Successful Endovascular Treatment Research Articles

Successful endovascular treatment of an occluded external iliac artery with a minimum outer vessel diameter of 2.5mm.

Successful endovascular treatment of an occluded external iliac artery with a minimum outer vessel diameter of 2.5mm.

Successful Emergency Endovascular Treatment of Cavernous Internal Carotid Artery Stenosis Due to Compression by a Hemorrhagic Pituitary Tumor

Ischemic stroke associated with pituitary apoplexy is an extremely rare but devastating complication. Arterial stenosis or occlusion due to direct compression secondary to acute expansion of the hemorrhagic pituitary adenoma may induce ischemic stroke. In case of presentation of diffusion-perfusion or diffusion-clinical mismatch, urgent tumor resection to decompress the involved arteries should be performed to salvage ischemic penumbra. If emergent surgery is not possible, other therapeutic options are needed to prevent the progression of cerebral ischemia. Herein, we report the case of successful revascularization achieved in a patient with ischemic stroke who underwent balloon angioplasty and stent placement for the non-atherosclerotic steno-occlusion of intracranial internal carotid artery due to pituitary apoplexy.

Successful endovascular treatment of aortic arch aneurysm in a pediatric patient

Successful endovascular treatment of aortic arch aneurysm in a pediatric patient

Long-term outcomes of endovascular therapy for right subclavian artery occlusive lesions: A multi-center experience.

To review our multi-institutional experience with endovascular therapy for right subclavian artery occlusive disease and to evaluate the long-term outcomes. We retrospectively evaluated all patients with right subclavian artery stenosis and occlusive disease who underwent endovascular therapy between March 2014 and September 2022 at two institutions. Patient baseline demographics, lesion characteristics, treatment strategies, and in-hospital and follow-up outcomes were prospectively collected and retrospectively analyzed. Between March 2014 and September 2022, 73 patients underwent endovascular treatment at the two institutions. The dominant cause of lesions in this cohort was atherosclerosis. Three different types of lesions were summarized, and the corresponding endovascular strategies were performed. 66 patients (90.4%) underwent successful endovascular treatment, and 62 patients (84.9%) underwent balloon-expandable stent deployment. The mean perioperative in-hospital stay was 4.0days (range, 3-6days). Two patients died due to myocardial infarction, and one died of cerebral hemorrhage resulting from a traffic accident within 30days of the intervention. The median follow-up time was 31.6months (range, 12-96 months). No complications, including death, stroke, stent fractures, or migration, were noted in any patient during the follow-up period. The overall complication rate was 7/73 (9.6%), and 5/7 (6.9%) of the complications required reintervention. Endovascular treatment of right subclavian artery lesions is safe, effective, and technically achievable. The reasonable use of balloon-expandable stents can achieve satisfactory outcomes with accurate orientation and promising patency.

699 Immune Activation on Stroke Thrombus Proteome Associated With Failed First Pass Recanalization by Thrombectomy

INTRODUCTION: Endovascular thrombectomy remains one of the most potent tools in the treatment kit for acute ischemic stroke. Prior cursory histopathological studies have demonstrated relationships between cellular composition of the thrombus and successful endovascular treatment. METHODS: Quantitative proteomes were generated using mass spectrometry from thromboembolic material from 59 stroke patients retrieved by mechanical thrombectomy. Clinical data, including whether or not Thrombolysis In Cerebral Infarction (TICI) score of 2b or greater was achieved on the first pass (FP±), was gathered by retrospective chart review. FP effect was related to the clinical variables, as well as the abundances of proteins identified by mass spectrometry. Finally, gene ontology and KEGG pathway analysis was used to examine the functional implications of proteins significantly associated with FP±. RESULTS: Both discharge and 90-day follow-up mRS were significantly greater in greater in patients who were FP- (Wilcoxon; Z = -1.84, -2.32; p = 0.03, 0.01). Additionally, mortality was significantly associated with FP effect (Fisher’s; p = 0.04). Numerous proteins were negatively and positively associated with FP± (Wilcoxon; 1.6 < |Z| < 2.8, p < 0.05). Notably, several neutrophil and histone proteins were associated with FP- thrombectomy (Wilcoxon; |Z| > 1.9, p < 0.05). GO tags represented in the proteins FP- thrombectomy included, among others, immune activation and granule secretion (padj < 0.001). KEGG pathways significantly represented in the FP- group also include immune activation, in particular neutrophil degranulation (padj < 1E-13). CONCLUSIONS: This study suggests that not only is angiographic FP effect significantly associated with short and long-term functional outcomes, but it is also associated with significant proteome-level differences in the composition of retrieved stroke thrombi. Specifically, immune activation may be related to failure to achieve FP recanalization.

