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Alexandre AM, Valente I, Consoli A, Piano M, Renieri L, Gabrieli JD, Russo R, Caragliano AA, Ruggiero M, Saletti A, Lazzarotti GA, Pileggi M, Limbucci N, Cosottini M, Cervo A, Viaro F, Vinci SL, Commodaro C, Pilato F, Pedicelli A. Posterior Circulation Endovascular Thrombectomy for Large-Vessel Occlusion: Predictors of Favorable Clinical Outcome and Analysis of First-Pass Effect. AJNR Am J Neuroradiol 2021; 42:896-903. [PMID: 33664106 DOI: 10.3174/ajnr.a7023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Successful vessel recanalization in posterior circulation large-vessel occlusion is considered crucial, though the evidence of clinical usefulness, compared with the anterior circulation, is not still determined. The aim of this study was to evaluate predictors of favorable clinical outcome and to analyze the effect of first-pass thrombectomy. MATERIALS AND METHODS A retrospective, multicenter, observational study was conducted in 10 high-volume stroke centers in Europe, including the period from January 2016 to July 2019. Only patients with an acute basilar artery occlusion or a single, dominant vertebral artery occlusion ("functional" basilar artery occlusion) who had a 3-month mRS were included. Clinical, procedural, and radiologic data were evaluated, and the association between these parameters and both the functional outcome and the first-pass effect was assessed. RESULTS A total of 191 patients were included. A lower baseline NIHSS score (adjusted OR, 0.77; 95% CI, 0.61-0.96; P = .025) and higher baseline MR imaging posterior circulation ASPECTS (adjusted OR, 3.01; 95% CI, 1.03-8.76; P = .043) were predictors of better outcomes. The use of large-bore catheters (adjusted OR, 2.25; 95% CI, 1.08-4.67; P = .030) was a positive predictor of successful reperfusion at first-pass, while the use of a combined technique was a negative predictor (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = .014). CONCLUSIONS The analysis of our retrospective series demonstrates that a lower baseline NIHSS score and a higher MR imaging posterior circulation ASPECTS were predictors of good clinical outcome. The use of large-bore catheters was a positive predictor of first-pass modified TICI 2b/3; the use of a combined technique was a negative predictor.
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Affiliation(s)
- A M Alexandre
- From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia
| | - I Valente
- From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia
| | - A Consoli
- Diagnostic and Interventional Neuroradiology (A.Consoli, R.R.), Foch Hospital, Suresnes, France
| | - M Piano
- Neuroradiologia (M.Piano, A.Cervo), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - L Renieri
- UOC Interventistica Neurovascolare (L.R., N.L.), Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - J D Gabrieli
- Neuroradiology Unit (J.D.G.), Policlinico Universitario di Padova, Padua, Italy
| | - R Russo
- Diagnostic and Interventional Neuroradiology (A.Consoli, R.R.), Foch Hospital, Suresnes, France
| | - A A Caragliano
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images (A.A.C., S.L.V.), Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - M Ruggiero
- Neuroradiology Unit (M.R., C.C.), Azienda Unità Sanitaria Locale Romagna, Cesena, Italy
| | - A Saletti
- Interventional Neuroradiology (A.S.), S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - G A Lazzarotti
- Department of Neuroradiology (G.A.L., M.C.), Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Pileggi
- Department of Neuroradiology (M.Pileggi), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - N Limbucci
- UOC Interventistica Neurovascolare (L.R., N.L.), Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - M Cosottini
- Department of Neuroradiology (G.A.L., M.C.), Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Cervo
- Neuroradiologia (M.Piano, A.Cervo), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - F Viaro
- UOC Neurologia (F.V.), Policlinico Universitario di Padova, Padua, Italy
| | - S L Vinci
- Neuroradiology Unit, Biomedical Sciences and Morphologic and Functional Images (A.A.C., S.L.V.), Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - C Commodaro
- Neuroradiology Unit (M.R., C.C.), Azienda Unità Sanitaria Locale Romagna, Cesena, Italy
| | - F Pilato
- UOC Neurologia (F.P.), Fondazione Policlinico Universitario A. Gemelli, Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italy
| | - A Pedicelli
- From the Unità Operativa Complessa Radiologia e Neuroradiologia (A.M.A., I.V., A.P.), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia. Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Roma, Italia
