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Meral R, Selcukbiricik OS, Uzum AK, Sahin S, Okutan M, Barburoglu M, Dolas I, Altun M, Yarman S, Kadıoglu P. Promising Outcomes in Acromegaly Patients Receiving CyberKnife Stereotactic Hypofractionated Radiotherapy. Cureus 2023; 15:e47936. [PMID: 37908695 PMCID: PMC10613787 DOI: 10.7759/cureus.47936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The primary treatment for patients with acromegaly has traditionally been transsphenoidal surgery, with decreasing reliance on radiotherapy (RT) due to advancements in pharmacotherapy (PT). Despite these advancements, a substantial portion of patients still face persistent acromegaly, necessitating novel treatment approaches. This study investigates the role of CyberKnife Stereotactic Hypofractionated Radiotherapy (CK-HFRT) in persistent acromegaly. OBJECTIVE The primary objective was to assess the impact of CK-HFRT on endocrine remission (ER) rates while maintaining acceptable toxicity levels. METHODS The study retrospectively analyzed 31 consecutive patients with acromegaly who received CK-HFRT following multiple unsuccessful surgeries and prolonged PT without ER. Various CK-HFRT dose fractionation regimes were administered, and dose volume histograms were evaluated. Tumor control, cured disease (CD), endocrine remission (ER) rates, and overall survival were estimated at a median follow-up of 62 months. Acute and late toxicity, including pituitary insufficiency and radiation-induced optic neuropathy (RION), were also assessed. RESULTS At 62 months of follow-up, the study group demonstrated excellent tumor control with 100% nonprogressive adenomas. Endocrine remission was achieved in 86.7% of patients, with a 22.4% CD rate at five years. Pituitary insufficiency occurred in 32.3% of patients, and no cases of RION were reported. The study observed three deaths related to cardiovascular diseases, all in patients receiving PT. Overall survival at five years was 79.2%. CONCLUSION CyberKnife stereotactic hypofractionated radiotherapy, as an adjunct to PT, provides a viable treatment option for patients with persistent acromegaly following unsuccessful surgeries. The therapy results in substantial ER rates and tumor control while minimizing the risk of permanent radiation-induced optic neuropathy. However, the decision to administer CK-HFRT should be individualized, considering the patient's overall condition and treatment history.
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Affiliation(s)
- Rasim Meral
- Department of Clinical Oncology, Istanbul University Institute of Oncology, Istanbul, TUR
- Department of Radiation Oncology, Istanbul University School of Medicine, Istanbul, TUR
| | | | - Ayse K Uzum
- Department of Endocrinology, Istanbul University School of Medicine, Istanbul, TUR
| | - Serdar Sahin
- Department of Endocrinology, Istanbul University - Cerrahpasa School of Medicine, Istanbul, TUR
| | - Murat Okutan
- Department of Medical Physics, Istanbul University Institute of Oncology, Istanbul, TUR
| | - Mehmet Barburoglu
- Department of Radiology, Istanbul University School of Medicine, Istanbul, TUR
| | - Ilyas Dolas
- Department of Neurological Surgery, Istanbul University School of Medicine, Istanbul, TUR
| | - Musa Altun
- Department of Radiation Oncology, Istanbul University School of Medicine, Istanbul, TUR
| | - Sema Yarman
- Department of Endocrinology, Istanbul University School of Medicine, Istanbul, TUR
| | - Pinar Kadıoglu
- Department of Endocrinology, Istanbul University - Cerrahpasa School of Medicine, Istanbul, TUR
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Aydin K, Puthuran M, Onal Y, Barburoglu M, Chandran A, Berdikhojayev M, Gravino G, Senturk YE, Aygun S, Velioglu M, Sencer S. The Angiographic and Clinical Follow-up Outcomes of the Wide-Necked and Complex Intracranial Aneurysms Treated With LVIS EVO-Assisted Coiling. Neurosurgery 2023; 92:827-836. [PMID: 36729762 DOI: 10.1227/neu.0000000000002283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/30/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Low Profile Visible Intraluminal Support EVO (LVIS EVO) is a self-expandable braided stent, which was recently introduced for the treatment of intracranial aneurysms. Full visibility of the stent and a relatively high metal coverage ratio are the unique features of the LVIS EVO. OBJECTIVE To assess the safety, efficacy, and midterm durability of LVIS EVO stent-assisted coiling for the treatment of wide-necked intracranial aneurysms. METHODS The endovascular databases were reviewed to identify patients treated with LVIS EVO-assisted coiling. The technical success and immediate clinical/angiographic outcomes were assessed. Periprocedural and delayed complications were evaluated. The follow-up angiographic/clinical outcomes were investigated. The preprocedural/follow-up neurological statuses were assessed with the modified Rankin Scale. RESULTS One hundred three aneurysms in 103 patients (63 females) with a mean age of 54.9 ± 11.3 years were included. The mean maximum sac diameter was 6.2 ± 2.9 mm. The procedural technical success rate was 100%. Immediate postprocedural angiography showed complete occlusion in 77.7%. The mean duration of the angiographic follow-up was 8.8 ± 3.6 months. Follow-up angiography showed complete aneurysm occlusion in 89% of the 82 patients with angiographic follow-up. Recanalization was observed in 7.3% of 82 patients. Two patients (2.4%) required retreatment. In addition, 8.7% of the patients had at least 1 complication, and 2.9% of the patients developed a permanent morbidity. All patients had mRS scores ≤2. CONCLUSION The results of this study demonstrate that SAC with LVIS EVO is a relatively safe, efficient, and durable treatment for wide-necked and complex intracranial aneurysms.
