Complete Cessation Of Flow Research Articles

Preliminary Experience with a Low-Profile High-Density Braid Occluder for Transcatheter Embolization of Pulmonary Arteriovenous Malformations

This brief report describes safety, technical feasibility, and early treatment effectiveness of the low-profile braided occluder (LOBO; Okami Medical, San Diego, Caliornia) for embolization of 9 pulmonary arteriovenous malformations (PAVMs) in 4 patients (3 female and 1 male; age range: 33 to 63 years; 3 patients showed positive results for hereditary hemorrhagic telangiectasia genes). A total of 10 occluders were deployed in 10 vessels (median treated vessel diameters, 3 and 4 mm for LOBO-3 and LOBO-5 groups, respectively). All devices were successfully deployed into the feeder pulmonary arteries, achieving complete cessation of flow. There were no severe adverse events or device migrations. Available short-term follow-up computed tomography (6 PAVMs: median, 7 months; range, 1.5–7 months) demonstrated complete occlusion without persistence or recanalization. The early experience of embolization of PAVMs using a low-profile braided occluder showed it to be safe and effective. Further studies with larger cohorts and longer follow-up periods are warranted.

Apical Aneurysms and Mid–Left Ventricular Obstruction in Hypertrophic Cardiomyopathy

BackgroundApical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. ObjectivesThe authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. MethodsThe authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). ResultsThere were 108 patients with a mean age of 57.4 ± 13.5 years; 40 (37%) were women. A total of 103 aneurysm patients (95%) had mid-LV obstruction with mid-LV complete systolic emptying. Of the patients with obstruction, 84% had a midsystolic Doppler signal void, a marker of complete flow cessation, but only 19% had Doppler systolic gradients ≥30 mm Hg. Five patients (5%) had relative hypokinesia in mid-LV without obstruction. Aneurysm size is not bimodal but appears distributed by power law, with large aneurysms decidedly less common. Comparing mid-LV obstruction aneurysm patients with all control groups, the short-axis (SAX) systolic areas were smaller (P < 0.007), the percent SAX area change was greater (P < 0.005), the papillary muscle (PM) areas were larger (P < 0.003), and the diastolic PM areas/SAX diastolic areas were greater (P < 0.005). Patients with aneurysms had 22% greater SAX PM areas compared with those with elevated LV velocities but no aneurysms (median: 3.00 cm2 [IQR: 2.38-3.70 cm2] vs 2.45 [IQR: 1.81-2.95 cm2]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. ConclusionsThe great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted.

Long-Term Effects of Proximal Splenic Artery Embolization on Splenic Volume and Platelet Count

The spleen is the most commonly injured visceral organ in blunt abdominal trauma. Post-splenectomy infection risk has led to the shift toward spleen preserving procedures and splenic artery embolization (SAE) is now the treatment of choice for hemodynamically stable patients with splenic injury. This study aims to assess the long-term effect of SAE on splenic volume and platelet count. Using CPT codes, 66 patients who underwent SAE were identified, and 14 of those who had the necessary imaging and laboratory follow-up were included in the study. Indications for SAE were portal hypertension in 8 patients, bleeding in 4 patients, and thrombocytopenia in 1, and one patient had a separate indication. Splenic volume was calculated by automated volumetric software (Aquarius, TeraRecon, Inc.). Paired t-tests were performed to compare splenic volume and platelets before and after SAE. Fourteen patients (7 males, 7 females) with a mean age of 51±11.95years underwent SAE and were followed by a repeat computed tomography scan at an average of 733.57days. Nine SAEs were performed using vascular plugs, 3 using micro coils, and 2 out of that were with Gelfoam slurry, and 2 using coils only. All embolizations were technically successful with complete cessation of flow. Mean splenic volumes pre- and post-SAE were 903.5±523.73cm3 and 746.5±511.95cm3, respectively, representing a mean decrease of 8.31% compared to baseline [P=0.346]. Minimum platelet counts (x103) pre-SAE (within 3months) and post-SAE (2weeks to 3months after the procedure) were 55.79±57.11 and 116±145.40, respectively. The minimum platelet count showed a statistically significant mean increase of 134.92% (P=0.033). The splenic volume is not altered significantly by SAE in the long term. Similarly, the platelet count is also not significantly altered at 3months follow-up. This study, although small, suggests that SAE is a safe intervention that can preserve splenic volume and function in the long term.

Ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the treatment of post-catheterization femoral artery pseudoaneurysm: King Saud University Medical Center Experience.

This study aims to evaluate the effectiveness of ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the management of iatrogenic femoral artery pseudoaneurysms. Between June 2006 and December 2015, a total of 29 consecutive patients (15 males, 14 females; mean age 54 years; range 26 to 81 years) with a femoral pseudoaneurysm treated by ultrasound-guided thrombin injection were retrospectively analyzed. These patients were compared with a historical group of 36 patients (21 males, 15 females; mean age 44 years; range 32 to 65 years) who underwent ultrasound-guided compression repair between February 1999 and May 2006. Medical records and vascular laboratory findings of all patients were reviewed. Successful treatment was defined as complete cessation of flow into the false lumen with preservation of flow in the femoral artery. The ultrasound-guided thrombin injection showed a success rate of 100%, whereas ultrasound-guided compression repair had a success rate of 80.5%, which was possibly affected by anticoagulant therapy, hypertension, and an aneurysm size of >6 cm. However, none of these factors did not affect the success of thrombin injections. Ultrasound-guided thrombin injection is a highly successful, easy to perform, accepted, and well-tolerated method by patients. It is more effective compared to compression therapy in patients with hypertension, large aneurysms, and who are on anticoagulant therapy.

Експериментальні дослідження розподілу питомого завантаження суміші по площі нахиленого лотка

The regularities of specific loading distribution of loose mixture on the area of a working surface of the inclined tray are established in the work. The studies were performed on the experimental setup consisting of a storage hopper and inclined flat trays of different lengths. The material of the study was a grain mixture of winter wheat variety "Myronivska 30". The magnitude of the load was determined using a receiving device, which allowed to obtain the specific load distribution on the width and length of the tray and over time. The specific loading of the tray is uneven in the area of the working surface: the central section is overloaded, and the wall is underloaded. The largest deviations of the specific load at the inlet of the tray, but with length they decrease, approaching a uniform distribution. The specific load profile across the width of the tray is asymmetric and has a local extremum. As the tray length increases, at the certain initial speed and angle, the specific load decreases and the mixture flow slows down. With a constant supply of material from the hopper, there is a gradual accumulation of the mixture in the tray, compaction and growth of the layer, which leads to complete cessation of flow. Uneven loading of the tray occurs due to uneven supply of material from the storage hopper, in which the movement begins. The initial feed varies across the width of the tray and over time, and the nature of the specific load profile formed at the entrance to the tray is preserved for almost its entire length. The movement of the mixture flow in the inclined tray is non-stationary, the specific load varies significantly over the entire surface area and largely depends on the initial conditions of movement. The obtained regularities of specific loading on the working surface area of the tray can be used in the calculation of the modes of loose mixtures movement and substantiation of the equipment parameters for loading the working bodies of machines.

Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature

BackgroundThe antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal magnetic resonance imaging adds significant anatomical detail and can aid in the diagnosis of these complicated cases. Upon an extensive literature review, there are no reports documenting these combined findings in a twin pregnancy. Therefore we believe this is the first case report of an antenatal diagnosis of combined pure esophageal and duodenal atresia in a twin gestation.Case presentationWe present a case of a 30-year-old G1P0 white woman at 22-week gestation with a monochorionic-diamniotic twin pregnancy discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected to proceed with radiofrequency ablation of the anomalous twin to maximize the survival of the normal co-twin. The procedure was performed successfully with complete cessation of flow in the umbilical artery and complete cardiac standstill in the anomalous twin with no detrimental effects on the healthy co-twin.ConclusionsPrenatal diagnosis of complex anomalies in twin pregnancies constitutes a multitude of ethical, religious, and cultural factors that come into play in the management of these cases. Fetal magnetic resonance imaging provides detailed valuable information that can assist in management options including possible prenatal intervention. The combination of a cystic structure with peristalsis-like movement above the diaphragm (for example, “the upper thoracic pouch sign”), polyhydramnios, and progressive distention of the stomach and duodenum should increase suspicion for a combined pure esophageal and duodenal atresia.

