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Ida S, Morita Y, Muraki R, Furuhashi S, Takeda M, Kikuchi H, Hiramatsu Y, Tanahashi Y, Goshima S, Takeuchi H. Anterior superior pancreaticoduodenal artery pseudoaneurysm after distal pancreatectomy with en bloc celiac axis resection successfully treated with balloon-assisted coil embolization. Clin J Gastroenterol 2022; 15:1198-1203. [PMID: 36208389 PMCID: PMC9700616 DOI: 10.1007/s12328-022-01710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
Bleeding is a fatal complication after pancreatectomy. Although coil embolization is a widely accepted treatment option, ischemia of the remaining organs should be prevented. This study reports the successful treatment of intra-abdominal hemorrhage following distal pancreatectomy with en bloc celiac axis resection (DP-CAR) using balloon-assisted coil embolization (BACE). A 59-year-old man was diagnosed with locally advanced pancreatic cancer. The tumor involves the common hepatic artery, splenic artery, and celiac artery. After four cycles of treatment with gemcitabine/nab-paclitaxel, the soft-density masses, surrounding the artery, shrunk. DP-CAR and R0 resections were performed. A minor postoperative pancreatic fistula occurred. Six months postoperatively, the computed tomography showed delayed asymptomatic bleeding from an anterior superior pancreaticoduodenal artery (ASPDA) pseudoaneurysm located near the gastroduodenal artery confluence. BACE was performed by placing a microballoon catheter in the region of confluence of the ASPDA and posterior superior pancreaticoduodenal artery (PSPDA) to prevent coil migration. After inserting the microballoon catheter, coil embolization was performed in the ASPDA. Hepatic blood flow was maintained from the PSPDA. BACE is a useful technique to preserve blood flow to the remnant organs when performing coil embolization for bleeding following a distal pancreatectomy, especially following a DP-CAR.
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Affiliation(s)
- Shinya Ida
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Ryuta Muraki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Satoru Furuhashi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Makoto Takeda
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.,Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Goshima
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
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Fiani B, DeStefano F, Cathel A, Soula M, Reardon TK. Single Center Retrospective Analysis of Cerebral Aneurysms from a Patient Sample Data Collection at a Comprehensive Stroke Center. Spartan Med Res J 2022; 7:34494. [PMID: 36128026 PMCID: PMC9448660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Institutional self-monitoring of cerebral aneurysm data should occur regularly. The objective of this retrospective single center study was to examine the reproducibility of a data collection and analytic method to examine cerebral aneurysm characteristics and trends. METHODS A single center retrospective analysis was performed from 2018 to 2021 of the most recent 100 patient presentations with a newly diagnosed cerebral aneurysm. Data collection included patient demographics, radiographic features, ruptured or unruptured status, location, grading scale, treatment strategy, survival, and length of stay, which were extracted and presented in tabular form and analyzed for overall trends. RESULTS Of the collected 100 patients meeting ICD-10 criteria, 10 (10%) patients were excluded due to having been previously diagnosed at the institution and not meeting the criteria of a new discovery of cerebral aneurysm for inclusion. The remaining 90 sample patients presented with newly diagnosed aneurysms to the authors' Emergency Department between 2018 and 2021. Most patients were between the ages of 25 and 65 with 55 (61%) patients identifying themselves as female sex. Of the 90 eligible sample patients, 59 (66%) had aneurysms that were not ruptured. Eighty-eight (97.7%) patients had cerebral aneurysms that were < 7mm in size. The most common location for aneurysms was in the anterior cerebral circulation, with identification of 27 middle cerebral artery aneurysms. Length of stay (LOS) ranged from 0-171 days with a mean of 11.97 days (SD = 19.9). Of the seven (7.7%) patients who expired, four (57%) experienced spontaneous subarachnoid hemorrhages, with two (29%) occurring in the anterior communicating artery and one (14%) in the left middle cerebral artery and basilar artery respectively. CONCLUSIONS The typical presentation of a cerebral aneurysm is unruptured with a pre-dominance in middle-aged females. Our findings are congruent with the literature regarding the location of the aneurysm originating in the anterior circulation. However, most aneurysms in our clinical cohort were located on the MCA/ICA in contrast to the literature reported (i.e., most anterior communicating artery). Of those patients who presented unruptured, outpatient follow-up and routine monitoring were appropriate with medical management in the setting of small aneurysms. The risk of progression and subsequent rupture was relatively small in this patient cohort. Multi-year examinations of single institution comprehensive stroke centers regarding cerebral aneurysms would enable researchers to conduct regional analyses and comparisons to national and international trends.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Frank DeStefano
