Intravascular Treatment Research Articles

Isolation and focal treatment of brain aneurysms using interfacial fluid trapping.

Current approaches for localized intravascular treatments rely on using solid implants, such as metallic coils for embolizing aneurysms, or on direct injection of a therapeutic agent that can disperse from the required site of action. Here, we present a fluid-based strategy for localizing intravascular therapeutics that leverages surface tension and immiscible fluid interactions, to allow confined and focal treatment at brain aneurysm sites. We first show, computationally and experimentally, that an immiscible phase can be robustly positioned at the neck of human aneurysm models to seal and isolate the aneurysm's cavity for further treatment, including in wide-neck aneurysms. We then demonstrate localized delivery and confined treatment, by selective staining of cell nuclei within the aneurysm cavity as well as by hydrogel-based embolization in patient-specific aneurysm models. Altogether, our interfacial flow-driven strategy offers a potential approach for intravascular localized treatment of cardiovascular and other diseases.

Prospective investigation of calcium score in optical coherence tomography-guided revascularization to identify lesions with low risk for stent under expansion: the CORAL study.

The optical coherence tomography (OCT)-based calcium scoring system was developed to guide optimal lesion preparation strategies for percutaneous coronary intervention (PCI) of calcified lesions. However, the score was derived retrospectively, and a prospective investigation is lacking. The CORAL (UMIN000053266) study was a single-arm, prospective, multicenter study that included patients with calcified lesions with OCT-calcium score of 1-2 to investigate whether these lesions could be optimally treated with a balloon-only preparation strategy using a non-compliant/scoring/cutting balloon. The primary endpoint was strategy success (successful stent placement with a final percent diameter stenosis [%DS] < 20% and Thrombolysis In Myocardial Infarction flow grade III without crossover to rotational atherectomy/orbital atherectomy/intravascular lithotripsy [RA/OA/IVL]). A superiority analysis for the primary endpoint was performed by comparing the study cohort with a performance goal of 83.3%. One hundred and eighteen patients with 130 lesions were enrolled. The mean age was 79.0 ± 10.3years, and 79 patients (66.9%) were male. The OCT-calcium score was 1 for 81 lesions (62.3%) and 2 for 49 lesions (37.7%). The %DS improved from 47.0 ± 14.8% preprocedure to 11.1 ± 5.6% postprocedure. Stent expansion ≥ 70% was achieved in 90.2%. The strategy success rate was 93.1% (95% confidence interval: 87.3-96.8), and superiority against the performance goal was achieved without any crossover to RA/OA/IVL (P = 0.0027). The OCT-calcium score could identify mild/moderately calcified lesions treatable by PCI with the balloon-first strategy using a non-compliant/scoring/cutting balloon for predilatation, with a high strategy success rate. These results support the intravascular imaging-based treatment algorithm for calcified lesions proposed by CVIT.

Intravascular Lithotripsy for Treatment of Severely Calcified Common Femoral Artery Disease: Results From the Disrupt PAD III Observational Study.

Surgical endarterectomy is currently considered the front-line therapy for the treatment of calcified lesions in the common femoral artery (CFA). Endovascular interventions have evolved, and their use is increasing in frequency. Intravascular lithotripsy (IVL) has shown promising safety and effectiveness in calcified CFA lesions in a small pilot study, but "real-world" evidence from a larger cohort is lacking. The Disrupt PAD III Observational Study (NCT02923193) was a prospective, multicenter registry designed to assess the acute safety and effectiveness of IVL treatment for calcified peripheral arterial disease. Any concomitant treatment with other calcium-modifying technologies as well as definitive treatment strategies was at the discretion of the operators. Patients with CFA lesions were evaluated for acute angiographic safety and effectiveness outcomes following IVL treatment as determined by an independent angiographic core lab. Common femoral artery treatment was indicated in 177 patients (n=163 could be analyzed based on core-laboratory data) enrolled at 23 sites. Characteristics for 164 treated lesions included moderate-severe calcification 95.1%, diameter stenosis 74.8±17.7%, and lesion length 53.6±53.1 mm. Concomitant calcium-modifying therapy was used in 32.3% of lesions. Final therapy included drug-coated balloons in 68.9% and stenting in 16.5% of lesions. Post-IVL and final residual stenoses were 29.2±16.5%and 23.6±11.5%, respectively. No vascular complications (flow-limiting dissections, perforations, embolization, slow or no reflow, or abrupt closure) were present at the end of the procedure by core-laboratory assessment, with 1 (0.8%) flow-limiting dissection initially occurring immediately following IVL treatment. This study represents the largest real-world experience of IVL treatment in heavily calcified CFA lesions. Intravascular lithotripsy treatment showed significant stenosis reduction and favorable periprocedural safety in this challenging patient population. In this study we show that calcified common femoral artery disease can be safely and effectively treated with shockwave balloon angioplasty with high procedural success and low complication rates and in clinical practice can now be offered as an alternative to surgical treatment in those patients reluctant to or high risk for vascular surgery. This opens another option for clinicians to treat calcified common femoral artery disease without the risk of dissection, perforation or distal embolization that are associated with atherectomy. This study shows that shockwave lithoplasty offers an innovative plaque modification technology to tackle calcified disease in the common femoral artery.