Gender Predicts Rupture of Pancreaticoduodenal Artery Aneurysms

There remains no consensus on indication or technique for repair of pancreaticoduodenal artery aneurysms (PDAA) due to the fact that they are exceedingly rare. We sought to evaluate risk factors for rupture, as well as compare the outcomes of open and endovascular surgery. We performed a retrospective review of all PDAAs over a 15-year period. The primary outcome was technical success, defined as complete cessation of flow within the aneurysm sac on follow-up imaging. Secondary outcomes included complications greater than Clavien-Dindo Grade I. A total of 21 PDAAs was identified (mean size 20mm, interquartile range 8-32). Eight patients (38%) were male with an average age at diagnosis of 54.3±2.4years. Aneurysm etiology included degenerative (90%), pancreatitis (14%), and connective tissue disorder (5%). Seven patients (33%) had additional aneurysms on imaging. Ten patients (48%) were asymptomatic, while 5 patients (24%) presented with rupture. Six patients (29%) had an open repair, including 4 aneurysm ligations and 2 emergent Whipple procedures. Eleven patients underwent an endovascular intervention including 10 (48%) embolizations and 1 stent-assisted coiling (9%). Technical success was 100% for the open group and 91% in the endovascular group. Clavien-Dindo grade >1 complications occurred in 67% of open patients and 0% of endovascular patients (P=0.01). Death occurred in 2 ruptured patients who underwent open repair. On univariate analysis, male gender was statistically associated with rupture (P=0.02); however, size of the aneurysm was not (P=0.77). There was a trend toward an increased rupture rate in those with celiac stenosis (P=0.10). In one of the largest series of PDAA to date, only male gender was associated with rupture. Furthermore, size of the aneurysm was not associated with rupture and should not be considered a criterion for repair. While technical success was greater in the open group, it was also associated with an increased incidence of clinically significant complications and death. Endovascular aneurysm embolization should be considered the treatment of choice.

Impact of pretreatment on defluoridation of drinking water by bone char adsorption

Fluoride concentrations in drinking water in excess of 1.5 mg L-1 are unsafe for human consumption. To reduce excess fluoride intake, developing countries must use low-cost, point-of-use defluoridation techniques. Although previous work has extensively assessed defluoridation using bone char (BC), most of the advanced studies have been based on the use of fluoridated distilled water as a feed solution. In the present study, BC columns were challenged with a range of model solutions, mimicking various pretreatment options. As a result, the relative impact of dissolved organic carbon (DOC) and suspended solids (SS) on the performance of BC filters was assessed. In addition, the performance of a gravity-driven, hollow fibre ultrafiltration (UF) module was examined with regards to the potential for use as a pretreatment option. SS were observed to severely clog the columns and cause the complete cessation of flow. The subsequent removal of SS by UF improved the general filter performance as well as increasing the BC lifetime by 50 %. The UF module achieved a reduction in DOC of 34 ± 6 %, resulting in an additional 30 % increase in the lifetime of the BC column.

Diagnostic value of the femoral vein flow pattern for the detection of an iliocaval venous obstruction.

Identification of iliocaval obstructions has traditionally been difficult due to the lack of a reliable noninvasive screening technique. Although femoral vein flow patterns have been used to detect outflow obstructions, the diagnostic accuracy of indirect Doppler parameters has not yet been fully elucidated. The purpose of this study was to establish the diagnostic value of the femoral vein waveform in detecting chronic iliocaval venous lesions. Medical records of consecutive patients with chronic venous disease classified as Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) C3-6 between March 2011 and December 2012 were assessed retrospectively. The results of common femoral vein duplex ultrasound examinations, based on the presence or absence of respiratory variation in the femoral flow as well as its response to the Valsalva maneuver, were compared with contrast venography and intravascular ultrasound imaging of the inferior vena cava and the bilateral common and external iliac veins. Three types of flow patterns in the common femoral vein were identified with duplex ultrasound examination: phasic flow correlated with respiration, minimally phasic flow (showing some phasicity but no cessation with respiration), and monophasic flow (continuous flattened flow). In addition, three types of responses to the Valsalva maneuver were recorded: complete cessation of flow, reversal of flow, and continuation of flow. The study evaluated 86 patients (63 men, 23 women) with a mean age 40.3± 1.5years. Contrast venography and intravascular ultrasound imaging were used to detect venous obstructions in the inferior vena cava and the right and left iliac veins in 16.3%, 32.6%, and 80.2% of patients, respectively. When various flow parameters were evaluated, the combination of common femoral vein monophasic flow at rest and continuous flow during the Valsalva maneuver had the highest diagnostic value for iliocaval venous obstructions. The sensitivity, specificity, positive predictive value, and negative predictive value of the combination of monophasic flow at rest and unceasing forward flow during the Valsalva maneuver for the diagnosis of any degree of iliac venous obstruction were 38.1%, 100%, 100%, and 55.8%, respectively. The sensitivity and negative predictive value of these diagnostic parameters increased as the degree of obstruction increased. An iliocaval venous obstruction is a frequent feature of chronic venous disease. Doppler examination of the common femoral vein can be used as a screening test for iliocaval venous obstructions. The monophasic flow of the common femoral vein is a reliable diagnostic tool for the detection of possible iliac vein obstructions.

