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Benson J, Nardi V, Madhavan A, Bois M, Saba L, Savastano L, Lerman A, Lanzino G. Reassessing the Carotid Artery Plaque "Rim Sign" on CTA: A New Analysis with Histopathologic Confirmation. AJNR Am J Neuroradiol 2022; 43:429-434. [PMID: 35210276 PMCID: PMC8910788 DOI: 10.3174/ajnr.a7443] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The CTA "rim sign" has been proposed as an imaging marker of intraplaque hemorrhage in carotid plaques. This study sought to investigate such findings using histopathologic confirmation. MATERIALS AND METHODS Included patients had CTA neck imaging <1 year before carotid endarterectomy. On imaging, luminal stenosis and the presence of adventitial (<2-mm peripheral) and "bulky" (≥2-mm) calcifications, total plaque thickness, soft-tissue plaque thickness, calcification thickness, and the presence of ulcerations were assessed. The rim sign was defined as the presence of adventitial calcifications with internal soft-tissue plaque of ≥2 mm in maximum thickness. Carotid endarterectomy specimens were assessed for both the presence and the proportional makeup of lipid material, intraplaque hemorrhage, and calcification. RESULTS Sixty-seven patients were included. Twenty-three (34.3%) were women; the average age was 70.4 years. Thirty-eight (57.7%) plaques had a rim sign on imaging, with strong interobserver agreement (κ = 0.85). A lipid core was present in 64 (95.5%) plaques (average, 22.2% proportion of plaque composition); intraplaque hemorrhage was present in 52 (77.6%), making up, on average, 13.7% of the plaque composition. The rim sign was not associated with the presence of intraplaque hemorrhage (P = .11); however, it was associated with a greater proportion of intraplaque hemorrhage in a plaque (P = .049). The sensitivity and specificity of the rim sign for intraplaque hemorrhage were 61.5% and 60.0%, respectively. CONCLUSIONS The rim sign is not associated with the presence of intraplaque hemorrhage on histology. However, it is associated with a higher proportion of hemorrhage within a plaque and therefore may be a biomarker of more severe intraplaque hemorrhage, if present.
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Affiliation(s)
- J.C. Benson
- From the Departments of Radiology (J.C.B., A.A.M.)
| | | | | | - M.C. Bois
- Laboratory Medicine and Pathology (M.C.B., A.L.)
| | - L. Saba
- Department of Medical Sciences (L. Saba), University of Cagliari, Cagliari, Italy
| | - L. Savastano
- Neurosurgery (L. Savastano, G.L.), Mayo Clinic, Rochester, Minnesota
| | - A. Lerman
- Laboratory Medicine and Pathology (M.C.B., A.L.)
| | - G. Lanzino
- Neurosurgery (L. Savastano, G.L.), Mayo Clinic, Rochester, Minnesota
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Larco J, Abbasi M, Liu Y, Dai D, Lanzino G, Savastano L, Cloft H, Kallmes D, Kadirvel R, Brinjikji W. Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study. AJNR Am J Neuroradiol 2022; 43:258-264. [PMID: 34916206 PMCID: PMC8985686 DOI: 10.3174/ajnr.a7369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Endovascular treatment of aneurysms with flow diverters or coiling is sometimes complicated by intraprocedural or postprocedural thrombosis along or within the devices. Thrombus composition and structure associated with such complications may provide insights into mechanisms of thrombus formation and clinical strategies to remove the thrombus. We present a retrospective histopathologic study of 4 patients who underwent mechanical thrombectomy due to acute occlusion of either implanted flow diverter devices or along coils during the treatment of intracranial aneurysm.