Predicting the clinical prognosis of acute ischemic stroke using machine learning: an application of radiomic biomarkers on non-contrast CT after intravascular interventional treatment.

This study aimed to develop a radiomic model based on non-contrast computed tomography (NCCT) after interventional treatment to predict the clinical prognosis of acute ischemic stroke (AIS) with large vessel occlusion. We retrospectively collected 141 cases of AIS from 2016 to 2020 and analyzed the patients' clinical data as well as NCCT data after interventional treatment. Then, the total dataset was divided into training and testing sets according to the subject serial number. The cerebral hemispheres on the infarct side were segmented for radiomics signature extraction. After radiomics signatures were standardized and dimensionality reduced, the training set was used to construct a radiomics model using machine learning. The testing set was then used to validate the prediction model, which was evaluated based on discrimination, calibration, and clinical utility. Finally, a joint model was constructed by incorporating the radiomics signatures and clinical data. The AUCs of the joint model, radiomics signature, NIHSS score, and hypertension were 0.900, 0.863, 0.727, and 0.591, respectively, in the training set. In the testing set, the AUCs of the joint model, radiomics signature, NIHSS score, and hypertension were 0.885, 0.840, 0.721, and 0.590, respectively. Our results provided evidence that using post-interventional NCCT for a radiomic model could be a valuable tool in predicting the clinical prognosis of AIS with large vessel occlusion.

Clinical Characteristics of Contrast Leakage and Contrast-Induced Encephalopathy Following Endovascular Treatment for Unruptured Intracranial Aneurysm.

Contrast-induced encephalopathy (CIE) is a rare but severe complication that can occur following intravascular treatment of intracranial vascular disease. Although CIE is considered a transient neurological disorder, its natural history, pathophysiology, and risk factors are poorly understood. Contrast leakage (CL) is a more frequently observed adverse event than CIE and can lead to CIE. This retrospective study aimed to elucidate the clinical characteristics of CL and CIE and identify the risk factors for each. We retrospectively reviewed the medical records of 61 patients with unruptured intracranial aneurysms who were treated at our institution between January 2019 and May 2023. Risk factors for CIE and CL were identified by Fisher's exact test for univariate analysis of categorical variables and by unpaired t-test for continuous variables. One-way analysis of variance (ANOVA) was conducted, followed by the Tukey-Kramer test for multiple comparisons. Of the 61 patients, 22 (36%) had CL and 4 (6%) had CIE. Among the clinical characteristics analyzed, older age (p = 0.031), larger aneurysm (p = 0.003), lower serum creatinine (p = 0.026), and use of a distal access catheter (p = 0.030) were significant risk factors for CL. CIE occurred only in CL-positive patients (p = 0.014). Of the 4 patients with CIE, neurological symptoms improved within 3 days in 3 patients, and neurological deficit persisted in 1 patient. Older age, larger aneurysm, lower serum creatinine, and use of a distal access catheter are risk factors for developing CL, and female sex and greater volume of contrast medium are potential risk factors. No risk factors for developing CIE from CL were identified.