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Cagnazzo F, Limbucci N, Nappini S, Renieri L, Rosi A, Laiso A, Tiziano di Carlo D, Perrini P, Mangiafico S. Flow-Diversion Treatment of Unruptured Saccular Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2019; 40:497-502. [PMID: 30765379 DOI: 10.3174/ajnr.a5967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/23/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Flow diversion for anterior communicating artery aneurysms required further investigation. PURPOSE Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents. DATA SOURCES A systematic search of 3 data bases was performed for studies published from 2008 to 2018. STUDY SELECTION According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion. DATA ANALYSIS Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. DATA SYNTHESIS We included 14 studies and 148 unruptured saccular anterior communicating artery aneurysms treated with flow diversion. The long-term complete/near-complete (O'Kelly-Marotta C-D) occlusion rate was 87.4% (91/105; 95% CI, 81.3%-93.6%; I2 = 0%) (mean radiologic follow-up of 11 months). The treatment-related complication rate was 8.6% (14/126; 95% CI, 4%-13.1%; I2 = 0%), with morbidity and mortality rates of 3.5% (5/126; 95% CI, 2%-7%; I2 = 0%) and 2.5% (2/148; 95% CI, 0.3%-5%; I2 = 0%), respectively. Most complications were periprocedural (12/126 = 7%; 95% CI, 3%-11%; I2 = 0%). Thromboembolic events were slightly higher compared with hemorrhagic complications (10/126 = 6%; 95% CI, 2%-10%; I2 = 0% and 4/126 = 3%; 95% CI, 1%-6%; I2 = 0%). Branching arteries (A2 or the recurrent artery of Heubner) covered by the stent were occluded in 16% (7/34; 95% CI, 3.5%-28%; I2 = 25%) of cases. Pre- and posttreatment low-dose and high-dose of antiplatelet therapy was not associated with significantly different complication and occlusion rates. LIMITATIONS We reviewed small and retrospective series. CONCLUSIONS Flow diversion for unruptured saccular anterior communicating artery aneurysms appears to be an effective alternative treatment for lesions difficult to treat with coiling or microsurgical clipping. The treatment-related complication rate was relatively low. However, larger studies are needed to confirm these results.
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Affiliation(s)
- F Cagnazzo
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - N Limbucci
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - S Nappini
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - L Renieri
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - A Rosi
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - A Laiso
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - D Tiziano di Carlo
- Department of Neurosurgery (D.T.d.C., P.P.), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - P Perrini
- Department of Neurosurgery (D.T.d.C., P.P.), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - S Mangiafico
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
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Cagnazzo F, Limbucci N, Nappini S, Renieri L, Rosi A, Laiso A, Tiziano di Carlo D, Perrini P, Mangiafico S. Y-Stent-Assisted Coiling of Wide-Neck Bifurcation Intracranial Aneurysms: A Meta-Analysis. AJNR Am J Neuroradiol 2018; 40:122-128. [PMID: 30523146 DOI: 10.3174/ajnr.a5900] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/15/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Y-stent-assisted coiling for wide-neck intracranial aneurysms required further investigation. PURPOSE Our aim was to analyze outcomes after Y-stent placement in wide-neck aneurysms. DATA SOURCES We performed a systematic search of 3 data bases for studies published from 2000 to 2018. STUDY SELECTION According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting Y-stent-assisted coiling of wide-neck aneurysms. DATA ANALYSIS Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. DATA SYNTHESIS We included 27 studies and 750 aneurysms treated with Y-stent placement. The immediate complete/near-complete occlusion rate was 82.2% (352/468; 95% CI, 71.4%-93%; I2 = 92%), whereas the long-term complete/near-complete occlusion rate was 95.4% (564/598; 95% CI, 93.7%-97%; I2 = 0%) (mean radiologic follow-up of 14 months). The aneurysm recanalization rate was 3% (20/496; 95% CI, 1.5%-4.5%; I2 = 0%), and half of the recanalized aneurysms required retreatment. The treatment-related complication rate was 8.9% (63/614; 95% CI, 5.8%-12.1%; I2 = 44%). Morbidity and mortality after treatment were 2.4% (18/540; 95% CI, 1.2%-3.7%; I2 = 0%) and 1.1% (5/668; 95% CI, 0.3%-1.9%; I2 = 0%), respectively. Crossing Y-stent placement was associated with a slightly lower complication rate compared with the kissing configuration (56/572 = 8.4%; 95% CI, 5%-11%; I2 = 46% versus 4/30 = 12.7%; 95% CI, 3%-24%; I2 = 0%). Occlusion rates were quite comparable among Enterprise, Neuroform, and LVIS stents, whereas the Enterprise stent was associated with lower rates of complications (8/89 = 6.5%; 95% CI, 1.6%-11%; I2 = 0%) compared with the others (20/131 = 14%; 95% CI, 5%-26%; I2 = 69% and 9/64 = 11%; 95% CI, 3%-20%; I2 = 18%). LIMITATIONS This was a small, retrospective series. CONCLUSIONS Y-stent-assisted coiling yields high rates of long-term angiographic occlusion, with a relatively low rate of treatment-related complications. Y-stent placement with a crossing configuration appears to be associated with better outcomes. Although Y-configuration can be obtained using many types of stents with comparable occlusion rates, the Enterprise stent is associated with lower complication rates.