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Affiliation(s)
- Kubilay Aydin
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Mani Puthuran
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Yilmaz Onal
- Department of Neurosurgery, JSC Central Hospital, Almaty, Kazakhstan
| | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Arun Chandran
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | | | - Gilbert Gravino
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Yunus Emre Senturk
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
| | - Serhat Aygun
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
| | - Murat Velioglu
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Serra Sencer
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
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Mutlu U, Telci Caklili O, Barburoglu M, Yarman S. Frequency of hyperostosis frontalis interna in patients with active acromegaly: is there a possible role of GH excess or hyperprolactinemia in its etiopathogenesis? Hormones (Athens) 2023; 22:25-32. [PMID: 36223065 DOI: 10.1007/s42000-022-00401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Acromegaly is characterized by bone changes due to excessive growth hormone (GH) secretion. Hyperostosis frontalis interna (HFI) is described as an overgrowth in the inner plate of the frontal bone. An increased incidence of HFI has been reported in patients with acromegaly. Since the etiology of HFI is poorly understood, we have analyzed whether there is a relationship between the hormonal and metabolic status of patients with acromegaly (with or without hyperprolactinemia) and the pathogenesis of HFI. METHODS Forty-five patients with acromegaly and two control groups consisting of 25 patients with prolactinoma (group 1) and 47 healthy subjects (group 2) were included in this retrospective study. Baseline hormonal data and cranial imaging were obtained from medical records and analyzed. RESULTS Mean frontal bone thickness was 6.75 mm in acromegaly, 4.85 mm in group 1, and 5.1 mm in group 2 of controls (p < 0.001). The frequency of HFI was higher in acromegalic patients than in the controls (22%, 0%, and 2.2%, respectively). There was no difference between the HFI positive and negative acromegalic patients in basal GH, IGF-1, and PRL levels, IGF-1 index, diagnosis lag time, and insulin resistance. There was no difference between groups regarding parietal and occipital bone thickness. CONCLUSION Although the frequency of HFI is 22% in patients with acromegaly, neither excess GH nor hyperprolactinemia plays a role in its etiopathogenesis. Various genetic or epigenetic factors may contribute to its etiology.
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Affiliation(s)
- Ummu Mutlu
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Turgut Ozal Street, Capa, Sehremini, Fatih, Istanbul, Turkey.
| | - Ozge Telci Caklili
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Turgut Ozal Street, Capa, Sehremini, Fatih, Istanbul, Turkey
| | - Mehmet Barburoglu
- Istanbul Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Sema Yarman
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Turgut Ozal Street, Capa, Sehremini, Fatih, Istanbul, Turkey
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Dolas I, Unal TC, Gulsever CI, Sahin D, Huseynov H, Barburoglu M, Ozturk O, Can H, Adiyaman AE, Dagdeviren HE, Sabanci PA, Aydoseli A, Aras Y, Sencer A, Sencer S. Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment. Neurocirugia (Astur : Engl Ed) 2023:S2529-8496(22)00097-1. [PMID: 36774258 DOI: 10.1016/j.neucie.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/29/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Relatively constant surgical risks and rapid advances in endovascular treatment have caused a major shift toward endovascular management of posterior circulation aneurysms. This paper presents the results of a series of endovascularly treated posterior circulation aneurysms. METHODS A total of 81 patients who underwent endovascular treatment of posterior circulation aneurysms performed by a single team between 2009 and 2019 were included. Demographic, clinical, radiologic, and management details were retrospectively obtained from hospital records. RESULTS Among the included patients, 50 (61.7%) and 31 (38.3%) were female and male, respectively. Subarachnoid hemorrhage was observed in 30 patients (37%). Moreover, 40 (49.3%) aneurysms were treated with stent-assisted coiling, 1 (1.2%) aneurysm was treated with parent artery occlusion, 2 (2.4%) aneurysms were coiled using balloon assistance, 24 (29.6%) aneurysms were coiled primarily, 1 (1.2%) patient had an unsuccessful treatment attempt, and 13 (16.0%) aneurysms were treated with flow-diverter stents or stent monotherapy. During the last follow-up, 57 (83.8%) aneurysms were completely occluded, whereas 6 (8.8%) and 2 (2.9%) aneurysms did and did not have a residual neck, respectively. Flow diversion was used to treat 13 patients, among whom 8 had total occlusion or stable residue. A total of 7 deaths (8.6%) were encountered in this series. CONCLUSION Endovascular treatment should be considered as the primary treatment modality for posterior circulation aneurysms. Despite the high morbidity and mortality rates, promising results can be achieved with correct patient selection. Flow diversion can be a feasible alternative for complex aneurysms that are difficult to treat.
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Affiliation(s)
- Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Duran Sahin
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Heydar Huseynov
- Department of Radiology, Istanbul Atlas University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Onur Ozturk
- Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey
| | - Halil Can
- Department of Neurosurgery, Istanbul Atlas University, Istanbul, Turkey
| | - Ali Ekrem Adiyaman
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Huseyin Emre Dagdeviren
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Serra Sencer
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Dolas I, Unal TC, Gulsever CI, Sahin D, Huseynov H, Barburoglu M, Ozturk O, Can H, Adiyaman AE, Dagdeviren HE, Sabanci PA, Aydoseli A, Aras Y, Sencer A, Sencer S. Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Aydin K, Berdikhojayev M, Cay F, Barburoglu M, Nurzhan S, Aygun S, Sencer S, Arat A. Safety, Efficacy, and Durability of Stent-Assisted Coiling Treatment of M2 (Insular) Segment MCA Aneurysms. AJNR Am J Neuroradiol 2022; 43:560-567. [PMID: 35301223 PMCID: PMC8993191 DOI: 10.3174/ajnr.a7461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Most distal MCA aneurysms are located within the insular segment, which lies between the limen insulae and circular sulcus. However, experience is limited in the microsurgical and endovascular management of insular segment MCA aneurysms. In this multicenter retrospective case series, we aimed to investigate the safety, efficacy, and durability of stent-assisted coiling for treatment of insular segment MCA aneurysms. MATERIALS AND METHODS A retrospective review was performed to identify patients with insular MCA aneurysms that were treated with stent-assisted coiling. The technical success of the procedures and the initial and follow-up clinical and angiographic outcomes were assessed. Periprocedural and delayed complications were reviewed. RESULTS Twenty-seven aneurysms in 27 patients with a mean age of 53.3 (SD,11.3) years were included. The mean size of the aneurysms was 6.3 (SD 2.6) mm. Endovascular procedures were successfully performed in all patients. Immediate postprocedural angiography revealed complete aneurysm occlusions in 81.5%. Periprocedural complications developed in 7.4% without causing permanent morbidity. A delayed thromboembolic complication resulted in a minor permanent morbidity in 1 patient (3.7%). There was no mortality. The mean duration of angiographic follow-up was 19.5 (SD, 9.8) months. The last follow-up examinations showed complete occlusion in 92.6%. During the follow-up period, none of the treated aneurysms showed recanalization. CONCLUSIONS The results of this study demonstrate that stent-assisted coiling with a low-profile self-expandable stent is a feasible and relatively safe technique for endovascular treatment of insular segment complex MCA aneurysms. Additionally, it provides an effective and durable treatment for insular MCA aneurysms.