Risk prediction of CISS classification in endovascular treatment of basilar artery stenosis

ObjectiveTo investigate the incidence of ischemic stroke complications after endovascular treatment for basilar artery stenosis used preoperative high-resolution magnetic resonance vascular wall imaging (HRMR/VWI) and diffusion-weighted imaging (DWI). MethodsThe clinical data of 47 patients with severe symptomatic basilar artery stenosis (stenosis rate ≥70 %) treated with endovascular therapy at the Neuro-interventional Center from December 2017 to December 2021 were retrospectively analyzed. High-resolution magnetic resonance angiography (HRMR VWI) and DWI were used to evaluate the location of atherosclerotic plaque at basilar artery stenosis and the distribution of cerebral infarction lesions in all patients before surgery.According to the CISS classification system for ischemic stroke, patients were divided into a perforation group and a hypoperfusion group, and the general situation, plaque distribution, and incidence of ischemic stroke complications 7 days after endovascular treatment in the two groups were analyzed. ResultsThere was no significant difference in baseline data between the two groups. After 7 days of intravascular treatment, the incidence of ischemic stroke was higher in the perforation group (20.0 %) than in the hypoperfusion group (0.0 %), and the difference was statistically significant (P = 0.027). A significant association was found between the perforation group and the hypoperfusion group for the incidence of ischemic stroke at 7 days (P = 0.003, OR = 2.347; 95 % CI = 2.056–4.268). There were a higher proportion of ventral plaques (74.1 %) and a lower proportion of dorsal plaques (33.3 %) in the hypoperfusion group, which were 15.0 % and 90.0 % in the perforation group, respectively (χ2 = 16.045, P < 0.001; χ2 = 15.092, P < 0.001). There was no significant difference in the proportion of left and right plaques between the two groups. ConclusionsThe risk of ischemic stroke is greater in patients with perforator artery obstruction undergoing endovascular therapy, and lower in patients with hypoperfusion/embolus removal.

Intravascular Treatment of Extracranial Internal Carotid Artery Dissection

Objective: To evaluate the efficacy and safety of endovascular treatment of extracranial dissection of the internal carotid artery, as well as pseudoaneurysm associated with dissection.Clinical cases: In this article we report the results of endovascular treatment of 2 patients with iatrogenic and spontaneous dissection of the cervical segment of the internal carotid artery.Conclusions: Internal carotid artery dissection can lead to significant narrowing of the vessel lumen, occlusion or pseudoaneurysm followed by hemodynamic or embolic stroke despite anticoagulant therapy. In some cases, endovascular stenting for dissection is a safe and effective method of restoring vessel lumen integrity with a good clinical outcome.

Short-and long-term clinical impact of intravascular ultrasound-guided endovascular treatment for patients with peripheral artery disease

Abstract Background Intravascular ultrasound (IVUS) has become a standard procedure in coronary intervention, but it is unclear whether IVUS usage improves procedural success rate or prognosis in patients with peripheral endovascular therapy (EVT). Methods This study analyzed more than 2,000 consecutive patients from the TOkyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry that prospectively enrolled consecutive patients with peripheral arterial disease (PAD) in 34 hospitals in Japan from August 2014 to August 2016. The primary outcome is adverse cardiac and cerebrovascular events (MACCE) and limb events including clinical target lesion revascularization (cTLR) and amputation in the median follow-up period of 10.4 month after the first EVT. The secondary outcomes are procedural success rate and major adverse limb events (MALE) in hospital setting. Every analysis was also conducted with adjusted model after propensity score matching. Results In enrolled 2,227 eligible cases, we compared the MACCE and limb events between 784 cases with IVUS usage and 1443 patients without IVUS usage during EVT procedure. There was no significant difference of MACCE and limb events between with and without IVUS usage during EVT procedure over 2 years. However, EVT procedure with IVUS usage contributed significantly higher procedural success rate than that without IVUS usage (98.5% vs 96.7%, p=0.02). Moreover, EVT procedure with IVUS usage contributed less MALE (1.6% vs 4.1%, p=0.02) in hospital setting than that without IVUS usage after propensity score matching. Especially, unscheduled revascularization rate in hospital was less in EVT procedure with IVUS usage than that without IVUS usage (1.5% vs 3.7%, p=0.01). Conclusion IVUS usage for EVT did not improve MACCE or limb events over 2-years. However, IVUS usage improved procedural success rate and contributed less MALE when limited to the period of hospitalization. IVUS usage could be recommended for EVT procedures.Table