Adjunct Intraarterial or Intravenous Tirofiban Versus No Tirofiban After Successful Recanalization of Basilar Artery Occlusion Stroke: The BASILAR Registry.

Approximately half of patients who achieve successful reperfusion do not achieve functional independence. The present study sought to investigate the clinical outcomes and safety of intraarterial or intravenous tirofiban as adjunct therapy in patients with acute basilar artery occlusion who had achieved successful recanalization with endovascular treatment. In the national, prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry, 458 patients who met inclusion criteria were divided into 3 groups based on tirofiban administration (no tirofiban, n=262; intravenous tirofiban, n=101; intraarterial+intravenous tirofiban, n=95). Their clinical outcomes were compared with 90-day modified Rankin Scale scores. Adjusted odds ratios (aORs) and 95% CIs were obtained by logistic regression models and propensity score matching. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. Among 458 included patients, 184 (40.2%) achieved a favorable outcome (modified Rankin Scale score 0-3). There were no differences between the intravenous tirofiban group and the no tirofiban group in terms of safety and clinical outcomes (all P>0.05). Compared with the no tirofiban group, the intraarterial+intravenous tirofiban group had higher odds of 90-day modified Rankin Scale score 0 to 3 (aOR, 2.44 [95% CI, 1.30-4.64], P=0.006) and lower 3-month mortality (aOR, 0.38 [95% CI, 0.19-0.71], P=0.002) without an increase in any ICH (aOR, 0.34 [95% CI, 0.09-1.01], P=0.07) or symptomatic ICH (aOR, 0.23 [95% CI, 0.03-0.90], P=0.05). Similar results of intraarterial+intravenous tirofiban on improving clinical outcomes were detected in novel cohorts constructed by propensity score matching. Intraarterial+intravenous rather than intravenous tirofiban improved clinical outcomes without increasing the frequency of symptomatic ICH among patients with basilar artery occlusion after successful endovascular treatment. Further studies are needed to delineate the roles of intraarterial+intravenous tirofiban in patients with basilar artery occlusion receiving endovascular treatment.

Endovascular treatment for sphenoidal region dural arteriovenous fistula.

Sphenoidal region dural arteriovenous fistulas (DAVFs) are rare. Endovascular treatment (EVT) is an effective treatment approach. However, understanding and performing EVT for sphenoidal region DAVFs are difficult and challenging. Therefore, we performed a review to explore this issue further. In this review, we discuss the dural feeders and venous structures of the sphenoidal region, the angioarchitecture of sphenoidal region DAVFs, the role and principle of EVT, various EVT techniques, and the prognosis and complications associated with EVT. We found that various EVT techniques, including transarterial embolization (TAE), retrograde transvenous embolization (TVE), and direct puncture EVT, can be used to treat sphenoidal region DAVFs. TAE represents the most commonly utilized approach. TVE and direct puncture EVT should be limited to highly selective cases. EVT must penetrate the fistula and very proximal venous recipient pouch with a liquid embolic agent or coil the fistula point to have a complete curative effect. Successful EVT can lead to the obliteration of sphenoidal region DAVFs and a good clinical outcome. However, these complications cannot be neglected.

Pulmonary arteriovenous malformations in Rendu-Osler-Weber syndrome.