Doppler Systolic Signal Void in Hypertrophic Cardiomyopathy: Apical Aneurysm and Severe Obstruction without Elevated Intraventricular Velocities.

In patients with hypertrophic cardiomyopathy (HCM), akinetic apical aneurysms are associated with ventricular tachycardia, heart failure, apical thrombus, and mortality. The cause of apical aneurysms remains unresolved, and there is controversy about prevalence and significance of mid-left ventricular (LV) obstruction, often present in these patients. The aim of this study was to test the hypothesis that low velocities in patients with aneurysms are due to near complete cessation of mid-LV flow, characteristically marked by a Doppler signal void. This was a retrospective analysis of 39 patients with HCM with segmental hypertrophy of the mid left ventricle and complete systolic emptying at the mid-LV level. The severity of dynamic obstruction was evaluated by measuring the time during which cross-sectional mid-LV cavity area was <1 cm(2). Presence or absence of an LV Doppler midsystolic signal void was determined. Akinetic apical aneurysms were present in 21 patients. The duration of two-dimensional mid-LV short-axis complete emptying was longer in patients with akinetic apical aneurysms (194 ± 45 vs 148 ± 63 msec, P = .013), nearly 50% of systole. Midsystolic signal voids were seen only in patients with akinetic apical aneurysms (P < .001), present in 86%. In patients with akinetic aneurysms, there was a strong correlation between the duration of the systolic signal void and the proportion of systole with complete emptying < 1 cm(2) (r = 0.704; P = .001). Complete emptying < 1 cm(2) for ≥ 38% of systole was associated with akinetic aneurysm (odds ratio, 9.35; P < .004). Patients with akinetic apical aneurysm HCM have near complete cessation of flow across severe dynamic mid-LV obstruction for nearly 50% of systole. This explains how the adverse effects of obstruction may occur without high velocities on echocardiography.

Gender Predicts Rupture of Pancreaticoduodenal Artery Aneurysms

There remains no consensus on indication or technique for repair of pancreaticoduodenal artery aneurysms (PDAAs) because they are exceedingly rare. We sought to evaluate risk factors for rupture and to compare the outcomes of open and endovascular surgery. We performed a retrospective review of all PDAAs over a 15-year period. The primary outcome was technical success, defined as complete cessation of flow within the aneurysm sac on follow-up imaging. Secondary outcomes included complications greater than Clavien-Dindo grade I. A total of 21 PDAAs were identified (mean size, 20 [interquartile range, 8-32] mm). Eight patients (38%) were male, with an average age at diagnosis of 54.3 ± 2.4 years. Aneurysm etiology included degenerative (90%), pancreatitis (14%), and connective tissue disorder (5%). Seven patients (33%) had additional aneurysms on imaging. Ten patients (48%) were asymptomatic, and five patients (24%) presented with rupture. Six patients (29%) had an open repair, including four aneurysm ligations and two emergency Whipple procedures. Eleven patients underwent an endovascular intervention, including 10 (48%) embolizations and one stent-assisted coiling (9%). Technical success was 100% for the open group and 91% in the endovascular group. Clavien-Dindo grade >1 complications occurred in 67% of open patients and in 0% of endovascular patients (P = .01). Death occurred in two ruptured patients who underwent open repair. On univariate analysis, male gender was statistically associated with rupture (P = .02); however, size of the aneurysm was not (P = .77). There was a trend toward an increased rupture rate in those with celiac stenosis (P = .10). In the largest series of PDAAs to date, only male gender was associated with rupture. Although technical success was greater in the open group, it was also associated with an increased incidence of clinically significant complications and death. Endovascular aneurysm embolization should be considered the treatment of choice.

