Retrieval of an embolization coil from the internal carotid artery using the Amplatz Microsnare Retrieval System

An unusual case of unintentional release of an embolization coil into the proximal internal carotid artery is reported. The coil migrated and lodged distally in the petrous portion of the internal carotid artery during initial removal attempts using a regular nitinol loop snare. The coil was retrieved with the Amplatz Nitinol Microsnare system.     

Tuberculous pleural effusions: ultrasonic diagnosis.

Twenty patients with tuberculous pleural effusions were studied with ultrasonography. In 18 patients, ultrasonography demonstrated regular pleural thickening which was less than 1 cm except in 1 case. In 4 cases there were a few pleural nodules, whereas in 2 cases the pleural surface showed small nodularity. The latter finding may be diagnostic for a tuberculous etiology. Eighteen patients had multiple, delicate, mobile septations in the effusions, and a lattice-like appearance had formed in 6 cases. Computed tomography was obtained in 7 cases, and pleural thickening was demonstrated in 6 of them. Ultrasonography is a useful imaging modality in the diagnosis of tuberculous pleurisy.     

Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension

AIM To determine the outcomes of partial splenic em-bolization(PSE) for massive splenomegaly due to idiopathic portal hypertension(IPH).METHODS In this prospective study, we evaluated the charac-teristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes.RESULTS A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm(21-28 cm), and severe hypersplenismwas diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. CONCLUSION Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.     

Interlocking detachable coil occlusion in the endovascular treatment of intracranial aneurysms: preliminary results.

PURPOSETo present our preliminary experience with the recently developed interlocking detachable coils in the treatment of intracranial aneurysms.METHODSTwo aneurysms of the basilar tip, two of the internal carotid artery, and one of the posterior inferior cerebellar artery were treated by an endovascular technique using interlocking detachable coils. Three of the patients had undergone unsuccessful surgical clipping. Three-month and 1-year control angiograms were obtained.RESULTSIn all patients but one, who had an aneurysm of the internal carotid artery, the aneurysmal sac was occluded with preservation of the parent artery and did not show recanalization on the follow-up control angiograms. In the other patient who had a wide-necked aneurysm of the internal carotid artery, the sac could not be totally obliterated and showed contrast filling in the neck remnant at 3-month angiography. None of the patients experienced neurologic deficit after treatment.CONCLUSIONBecause they are soft and retrievable, interlocking detachable coils, with their immediate coil release design, may provide an alternative to surgery in the future treatment of endovascular aneurysms.     

A high incidence of spontaneous splenorenal shunting shown by digital splenoportography

The technique of digital splenoportography with thin flexible needles and small amounts of dilute contrast medium is described as one particularly suitable for use in paediatric patients. The authors report a high incidence of spontaneous splenorenal shunting revealed in their patients by this technique.     

Selective intraarterial nimodipine treatment in an experimental subarachnoid hemorrhage model

BACKGROUND AND PURPOSE: Cerebral vasospasm secondary to subarachnoid hemorrhage (SAH) has been a serious clinical problem. The aim of the present study is to evaluate the efficacy of selective intraarterial (IA) nimodipine treatment in a rabbit model of chronic cerebral vasospasm. METHODS: Twenty-two adult New-Zealand rabbits of either sex, weighing 2500-3800 g were used for this study. Following a control angiography, all animals received 1 mL of fresh unheparinized autologuous arterial blood into the cisterna magna. Three days later, the presence of vasospasm was demonstrated angiographically by selective vertebral artery injection. The experimental design was as follows: separate groups of animals (n = 5, in each group) received nimodipine (0.05 mg/kg), papaverine (6 mg/kg), or vehicle intraarterially, after placement of a microcatheter into the vertebral artery. Another group (n = 5) received nimodipine (0.05 mg/kg) directly into the cisterna magna, and vehicle injection was made into cisterna magna in two other animals. Thirty minutes after treatment, angiographies were repeated and changes in arterial diameter were expressed as percentages of control. RESULTS: IA nimodipine and IA papaverine were effective in relieving veretebral and basilary vasospasm (P < .05). IA nimodipine was more effective than IA papaverine (P < .05). IA nimodipine was not more effective than intrathecal (IT) nimodipine in relieving vertebral artery vasospasm, although it was more effective than IT nimodipine in basilar artery. Vehicle injections (IA or IT) failed to reverse the vasospasm induced by autologuous blood injection. CONCLUSION: This study showed that selective IA nimodipine treatment may be considered as an alternative in the treatment of chronic vasospasm following SAH.     

Embolization of a giant pulmonary artery aneurysm from Behcet disease with use of cyanoacrylate and the "bubble technique"

Pulmonary artery aneurysm (PAA) is a common manifestation and leading cause of mortality related to Behcet disease. Endovascular treatment is usually required when medical therapy alone fails to control progression. Successful superselective embolization of a giant PAA with the "bubble technique" was performed with use of a high concentration (75%) of n-butyl-cyanoacrylate in a patient with Behcet disease who had recurrent hemoptysis.     

Bile Duct Varices or "Pseudo-Cholangiocarcinoma Sign" in Portal Hypertension Due to Cavernous Transformation of the Portal Vein

A total of 832 patients with portal hypertension resulting from different etiology was studied by ultrasonograph as a screening test. In 17 of the 832 patients, cavernous transformation of the portal vein was detected by means of ultrasonography. We have prospectively studied these 17 patients, and the diagnosis of cavernous transformation was confirmed by portography in all patients. To evaluate how much biliary tract has been affected from cavernous transformation of the portal vein, and to explain the cause of mildly increased alkaline phosphatase and serum bilirubin levels, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 16 of the 17 patients. There were narrowing, irregularity, undulation and nodular extrinsic defects resulting from compression of thrombosis of the portal vein and the collateral vessels, mimicking cholangiocarcinoma spreading along the common bile duct on the extrahepatic biliary tract in all 16 patients who underwent ERCP. Similar ERCP findings were not found in six patients with portal hypertension due to liver cirrhosis. The ultrasonographic, portographic, and ERCP findings corresponded to surgical findings in six patients who had undergone splenectomy for either hypersplenism or bleeding from esophageal varices. The results indicate that cavernous transformation of the portal vein cause the above-mentioned radiographic findings that we propose to call "pseudo-cholangiocarcinoma sign."