Showing papers by "Arturo Consoli published in 2013"

Endovascular treatment of deep hemorrhagic brain arteriovenous malformations with transvenous onyx embolization.

Abstract: SUMMARY: Brain AVMs are a rare cause of cerebral hemorrhage and SAH, and their treatment is still debated. The aim of this study was to describe a novel endovascular approach with transvenous embolization of deep hemorrhagic brain AVMs. Five patients (3 females, 2 males; mean age, 33.2 years) underwent a transvenous embolization of a deep hemorrhagic brain AVM at our institution between February and April 2012. Clinical and angiographic data at the end of the procedure and after 6 months are reported. All the AVMs were completely obliterated, and no intra- or postprocedural complications occurred. The clinical outcome was unchanged or improved in all patients. Transvenous endovascular treatment may be considered in small, hemorrhagic, and deep AVMs with single deep drainage in those cases in which neurosurgical and radiosurgical treatment might not be indicated. ABBREVIATIONS: ACA anterior cerebral artery; AchoA anterior choroidal artery; bAVMs brain AVM; mRS modified Rankin Scale; PCA posterior cerebral artery

Balloon-Assisted Coiling of the Cavernous Sinus to Treat Direct Carotid Cavernous Fistula: A Single Center Experience of 13 Consecutive Patients

Abstract: This study evaluated clinical and neuroradiological results in 13 consecutive patients with spontaneous and traumatic direct carotid cavernous fistulas treated at our center between January 2006 and September 2012. All patients were treated by coiling of the cavernous sinus. Coiling was always performed while a semi-compliant non-detachable balloon was temporarily inflated in the internal carotid artery. This technique (balloon-assisted coiling) permitted a clear visualization of the fistula, facilitated coil positioning and protected the patency of the artery. All patients’ clinical data and radiological examinations were reviewed; nine patients underwent radiological and clinical follow-up, with a mean duration of 3.8 years (range: six months-six years). Overall results at discharge showed a complete occlusion of the fistula in seven patients (7/13, 54%) and a resolution of symptoms in eight patients (8/12, 67%). Radiological follow-up showed complete occlusion of the fistula in all patients (9/9, 100%) and clinical follow-up showed a resolution of symptoms in eight patients (8/9, 89%) and persistent symptoms in one (1/9, 11%). No procedure-related complications occurred. Balloon-assisted coiling of the cavernous sinus for the treatment of direct carotid cavernous fistulas proved an effective and safe technique, both in angiographic and clinical terms, and may be considered a technical improvement.

Double arterial catheterization technique for embolization of brain arteriovenous malformations with onyx.

Abstract: Background Arteriovenous malformation (AVM) treatment is multidisciplinary, and the patient may undergo embolization, neurosurgery, or radiosurgery combined. Great improvement in endovascular techniques was provided by the introduction of Onyx with different kinds of approach. Objective To evaluate the efficacy and the safety of Onyx embolization of brain AVMs with the double arterial catheterization technique (DACT). Methods This was a retrospective study. From January 2006 until June 2011, 61 AVMs eligible for the DACT were treated. Forty-one of the 61 AVMs were treated with single arterial catheterization technique and 20 of 61 with DACT; patient age and Spetzler-Martin AVM grade were similar in the 2 groups. Results In the DACT group, we obtained complete occlusion of the nidus in all small AVMs, whereas in the single arterial catheterization technique group, we obtained complete occlusion in only 1 of the 36% of the cases. Among the medium-size AVMs, there were no significant differences in the 2 groups, but we performed fewer procedures per patient when we used the DACT (1.4 vs 2.2). In the DACT group, we observed fewer hemorrhagic complications (3.4% vs 12.5% per procedure) and lower morbidity (5% vs 7% per patient) and mortality (0% vs 2.4%) rates. Conclusion The DACT in multifeeder AVMs may lead to a higher occlusion rate of the nidus for small AVMs and reduce the number of procedures, ensuring a higher standard of safety because of the possibility of managing the progression of Onyx into venous drainage.

Semi-quantitative and qualitative evaluation of pial leptomeningeal collateral circulation in acute ischemic stroke of the anterior circulation: the Careggi Collateral Score

Abstract: Introduction: The imaging of ischemic penumbra in acute stroke is a debated issue and establishing commonly accepted criteria is difficult. Computerized tomography-perfusion studies conducted in animals have showed that the modifications occurring in the brain parenchima are part of a dynamic and progressive process involving the microcirculation. The purpose of this paper is to propose a new angiographic classification of collateral circulation in patients with acute ischemic stroke, with a possible correlation with the clinical outcome. Materials and methods: The basal angiograms of 57 patients with acute ischemic stroke is the territory of anterior circulation secondary to a major occlusion, who underwent endovascular treatment, were retrospectively reviewed and collaterals were classified according to our novel Careggi Collateral Score in 6 grades (0-6). The clinical outcome after 3 months was evaluated with modified Rankin Scale. A ROC (receiver operating characteristic) curve analysis identified a cut-off value of 1. Results: Patients with favorable collateral circulation (grades 2-5) showed a significant correlation with good clinical outcome (modified Rankin Scale ≤2). Conclusions: The Careggi Collateral Score resulted a useful tool to evaluate the chance of obtaining a favorable result with endovascular treatment in patients with acute ischemic stroke in the anterior circulation secondary to the occlusion of a major artery.

Effects of hyper-early (<12 hours) endovascular treatment of ruptured intracranial aneurysms on clinical outcome.

