months). None of them (re)hemorrhaged during this period. CONCLUSION: The EVT of AChA berry aneurysms is effective to protect from rebleeding. Our complication rate compares favorably with those of the surgical series.     

Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas

BACKGROUND AND PURPOSE: Substantial intraoperative bleeding during surgical removal of head and neck paragangliomas may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial approach has proved beneficial but is often limited by complex vascular anatomy and unfavorable locations. We report our experience with the preoperative devascularization of head and neck paragangliomas by using direct puncture and an intralesional injection of cyanoacrylate. METHODS: We retrospectively analyzed nine consecutive patients with head and neck paragangliomas who were referred for preoperative devascularization. Three patients were treated for carotid-body tumors; two for vagal lesions; and four, for jugular paragangliomas. Direct puncture of the lesion was performed by using roadmap fluoroscopic guidance. Acrylic glue was injected by using continuous biplane fluoroscopy. All patients underwent postembolization control angiography and immediate postoperative CT scanning. RESULTS: Angiograms showed that complete devascularization was achieved in all cervical glomus tumors, whereas subtotal devascularization was achieved in jugular paragangliomas. In this latter location, the injection of acrylic glue was limited by the potential risk of reflux into normal brain territory via feeders from the internal carotid or vertebral artery. The tumors were surgically removed and histologically examined. No technical or clinical complications related to the embolization procedure occurred. CONCLUSION: Percutaneous puncture of paragangliomas in the head and neck region and their preoperative devascularization by intralesional injection of acrylic glue is a feasible, safe, and effective technique.     

Carotid rupture during stent-assisted aneurysm treatment

We report the case of a supraclinoid carotid rupture during the delivery of a balloon-expandable stent in a 59-year-old patient with incidental paraclinoid berry aneurysms for whom stent-assisted coiling was planned. The deployment of the stent resulted in immediate rupture of the artery. We describe the emergent management of this complication with prolonged balloon inflation to occlude the site of rupture, a treatment that led to the discharge of the patient 2 weeks later without any sequelae.     

Facial infantile hemangiopericytoma resembling an arteriovenous malformation

Malignant highly vascularized tumors such as hemangiopericytomas (HPC) may mimic a benign arteriovenous malformation (AVM) which is sometimes still referred to as "angioma". We describe the clinical and radiological findings of a facial hemangiopericytoma in comparison to an AVM in order to avoid misdiagnosis between these two pathologies since evolution and therapeutic management are completely different. Because hemangiopericytomas in children show malignant behavior requiring aggressive management, early and accurate diagnosis is of significant importance for the clinical outcome.     

Imaging technique selection for the preoperative planning of oral implants: a review of the literature

Background: As the use of oral implants for the treatment of partially as well as fully edentulous patients has increased the past two decades, more specialized radiographie techniques have become available for the preoperative planning of oral implant placement. Purpose: The goal of this article was to enable clinicians to select the appropriate imaging techniques when planning for oral implants. Materials and Methods: This article reviews the available literature about various imaging techniques and their indication for the preoperative planning of oral implants. The advantages and drawbacks of each technique are described. A dosimet‐ric overview is given relative to different radiologie techniques used in various clinical situations. Results: For preoperative planning of implant placement, advantages and drawbacks of the available imaging techniques have been considered, which allows guidelines for image technique selection to be formulated based on the clinical situation provided, considering the diagnostic yield of each technique and the radiation doses involved. Conclusions: From the available literature, it can be stated that many clinical situations demand the use of cross‐sectional imaging techniques for optimal preoperative planning of implant placement. Nevertheless, such techniques are not required in cases in which the clinical examination reveals sufficient bone width and where standard radiographie examinations, such as intraoral and panoramic radiography, reveal adequate bone height and space for implant placement.     

Balloon-assisted coil placement in wide-neck bifurcation aneurysms by use of a new,compliant balloon microcatheter

Two types of balloon are usually employed to perform balloon-assisted coil placement in cerebral aneurysms: oval, guide-dependent balloons for sidewall aneurysms and round balloons for bifurcation aneurysms. We report on the use of a new, more compliant, guide-dependent oval balloon microcatheter to seal wide-neck bifurcation aneurysms with coils during endovascular occlusion.     

Computerized hemodynamic evaluation of the cerebral circulation for bypass

This article describes details of the application of computer modeling of cerebral blood circulation. A brief review of the different computer modeling techniques and the current models used today for predicting surgical options for bypass surgery are presented. The use of phase contrast MR for estimating intracranial flow rates makes these models even more accurate. Two case studies are presented with computer simulation results with verification of predicted outcome both clinically and from actual flow of measurements.     

Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

BackgroundObesity has been described as a protective factor in cardiovascular and other diseases being expressed as ‘obesity paradox’. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI).MethodsWe retrospectively collected data up to May 31^st, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m²; n = 1110, 25?30 kg/m²; n = 1464, and >30 kg/m²; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed.ResultsThe rate of respiratory insufficiency was more recorded in BMI 25?30 kg/m² as compared to BMI < 25 kg/m² (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m² than BMI < 25 kg/m², respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25?30 kg/m² and BMI > 30 kg/m² as compared to BMI < 25 kg/m², respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25?30 kg/m² and BMI > 30 kg/m² as compared to BMI < 25 kg/m², respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m² and BMI > 30 kg/m² did not impact the mortality rate (HR 1.15, 95% CI: 0.889?1.508; p = 0.27) (HR 1.15, 95% CI: 0.893?1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m² is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538?1.004; p = 0.05).ConclusionsHOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.     

Analysis of glutathione <Emphasis Type=Italic>S</Emphasis>-transferase Pi isoform (GSTP1) single-nucleotide polymorphisms and macular telangiectasia type 2

Recent imaging studies have suggested that macular pigment is decreased centrally in macular telangiectasia type 2 (MT2). The uptake of xanthophyll pigment into the macula is thought to be facilitated by a xanthophyll-binding protein (XBP). The Pi isoform of glutathione S-transferase (GSTP1) represents one such XBP with high binding affinity. This case–control study aimed to determine whether two common single-nucleotide polymorphisms (SNPs) of GSTP1 were associated with MT2. DNA samples from 39 cases and 21 controls were collected. Two polymorphic sites of Ile105Val and Ala114Val in exons 5 and 6 respectively, of the GSTP1 gene were analysed. Comparison of alleles and genotypes between cases and controls indicated that there were no statistically significant differences for either the Ile105Val SNP (P = 0.43) or the Ala114Val SNP (P = 0.85), or for any combinations; however, the homozygous at-risk genotype (GG) of the Ile105Val SNP was present in 8% of cases but absent in controls. This study found no statistically significant association between two common GSTP1 SNPs and MT2; however, a trend towards a greater frequency of the GG genotype of the Ile105Val SNP in cases is of great interest. The biological plausibility of disturbed macular pigment uptake in MT2 makes GSTP1 an excellent candidate gene. Further investigation is warranted in future studies of MT2.