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Affiliation(s)
- K Aydin
- From the Department of Interventional Neuroradiology (K.A., S.A.), Koç University Hospital, Topkapi, Istanbul, Turkey
- Department of Neuroradiology (K.A., M. Barburoglu, S.S.), Istanbul Faculty of Medicine, Capa, Istanbul University, Istanbul, Turkey
| | - M Berdikhojayev
- Department of Neurosurgery (M. Berdikhojayev, S.N.), JSC Central Hospital, Almaty City, Kazakhstan
| | - F Cay
- Department of Radiology (F.C., A.A.), Hacettepe University Medical School, Hacettepe Hospitals, Sihhiye, Ankara, Turkey
| | - M Barburoglu
- Department of Neuroradiology (K.A., M. Barburoglu, S.S.), Istanbul Faculty of Medicine, Capa, Istanbul University, Istanbul, Turkey
| | - S Nurzhan
- Department of Neurosurgery (M. Berdikhojayev, S.N.), JSC Central Hospital, Almaty City, Kazakhstan
| | - S Aygun
- From the Department of Interventional Neuroradiology (K.A., S.A.), Koç University Hospital, Topkapi, Istanbul, Turkey
| | - S Sencer
- Department of Neuroradiology (K.A., M. Barburoglu, S.S.), Istanbul Faculty of Medicine, Capa, Istanbul University, Istanbul, Turkey
| | - A Arat
- Department of Radiology (F.C., A.A.), Hacettepe University Medical School, Hacettepe Hospitals, Sihhiye, Ankara, Turkey
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Barburoglu M, Aydin K, Onal Y, Cengiz D, Velioglu M. Feasibility and Results of the Stentectomy Procedure Performed as Rescue Treatment for Acute Thrombosis of Self-Expandable Intracranial Stents: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:277-283. [DOI: 10.1227/ons.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022] Open
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Aydoseli A, Unal TC, Dolas I, Dagdeviren HE, Kucuk C, Barburoglu M, Sencer A. Evaluation of the usefulness of an expandable stent for establishing patency in endoscopic third ventriculostomy: a fresh cadaveric study. Turk Neurosurg 2022; 32:330-335. [DOI: 10.5137/1019-5149.jtn.37281-21.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aydin K, Stracke P, Berdikhojayev M, Barburoglu M, Mosimann PJ, Suleimankulov N, Sarshayev M, Sencer S, Chapot R. Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa590_s127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aydin K, Stracke P, Berdikhojayev M, Barburoglu M, Mosimann P, Suleimankulov N, Sarshayev M, Sencer S, Chapot R. In Reply: Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021; 89:E274-E276. [PMID: 34409998 DOI: 10.1093/neuros/nyab323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kubilay Aydin
- Department of Neuroradiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey.,Department of Interventional Radiology Koc University Hospital, Istanbul, Turkey
| | - Paul Stracke
- Department of Neuroradiology and Intracranial Endovascular Therapy Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Mehmet Barburoglu
- Department of Neuroradiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey
| | - Pascal Mosimann
- Department of Neuroradiology and Intracranial Endovascular Therapy Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Marat Sarshayev
- Department of Neurosurgery JSC Central Clinical Hospital, Almaty City, Kazakhstan
| | - Serra Sencer
- Department of Neuroradiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy Alfried Krupp Krankenhaus, Essen, Germany
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Erdem Y, Erdem S, Barburoglu M, Karaayvaz EB, Shugaiv E, Kurtuncu M, Salmaslioglu A, Oflaz H, Kose AA, Kadioglu A. The risk of endothelial and erectile dysfunctions in Behçet's disease: a comparative analysis of mucocutaneous and systemic patient groups. Postepy Dermatol Alergol 2021; 38:622-628. [PMID: 34658705 PMCID: PMC8501428 DOI: 10.5114/ada.2021.108931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/16/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Behçet's disease (BD) is a chronic inflammatory disease which can be limited to only mucocutaneous tissues or can affect different systems of the body. AIM To investigate the association of endothelial and erectile dysfunctions with BD, on the basis of comparative analysis between mucocutaneous and systemic BD. MATERIAL AND METHODS Thirty-eight men diagnosed with BD were included in the present study. The patients were stratified into two groups as mucocutaneous BD (n = 20, MBD group), and systemic BD (n = 18, SBD group). Erectile dysfunction (ED) was assessed using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. The coronary flow reserve (CFR) assessment was done for analysing endothelial dysfunction (EnD), and CFR < 2 was defined as EnD. Penile Doppler ultrasonography (PDU) was performed for ED. The demographic and clinical parameters, IIEF-EF score ED classification, CFR and PDU test findings were compared between two groups. RESULTS The median age was 34 (22-52) years in the overall population, and there was no difference between two groups (p = 0.558). Time from diagnosis was significantly longer (24 vs. 102 months, p = 0.021) and the use of immunosuppressive therapies was higher (0 vs. 70.6%, p < 0.001) in the SBD group. In overall, median CFR was 1.92 (1.1-5.96), and there was no difference between two groups (1.88 vs. 1.97, p = 0.812). The percentage of patients with CFR < 2 was similar in two groups (52.6% vs. 52.9%, p = 0.985). The ED status according to IIEF-EF was similar in two groups (45% vs. 27.8%, p = 0.538) as well as according to PDU analyses (10% vs. 16.7%, p = 0.544). CONCLUSIONS The increased risk of endothelial, and erectile dysfunctions should be considered in men who were diagnosed with mucocutaneous and systemic BD.