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Affiliation(s)
- F Cagnazzo
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - N Limbucci
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - S Nappini
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - L Renieri
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - A Rosi
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - A Laiso
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
| | - D Tiziano di Carlo
- Department of Neurosurgery (D.T.d.C., P.P.), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - P Perrini
- Department of Neurosurgery (D.T.d.C., P.P.), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - S Mangiafico
- From the Interventional Neuroradiology Unit (F.C., N.L., S.N., L.R., A.R., A.L., S.M.), Careggi University Hospital, Florence, Italy
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Adeeb N, Griessenauer CJ, Dmytriw AA, Shallwani H, Gupta R, Foreman PM, Shakir H, Moore J, Limbucci N, Mangiafico S, Kumar A, Michelozzi C, Zhang Y, Pereira VM, Matouk CC, Harrigan MR, Siddiqui AH, Levy EI, Renieri L, Marotta TR, Cognard C, Ogilvy CS, Thomas AJ. Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms. AJNR Am J Neuroradiol 2018; 39:1303-1309. [PMID: 29880475 DOI: 10.3174/ajnr.a5696] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 11/21/2017] [Accepted: 04/10/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. MATERIALS AND METHODS A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well. RESULTS A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16). CONCLUSIONS There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.
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Affiliation(s)
- N Adeeb
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - C J Griessenauer
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (C.J.G.), Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
| | - A A Dmytriw
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
- Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - H Shallwani
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - R Gupta
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - P M Foreman
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - H Shakir
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - J Moore
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - N Limbucci
- Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy
| | - S Mangiafico
- Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy
| | - A Kumar
- Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C Michelozzi
- Department of Diagnostic and Therapeutic Neuroradiology (C.M., C.C.), Toulouse University Hospital, Toulouse, France
| | - Y Zhang
- Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - V M Pereira
- Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - M R Harrigan
- Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - A H Siddiqui
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - L Renieri
- Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C Cognard
- Department of Diagnostic and Therapeutic Neuroradiology (C.M., C.C.), Toulouse University Hospital, Toulouse, France
| | - C S Ogilvy
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts
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Pasi M, Nappini S, Salvadori E, Mangiafico S, Limbucci N, Pantoni L. Rapidly progressive cognitive impairment in a patient with high flow dural arteriovenous fistulas, cerebral sinus thrombosis and protein S deficiency. J Clin Neurosci 2014; 21:1654-6. [DOI: 10.1016/j.jocn.2013.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/10/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Consoli A, Renieri L, Nappini S, Limbucci N, Mangiafico S. Endovascular treatment of deep hemorrhagic brain arteriovenous malformations with transvenous onyx embolization. AJNR Am J Neuroradiol 2013; 34:1805-11. [PMID: 23557955 DOI: 10.3174/ajnr.a3497] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Brain AVMs are a rare cause of cerebral hemorrhage and SAH, and their treatment is still debated. The aim of this study was to describe a novel endovascular approach with transvenous embolization of deep hemorrhagic brain AVMs. Five patients (3 females, 2 males; mean age, 33.2 years) underwent a transvenous embolization of a deep hemorrhagic brain AVM at our institution between February and April 2012. Clinical and angiographic data at the end of the procedure and after 6 months are reported. All the AVMs were completely obliterated, and no intra- or postprocedural complications occurred. The clinical outcome was unchanged or improved in all patients. Transvenous endovascular treatment may be considered in small, hemorrhagic, and deep AVMs with single deep drainage in those cases in which neurosurgical and radiosurgical treatment might not be indicated.