Rendu-Osler-Weber syndrome, also known as hereditary hemorrhagic telangiectasia, is an autosomal dominant hereditary disorder. It is characterized by presence of multiple arteriovenous malformations (AVMs) and telangiectasias. This article reports two cases of patients with Rendu-Osler-Weber syndrome who had pulmonary AVMs and underwent successful endovascular treatment. A brief review of the literature shows that up to 50% of patients with the syndrome have pulmonary AVMs and there is usually a positive family history in these patients. These pulmonary AVMs are multiple in 30% of cases and are associated with the most severe disease complications. Most patients are asymptomatic, even in the presence of AVMs with right-left shunts. When these shunts exceed 25% of the total blood volume, dyspnea, cyanosis, digital clubbing, and extracardiac murmurs may occur. Endovascular treatment is safe and offers control of complications from hereditary hemorrhagic telangiectasia and is currently the treatment of choice for these lesions.

Successful Endovascular Treatment of Postbiopsy AVF in Transplanted Kidneys: Lessons Learned from Two Cases in Multiorgan Transplant Recipients

AbstractAllograft biopsy is a cornerstone in the management of transplanted kidneys. It is a safe procedure, often performed in the outpatient setting. A rare complication is formation of a postbiopsy arteriovenous fistula (AVF). We present here a report of two cases of postbiopsy AVFs treated endovascularly. Selective embolization is a safe and effective method of treatment of postbiopsy AVFs in renal allografts.

The Presence of Communicating Arteries in the Circle of Willis Is Associated with Higher Rate of Functional Recovery after Anterior Circulation Ischemic Stroke.

Acute ischemic stroke (AIS) is the world's second leading cause of mortality. An established method for treating stroke patients in acute settings is endovascular therapy (EVT). However, the correlation of the successful endovascular treatment of AIS with the presence of communicating arteries in the circle of Willis needs to be proven. Our study examined clinical and radiological data of 158 consecutive patients treated with mechanical thrombectomy (MT) at our comprehensive stroke center. We analyzed their CT angiograms and digital subtraction angiography (DSA) to assess anatomical variants of Willis' circle and formed two groups-collateral-negative and collateral-positive group. The first group included patients with aplasia of both anterior (ACoA) and posterior communicating Artery (PCoA). The second group included patients that have at least one communicating artery (either anterior or posterior). We evaluated their reperfusion outcomes and functional recovery three months later. Our results showed that patients with communicating arteries had smaller areas of infarction on post-interventional CT and higher rates of functional recovery (Modified Rankin Score). The ACoA had a higher impact on early and late outcomes, confirmed by lower control CT scores and more favorable functional recovery. Therefore, anatomic variants of Willis' circle should be considered as a significant prognostic factor in AIS.

Outcomes of Endovascular Treatment for Critical Limb Threatening Ischemia

INTRODUCTIONCritical limb threatening ischemia (CLTI), particularly in patients with ischemic ulceration has been associated with significant morbidity and mortality. Typically, endovascular therapy has been first-line therapy for our patients, but this strategy has come into question based upon the Best Endovascular Versus Best Surgical Therapy in Patients with Critical Limb Threatening Ischemia (BEST-CLI) trial data. METHODS& RESULTS: For comparative purposes, we evaluated outcomes from 150 CLTI patients with ischemic ulceration treated with endovascular-first therapy. The mean age was 72 years in this pre-dominate male, Caucasian, ambulatory group. The major co-morbidities were smoking history in 49% and diabetes mellitus in 67%. Anatomic scoring, using SVS criteria, revealed only 35.6% had favorable anatomy (GLASS of 0,1) for long-term patency compared to 64.4% of limbs with unfavorable anatomy for long-term patency (GLASS 2,3). Stents were used in 47% of cases. Reintervention occurred in 36% over 24 months follow-up. At 12 and 24 months, the Kaplan-Meier projections for survival was 0.80 (0.73, 0.87) and 0.69 (0.59, 0.79); amputation was 0.69 (0.61, 0.77) and 0.59 (0.46, 0.71); amputation-free survival was 0.56 (0.48, 0.65) and 0.38 (0.27, 0.50), respectively. Amputation was more common in those with reinterventions (p=0.033). Mortality was predicted with ABI <0.40 or >1.30 (p=0.0019) and the presence of infection (p=0.0047). Amputation-free survival was predicted by the presence of any infection (p=0.0001). CONCLUSIONDespite technically successful endovascular treatment, patients who present with CLTI maintain a high-risk for limb loss and mortality. Amputation prevention must vigilantly address infection risk. These data correlate with outcomes from BEST-CLI trial enhancing applicability to patient-centered care.