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Affiliation(s)
- Yasemin Erdem
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ekrem Bilal Karaayvaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erkingul Shugaiv
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kurtuncu
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Artur Salmaslioglu
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Afet Akdag Kose
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Aydin K, Stracke P, Berdikhojayev M, Barburoglu M, Mosimann PJ, Suleimankulov N, Sarshayev M, Sencer S, Chapot R. Safety, Efficacy, and Durability of Stent Plus Balloon-Assisted Coiling for the Treatment of Wide-Necked Intracranial Bifurcation Aneurysms. Neurosurgery 2021; 88:1028-1037. [PMID: 33575798 DOI: 10.1093/neuros/nyaa590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Wide-necked bifurcation aneurysms remain a challenge for endovascular surgeons. Dual-stent-assisted coiling techniques have been defined to treat bifurcation aneurysms with a complex neck morphology. However, there are still concerns about the safety of dual-stenting procedures. Stent plus balloon-assisted coiling is a recently described endovascular technique that enables the coiling of wide-necked complex bifurcation aneurysms by implanting only a single stent. OBJECTIVE To investigate the feasibility, efficacy, safety, and durability of this technique for the treatment of wide-necked bifurcation aneurysms. METHODS A retrospective review was performed of patients with wide-necked intracranial bifurcation aneurysms treated with stent plus balloon-assisted coiling. The initial and follow-up clinical and angiographic outcomes were assessed. Preprocedural and follow-up clinical statuses were assessed using modified Rankin scale. RESULTS A total of 61 patients (mean age: 54.6 ± 10.4 yr) were included in the study. The immediate postprocedural digital subtraction angiography revealed complete aneurysm occlusion in 86.9% of the cases. A periprocedural complication developed in 11.5% of the cases. We observed a delayed ischemic complication in 4.9%. There was no mortality in this study. The permanent morbidity rate was 3.3%. The follow-up angiography was performed in 55 of 61 patients (90.1%) (the mean follow-up period was 25.5 ± 27.3 mo). The rate of complete aneurysm occlusion at the final angiographic follow-up was 89.1%. The retreatment rate was 1.8%. CONCLUSION The results of this study showed that stent plus balloon-assisted coiling is a feasible, effective, and relatively safe endovascular technique for the treatment of wide-necked bifurcation aneurysms located in the posterior and anterior circulation.
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Affiliation(s)
- Kubilay Aydin
- Department of Neuroradiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.,Department of Interventional Radiology, Koc University Hospital, Istanbul, Turkey
| | - Paul Stracke
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pascal J Mosimann
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Marat Sarshayev
- Department of Neurosurgery, JSC Central Clinical Hospital, Almaty City, Kazakhstan
| | - Serra Sencer
- Department of Neuroradiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
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Akgul E, Onan HB, Islek I, Tonge M, Durmus Y, Barburoglu M, Azizova A, Erol C, Hakyemez B, Sencer S, Aydin K, Arat A. Flow diverter stents in the treatment of recanalized intracranial aneurysms. Interv Neuroradiol 2021; 27:481-489. [PMID: 33509011 DOI: 10.1177/1591019921990507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We assessed the safety and efficacy of flow diverter stents (FDSs) in the treatment of recanalized or residual intracranial aneurysms treated endovascularly. MATERIALS & METHODS Patients whose recanalized or residual aneurysms were treated with FDSs in five tertiary hospitals were reviewed retrospectively. The patients' demographic data, aneurysm characteristics, types of previous treatment, and clinical complications, or serious adverse events associated with FDSs, as well as the results of neurological and angiographic follow-up assessments, were recorded. RESULTS Eighty-six patients (37 males) with 87 aneurysms were included in this study. Eighty (91.9%) aneurysms were in the anterior and seven (8.1%) in the posterior circulation. The initial treatment methods were the primary coiling or balloon remodeling technique in 69 (79.3%) and stent-assisted coiling in 18 (20.7%) aneurysms. The endovascular procedure was successful in all patients. Complications occurred in four patients, for a total complication rate of 4.6%. A technical complication developed in one patient (1.2%). An in-stent thrombosis treated with tirofiban was seen in two cases. Late in-stent stenosis exceeding 50% was treated with balloon angioplasty in one patient. The mean length of follow-up was 21.0 months. The first angiographic follow-up (3-6 months) revealed the complete occlusion of 74 aneurysms (85.1%). While 76 aneurysms (87.4%) were occluded at the last angiographic follow-up (mean: 26.0 months), 11 aneurysms (12.6%) were still filling. Morbimortality was zero. CONCLUSION The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion.