TCT-560 3-Year Outcome Following Intravascular Lithotripsy Treatment for Coronary Artery Calcification in a High-Risk Real-World Population

TCT-560 3-Year Outcome Following Intravascular Lithotripsy Treatment for Coronary Artery Calcification in a High-Risk Real-World Population

Risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome

ObjectiveWe analyzed the risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome (SVCS) and effectiveness of endovascular intervention in hypotension related to SVCS. MethodsThis was a retrospective cohort study. A total of 194 maintenance hemodialysis patients diagnosed with SVCS who were admitted to the Department of Nephrology, West China Hospital of Sichuan University from January 2019 to December 2021 were selected and divided into a hypotension group and a nonhypotension group. Demographic and clinical data were compared. Hypotension simply refers to blood pressure levels of <90/60 mm Hg on a nondialysis day. All patients received endovascular intervention. ResultsHypotension was found in 85 of the 194 patients. The following factors were significantly different between the hypotension and nonhypotension groups: body mass index, history of hypertension, tunneled-cuffed catheter as the means of dialysis access, azygos ectasis, SVC stenosis of >70% or occlusion, occlusion at the cavitary junction, serum calcium, diastolic left ventricular (LV) posterior wall thickness, LV end-diastolic volume, stroke output, and LV ejection fraction. Multivariate logistic regression analysis showed that hypertension history (OR, 0.314; P = .027), tunneled-cuffed catheter as vascular access (OR, 3.997; P < .001), SVC stenosis of >70% or occlusion (OR, 5.243; P < .001), LV posterior wall thickness (OR, 0.772; P = .044), and serum calcium (OR, 0.146; P = .005) were independent risk factors for hypotension. The mean values of systolic and diastolic blood pressure after intravascular treatment were significantly elevated from those before intervention (P < .001). The primary patency rates of SVC were 66.8%, 58.7%, and 50.0% at 3, 6, and 12 months after the procedure. ConclusionsThe incidence of hypotension in patients with hemodialysis-associated SVCS is high. The identification of risk factors of hemodialysis-related hypotension provides insight into potential treatment strategies. Endovascular treatment is expected to improve hypotension related to SVCS in hemodialysis patients.

Intravascular Ultrasound-Guided Versus Angiography-Guided Endovascular Therapy for Femoropopliteal Artery Disease: A Scoping Review.

The objective of this study was to summarize whether the application of additional intravascular ultrasound (IVUS) can change the outcomes of endovascular treatment in femoropopliteal atherosclerotic lesions compared with conventional angiography alone based on the existing study and evidence. Studies published until September 2022 were searched from PubMed, Embase, and Cochrane databases using the methods of combination of Medical Subject Headings and free text words. The outcomes included in these studies were primary patency rate or restenosis rate and freedom from clinically driven target lesion revascularization (cdTLR) rate, and most studies were concerned about the 12-month results. Two independent authors conducted the process of study selection. And the pooled analysis was attempted. Finally, the inclusion criteria were met by 4 studies (1 randomized controlled trial and 3 retrospective studies) involving 1160 patients. IVUS played its role in measuring lesions and/or guiding wiring passage. Most of the included studies showed that IVUS could achieve a higher 12-month primary patency rate (from 70% to 90%) and higher 12-month freedom from cdTLR rate (from 83.9% to 94.7%) than angiography. The tentative pooled analysis also showed that IVUS significantly improved the 12-month primary patency rate (OR: 2.21, 95%CI: [1.38-3.55], p=0.001) and the 12-month freedom from cdTLR rate (OR: 1.70, 95%CI [1.04-2.78], p=0.03) compared with angiography alone. Intravascular ultrasound-guided endovascular treatment of femoropopliteal artery lesions may have its own advantages such as higher primary patency rate and freedom from cdTLR rate at 12 months. As a novel technology, IVUS is expected to become another beneficial option to guide clinicians performing endovascular therapy in addition to angiography and may achieve better clinical outcomes. More prospective and high-quality studies are needed in the future to investigate the role of IVUS in the process of femoropopliteal artery lesions endovascular treatment. This review summarized a few available studies to promote understanding of IVUS and reveal its potential. This novel technology shows the possibility of achieving better clinical outcomes than angiography in femoropopliteal artery lesions endovascular therapy such as higher 12-month primary patency rate shown in some studies. Currently, it is important to consider suitable technologies applied to individualized treatment. IVUS seems to provide clinicians additional option in clinical practice and benefit patients well in the future. And it needs us to conduct more high-quality studies to explore its roles and advantages in endovascular treatment.