Dissecting Aneurysm of the Posterior Cerebral Artery

Posterior circulation aneurysms are more likely to rupture than those in the anterior circulation but also pose more of a challenge for endovascular treatment or neurosurgical clipping. Aneurysms arising from the posterior cerebral artery are rare; dissecting aneurysms are even rarer. Dissecting posterior cerebral artery aneurysms can be spontaneous or post traumatic. Our case depicts a patient with acute subarachnoid hemorrhage due to a ruptured, dissecting posterior cerebral artery aneurysm who underwent successful endovascular treatment by means of flow diversion.

Early and late infarct growth rate in ischemic stroke patients after successful endovascular treatment in early time window: correlation of imaging and clinical factors with clinical outcome.

The prospective study assessed infarct growth rate (IGR) in acute ischemic stroke (AIS) with large vessel occlusion (LVO) after recanalization in early time window. Early IGR (EIGR) and late IGR (LIGR) were correlated with imaging and clinical data; we searched for outcome predictors. We included 71 consecutive patients. Subjects underwent computed tomography perfusion (CTP) for ischemic core volume assessment at 99.0 minutes (median) from stroke onset, recanalization was performed at 78.0 minutes (median) from CTP. Final infarct volume (FIV) was measured on 24±2 hours imaging follow-up. EIGR was calculated as the core volume/time between stroke onset and CTP; LIGR was calculated as FIV/time between CTP and imaging follow-up. Twenty-two subjects were assessed as poor outcome, 49 as good outcome. Group differences were tested by Mann-Whitney test and χ2 test. Bayesian logistic regression models were used to predict clinical outcome, Pearson correlations for the log-transformed predictors. Subjects with poor outcome were older, median age 78.0 [interquartile range (IQR): 71.8, 83.8] versus 68.0 (IQR: 57.0, 73.0) years; 95% confidence interval (CI): 6.00 to 16.00; P<0.001. Their stroke severity scale was higher, median 19.0 (IQR: 16.0, 20.0) versus 15.5 (IQR: 10.8, 18.0); 95% CI: 1.00 to 6.00; P<0.001. They had higher EIGR, median 23.9 (IQR: 6.4, 104.0) versus 6.7 (IQR: 1.7, 13.0) mL/h; 95% CI: 3.26 to 53.68; P=0.002; and larger core, median 52.5 (IQR: 13.1, 148.5) versus 10.0 (IQR: 1.4, 20.0) mL; 95% CI: 11.00 to 81.00; P<0.001. In subjects with poor outcome, infarct growth continued after thrombectomy with LIGR 2.0 (IQR: 1.2, 9.7) versus 0.3 (IQR: 0.0, 0.7) mL/h; 95% CI: 1.10 to 6.10; P<0.001; resulting in larger FIV, median 186.5 (IQR: 49.3, 280.8) versus 18.5 (IQR: 8.0, 34.0) mL; 95% CI: 55.30 to 214.00; P<0.001. Strong correlations among predictors were found e.g., core and EIGR (r=0.942), LIGR and FIV (r=0.779), core and FIV (r=0.761). Clinical outcome was best predicted using data from later measurements as FIV and LIGR. Data from later measurements were more predictive, there was no major benefit to use growth over volume data.

A Rare Case of Post-Traumatic Cervical Ligamentous Tear Complicated by Vertebral Arteriovenous Fistula (vAVF), with Successful Endovascular Treatment.