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Affiliation(s)
- J.A. Larco
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - M. Abbasi
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - Y. Liu
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - D. Dai
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - G. Lanzino
- Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - L.E. Savastano
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - H. Cloft
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - D.F. Kallmes
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - R. Kadirvel
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - W. Brinjikji
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
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Liu Y, Gebrezgiabhier D, Zheng Y, Shih A, Chaudhary N, Pandey A, Larco J, Madhani S, Abbasi M, Shahid A, Quinton R, Kadirvel R, Brinjikji W, Kallmes D, Savastano L. Arterial Collapse during Thrombectomy for Stroke: Clinical Evidence and Experimental Findings in Human Brains and In Vivo Models. AJNR Am J Neuroradiol 2022; 43:251-257. [PMID: 35027348 PMCID: PMC8985669 DOI: 10.3174/ajnr.a7389] [Citation(s) in RCA: 2] [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: 05/12/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Aspiration thrombectomy has become a preferred approach to recanalize large-vessel occlusion in stroke with a growing trend toward using larger-bore catheters and stronger vacuum pumps. However, the mechanical response of the delicate cerebral arteries to aspiration force has not been evaluated. Here, we provide preclinical and clinical evidence of intracranial arterial collapse in aspiration thrombectomy. MATERIALS AND METHODS We presented a clinical case of arterial collapse with previously implanted flow diverters. We then evaluated the effect of vacuum with conventional aspiration catheters (with and without stent retrievers) in a rabbit model (n = 3) using fluoroscopy and intravascular optical coherence tomography. Then, in a validated human cadaveric brain model, we conducted 168 tests of direct aspiration thrombectomy following an experimental design modifying the catheter inner diameter (0.064 inch, 0.068 inch, and 0.070 inch), cerebral perfusion pressures (mean around 60 and 90 mm Hg), and anterior-versus-posterior circulation. Arterial wall response was recorded and graded via direct transluminal observation. RESULTS Arterial collapse was observed in both the patient and preclinical experimental models. In the human brain model, arterial collapse was observed in 98% of cases in the M2 and in all the cases with complete proximal flow arrest. A larger bore size of the aspiration catheter, a lower cerebral perfusion pressure, and the posterior circulation in comparison with the anterior circulation were associated with a higher probability of arterial collapse. CONCLUSIONS Arterial collapse does occur during aspiration thrombectomy and is more likely to happen with larger catheters, lower perfusion pressure, and smaller arteries.
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Affiliation(s)
- Y. Liu
- From the Departments of Radiology (Y.L., M.A., R.K., W.B., D.F.K.),Departments of Mechanical Engineering (Y.L., Y.Z., A.J.S.)
| | - D. Gebrezgiabhier
- Neurosurgery (D.G., A.S.P., L.E.S.),UCSF Graduate Program in Bioengineering (D.G.), University of California Berkeley, San Francisco, California
| | - Y. Zheng
- Departments of Mechanical Engineering (Y.L., Y.Z., A.J.S.),Department of Mechanical Engineering (Y.Z.), Worcester Polytechnic Institute, Worcester, Massachusetts
| | - A.J. Shih
- Departments of Mechanical Engineering (Y.L., Y.Z., A.J.S.)
| | - N. Chaudhary
- Radiology (N.C.), University of Michigan, Ann Arbor, Michigan
| | | | | | | | - M. Abbasi
- From the Departments of Radiology (Y.L., M.A., R.K., W.B., D.F.K.)
| | - A.H. Shahid
- Neurosurgery (J.L.A.L., S.I.M., A.H.S., L.E.S.)
| | - R.A. Quinton
- Division of Anatomic Pathology (R.A.Q.), Mayo Clinic, Rochester, Minnesota
| | - R. Kadirvel
- From the Departments of Radiology (Y.L., M.A., R.K., W.B., D.F.K.)
| | - W. Brinjikji
- From the Departments of Radiology (Y.L., M.A., R.K., W.B., D.F.K.)
| | - D.F. Kallmes
- From the Departments of Radiology (Y.L., M.A., R.K., W.B., D.F.K.)
| | - L.E. Savastano
- Neurosurgery (J.L.A.L., S.I.M., A.H.S., L.E.S.),Neurosurgery (D.G., A.S.P., L.E.S.)