Abstract: Despite the encouraging results obtained with the endovascular treatment of ruptured intracranial aneurysms, few data are available on the effects of the timing of this approach on clinical outcome. The aim of our study was to evaluate the effects of the hyper-early timing of treatment and of pre-treatment and treatment-related variables on the clinical outcome of patients with ruptured intracranial aneurysms. Five hundred and ten patients (167 M, 343 F; mean age 56.45 years) with 557 ruptured intracranial aneurysms were treated at our institution from 2000 to 2011 immediately after their admission. The total population was divided into three groups: patients treated within 12 hours (hyper-early, group A), between 12-48 hours (early, group B) and after 48 hours (delayed, group C). A statistical analysis was carried out for global population and subgroups. Two hundred and thirty-four patients (46%) were included in group A, 172 (34%) in group B and 104 (20%) in group C. Pre-treatment variables (HuntH 1.2% of pre-treatment rebleedings were observed. The hyper-early endovascular treatment of ruptured intracranial aneurysm does not seem to be statistically correlated with good clinical outcomes although it may reduce the incidence of pre-treatment spontaneous rebleedings without being associated with a higher risk of intra-procedural complications. However, since no significant differences in terms of clinical outcome and pre-treatment rebleeding rate were observed, a hyper-early treatment is not be supported by our data.

Endovascular treatment with ‘kissing’ flow diverter stents of two unruptured aneurysms at a fenestrated vertebrobasilar junction

Abstract: Background and purpose Fenestration of the vertebrobasilar junction (VBJ) is a rare condition which may be associated with the presence of aneurysms. The endovascular approach is usually the first-line treatment in these cases since the location of the aneurysm may be unsuitable for a surgical approach. This anatomical variation may even influence the endovascular strategy, particularly in those cases in which the sacrifice of a vessel could be avoided. This paper describes an innovative approach of flow diversion in such challenging situations. Methods Two women were admitted after an occasional diagnosis of an aneurysm arising from a fenestrated VBJ. In both cases the endovascular approach was performed with two flow diverter stents and dual antiplatelet therapy was administered for 6 months. Results Complete exclusion of the two aneurysms was obtained after 6 and 7 months, respectively, and the clinical outcome was excellent. Conclusions Endovascular treatment of unruptured aneurysms located on a fenestrated VBJ with flow diverter stents represents a valid therapeutic approach with excellent clinical and radiological outcomes.

Congenital defects of pericardium: case reports and review of literature.

Abstract: Introduction: Pericardial defects are a rare condition, generally asymptomatic, due to failure in development of pericardial sac. They are difficult to detect, particularly the complete absence of the pericardium. At present magnetic resonance imaging (MRI) is considered the best performing exam and it could be the first choice in the diagnosis of agenesia of the pericardium. Materials and Methods: A comprehensive review of dedicated books and PubMed literature was performed and three clinical cases have been analyzed. Results: We report three cases , one with partial and two with total agenesia of the left pericardium, seen at our Institute and diagnosed at MRI as unexpected findings. Discussion: The diagnosis of a congenital defect of the pericardium is challenging, even for expert radiologists, because this kind of deformity does not provide specific clinical nor conventional radiology findings. Nowadays, the most effective instrument for a certain diagnosis is MRI, interlocked with electrocardiography.

Cooperative patient general anesthesia (Co.Pa.Ge.A.): the new anesthetic technique for neurological monitoring of the "cooperative" patient during endovascular treatment of elective brain arteriovenous malformations with Onyx18.

Abstract: Background An anesthetic technique, which allows for neurological monitoring as well as continuous and safe monitoring of the airways with orotracheal intubation (cooperative patient general anesthesia [Co.Pa.Ge.A.]) has been described in patients undergoing elective thromboendoarterectomy surgery. The aim of this paper is to evaluate the effectiveness and the safety of Co.Pa.Ge.A. during scheduled endovascular treatments of brain arteriovenous malformations with a polymeric embolization agent, Onyx18. Methods Ten patients (3 F, 7 M; median age: 33.5±6.0 y, range: 20 to 39 y, American Society of Anesthesiologists class I to II) underwent endovascular embolization of brain arteriovenous malformations located in an eloquent area. Remifentanil was administered i.v. until an anesthetic target level was reached which allowed the anesthesiologists and the neuroradiologists to perform neurological monitoring during the entire procedure. The degree of patient satisfaction was evaluated based on a questionnaire administered the day after the procedure. Results Co.Pa.Ge.A. was successfully performed on all of the patients. No intraprocedural or postprocedural adverse events occurred. Hemodynamic stability was maintained in 5 cases with Remifentanil alone, in 2 cases with Remifentanil and Clonidine and in 1 case with Remifentanil and Nimodipine. Conclusions At the moment and to the best of our knowledge, this is the first report in the medical literature on this new anesthetic technique in interventional neuroradiology. Co.Pa.Ge.A. can be considered a safe, effective, and satisfactory technique characterized by hemodynamic stability and good control of the respiratory pattern, offering the possibility to perform real-time neurological monitoring and easy conversion to general anesthesia in case of intraprocedural complications or anesthetic necessity.

How and When to Carry Out Spinal Biopsy

Abstract: Spinal biopsies are carried out to obtain specimens of vertebral bodies or vertebral lesions. This provides biological samples for cytological and histopathological analyses. Primary and secondary tumors and infectious diseases are the most common causes for which vertebral biopses are required.