Post-traumatic vertebral arteriovenous fistula (vAVF) caused by motor vehicle accidents (MVA) is a rare condition in which there is abnormal communication between the vertebral artery and its adjacent veins. In a post-MVA setting, it is commonly associated with vertebral body fracture. In this paper, we report a case of a 19-year-old girl with a complete C2/C3 anterior and posterior ligament tear post MVA without any cervical bony injury. Initial plain computed tomography (CT) cervical scan showed a prevertebral hematoma. A CT angiogram (CTA) raised the suspicion of a pseudo-aneurysm at the right posterior C3 vertebral body. Further imaging with magnetic resonance imaging (MRI) demonstrated traumatic AVF at the C2/C3 level involving the V2/V3 right vertebral artery to the vertebral venous plexus. Digital Subtraction Angiography (DSA) further revealed a transected right vertebral artery at the C2/C3 level with an arteriovenous fistula and an enlarged vertebral venous plexus. The fistulous communication was successfully occluded with coils from a cranial and caudal approach to the transected segment right vertebral artery, with a total of eight coils. Post-MVA vertebral arteriovenous fistula (vAVF) is a rare sequela of vertebral bony injury at the cervical region, and is an even rarer association with an isolated ligamentous injury, whereby endovascular treatment with ipsilateral vertebral artery closure is a feasible treatment of vAVF.

Extended treatment in cerebral ischemia score 2c or 3 as goal of successful endovascular treatment is associated with clinical benefit

Background and purposeSuccessful reperfusion, defined as a modified treatment in cerebral ischemia (mTICI) score 2b or 3, is an important goal for endovascular treatment (EVT) of stroke. Recently, an extension of the mTICI score with an additional grade 2c indicating near-complete reperfusion (expanded TICI, eTICI) and a revised definition of success as eTICI 2c or 3 were proposed. We evaluate whether eTICI 2c translates into improved clinical outcome compared to eTICI 2b. Material and methodsConsecutive patients with large vessel occlusion in the anterior circulation who underwent EVT between December 2013 and December 2020 were included. Clinical outcome measures were favorable functional outcome at 90 days (modified Rankin Scale [mRS] scores 0 to 2 or return to pre-stroke mRS) and early neurological improvement (National Institutes of Health Stroke Scale [NIHSS] improvement ≥4 points or a score of 0–1 at 24 h). ResultsOf 1282 included patients (median age 76, median NIHSS 16), reperfusion was classified as eTICI 2b in 410 (32%), eTICI 2c in 242 (19%) and eTICI 3 in 464 (36%). eTICI 2c differed significally from 2b with respect to early neurological improvement (aOR = 1.49, 95% CI = 1.01–2.19). No statistically significant difference in favorable functional outcome at 90 days was found (eTICI 2c vs 2b, aOR = 1.31, 95% CI = 0.88–2.00). ConclusionOur study indicates early clinical benefit at 24 h of achieving eTICI 2c compared to eTICI 2b, but no significant difference was seen in favorable functional outcome at 90 days. Our results support eTICI 2c and 3 as the goal of a successful thrombectomy but do not exclude eTICI 2b as an acceptable result.

Combined Endovascular and Surgical Treatment of High-Grade Meningioma - Case Report

Surgical resection of hypervascular meningiomas is often complex and may be accompanied by blood loss, followed by incomplete resection and tumor recurrence. We present a case of successful combined endovascular and surgical treatment for a large, complex, transcalvarial meningioma that is successfully resected. A 52-year-old male is admitted to our hospital with large left fronto-parietal tumefaction. Magnetic resonance imaging revealed extra-axial, transcalvarial fronto-temporal-parietal space occupying lesion with vivid contrast enhancement. Preoperative embolization was done using microspheres and coils. Surgical resection of tumor was done and pathohistology report showed Grade III meningioma. The patient recovers completely after the surgery and at first clinical follow-up 30 days later mRS was 0. Preoperative embolization of grade III meningioma reduces the surgery time, intraoperative blood loss and allows better resection without significant increase of perioperative complications. Reports on the association between embolization and tumor recurrence are insubstantial and require more research in future.