PP02 Presentation Time: 4:39 PM: Development of a Novel Dosimetry Software for Patient-Specific Intravascular Brachytherapy Treatment Planning on Optical Coherence Tomography Images

PP02 Presentation Time: 4:39 PM: Development of a Novel Dosimetry Software for Patient-Specific Intravascular Brachytherapy Treatment Planning on Optical Coherence Tomography Images

1H-NMR Metabolomics Study after Foliar and Endo-Therapy Treatments of Xylella fastidiosa subsp. pauca Infected Olive Trees: Medium Time Monitoring of Field Experiments.

Here we report the medium-term effects of foliar spray and endo-therapy treatments with different doses of a Cu/Zn citric acid biocomplex (Dentamet®) in Xylella fastidiosa infected olive trees of Salento, Apulia region (South-east Italy). Leaf extract samples from field-treated 150 years old olive trees cvs Ogliarola salentina and Cellina di Nardò were studied by 1H NMR-based metabolomics. The result of different applications of Dentamet® endo-therapy after 60, 120 and 180 days in comparison with traditional foliar spray treatment and water injection as a control have been investigated. The metabolic profile analyses, performed by 1H NMR-based metabolomic approach, indicated plant metabolites variations connected to the disease progression such as mannitol, quinic acid, and oleuropein related compounds. The best results, in terms of discrimination of the metabolic profiles with respect to water injection, were found for monthly endo-therapy treatments. Dentamet® foliar application demonstrated more specific time related progressive effectiveness with respect to intravascular treatments. Therefore, besides a possible more effective performance of endo-therapy with respect to foliar treatments, the need of further doses/frequencies trimming to obtain long-term results was also assessed. The present field studies confirmed the indication of Dentamet® effectiveness in metabolic variation induction, potentially linked with reducing the X. fastidiosa subspecies pauca related Olive Quick Decline Syndrome (OQDS) symptoms development.

Single-Center Experience with Simultaneous Mural Aortic Thrombosis and Peripheral Obstructive Disease in Pre-COVID-19 and COVID-19 Era

Mural aortic thrombosis associated with chronic peripheral obstruction of the lower limbs is an unusual event. Repeated embolism of instability aortic mural thrombosis caused acute limb ischemia (Rutherford 2 classification) in patients with peripheral arterial disease (PAD). We report a single-center experience for patients with transmural aortic thrombosis and peripheral artery disease. We retrospectively analyzed data of 54 patients with aortic mural thrombus disease with PAD presentation, treated at our center between 2013 and 2022. Thirty patients (six with proven SARS-CoV-2 infection) underwent hybrid or staged treatment for an aortic lesion and for lower limb ischemia, by the placement of an endovascular aortic stent graft and a femoro-distal or a popliteal-distal bypass graft. The remaining 24 cases were only subjected to an intravascular treatment of the thoracic or abdominal aorta. Transient renal failure occurred in three patients. No embolic events were detected during the procedures. Aortic-related mortality was reported in just one patient who died from multiple organ failure. There was an embolic stroke in one patient with proven SARS-CoV-2 infection, three major amputations in patients with proven SARS-CoV-2 infection and no aortic-related mortality. Stent coverage of complex aortic lesions, alone or in association with a distal bypass graft, supports this approach in a variety of settings. The COVID-19 pandemic caused an increased mortality and amputation rate.