Reperfusion Rates of Pulmonary Arteriovenous Malformations after Coil Embolization: Evaluation with Time-Resolved MR Angiography or Pulmonary Angiography

PurposeTo assess reperfusion rates after coil embolization for pulmonary arteriovenous malformations (PAVMs) using time-resolved magnetic resonance (MR) angiography or pulmonary angiography. Materials and MethodsPatients with PAVMs who underwent embolization and met the following inclusion criteria were included: (a) embolization was performed using bare or fibered platinum microcoils or both, (b) the complete cessation of flow was confirmed by digital subtraction angiography, and (c) follow-up examinations were conducted with time-resolved MR angiography or pulmonary angiography. Coil embolization was performed in 16 patients with 24 untreated or reperfused PAVMs. Sac embolization was performed for 12 untreated PAVMs. Feeding artery embolization was performed as primary embolization in each of the 12 reperfused PAVMs. Five PAVMs were treated 2 to 4 times because of reperfusion. The study included 32 coil embolizations. Follow-up images were reviewed, and reperfusion rates were assessed. The relationships between reperfusion and the location of PAVM, size of PAVM (feeding artery and venous sac), coils (number and total length), timing of embolization (primary or repeat embolization), and types of coils used (with or without fibered coils) were examined. ResultsReperfusion rates at 3, 6, 12, and 24 months were 8%, 27%, 36%, and 49%, respectively, for the 12 untreated PAVMs (primary embolization) and 50%, 50%, 92%, and 100%, respectively, for the 12 reperfused PAVMs (repeat embolization) (P = .0062). No significant differences were observed in the other parameters measured. ConclusionsWhen evaluated with time-resolved MR angiography or pulmonary angiography, reperfusion rates after coil embolization for PAVM were considerably high, particularly with repeat embolization.

Flow-independent dynamics in aneurysms: intra-aneurysm pressure measurements following complete flow cessation in internal carotid artery aneurysms.

To determine if complete flow obliteration by covered stents reduces intra-aneurysm pressures in internal carotid artery (ICA) aneurysms. A single lumen microcatheter was placed into the aneurysm sac prior to covered stent deployment in 3 patients and connected to a pressure monitoring system. The intra-aneurysm pressure was continuously monitored, and readings were recorded prior to and immediately after stent deployment and at 5-minute intervals up to 20 minutes after stent placement. Complete occlusion of flow into the aneurysms was confirmed by carotid angiography. There was no change in mean pressure within the aneurysm before and immediately after stent placement (80 mmHg) in any patient, nor was there a change in waveform of the intra-aneurysm pressure recording. The average of intra-aneurysm pressures among the 3 patients was higher (99 mmHg) at 10 and 15 minutes after stent placement. In 2 patients, the microcatheter was retracted into the parent arterial lumen; no difference in pressure was noted. Our observations suggest no change in the pressures within the aneurysm after complete flow cessation (flow-independent). These findings may assist clinicians in better understanding aneurysm hemodynamics and rupture after covered stent deployment.

Role of IL‐6 in a novel murine model of transient ischemic attack (853.1)

TIA is a precursor event in 7‐40% of patients who suffer from an ischemic stroke. This study involves the development of a murine model of TIA and explores the mechanism that accounts for the increased vulnerability of cerebral arterioles to thrombus development after TIA. TIA was simulated by brief (2.5 ‐ 10 min) occlusion of the middle cerebral artery. Thrombus formation in cerebral arterioles (induced by light/dye photoactivation of FITC‐dextran) was evaluated 1 ‐ 28 days after the TIA. Thrombosis was quantified using time of onset of platelet aggregation on the vessel wall and the time to complete flow cessation. While the brief period of TIA was not associated with neurological deficits or brain infarction (evaluated after 1 day), it yielded a pronounced and prolonged (up to 28 days) acceleration of thrombus formation, compared to control (sham) mice. Either immunoblockade of the interleukin‐6 (IL‐6) receptor or genetic deficiency of IL‐6, but not IL‐6‐/‐ bone marrow chimeras, signficantly protected against the TIA induced enhancement of thrombosis. Our findings indicate that the increased vulnerability of the cerebral vasculature to thrombus development after TIA can be recapitulated in a murine model, and that IL‐6, likely derived from brain tissue, rather than circulating immune cells, is an important mediator of, and possible therapeutic target for, TIA‐induced thrombogenesis.Grant Funding Source: HL26441

Detrusor after contractions in men with lower urinary tract symptoms: Myth or reality?