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA
| | - Marisol Soula
- Grossman School of Medicine, New York University, New York, NY
| | - Taylor K Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY
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Imamura H, Tani S, Adachi H, Fukumitsu R, Sunohara T, Fukui N, Omura Y, Sasaki N, Akiyama T, Fukuda T, Kajiura S, Shigeyasu M, Asakura K, Horii R, Sakai N. Comparison of Symptomatic Vasospasm after Surgical Clipping and Endovascular Coiling. Neurol Med Chir (Tokyo) 2022; 62:223-230. [PMID: 35418528 PMCID: PMC9178112 DOI: 10.2176/jns-nmc.2021-0126] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vasospasm, initial neurological damage, rebleeding, and periprocedural complications are associated prognostic factors for clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH). In this study, factors related to delayed ischemic neurological deficit (DIND) are evaluated using data from our institute for the last 18 years. Data from 2001 to 2018 of patients with aneurysmal SAH who underwent surgical clipping (SC) or endovascular coiling (EC) within 7 days of onset were retrospectively analyzed. Cases of mortality within 5 days after treatment were excluded. Multivariate analysis was used to identify the risk factors for DIND. In total, 840 cases of SAH were assessed; among these cases, 384 (45.7%) and 456 (54.3%) were treated with SC and EC, respectively. The frequency of DIND in the EC group was significantly less than that in the SC group (11.8% vs. 17.7%; p = 0.016). In the results of multivariate analysis, internal carotid artery (ICA) aneurysm and hemorrhagic complications were the risk factors for DIND. Cilostazol administration and EC were significant factors for vasospasm prevention after aneurysmal SAH (odds ratio of ICA aneurysm: 1.59, hemorrhagic complications: 1.76, SC: 1.51, and cilostazol administration: 0.51, respectively). Cilostazol administration was also a significant factor in patients who were treated with EC. ICA aneurysm, treatment strategy, hemorrhagic complications, and cilostazol administration were associated with DIND. Oral administration of cilostazol and avoiding hemorrhagic complications were effective in DIND prevention. If both treatments are available for ruptured aneurysms, clinicians should choose EC on the basis of its ability to prevent DIND.
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Affiliation(s)
- Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Ryu Fukumitsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Tadashi Sunohara
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Nobuyuki Fukui
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Yoshihiro Omura
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Natsuhi Sasaki
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Tomoaki Akiyama
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Tatsumaru Fukuda
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Shinji Kajiura
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Masashi Shigeyasu
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Kento Asakura
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Ryo Horii
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
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Ikezawa M, Izumi T, Nishihori M, Tsukada T, Tamari Y, Araki Y, Yokoyama K, Uda K, Goto S, Kropp AE, Otsuka T, Kato N, Nakano M, Saito R. Evaluation of the differences in pressure applied to the vessel wall by different types of balloon remodeling microcatheters in an experimental model. Interv Neuroradiol 2021; 28:323-331. [PMID: 34515567 DOI: 10.1177/15910199211031765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We examined compliance differences among balloon remodeling microcatheters, which have not been established previously. METHODS Straight and 120° angulated vascular models were created in a 3 mm diameter tube with 3 mm hole (vascular model A), a tube with a 4 mm hole (vascular model B), and a 4 mm diameter tube (vascular model C). We compared the pressure exerted when each balloon was herniated 1 or 2 mm between three compliant balloons (SHOURYU SR, TransForm C, and Scepter C) and four super-compliant balloons (HyperForm, SHOURYU HR, TransForm SC, and Scepter XC). RESULTS In vascular model A, there was a significant difference in the pressure exerted by compliant balloons and super-compliant balloons in both the straight and angulated models. In the straight model (1 and 2 mm), the lowest pressure was exerted by HyperForm (super-compliant balloons group) and SHOURYU SR (compliant balloons group). The lowest pressure was exerted in the angulated model by HyperForm (super-compliant balloons group) and Scepter C (compliant balloons group). The Scepter balloon exerted higher pressure in the straight model than other balloon remodeling microcatheters but less in the angulated model. In vascular model B, the pressure decreased in all balloons compared with model A. In vascular model C, the pressure increased in all balloons compared with model A. CONCLUSIONS Pressure differed across balloon remodeling microcatheters. In addition, vessel shape and diameter, and hole size, affected the results. Our findings can help select balloon remodeling microcatheters.