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Affiliation(s)
- A Consoli
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
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Catalucci A, Anselmi M, Splendiani A, Smith JD, Limbucci N, Giangaspero F, Gallucci M. Pediatric inflammatory diseases. Part I: multiple sclerosis. Neuroradiol J 2012; 25:684-94. [PMID: 24029182 DOI: 10.1177/197140091202500608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 10/23/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory CNS disease characterized by multifocal areas of demyelination; usually it arises in young adults, but can also occur in children (under the age of 10) and adolescents (under the age of 18). As in adult, pediatric MS (PMS) diagnosis is based on the demonstration of multiple demyelination episodes separated in time and spaces. Diagnostic criteria realized for childhood are similar to those employed for adults. Although clinical and imaging features of PMS can be similar to those of adults, the disease is often characterized by a more aggressive course and atypical imaging findings, with giant and pseudotumoral plaques. Differential diagnosis between PMS and ADEM could be difficult: clinical findings and MRI are necessary; sometimes MRI follow-up is required for definitive diagnosis.
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Affiliation(s)
- A Catalucci
- Chair and Unit of Neuroradiology, University of L'Aquila; L'Aquila, Italy -
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Gallucci M, Smith JD, Limbucci N, Giangaspero F, Rossi A. Pediatric Inflammatory Diseases. Part II: Acute Post-Infectious Immune Disorders. Neuroradiol J 2012; 25:702-14. [PMID: 24029184 DOI: 10.1177/197140091202500610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 11/16/2022] Open
Abstract
Acute post-infectious immune disorders include Acute Disseminated Encephalomyelitis (ADEM) and its variants such as Acute Hemorrhagic Encephalomyelitis (AHEM), acute necrotizing hemorrhagic leukoencephalitis (ANHLE) of Weston Hurst, multiphasic and recurrent ADEM. Acute Necrotizing Encephalopathy of Childhood (ANE or ANEC) represents a dramatic event, consequent to viral infections, especially Influenza-A, and is now considered different from ADEM. ADEM and variants are classically described as uniphasic syndrome occurring in association with an immunization or vaccination (postvaccine encephalomyelitis) or systemic viral infection (parainfectious encephalomyelitis). However, multiphasic forms are not rare. Pathologically, there is perivascular inflammation, edema, and demyelination within the CNS. Clinical features are focal or multifocal neurologic disorder following exposure to virus or receipt of vaccine. The onset of the CNS disorder is usually rapid and include encephalopathy ranging from lethargy to coma, seizures, and focal and multifocal signs reflecting cerebral and spinal cord involvement. The mortality rate is estimated at 10 to 30 percent, with complete recovery rates of 50 percent cited. Poor prognosis is correlated with severity and abruptness of onset of the clinical syndrome. Multifocal CNS lesions are generally evident on MRI that can be similar from those observed in MS.