Clinical Characteristics of the Patient With Unmeasurable Ankle-Brachial Index in Endovascular Treatment.

Introduction Ankle-brachial index (ABI) is an important indicator to diagnose lower extremity arterial disease (LEAD). However, patients with unmeasurable ABI are sometimes excluded from the analysis and their clinical characteristics are poorly understood. Methods One hundred twenty-two consecutive Japanese subjects (mean age, 72 years), who underwent successful endovascular treatment (EVT) for lower extremity arteries at our hospital were retrospectively studied. Results Of the 122 patients, 23 (19%) patients presented an unmeasurable ABI before EVT. Five of 23 (22%) had still an unmeasurable ABI one day after EVT. Comorbidities including hypertension, diabetes, dyslipidemia, hemodialysis, smoking, ischemic heart disease, atrial fibrillation, and past-EVT history were not different between ABI measurable and unmeasurable patients. However, patients with unmeasurable ABI presented a significantly higher degree of Rutherford category and a smaller number of tibial vessel runoff than patients with measurable ABI before EVT (p<0.05 and p<0.01, respectively). There was no difference in the lesion site between the two groups. The event rate including all-cause mortality, re-EVT, lower limb amputation, and bypass surgery did not differ between two groups four years after EVT. ABI after four years of initial EVT did not differ between pre-EVT measurable and unmeasurable patients (0.96 vs. 0.84, p=0.48). Conclusions Patients with unmeasurable ABI before EVT were characterized by higher degree of Rutherford categorization and a small number of tibial vessel runoff, but there was no significant difference in outcomes during the follow-up period.

A Novel Score Predicts Need of Open Revascularization Following Endovascular Revascularization in Patients with Infrainguinal Chronic Limb-threatening Ischemia

This study aims to assess the ability of a novel score, the infrainguinal successful endovascular treatment (iSET) score in predicting risk of open revascularization in patients undergoing endovascular revascularization (ER) for infrainguinal chronic limb-threatening ischemia (CLTI). A retrospective analysis of consecutive patients undergoing ER for CLTI between January 2015 and December 2018. The iSET is a score between 1 and 63. It combines components of the Global Vascular Guidelines evidence-based revascularization as follows: iSET = Wound, Ischemia, foot Infection (WIfI) × WIFI + inflow disease + 4 × Global limb anatomic staging system (GLASS) FP + 6 × GLASS IP + 3 × IM pedal modifier. It stratifies patients into low (0-21), moderate (22-42), and high (43-63). The primary outcome was freedom from open revascularization at 2 years. Secondary outcomes were 30-day and 1-year endovascular reintervention, major amputations (above the ankle joint), minor amputations (below the ankle joint) and mortality. Kaplan-Meier estimates and Cox proportional hazard model assessed ability of iSET to predict open revascularization risk. A P value < .05 was significant. The study included 159 limbs in 150 patients with 12% (n = 19), 53% (n = 84), and 35% (n = 56) having a low, moderate, and high iSET scores, respectively. Most patients presented with tissue loss (86%), WIfI stage 4 (64%), and GLASS III (47%). Patients with a high iSET were more likely to have received antibiotics prior to ER (odds ratio, 1.35; 95% confidence interval [CI], 1.08-1.70; P = .013) and less likely to have elective ER (odds ratio, 0.36; 95% CI, 0.18-0.72; P = .003). Most ER involved the femoropopliteal segment (84%), with 55% of these including concomitant infrapopliteal revascularization. Kaplan-Meier survival curves showed that 2-year freedom from open revascularization was 100%, 93%, and 79% with low, moderate, and high iSET, respectively (Fig). Mortality, reinterventions, and major amputations were similar at 30 days and 1 year (Table). There was an increase in minor amputations at 1 year with high iSET patients (38%; n = 20) compared with low (6%; n = 1) and moderate (21%; n = 15) iSET (P = .016). High iSET score predicted increased risk of open revascularization (hazard ratio, 4.75; 95% CI, 1.67-13.48; P = .003). The iSET is a novel comprehensive score incorporating guideline-driven parameters. The score correlated significantly with ER failure at 2 years with progressively lower freedom from open revascularization between low, moderate, and high iSET scores. Additionally, a high iSET score independently predicted subsequent open revascularization after ER. Further studies are needed to validate it as an adjunctive decision-making tool in patients with CLTI.TableThirty-day and 1-year outcomes in patients stratified by groupsOverallLowModerateHighP-value30-day Death2 (3)03 (2)2 (1).775 Endovascular reintervention8 (11)08 (6)10 (5).447 Major amputation2 (2)02 (1)3 (1).848 Minor amputation13 (18)6 (1)8 (6)21 (11).0861-year Death11 (15)013 (9)11 (6).334 Endovascular reintervention34 (48)31 (5)33 (24)37 (19).885 Major amputation13 (18)014 (10)15 (8).262 Minor amputation25 (36)6 (1)21 (15)38 (20).016Data is presented as percentage (number). Open table in a new tab