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Affiliation(s)
- Erol Akgul
- Interventional Neuroradiology Section, Radiology Department, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hasan Bilen Onan
- Radiology Department, School of Medicine, Cukurova University, Adana, Turkey
| | - Irem Islek
- Radiology Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Tonge
- Neurosurgery Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Yavuz Durmus
- Radiology Department, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aynur Azizova
- Radiology Department, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Cengiz Erol
- Radiology Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Bahattin Hakyemez
- Radiology Department, School of Medicine, Uludag University, Bursa, Turkey
| | - Serra Sencer
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kubilay Aydin
- Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Interventional Neuroradiology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Anil Arat
- Radiology Department, School of Medicine, Hacettepe University, Ankara, Turkey
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Aydin K, Stracke CP, Barburoglu M, Yamac E, Berdikhojayev M, Sencer S, Chapot R. Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent–assisted coiling. J Neurosurg 2021:1-10. [DOI: 10.3171/2019.9.jns191733] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe endovascular treatment of complex bifurcation aneurysms possessing a neck that incorporates multiple side branches remains a surgical challenge. Double-stent–assisted coiling techniques, such as those with stents in an X and Y configuration, enable the endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. However, the intraluminal struts at the intersection point in X- and Y-stents are not amenable to endothelialization, which may lead to thromboembolic complications. Stenting in the T configuration is a relatively new double-stent coiling technique. T-stenting differs from X- or Y-stenting in that there are no overlapping or intersecting stent segments. Promising short-term results of T-stent–assisted coiling were recently reported. However, the long-term results have not yet been demonstrated. This retrospective study investigated the long-term angiographic and clinical results in patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent–assisted coiling.METHODSA retrospective review was performed to identify patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent–assisted coiling at 4 institutions. The technical success and the initial and follow-up clinical and angiographic outcomes were assessed. Aneurysm filling status was assessed according to the Raymond classification. Periprocedural and delayed complications were reviewed. The neurological status of the patients was evaluated using the modified Rankin Scale (mRS).RESULTSOne hundred two aneurysms in 102 patients (54 females), whose mean age was 57.9 ± 13.0 years, were included in the study. T-stenting was performed successfully in all patients. Immediate postprocedural angiography revealed complete occlusion in 83.3% of patients. Periprocedural complications developed in 13.7%, resulting in permanent morbidity in 1.9% and death in 1%. Eighty patients (78.4%) had at least one follow-up DSA examination performed at 6 months or later following the endovascular procedure. The mean duration of angiographic follow-up was 30.0 ± 16.3 months. The last follow-up examinations showed complete occlusion in 90.0% of patients. During the follow-up period, only 1 patient (1.3%) required retreatment. Delayed thromboembolic complications were observed in 4 patients (3.9%) without permanent morbidity. The mRS scores of all patients at the last clinical follow-up were between 0 and 2.CONCLUSIONSThe short-term angiographic findings showed that T-stent–assisted coiling is a feasible and effective endovascular method to treat wide-necked complex bifurcation aneurysms. The long-term angiographic follow-up results suggest that T-stent–assisted coiling provides a durable treatment for wide-necked complex bifurcation aneurysms with favorable clinical outcomes, demonstrating the long-term safety of T-stent–assisted coiling.
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Affiliation(s)
- Kubilay Aydin
- 1Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Capa
- 2Department of Interventional Radiology, Koç University Hospital, Istanbul, Turkey
| | - Christian Paul Stracke
- 3Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany; and
| | - Mehmet Barburoglu
- 1Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Capa
| | - Elif Yamac
- 3Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany; and
| | | | - Serra Sencer
- 1Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Capa
| | - René Chapot
- 3Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany; and
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Aydin K, Balci S, Sencer S, Barburoglu M, Umutlu MR, Arat A. Y-Stent-Assisted Coiling With Low-Profile Neuroform Atlas Stents for Endovascular Treatment of Wide-Necked Complex Intracranial Bifurcation Aneurysms. Neurosurgery 2019; 87:744-753. [DOI: 10.1093/neuros/nyz516] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/20/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Y-stent-assisted coiling is one of the eligible techniques for the treatment of complex bifurcation aneurysms. In majority of previous literature, Y-stenting has been performed using stents that could be delivered through large profile microcatheters that are often difficult to manipulate during navigation through sharply angled side branches. Attempts to navigate with these large profile catheters might cause serious complications during Y-stenting procedure.
OBJECTIVE
To investigate the safety, feasibility, and efficacy of Y-stent-assisted coiling procedure with Neuroform Atlas stents for the treatment of complex bifurcation aneurysms; Neuroform Atlas is a recently introduced open-cell stent that can be delivered though low-profile microcatheters.
METHODS
We identified the patients with intracranial bifurcation aneurysms treated by Y-stent-assisted coiling procedure with Neuroform Atlas stents. We assessed the immediate postoperative and follow-up clinical and angiographic outcomes. We also investigated the periprocedural and delayed complications.
RESULTS
A total of 30 aneurysms in 30 patients were included in the study. Y-stenting was successfully performed without any technical complications in all cases (100%). Immediate postprocedural angiography revealed total aneurysm occlusion in 83.3% of patients. The mean angiographic follow-up time was 11.8 mo. The last follow-ups showed complete occlusion in 93.3% of patients. There was no mortality in this study. A procedure-related complication developed in 6.7% and resulted in permanent morbidity in 3.3% of patients.
CONCLUSION
Neuroform Atlas stent combines the advantages of low-profile deployment microcatheters with an open-cell structure to achieve a successful Y-stenting procedure. Y-stent-assisted coiling with Neuroform Atlas stents provides a safe and effective endovascular treatment for wide-necked complex bifurcation aneurysms.