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Affiliation(s)
- M Gallucci
- Chair and Unit of Neuroradiology, University of L'Aquila; L'Aquila, Italy -
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Splendiani A, Catalucci A, Limbucci N, Turner M, Krings T, Gallucci M. Pediatric Inflammatory Diseases. Part III: Small Vessels Vasculitis. Neuroradiol J 2012; 25:715-24. [PMID: 24029185 DOI: 10.1177/197140091202500611] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 11/16/2022] Open
Abstract
Central nervous system (CNS) vasculitis can affect both adults and children, but some of these occur almost exclusively in childhood. In children may develop as a primary condition or secondary to an underlying systemic disease. Cerebral vasculitis can be classified on the basis of the diameter of the involved vessels, although there is no univocal consensus. The diagnosis of CNS vasculitis is particularly difficult because the available investigative modalities have limited sensitivities and specificities. The most helpful diagnostic tests include cerebrospinal fluid analysis, MRI (MR angiography/venography (MRA/MRV) of the brain, and angiography. However, brain biopsy may be required to diagnose small vessel vasculitis in order to make differential diagnosis with a wide range of conditions, such as degenerative vasculopathies, embolic diseases, or coagulation disorders. This paper discusses on current understanding of most frequent primary and secondary central nervous system vasculitis in children in which are involved small vessel.
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Affiliation(s)
- A Splendiani
- Chair and Unit of Neuroradiology, University of L'Aquila; L'Aquila, Italy -
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Gallucci M, Smith J, Limbucci N, Rossi A, Demaerel P, Krings T, Damico A, Micheli C. Pediatric Inflammatory Diseases. Neuroradiol J 2012; 25:725-38. [DOI: 10.1177/197140091202500612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 10/23/2022] Open
Abstract
Some rare neurological diseases affecting children have no well defined etiology and pathogenetic mechanisms. In this article diseases like Reye syndrome, Behçet disease, pediatric neurosarcoidosis, Posterior Reversible Encephalopathy Syndrome are described. Some of the main neuroradiological differential aspects are also critically considered. Reye syndrome is characterized by symmetric thalamic, white matter and basal ganglia lesions, in children with recent history of salycilates or immunosuppressive drugs intake. The most typical MRI feature of neurosarcoidosis is basilar meningeal thickening and enhancement with intraparenchymal enhancing nodules and white matter focal abnormalities. The classical distribution of lesions helps differential diagnosis with infectious meningoencephalitis. Differential diagnosis with relapsing-remitting multiple sclerosis his helped by the evidence of meningeal abnormalities. Neuro-Behçet is characterized by mesodiencephalic lesions in children with encephalopathy and coexistence of oral and genital ulcers and ocular abnormalities. PRES can be differentiated from vasculitis for the typical posterior white matter involvement and the different clinical features.
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Affiliation(s)
- M. Gallucci
- Chair and Unit of Neuroradiology, University of L'Aquila; L'Aquila, Italy
| | - J.D. Smith
- Drexel University; Philadelphia, PA, USA
| | - N. Limbucci
- Unit of Interventional Neuroradiology, Careggi Hospital; Firenze, Italy
| | - A. Rossi
- Neuroradiology, Gaslini Children Hospital; Genoa, Italy
| | - P. Demaerel
- Neuroradiology, University of Leuven; Leuven, Belgium
| | - T. Krings
- Neuroradiology, Department of Neurological Sciences, Federico II University; Naples, Italy
| | - A. Damico
- Neuroradiology, University of Toronto, Toronto Western Hospital; Toronto, Canada
| | - C. Micheli
- Radiology Unit, General Hospital of Rieti; Rieti, Italy
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Limbucci N, Rossi F, Salvati F, Pistoia LM, Barile A, Masciocchi C. Bilateral suprascapular nerve entrapment by glenoid labral cysts associated with rotator cuff damage and posterior instability in an amateur weightlifter. J Sports Med Phys Fitness 2010; 50:64-67. [PMID: 20308974] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Suprascapular nerve entrapment is a common condition in athletes. The entrapment is most frequently due to a "glenoid labral cyst" produced by joint fluid extrusion in consequence of labral degenerative changes. The bilaterality of the entrapment and the association with rotator cuff pathology are a rare evidence. We present the case of a 38-year-old amateur weightlifter with an history of left shoulder chronic posterior pain and progressive external rotation weakness, and with an acute right shoulder pain and weakness. Magnetic resonance imaging showed a bilateral glenoid labral cyst in association with partial tear of the supraspinatus tendon, atrophy of the infraspinatus muscle and type 2 SLAP lesion at the left shoulder and subacromial impingement syndrome (due to acromio-clavicular osteophyte), mild atrophy of the infraspinatus muscle and type 1-2 SLAP lesion at the right side.