ObjectivesTo study after contractions in men with lower urinary tract symptoms (LUTS) related to bladder outlet obstruction (BOO), in the absence of neuropathy, and to verify whether it is associated with the severity of symptoms or certain filling and voiding variables. Patients and methodsOf 380 patients with LUTS and who were assessed using urodynamic studies, we retrospectively analysed those who had after contractions (ACs). Bladder overactivity was diagnosed as any increase in the detrusor pressure of <2-s duration during the filling phase, and an AC was diagnosed as any increase in the detrusor pressure of ⩾2s after the end of the voiding phase and complete cessation of flow. The presence of ACs was then assessed in relation to different components of the International Prostate Symptom Score (IPSS), using a two-tailed Levene’s test, and to filling and voiding cystometry variables, using Mann–Whitney-Wilcoxon Rank test. ResultsIn all, 373 of the 380 patients were included (seven had invalid voiding cystometry); ACs were detected in 51 (13.9%). There was no statistical significance for associations between AC and any of the variables assessed, including individual questions of the IPSS, detrusor overactivity, cystometric capacity, compliance, maximum urinary flow rate (Qmax), detrusor pressure at Qmax or the maximum detrusor voiding pressure. ConclusionACs detected on voiding cystometry of men with LUTS attributed to BOO do not seem to be related to symptoms, or filling and voiding variables.

Enhanced thrombus development after transient cerebral ischemia

Transient ischemic attack (TIA) is a precursor event in 7–40% of patients who suffer from an ischemic stroke. This study examined whether a brief transient period of ischemia leads to an increased vulnerability of the brain to thrombus development. TIA were induced in mouse brain by occluding the middle cerebral artery for 2.5 to 10 mins. Twenty‐four hrs thereafter, mice were evaluated for neurological deficits, and thrombus formation was induced in cerebral microvessels using the light/dye method. Thrombosis was quantified using time of onset of platelet aggregation on the vessel wall and time to complete flow cessation. Compared to control mice, TIAs ranging in duration from 2.5 to 10 mins resulted in an accelerated rate of thrombus development. The TIA enhanced thrombogenesis was not accompanied by changes in neurological function or brain infarction (assessed by TTC staining). Aspirin (ASA), which is an initial line of treatment for TIA in humans, was shown to offer modest but significant protection against TIA enhanced thrombus development. Our findings indicate that TIA accelerates thrombus development in the cerebral microcirculation and that ASA treatment offers modest benefit in preventing this response.

Temporary Sphenopalatine Artery Occlusion: A Cadaver Study

Objective: To assess the ability of a surgical device (SinuStat, Sinocclusive LLC) to temporarily occlude flow in the sphenopalatine artery in the human cadaver model. Method: The experiment was performed on January 28, 2012, in the setting of a fully accredited ambulatory surgical suite. A human cadaver model simulating hydraulic pressure of 100 mm Hg in the maxillary artery was obtained by cannulating this artery via external dissection to the infratemporal fossa. The sphenopalatine artery and its immediate branches were identified endoscopically and perforated distal to the foramen with a 21G spinal needle. Control (without device in place) and study (with device in place) flow were evaluated endoscopically for the amount of penetration to the nasal cavity of dye-enhanced normal saline. Four sequential insertions and removals of the device were tested. Results: The placement of the SinuStat device into the sphenopalatine foramen, compared to control flow, resulted in complete or near complete cessation of flow in 4 of 4 insertions. Conclusion: In the model studied, the SinuStat temporary sphenopalatine artery occlusion device completely or near-completely occludes flow from the sphenopalatine artery when subjected to a static hydraulic pressure of 100 mm Hg. Use of the SinuStat device in endonasal procedures is thus anticipated to completely or near-completely occlude blood flow through the sphenopalatine artery at mean arterial pressures around 100 mm Hg. More studies will be required to determine the impact this will have on the quality of the surgical field during endonasal surgery.