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Affiliation(s)
- Kubilay Aydin
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Interventional Radiology, Koc University Hospital, Istanbul, Turkey
| | - Sinan Balci
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Serra Sencer
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muzaffer Reha Umutlu
- Neuroradiology Division, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anil Arat
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
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Aydin K, Men S, Barburoglu M, Sencer S, Akpek S. Initial and Long-Term Outcomes of Complex Bifurcation Aneurysms Treated by Y-Stent-Assisted Coiling with Low-Profile Braided Stents. AJNR Am J Neuroradiol 2018; 39:2284-2290. [PMID: 30409852 DOI: 10.3174/ajnr.a5869] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Coiling complex intracranial bifurcation aneurysms often necessitates the implantation of double stents in various configurations, such as Y-stent placement. Low-profile braided stents have been introduced recently to facilitate the endovascular treatment of wide-neck aneurysms. We aimed to investigate the feasibility, safety, efficacy, and durability of Y-stent-assisted coiling with double low-profile braided stents for the treatment of complex bifurcation aneurysms. MATERIALS AND METHODS A retrospective review was performed to identify patients who were treated using Y-stent-assisted coiling with low-profile braided stents. Technical success was assessed, as were initial and follow-up clinical and angiographic outcomes. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed using the modified Rankin Scale. RESULTS Forty patients with 40 intracranial aneurysms were included in the study. Y-stent placement was successfully performed in all cases. Immediate postprocedural digital subtraction angiography images revealed total aneurysm occlusion in 72.5% of cases. The mean angiographic follow-up time was 24.8 months. The last follow-up angiograms showed complete occlusion in 85% of patients. During follow-up, only 1 patient showed an increase in the filling status of the aneurysm and that patient did not require retreatment. There was no mortality in this study. The overall procedure-related complication rate, including asymptomatic complications, was 17.5%. A permanent morbidity developed in 1 patient (2.5%). CONCLUSIONS The long-term angiographic and clinical outcomes of this retrospective study demonstrate that Y-stent-assisted coiling using low-profile braided stents is an effective, relatively safe, and durable endovascular treatment for wide-neck and complex bifurcation aneurysms.
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Affiliation(s)
- K Aydin
- From the Department of Radiology (K.A., S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Radiology (K.A., M.B.), Koç University Medical School, Istanbul, Turkey
| | - S Men
- Department of Radiology (S.M.), Dokuz Eylul University, Izmir, Turkey
| | - M Barburoglu
- Department of Radiology (K.A., M.B.), Koç University Medical School, Istanbul, Turkey
| | - S Sencer
- From the Department of Radiology (K.A., S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Akpek
- Department of Radiology (S.A.), VKV American Hospital, Istanbul, Turkey
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Aydin K, Barburoglu M, Oztop Cakmak O, Yesilot N, Vanli ENY, Akpek S. Crossing Y-Solitaire thrombectomy as a rescue treatment for refractory acute occlusions of the middle cerebral artery. J Neurointerv Surg 2018; 11:246-250. [DOI: 10.1136/neurintsurg-2018-014288] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022]
Abstract
BackgroundMechanical thrombectomy using a stent retriever has become the standard of care for acute large-vessel occlusions in the anterior circulation. Clots that are refractory to single stent retriever thrombectomy remain a challenge for neurointerventionalists.ObjectiveTo assess the efficacy and safety of double stent retriever (crossing Y-Solitaire) thrombectomy as a rescue treatment for acute middle cerebral artery (MCA) occlusions that are refractory to single stent retriever thrombectomy.MethodsWe retrospectively reviewed the databases of our hospitals to identify patients who presented with an acute MCA occlusion and were treated with crossing Y-Solitaire thrombectomy. The angiographic (Thrombolysis in Cerebral Infarction (TICI) scale) and clinical outcomes (National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores) and complications were assessed.ResultsTen patients were included in the study. The median initial NIHSS score and Alberta Stroke Program Early CT Score (ASPECTS) were 19.0 and 9.6, respectively. Crossing Y-Solitaire thrombectomy was performed as a rescue technique after unsuccessful single Solitaire thrombectomy passes in all cases. Successful recanalization (TICI 2b/3) was achieved in 8 (80%) patients. We observed asymptomatic reperfusion hemorrhages in 2 (20%) patients. No procedural related complications were seen other than reversible vasospasms in 5 (50%) patients. Sixty percent of the patients had a mRS score of between 2 and 0 at 90 days after the procedure. There was no mortality.ConclusionCrossing Y-Solitaire thrombectomy seems to be an effective and safe alternative rescue technique to treat refractory MCA bifurcation occlusions that are refractory to standard thrombectomy procedures.
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18
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Aydin K, Sencer S, Barburoglu M, Berdikhojayev M, Aras Y, Sencer A, İzgi N. Midterm results of T-stent–assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents. J Neurosurg 2017; 127:1288-1296. [DOI: 10.3171/2016.9.jns161909] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVECoiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent–assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent–assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique.METHODSThe authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent–assisted coiling with a T-stent configuration.RESULTSTwenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2.CONCLUSIONST-stent–assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.
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Affiliation(s)
- Kubilay Aydin
- 1Department of Radiology, Neuroradiology Division, and
- 2Department of Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey; and
| | - Serra Sencer
- 1Department of Radiology, Neuroradiology Division, and
| | | | | | - Yavuz Aras
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
| | - Altay Sencer
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
| | - Nail İzgi
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
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19
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Aydin K, Barburoglu M, Sencer S, Berdikhojayev M, Coskun B, Akpek S. Flow Diversion with Low-Profile Braided Stents for the Treatment of Very Small or Uncoilable Intracranial Aneurysms at or Distal to the Circle of Willis. AJNR Am J Neuroradiol 2017; 38:2131-2137. [PMID: 28882859 DOI: 10.3174/ajnr.a5362] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The endovascular treatment of aneurysms located at or distal to the circle of Willis and not amenable to coiling remains a challenge. We report our experience with flow-diversion treatment using low-profile braided stents as a stent monotherapy procedure for treating distally located very small or uncoilable aneurysms. MATERIALS AND METHODS We retrospectively reviewed our data bases to identify patients with aneurysms located at or distal to the circle of Willis who were treated with stent monotherapy using low-profile braided stents. The immediate and follow-up angiographic findings and clinical status of the patients were assessed. RESULTS Twenty aneurysms in 19 patients were included in the study. The mean size of the aneurysms was 4.7 ± 2.4 mm. Patients were treated via telescopic implantation of 2 stents for 11 aneurysms; single-stent placement was used for the remaining aneurysms. The technical success rate was 95%. We observed a technical complication in 1 case (5.3%) and a late ischemic event in another (5.3%). The final angiographies during a mean follow-up of 14.7 months showed complete aneurysm occlusion in 73.7%. The complete occlusion rate of the aneurysms treated with telescopic stent placement was 81.8%. The modified Rankin scale scores of all patients at the last follow-up were between 0 and 2. CONCLUSIONS Flow diversion with low-profile braided stents as a stent monotherapy procedure for very small or uncoilable intracranial aneurysms located at or beyond the circle of Willis is a promising, relatively safe, and durable endovascular procedure.