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Affiliation(s)
- N Limbucci
- Department of Radiology, University of L'Aquila, L'Aquila, Italy
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12
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Affiliation(s)
- M. Gallucci
- Neuroradiology Unit, University Hospital of L'Aquila, L'Aquila, Italy
| | - A. Conchiglia
- Neuroradiology Unit, University Hospital of L'Aquila, L'Aquila, Italy
| | - G. Lanni
- Neuroradiology Unit, University Hospital of L'Aquila, L'Aquila, Italy
| | - L. Conti
- Neuroradiology Unit, University Hospital of L'Aquila, L'Aquila, Italy
| | - N. Limbucci
- Neuroradiology Unit, University Hospital of L'Aquila, L'Aquila, Italy
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Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C. Mucoid metaplastic-degeneration of anterior cruciate ligament. J Sports Med Phys Fitness 2008; 48:483-487. [PMID: 18997652] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Mucoid degeneration of the anterior cruciate ligament (ACL) is a pathological state not yet well morphologically defined, involving people without history of knee instability or significant trauma, and causing important pain. The aim of this study was to define the histopathological and radiographic features of this pathological condition. METHODS Analysis of 1 215 knee magnetic resonance (MR) examinations found 64 cases (5.3%) of ACL mucoid metaplastic-degeneration (MMD), subsequently all subjects underwent surgical and arthroscopic validation. MR examinations have been performed using a dedicate system provided with a permanent magnet of 0.18 T and with a dedicate coil of 12 cm of field of view (FOV) or an high field instrument with 1.5 T. Radiological criteria to define ACL MMD were based essentially on increased signal intensity in T2W sequences and in STIR ones, as in T1W scans the ligament showed an intermediate signal. RESULTS ACL MMD was diagnosed in 36 males and 28 females, with a mean age of 44 years. ''Segmentary MMD'' was found in 11 subjects (17.2%) commonly affecting the postero-lateral bundle of the ligament without femoral or tibial spongious mucoid intrusion. ''Total MMD'' (involving the entire ligament and accompanied with femoral or tibial intrusion) was found in 53 subjects (82.8%). CONCLUSION The comparison between histopathological and MR findings suggests that the commonly called ACL mucoid degeneration (ACL MD) should be better defined as mucoid metaplastic degeneration (MMD).
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Affiliation(s)
- F Salvati
- Department of Radiology, San Salvatore Hospital, University of L'Aquila, Italy
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Pupillo V, Di Cesare E, Frieri G, Limbucci N, Masciocchi C. Assessment of inflammatory activity in Crohn's disease by means of dynamic contrast-enhanced MRI. Clin Imaging 2008. [DOI: 10.1016/j.clinimag.2008.02.006] [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: 10/22/2022]
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Pupillo VA, Di Cesare E, Frieri G, Limbucci N, Tanga M, Masciocchi C. Dynamic studies of gadolinium uptake in brain tumors using inversion-recovery echo-planar imaging. Magn Reson Med 1992; 112:798-809. [PMID: 17885739 DOI: 10.1007/s11547-007-0192-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [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: 09/05/2006] [Accepted: 01/12/2007] [Indexed: 12/24/2022]
Abstract
Echo-planar imaging has been used to observe the dynamics of Gd-DTPA uptake in brain tumors. It has been possible to examine both vascular uptake and diffusion across the blood-brain barrier in a single experiment, by using the IR-MBEST echo-planar sequence which combines a high temporal resolution (approximately 3 s) with strong T1 weighting. To model the uptake it is necessary to know the arterial concentration of Gd-DTPA; in this study the signal in the sagittal sinus was measured to avoid the need to take repeated blood samples. The time constant for transfer across the blood-brain barrier was measured to be between 20 and 1050 s for different tumors. The results of the modeling correlated with the results of other assessments of tumor vascularity.
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Affiliation(s)
- V A Pupillo
- Dipartimento di Diagnostica per Immagini, Università degli Studi di L'Aquila, Via della Mainetta 88D, Coppito, L'Aquila, Italy.
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