The Woven EndoBridge: A New Aneurysm Occlusion Device

The WEB device is an intrasaccular ellipsoid braided-wire embolization device designed to provide flow disruption along the aneurysm neck. The purpose of this study was to evaluate, in an in vivo aneurysm model, the acute and chronic performance of the WEB device regarding immediacy, degree, and durability of aneurysm occlusion. The WEB device was implanted in 24 elastase-induced aneurysms in New Zealand white rabbits and followed for 1, 3, 6, and 12 months (n = 6 at all time points). Degree of intra-aneurysmal flow disruption was graded on a 4-point scale based on DSA within 10 minutes following device implantation. Chronic aneurysm occlusion was rated by using a 3-point scale. All aneurysms were harvested for histologic analysis. Immediate postimplant grade 1 (complete flow cessation) was noted in 7 (29%) of 24 cases. Grade 2 (near-complete flow cessation) was noted in 13 (54%) of 24 cases. At follow-up, complete occlusion was noted in 8 (33%) of 24 cases. Near-complete aneurysm occlusion was noted in 14 (58%) of 24 cases, while incomplete occlusion was noted in 2 (8%) cases. Stable aneurysm occlusion was present in 7 (29%) of 24 cases; progressive occlusion, in 14 (58%); and recanalization, in 3 (13%) cases. Histologic findings included aneurysm cavities filled with organized thrombus with connective tissue across the aneurysm neck. The WEB device in experimental aneurysms demonstrated promising rates of immediate and long-term aneurysm occlusion.

Acute reversible ischaemic neurological deficit induced by internal carotid artery kinking: Case report

INTRODUCTION Internal carotid artery (ICA) kinking is a pathological malformation with angulation of the vessel's axis of 90 degrees or less. It is known that kinking causes the reduction of flow within the vessel that may be exacerbated by progressive head rotation up to the point that causes complete cessation of flow. In this article, we report on the case of acute reversible ischaemic deficit induced by internal carotid artery kinking and immediate neurological recovery following surgical reconstruction. CASE OUTLINE A 64-year-old woman was admitted to Vascular Surgery Clinic due to severe dizziness, fainting and walking instability, suddenly arising a few days prior to admission. Two years before, the left ICA reconstruction was done for kinking, after which there was no cerebral ischaemia symptoms. Symptoms have been present perpetually, enhanced when resting and with head movement. CT angiography (MSCT) showed haemodynamic significant right ICA kinking. The left ICA postoperative finding was regular. Computerized tomography (CT) of the endocranium was done and no novel lessions were verified than those seen two years earlier. Resection, shortening and reimplantation of the right ICA were performed. A few hours following surgical reconstruction, there was no cerebral ischaemia symptoms, neither when resting nor with head movement. On the third postoperative day, the patient was discharged for home treatment. Surgical repair for symptomatic ICA kinking contributes to cerebral ischaemia symptoms reduction, improves cerebral perfusion and significantly prevents carotid thrombosis and stroke. In this paper, we have seen that in case of acute cerebral ischaemia symptoms and ICA kinking, surgical ICA treatment appears to be justified.

Preliminary Results of the Luna Aneurysm Embolization System in a Rabbit Model: A New Intrasaccular Aneurysm Occlusion Device

Recent advances in endovascular devices have been aimed at providing high density, mesh-like metallic materials across the aneurysm neck, in place of coil technology. Therefore our aim was to report the in vivo preclinical performance of a self-expanding intrasaccular embolization device. Elastase-induced aneurysms were created in 12 rabbits. Each aneurysm was embolized with a Luna AES. DSA was performed preimplantation; 5, 10, and 30 minutes postimplantation; and at 1 month in 12 rabbits and at 3 months in 8 rabbits. Early postimplantation intra-aneurysmal flow was graded as unchanged, moderately diminished, or completely absent. One- and 3-month DSAs were graded by using a 3-point scale (complete, near-complete, or incomplete occlusion). Aneurysms were harvested for gross and microscopic histologic evaluation at 1 month (n = 4) and at 3 months (n = 8). Tissues within the aneurysm dome and across the aneurysm neck were assessed by using HE staining. Ten (83%) of 12 aneurysms demonstrated complete cessation of flow within 30 minutes of device implantation. At 1-month follow-up, 10 (83%) of 12 aneurysms were completely occluded. At 3 months, 7 of 8 (88%) aneurysms remained completely occluded. One-month gross examination in 4 rabbits demonstrated that membranous tissue completely covered the device in 3 subjects (75%). Microscopic examination showed that 3 aneurysms had loose connective tissue filling the aneurysm cavity. Three-month gross and microscopic examinations demonstrated membranous tissue completely covering the device, loose connective tissue filling the aneurysm cavity, and neointima formation crossing the aneurysm neck in 8 of 8 (100.0%) subjects. The Luna AES achieved high rates of complete angiographic occlusion and showed promising histologic findings in the rabbit aneurysm model.