A clinical case of successful palliative endovascular treatment of a patient with a single ventricle, mitral valve atresia, an intact atrial septum and persistent cardinal vein

BackgroundTreatment of newborns with univentricular hemodynamics in combination with an anomaly of pulmonary venous return has the worst correction results in modern cardiac surgical papers. According to the data obtained by different authors, postoperative mortality in this cohort of patients varies from 41.7 to 53%. The presence of the venous outflow tract obstruction, as well as the serious condition of a newborn, is one of the main factors that increase the risk of death in the postoperative period.Case presentationThis article reveals a clinical case of a patient with a combined heart disease prenatally diagnosed in the form of a functionally single ventricle with a double outlet of the main vessels from it, mitral valve atresia, an intact atrial septum and an anomaly of venous return, when the blood outflow from the left atrium was carried out through a single fetal communication such as stenotic cardinal vein. In order to stabilize the patient's condition, the newborn urgently underwent stenting of the stenotic section of the cardinal vein. However, due to the lack of positive dynamics in the postoperative period, the child underwent repeated endovascular intervention and stenting of the intraoperatively created interatrial communication was performed. Taking into account the absence of obstruction of the outflow tract to the pulmonary artery, it was necessary to perform an open surgical intervention in a short time such as pulmonary artery banding.ConclusionsThus, palliative endovascular intervention in critically ill neonates with univentricular hemodynamics and anomalous pulmonary venous return can be considered as a method of choice that can become a new safer strategy for managing infants in order to stabilize the condition before the main stage of surgical intervention comes.

Utility of virtual stenting in treatment of cerebral aneurysms by flow diverter devices.

Successful endovascular treatment by stenting of intracranial aneurysms requires proper placement of the device and appropriate choice of its diameter and length. To date, several methods have been employed to achieve these goals, although each has inherent critical issues. Recently developed stent planning software applications can be used to assist interventional neuroradiologists. Based on a 3D-DSA image acquired before stenting, these applications simulate and visualize the final placement of the deployed stent. In this single-centre retrospective study, 27 patients undergoing an intravascular procedure for the treatment of intracranial aneurysms from June 2019 to July 2020 were evaluated according to strict inclusion criteria. Stent virtualization was performed with Syngo 3D Aneurysm Guidance Neuro software. We compared the software-generated stent measurement and measurements taken by the interventional radiologist. Statistical analysis was performed using the STAC web platform. Mean and standard deviations of absolute and relative discrepancies between predicted and implanted stents were recorded. Friedman's nonparametric test was used to refute the null hypotheses, i.e. (I) discrepancies between the size of virtual and implanted stents would occur, and (II) operator influence does not affect the outcome of the virtual stenting process. Based on these observations, it is believed that the virtual stenting process can validly assist interventional neuroradiologists in selecting the appropriate device and reducing peri- and post-procedural complications. The results of our study suggest that virtual reality simulation of devices used for endovascular treatment of intracranial aneurysms is a useful, rapid, and accurate tool for interventional procedure planning.