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Affiliation(s)
- Mizuka Ikezawa
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Takashi Izumi
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Tetsuya Tsukada
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Yosuke Tamari
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan.,Department of Neurosurgery, 13864National Hospital Organization Nagoya Medical Center, Japan
| | - Yoshio Araki
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Kenji Uda
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Asuka E Kropp
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Takafumi Otsuka
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Naoki Kato
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Mizuki Nakano
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
| | - Ryuta Saito
- Department of Neurosurgery, 220905Nagoya University Graduate School of Medicine, Japan
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Campos JK, Lien BV, Wang AS, Lin LM. Advances in endovascular aneurysm management: coiling and adjunctive devices. Stroke Vasc Neurol 2020; 5:14-21. [PMID: 32411403 PMCID: PMC7213502 DOI: 10.1136/svn-2019-000303] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/15/2020] [Accepted: 02/27/2020] [Indexed: 01/30/2023] Open
Abstract
Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.
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Affiliation(s)
- Jessica K Campos
- Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Brian V Lien
- Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Alice S Wang
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, AZ, United States
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Imamura H, Sakai N, Satow T, Iihara K. Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms. J Neurointerv Surg 2020; 12:605-609. [PMID: 31980542 DOI: 10.1136/neurintsurg-2019-015459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE The risk factors for adverse events for example, intraprocedural rupture (IPR), ischemic complication within 24 hours, and rebleeding after endovascular coil embolization for a ruptured cerebral aneurysm remain unclear. The aim of this study was to identify significant associated risk factors. METHODS We retrospectively evaluated data from 5358 patients listed on the Japanese Registry of Neuroendovascular Therapy 3 during 2010-2014. RESULTS IPR, ischemic complications, and rebleeding occurred during or after 221 (4.1%), 226 (4.2%), and 63 (1.2%) treatments, respectively. All of the adverse events were significantly associated with the patients' poor outcomes at 30 days. Multivariate analysis revealed the factors independently related to these adverse events as follows: (1) for IPR: female sex, bifurcation type, <5 mm aneurysm, emergent surgery, local anesthesia, a balloon-assisted technique; (2) for an ischemic complication: poor World Federation World Federation of Neurological Societies (WFNS) grade, wide neck, and stent-assisted technique; (3) for rebleeding: poor WFNS grade, bifurcation type, wide neck, and body filling as the initial result. CONCLUSIONS Knowledge of the risk factors of endovascular coil embolization and paying attention to them are essential for patients' safe treatment and good outcomes.
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Affiliation(s)
- Hirotoshi Imamura
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe-city, Hyogo, Japan
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe-city, Hyogo, Japan
| | - Tetsu Satow
- Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Neurosurgery, Kyushu University Faculty of Medicine Graduate School of Medical Sciences, Fukuoka, Japan
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Impact of Methamphetamine Abuse: A Rare Case of Rapid Cerebral Aneurysm Growth with Review of Literature. Case Rep Neurol Med 2018; 2018:1879329. [PMID: 30402309 PMCID: PMC6193347 DOI: 10.1155/2018/1879329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/23/2018] [Indexed: 12/30/2022] Open
Abstract
Methamphetamine or "meth" is a sympathomimetic amine of the amphetamine-type substances (ATS) class with an extremely high potential for abuse. Illicitly abused neurostimulants like cocaine and meth predispose patients to the aneurysmal formation with reported rupture at a younger age and in much smaller sized aneurysms. However, very rapid growth of aneurysm within less than 2 weeks with methamphetamine abuse is very rarely observed or reported. In this report, we present a patient with repeated and recurrent meth abuse who demonstrated rapid growth of a pericallosal aneurysm over the period of less than two weeks. The pathophysiology of stroke related to meth and ATS abuse is multifactorial with hypertension, tachycardia, and vascular disease postulated as major mechanisms. The rapid growth of an aneurysm has a high risk of aneurysmal rupture and SAH, which is a neurosurgical emergency and therefore warrants careful consideration and close monitoring. This case confirms the dynamic temporal effects of methamphetamine use on intracranial vessels and this specific neurostimulants association to rapid aneurysmal formation. In light of vascular pathologies the possibility of drug-induced pseudoaneurysm should also be considered in young patients with history of meth abuse.
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