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Affiliation(s)
- K Aydin
- From the Department of Radiology (K.A., M.Barburoglu, S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey .,Department of Radiology (K.A.), Interventional Radiology Unit, Koç University School of Medicine, Koç University Hospital, Topkapi, Istanbul, Turkey
| | - M Barburoglu
- From the Department of Radiology (K.A., M.Barburoglu, S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey
| | - S Sencer
- From the Department of Radiology (K.A., M.Barburoglu, S.S.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey
| | - M Berdikhojayev
- Department of Neurosurgery (M.Berdikhojayev), JSC Central Clinical Hospital, Almaty City, Kazakhstan
| | - B Coskun
- Department of Radiology (B.C., S.A.), Vehbi Koc Vakfi American Hospital, Nisantasi, Istanbul, Turkey
| | - S Akpek
- Department of Radiology (B.C., S.A.), Vehbi Koc Vakfi American Hospital, Nisantasi, Istanbul, Turkey
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Ugurlucan M, Oztas DM, Onal Y, Canbay C, Sayin OA, Barburoglu M, Filik ME, Ocal D, Buget M, Acunas B, Alpagut U. Treatment of Dacron Grafting Dilatation with Endovascular Stent Graftıng. Aorta (Stamford) 2017; 4:162-166. [PMID: 28516091 DOI: 10.12945/j.aorta.2016.15.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 07/15/2016] [Indexed: 11/18/2022]
Abstract
Dacron grafts are frequently used during surgical revascularization procedures. Complications including graft thrombosis and infection are well known; however, aneurysm formation is extremely rare. In this report, we describe dilatation of a Dacron graft detected four years after aortobifemoral bypass procedure in a 50-year-old male patient who was treated with endovascular stent grafting.
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Affiliation(s)
- Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Didem Melis Oztas
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Yilmaz Onal
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Cagla Canbay
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Omer Ali Sayin
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Mehmet Barburoglu
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Deniz Ocal
- Department of General Surgery, Duzce Ataturk State Hospital, Istanbul, Turkey
| | - Mehmet Buget
- Department of Anesthesia, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Bulent Acunas
- Department of Radiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Barburoglu M, Arat A. Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases. AJNR Am J Neuroradiol 2016; 38:113-118. [PMID: 27765738 DOI: 10.3174/ajnr.a4959] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/08/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children. MATERIALS AND METHODS Retrospective review of children (17 years of age or younger) treated with flow diverters between May 2011 and July 2014 was performed. Clinical and laboratory data and angiographic findings were extracted. Seven patients (6 males, 1 female; mean age, 12.7 years; range, 3-16 years) were included. Two presented with posttraumatic fistulas. The remaining patients presented with traumatic aneurysms of the cavernous carotid artery or fusiform aneurysms of the distal vertebral artery, M1, or A2 segments. All patients were premedicated with clopidogrel (75 mg daily for patients with body weights of >45 kg, 37.5 mg daily for 1 small child with a body weight of <45 kg) and aspirin (300 mg daily for ≥45 kg, 100 mg daily for smaller children). RESULTS VerifyNow and Multiplate Analyzer values were higher than expected. No clinical complications were noted. Imaging performed at 7-52 months after the procedure (mean/median, 22.3/14 months) revealed occlusions of all aneurysms and fistulas. One patient had an asymptomatic occlusion of the parent artery; otherwise, no hemodynamically significant parent artery restenosis was observed. There were no clinically significant neurologic events during follow-up. CONCLUSIONS Although flow-diverter placement appears to be safe and effective on midterm follow-up in children, longer follow-up is critical. The current sizes of flow diverter devices and delivery systems cover the pediatric size range, obviating developing flow diverters specific to children.
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Affiliation(s)
- M Barburoglu
- From the Department of Radiology (M.B.), Istanbul University Medical School, Istanbul, Turkey
| | - A Arat
- Department of Radiology (A.A.), School of Medicine, Hacettepe University, Ankara, Turkey.