Reconstruction of a Forearm Radiation Ulcer Using an Anterolateral Thigh Flap: A Case Report

We present a rare case of a forearm radiation ulcer. Recently, technological advances in intravascular treatments involving X-ray radiography have enabled the application of this treatment in more patients. This has caused more frequent problems due to radiation ulcers. Here we report the case of a 54-year-old man who developed an ulcer on his left forearm six months after placing a stent graft to treat an abdominal aortic aneurysm. A radiation ulcer was diagnosed because of the distance between the position of the ulcer and pigment deposition in the lateral abdominal region and because of the following pathological findings: coagulative necrosis and fibrinoid degeneration and narrowing of the lumen in the small blood vessels. The ulcer was treated by debridement (skin defect size, 22 × 10 cm), followed by reconstruction with an anterolateral thigh flap (23 × 12 cm). Cosmetic and functional improvements were observed, with the latter indicated by an increased range of motion.

A Flexible Magnetic Soft Continuum Robot for Manipulation and Measurement at Microscale

Magnetic soft continuum robots have received interest in diverse fields, because of their active steering and remote control capabilities. However, a more challenging task is the development of magnetic soft continuum robots for analyzing the mechanical properties of biological tissue during intravascular treatments. Here, we present a force-controlled soft continuum robot with a magnetic end-effector for measurement of biological mechanical properties. The magnetically driven system contains a set of Helmholtz coils and a permanent magnet. The Helmholtz coils produce an oscillating magnetic field for overcoming friction. The permanent magnet is responsible for steering and providing traction for forward motion. The force on the magnetic tip was calibrated with a soft rod with a known elasticity coefficient. Experimental results indicated that the magnetic soft continuum robot successfully achieved manipulation and stiffness measurement of biological embryos. This strategy for mechanical property analysis of biological tissue expands the opportunities for use of soft continuum robots and broadens the field of functionalization for continuum microrobots.

Analysis of Influencing Factors of Anxiety and Depression in Patients with Intracranial Dural Arteriovenous Fistulas before Endovascular Treatment: A Retrospective Study.

Typical treatment of dural arteriovenous fistula (DAVF) emphasizes clinical procedures such as surgery, radiotherapy, and endovascular treatment. However, external factors of adverse psychological emotions in patients with DAVF before treatment have not yet been evaluated in a multicenter study. This study aimed to fill the research gap regarding the effects of factors by evaluating the anxiety and depression status among patients with DAVF before and after endovascular treatment and identify factors influencing the development of anxiety and depression before their endovascular treatment. This retrospective study included 168 DAVF patients treated at two independent neurosurgical medical centers from December 2012 to December 2022. The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were assessed before and after endovascular treatment. Demographic and clinical data were also collected. Statistical tests were performed to calculate the proportion of DAVF patients with anxiety and depression. A multivariate analysis was conducted to identify independent risk factors for anxiety and depression in patients with DAVF before endovascular treatment. A significant decrease in the percentage of patients with anxiety and depression was observed in patients after endovascular treatment compared with before treatment. Patients with DAVF who were at a higher risk for anxiety and depression were females had multiple visits, comorbid conditions, and a lower economic status and were presented with symptoms. After endovascular treatment, the anxiety or depression symptoms of DAVF patients significantly improved. Our findings provide additional evidence to support the role of intravascular treatment in improved DAVF patients' psychological outcomes.

Aneurysm of the primitive trigeminal artery: a clinical case and a literature review

Background. The primitive trigeminal artery is a fetal anastomosis connecting carotid and vertebrobasilar basins during embryonic period of development. After birth, this artery in the child is obliterated and reduced in most cases. Sometimes the obliteration does not occur and as a result the aneurysms may be formed on this artery (due to change in ordinary hemodynamics in carotid basin), as a consequence, it produces a risk of subarachnoid hemorrhage that sharply worsens prognosis of the disease outcome. The usual microsurgical treatment methods of aneurysms of such localization are of little use and are highly traumatic due to the very “low” location of the neck, because the surgery may need extended basal accesses requiring resection of skull base bones. Also, an “open” surgery produces risks of perforating arteries injury that often extend from trigeminal artery and feed the brain stem, the injury will immediately result in brain ischemic damage. That is why the preferred method for treatment of that kind of pathology may include endovascular intervention both of non‑reconstructive type employing microcoils only and those of reconstructive requiring implantation of assisting or flow‑redirecting stents.Aim. To demonstrate a case of successful treatment of patient with a primitive trigeminal artery aneurysm.Materials and methods. A woman, who was admitted to clinic with complaints of convergent strabismus, undergone surgery for large aneurysm located on primitive trigeminal artery. CT brain angiography revealed large aneurysm of primitive trigeminal artery on the right, the result was later confirmed by data of selective cerebral subtraction angiography. Taking into account oculomotor disorders in the patient, it was decided to refrain from microcoils use due to risk of the mass‑effect preservation. Under double disaggregant therapy (ticagrelor 90 mg twice daily + acetylsalicylic acid 100 mg once daily in the evening) and monitoring the functional activity of platelets, a flow‑deflecting stent was implanted into the right internal carotid artery.Results. The patient was discharged from hospital on the 1st day after the surgery and returned to work. A control angiography performed 3 years later revealed a total shutdown of the aneurysm from bloodstream as well as a partial regression of oculomotor disorders. Intravascular treatment in this situation served as an effective method of choice and made it possible to reliably turn off the aneurysm from bloodstream without impairing the functional outcome of patient’s treatment.Conclusions. It can be assumed that intravascular intervention in case of such aneurysms serves as an effective method of choice as minimally invasive and low‑traumatic surgery in the treatment of patients with that type of pathology.