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4
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Larson AS, Brinjikji W, Savastano L, Rabinstein AA, Saba L, Huston J, Benson JC. Carotid Intraplaque Hemorrhage and Stenosis: At What Stage of Plaque Progression Does Intraplaque Hemorrhage Occur, and When is It Most Likely to Be Associated with Symptoms? AJNR Am J Neuroradiol 2021; 42:1285-1290. [PMID: 33888452 DOI: 10.3174/ajnr.a7133] [Citation(s) in RCA: 2] [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: 06/23/2020] [Accepted: 02/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The relationship between carotid intraplaque hemorrhage and luminal stenosis severity is not well-established. We sought to determine whether intraplaque hemorrhage is related to carotid stenosis and at what degree of stenosis intraplaque hemorrhage most likely contributes to ischemic symptoms. MATERIALS AND METHODS Consecutive patients who underwent MR carotid plaque imaging with MPRAGE sequences to identify intraplaque hemorrhage were retrospectively reviewed. Degrees of stenoses were categorized as minimal (<30%), moderate (30%-69%), and severe (>70%). Arteries were categorized into 2 groups: symptomatic (ipsilateral to a cerebral ischemic event) and asymptomatic (from a patient without an ischemic event). Multiple regression analyses were used to determine independent associations between the degree of stenosis and intraplaque hemorrhage and the presence of intraplaque hemorrhage with symptoms among categories of stenosis. RESULTS We included 449 patients with 449 carotid arteries: Two hundred twenty-five (50.1%) were symptomatic, and 224 (49.9%) were asymptomatic. An increasing degree of stenosis was independently associated with the presence of intraplaque hemorrhage (OR = 1.02; 95% confidence interval, 1.01-1.03). Intraplaque hemorrhage was independently associated with ischemic events in arteries with <30% stenosis (OR = 5.68; 95% CI, 1.49-21.69). No such association was observed in arteries with >30% stenosis. Of symptomatic arteries with minimal stenosis, 8.7% had intraplaque hemorrhage versus 1.7% of asymptomatic arteries (P = .02). No differences in intraplaque hemorrhage prevalence were found between symptomatic and asymptomatic groups with moderate (P = .18) and severe stenoses (P = .99). CONCLUSIONS The presence of intraplaque hemorrhage on high-resolution plaque imaging is likely most useful in identifying symptomatic plaques in cases of minimal stenosis.
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Affiliation(s)
- A S Larson
- From the Departments of Radiology (A.S.L., W.B., J.H., J.C.B.) .,Neurosurgery (A.S.L., W.B., L. Savastano)
| | - W Brinjikji
- From the Departments of Radiology (A.S.L., W.B., J.H., J.C.B.).,Neurosurgery (A.S.L., W.B., L. Savastano)
| | | | | | - L Saba
- Department of Radiology (L. Saba), University of Cagliari, Cagliari, Italy
| | - J Huston
- From the Departments of Radiology (A.S.L., W.B., J.H., J.C.B.)
| | - J C Benson
- From the Departments of Radiology (A.S.L., W.B., J.H., J.C.B.)
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5
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Fitzgerald ST, Liu Y, Dai D, Mereuta OM, Abbasi M, Larco JLA, Douglas AS, Kallmes DF, Savastano L, Doyle KM, Brinjikji W. Novel Human Acute Ischemic Stroke Blood Clot Analogs for In Vitro Thrombectomy Testing. AJNR Am J Neuroradiol 2021; 42:1250-1257. [PMID: 33832952 DOI: 10.3174/ajnr.a7102] [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: 09/29/2020] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have successfully created blood clot analogs for in vitro endovascular device testing using animal blood of various species. Blood components vary greatly among species; therefore, creating clot analogs from human blood is likely a more accurate representation of thrombi formed in the human vasculature. MATERIALS AND METHODS Following approval from the Mayo Clinic institutional review board, human whole-blood and platelet donations were obtained from the blood transfusion service. Twelve clot analogs were created by combining different ratios of red blood cells + buffy coat, plasma, and platelets. Thrombin and calcium chloride were added to stimulate coagulation. Clot composition was assessed using histologic and immunohistochemical staining. To assess the similarities of mechanical properties to patient clots, 3 types of clot analogs (soft, elastic, and stiff) were selected for in vitro thrombectomy testing. RESULTS The range of histopathologic compositions produced is representative of clots removed during thrombectomy procedures. The red blood cell composition ranged from 8.9% to 91.4%, and fibrin composition ranged from 3.1% to 53.4%. Platelets (CD42b) and von Willebrand Factor ranged from 0.5% to 47.1% and 1.0% to 63.4%, respectively. The soft clots had the highest first-pass effect and successful revascularization rates followed by the elastic and stiff clots. Distal embolization events were observed when clot ingestion could not be achieved, requiring device pullback. The incidence rate of distal embolization was the highest for the stiff clots due to the weak clot/device integration. CONCLUSIONS Red blood cell-rich, fibrin-rich, and platelet-rich clot analogs that mimic clots retrieved from patients with acute ischemic stroke were created in vitro. Differing retrieval outcomes were confirmed using in vitro thrombectomy testing in a subset of clots.