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Akcakaya MO, Aydoseli A, Aras Y, Sabanci PA, Barburoglu M, Alkir G, Sencer A, Sencer S, Aydin K, Kiris T, Hepgul K, Unal OF, Barlas O, Izgi N. Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature. Turk Neurosurg 2016; 27:732-742. [DOI: 10.5137/1019-5149.jtn.18359-16.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barburoglu M, Aydin K. Rescue Retrieval of a Fully Deployed Low-Profile Intracranial Stent After Acute Occlusion. World Neurosurg 2016; 85:349-52. [DOI: 10.1016/j.wneu.2015.08.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 11/28/2022]
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Aydin K, Arat A, Sencer S, Barburoglu M, Men S. Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results. AJNR Am J Neuroradiol 2015; 36:1934-41. [PMID: 26021624 DOI: 10.3174/ajnr.a4355] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/25/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Low-profile self-expandable stents were recently introduced for the treatment of wide-neck intracranial aneurysms. This study investigated the initial and midterm clinical and angiographic results of LEO Baby stent-assisted coiling in the treatment of wide-neck intracranial aneurysms. MATERIALS AND METHODS A retrospective review was performed to identify patients who were treated with LEO Baby stent-assisted coiling. Eighty patients with 80 wide-neck intracranial aneurysms were included in the study. Eleven patients (13.8%) presented with subarachnoid hemorrhage. All patients were treated with LEO Baby stent-assisted coiling. Technical success and immediate postprocedural clinical and angiographic outcomes were evaluated. Seventy-three patients attended angiographic and clinical follow-up for a mean duration of 7.2 ± 3.8 months. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed by using the modified Rankin Scale. RESULTS The technical success rate of the procedure was 97.5%. The immediate postprocedural angiography revealed a complete occlusion of the aneurysm in 75% of the 80 patients. The last follow-up angiograms showed complete occlusion in 85.7% of the 77 patients with an angiographic follow-up. Of the 77 patients with a follow-up angiography, 6.5% showed an increase in the filling status of the aneurysm and 5.2% required retreatment. The overall procedure-related complication rate, including asymptomatic complications, was 11.3%. The permanent morbidity rate was 3.8%. There was no mortality in this study. CONCLUSIONS This case series demonstrates the relative safety, efficacy, and midterm durability of the LEO Baby stent-assisted coiling procedure for the treatment of wide-neck intracranial aneurysms.
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Affiliation(s)
- K Aydin
- From the Department of Radiology (K.A., S.S., M.B.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Arat
- Department of Radiology (A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
| | - S Sencer
- From the Department of Radiology (K.A., S.S., M.B.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Barburoglu
- From the Department of Radiology (K.A., S.S., M.B.), Neuroradiology Division, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Men
- Department of Radiology (S.M.), Dokuz Eylul University, Izmir, Turkey
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Oztas DM, Ugurlucan M, Sayin OA, Barburoglu M, Sencer S, Alpagut U, Dayioglu E. Surgical Treatment of Localized Dissection of the Internal Carotid Artery. Ann Vasc Surg 2015; 29:1018.e13-6. [DOI: 10.1016/j.avsg.2015.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 10/23/2022]
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Akgoz A, Barburoglu M, Aydin K, Sencer S, Men S, Arat A. E-140 initial and mid-term clinical and angiographic results of leo baby stent-assisted coiling treatment of wide-necked intracranial aneurysms. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Akmangit I, Aydin K, Sencer S, Topcuoglu OM, Topcuoglu ED, Daglioglu E, Barburoglu M, Arat A. Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms. AJNR Am J Neuroradiol 2015; 36:323-9. [PMID: 25234031 DOI: 10.3174/ajnr.a4106] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment of wide-neck, complex, and distally located cerebral aneurysms is a challenging issue. This study evaluated the safety and efficacy of dual stent placement by using a low-profile stent system (LEO Baby) for the treatment of challenging distal intracranial aneurysms. MATERIALS AND METHODS We retrospectively reviewed patients in whom at least 1 LEO Baby stent was used in the context of dual stent placement for the treatment of intracranial aneurysms. Patients who were treated with dual stent-assisted coil embolization and telescopic implantation of LEO Baby stents were included in the study. Clinical and angiographic findings, procedural data, and follow-up are reported. RESULTS Twelve patients were included in this study. Three patients presented with subarachnoid hemorrhage in the subacute-chronic phase, and the remaining patients had unruptured aneurysms. Nine patients were treated by using the dual stent-assisted coiling method. X- (nonintersecting), Y- (intersecting and reversible), T-, and parallel-stent configurations were performed for the dual stent-assisted coiling procedures. Three patients were treated by using telescopic stent placement for a flow diverter-like effect. The procedures were successful in all cases. Technical complications without a significant clinical adverse event developed in 2 patients. The 3- and 6-month control MRAs and DSAs demonstrated complete occlusion of the aneurysms in all patients except 1. All patients had good clinical outcomes on follow-up (mRS ≤1). CONCLUSIONS The results of this small study showed the feasibility of dual stent placement by using low-profile LEO Baby stents to treat distally located complex intracranial aneurysms.
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Affiliation(s)
- I Akmangit
- From the Department of Radiology (I.A., E.D., A.A.), Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology (I.A., O.M.T., A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
| | - K Aydin
- Neuroradiology Division (K.A., S.S., M.B.), Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Sencer
- Neuroradiology Division (K.A., S.S., M.B.), Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - O M Topcuoglu
- Department of Radiology (I.A., O.M.T., A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
| | - E D Topcuoglu
- Department of Radiology (E.D.T.), School of Medicine, Ufuk University, Ankara, Turkey
| | - E Daglioglu
- From the Department of Radiology (I.A., E.D., A.A.), Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - M Barburoglu
- Neuroradiology Division (K.A., S.S., M.B.), Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Arat
- From the Department of Radiology (I.A., E.D., A.A.), Ankara Numune Education and Research Hospital, Ankara, Turkey Department of Radiology (I.A., O.M.T., A.A.), School of Medicine, Hacettepe University, Ankara, Turkey
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Ugurlucan M, Barburoglu M, Sayin OA, Beyaz MO, Ekiz F, Acunas B, Dayioglu E, Alpagut U. Endovascular Treatment for Primary Aortic Angiosarcoma to Relieve Thoracic Aortic Stenosis. Ann Vasc Surg 2014; 28:1799.e5-8. [DOI: 10.1016/j.avsg.2014.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/03/2014] [Accepted: 05/08/2014] [Indexed: 12/27/2022]
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Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, İzgi N. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg 2014; 7:202-9. [DOI: 10.1136/neurintsurg-2013-011090] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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