Photosensitive Hydrogel-Based Embolic Agent Treatment of Wide-Necked Aneurysms: Preliminary Animal Results.

Background: The endovascular treatment of cerebral aneurysms has become widespread but may still be limited by recurrence rates or complications. The discovery of novel embolic strategies may help mitigate these concerns. Methods: We formulated a Photosensitive Hydrogel Polymer (PHP) embolic agent which is low-viscosity, shear-thinning, and radio-opaque. After the filling of an aneurysm with PHP with balloon assistance, we utilized photopolymerization to induce solidification. Different methods of light delivery for photopolymerization were assessed in silicone models of aneurysms and in four acute animal trials with venous anastomosis aneurysms in pigs. Then, balloon-assisted embolization with PHP and photopolymerization was performed in three aneurysms in pigs with a one-month follow-up. Filling volume, recurrence rates, and complications were recorded. Results: The PHP was found to be suitable for the intravascular delivery and treatment of cerebral aneurysms. It was found that light delivery through the balloon catheter, as opposed to light delivery through the injection microcatheter, led to higher rates of filling in the 3D model and acute animal model for cerebral aneurysms. Using the balloon-assisted embolization and light delivery strategy, three wide-necked aneurysms were treated without complication. One-month follow-up showed no recurrence or neck remnants. Conclusions: We demonstrated a novel method of balloon-assisted photosensitive hydrogel polymer embolization and photopolymerization, leading to complete aneurysm filling with no recurrence at 1 month in three wide-necked aneurysms in pigs. This promising methodology will be investigated further with longer-term comparative animal trials.

Mesenchymal stem cells suppressed skin and lung inflammation and fibrosis in topoisomerase I-induced systemic sclerosis associated with lung disease mouse model.

Systemic sclerosis associated with lung interstitial lung disease (SSc-ILD) is the most common cause of death among patients with SSc. Mesenchymal stem cell (MSCs) transplantations had been treated by SSc patients that showed in the previous case report. The therapeutic mechanisms and effects of MSCs on SSc-ILD are still obscure. In this study, we investigated the therapeutic effects and mechanisms of treatment of BM-MSC derived from C57BL/6 on the topoisomerase I (TOPO I) induced SSc-ILD-like mice model. The mice were immunized with a mixture of recombinant human TOPO I in PBS solution (500 U/mL) and completed Freund's adjuvant [CFA; 1:1 (volume/volume)] twice per week for 9weeks. On week 10, the mice were sacrificed to analyze the related pathological parameters. Lung and skin pathologies were analyzed using histochemical staining. CD4 T-helper (TH) cell differentiation in lung and skin-draining lymph nodes was detected using flow cytometry. Our results revealed that allogeneic and syngeneic MSCs exhibited similar repressive effects on TOPO I-induced IgG1 and IgG2a in the SSc group. After intravascular (IV) treatment with syngeneic or allogeneic MSCs, the dermal thickness and fibrosis dramatically condensed and significantly reduced airway hyperresponsiveness. These findings showed that both allogeneic and syngeneic MSCs have therapeutic potential for SSc-ILD.