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Affiliation(s)
- S T Fitzgerald
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.) .,Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.)
| | - Y Liu
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - D Dai
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - O M Mereuta
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.).,Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.).,SFI Centre for Research in Medical Devices (O.M.M., A.S.D., K.M.D.), National University of Ireland Galway, Galway, Ireland
| | - M Abbasi
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - J L A Larco
- Neurosurgery (J.L.A.L., L.S., W.B.), Mayo Clinic, Rochester, Minnesota
| | - A S Douglas
- Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.).,SFI Centre for Research in Medical Devices (O.M.M., A.S.D., K.M.D.), National University of Ireland Galway, Galway, Ireland
| | - D F Kallmes
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.)
| | - L Savastano
- Neurosurgery (J.L.A.L., L.S., W.B.), Mayo Clinic, Rochester, Minnesota
| | - K M Doyle
- Department of Physiology (S.T.F., O.M.M., A.S.D., K.M.D.).,SFI Centre for Research in Medical Devices (O.M.M., A.S.D., K.M.D.), National University of Ireland Galway, Galway, Ireland
| | - W Brinjikji
- From the Departments of Radiology (S.T.F., Y.L., D.D., O.M.M., M.A., D.F.K., W.B.).,Neurosurgery (J.L.A.L., L.S., W.B.), Mayo Clinic, Rochester, Minnesota
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Roark C, Savastano L, Wilkinson D, Shastri R, Vadlamudi V, Chaudhary N, Pandey A, Gemmete J. E-088 successful mechanical thrombectomy for basilar artery stroke in a 22-month old child. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.163] [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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Marsella LT, Savastano L, Saracino V, Del Vecchio R. [Child labour]. Clin Ter 2005; 156:273-80. [PMID: 16463564] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The authors emphasize the violation of children's and adolescents' rights as a result of the exploitation of child labour. Besides the legal aspect, they pointed out the medical features related to the delicate growing process of the child in the phases of development and adaptation of the main organs to hard work. Currently the problem is being supervised by those states that recognize the right for minors to be protected against any kind of physical, mental, spiritual and moral risk.
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Affiliation(s)
- L T Marsella
- Dipartimento di Odontostomatologia, Università di Tor Vergata, Roma.
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Savastano L, Bonacci S, Saracino V, Longo M. [The association of lung cancer with asbestos and tobacco smoking]. Clin Ter 2004; 155:69-74. [PMID: 15244110] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
This work summarises the potential association link for lung cancer between asbestos and smoking. This link emerges not only from different epidemiological and experimental studies, but also from a wide data collection carried out by an omogeneous Italian industrial group. The examination of the data set has led to the conclusion that the simultaneous exposition to asbestos and tobacco's smoke entails a factor, usually multiplicative and also partially additive, in relation to lung cancer; on the other hand, it does not seem to have a great relevance for mesothelioma pleurico. On the basis of this evidence, the Authors focus in particular on the measures of prevention in the contest of work conditions, in order to highlight the impact of the two carcinogenic agents in workers.
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Affiliation(s)
- L Savastano
- Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Fac. di Medicina e Chirurgia, Università degli Studi di Roma La Sapienza, Roma, Italia
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Abstract
A kinetic model analogous to two chemical reactions occurring in series describes the dissolution behavior of tablets and pellets coated with either microporous or semipermeable membranes. Microporous membranes permit free water influx, but moderated core dissolution and dialytically controlled solution efflux. Semipermeable membranes allow osmotically limited water influx, moderated core dissolution, but relatively unimpeded solution efflux through a release orifice. An explanation is offered which illustrates why the systems perform similarly despite major differences in the membrane structure and need for a release orifice. Applications to literature examples and experimental evidence demonstrate the suitability of the model.
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Affiliation(s)
- L Savastano
- Pharmaceutical Institute, University of Basle, Switzerland
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