Plug-Based Embolization Techniques of Aortic Side Branches during Standard and Complex Endovascular Aortic Repair

Vascular plugs are an evolving family of vessel occluders providing a single-device embolization system for large, high-flow arteries. Nitinol mesh plugs and polytetrafluoroethylene membrane plugs are available in different configurations and sizes to occlude arteries from 3 to 20 mm in diameter. Possible applications during complex endovascular aortic procedures are aortic branch embolization to prevent endoleak or to gain an adequate landing zone, directional branch occlusion, and false lumen embolization in aortic dissection. Plugs are delivered through catheters or introducers, and their technical and clinical results are comparable to those of coil embolization. Plugs are more accurate than coils as repositionable devices, less prone to migration, and have fewer blooming artifacts on postoperative computed tomography imaging. Their main drawback is the need for larger delivery systems. This narrative review describes up-to-date techniques and technology for plug embolization in complex aortic repair.

Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas

OBJECTIVE

Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs.

METHODS

The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular techniques between 2013 and 2023. Demographics, clinical presentation, CCF features, EVT characteristics, and clinical and radiological outcomes were evaluated and analyzed. The analysis was performed to compare the clinical and radiological data between different endovascular approaches and different embolic materials.

RESULTS

Ninety-eight patients were included in the study. EVT was successful in 95 patients (96.9%). Immediate complete obliteration of the CCF was achieved in 93.9% of patients, with 98% undergoing embolization with liquid embolic agents (LEAs) and 95.6% undergoing coiling alone. Complete CCF obliteration was higher in the transvenous than in the transarterial approach (94.3% vs 75%, p = 0.010). At ≥ 6 months follow-up, complete CCF obliteration was achieved in all patients (100%). The rate of procedure-related complications was higher following LEAs than with coiling alone (32.0% vs 15.6%). New cranial nerve (CN) palsy was diagnosed in 26.0% and 2.2% after embolization with LEAs and coiling alone, respectively (p = 0.001), with complete CN palsy recovery in 78.6%. Procedure-related intracranial hemorrhage occurred in 3 patients (3.1%). Two patients experienced an ischemic stroke following Onyx migration into the internal carotid artery. Ocular symptoms improved in 93% (83/89) of the patients who were followed.

CONCLUSIONS

In this study, complete obliteration of an indirect CCF was achieved in more than 90% of patients. Despite the occurrence of some new postprocedural ocular CN palsy, ocular symptoms improved in most patients in long-term follow-up. The transvenous approach was the most effective method for treating the indirect CCF. Coiling was safer than LEAs for the embolization of the indirect CCF.

Simple coiling of middle meningeal artery embolization for chronic subdural hematoma: An inverse probability of treatment weighting matched cohort study

BACKGROUND

Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) has gained much attention in recent years. However, unintended embolization may occur when employing liquid embolic agents or particles. We present our clinical experience in simple coiling of MMAE to manage CSDH.

METHODS

Patients underwent either surgical evacuation or MMAE with simple coiling for CSDH were reviewed. Clinical and radiographic outcomes were assessed at admission, 1-month, and 6-month intervals. Two treatment groups were matched with inverse probability of treatment weighting.

RESULTS

One hundred twelve patients were included, with 27 patients in MMAE group and 87 patients in surgery group. In MMAE group, significant reductions were observed in hematoma width (admission vs. 1-month, 2.04 [1.44-2.60] cm vs. 0.62 [0.37-0.95] cm, p < 0.001). The adjusted odds ratio (aOR) of surgical rescue rate (0.77 95%CI 0.13-4.47, p = 0.77), hematoma reduction (>50%) (0.21 95%CI 0.04-1.07, p = 0.06), and midline shift improvement rate (3.22, 95%CI 0.84-12.4, p = 0.09) had no substantial disparities between two groups at 1-month follow-up. In addition, no significant difference was noted between two groups in terms of hematoma reduction (>50%) at 6-month follow-up (aOR 1.09 95%CI 0.32-3.70, p = 0.89). No procedure-related complications were found in MMA embolization group.

CONCLUSION

Simple coiling for MMA had comparable outcomes with surgical evacuation for CSDH. Our findings suggest that simple coiling can be an alternative choice for liquid agents or particles in MMA embolization for CSDH with acceptable safety.

EUS-Guided Combined Injection Therapy as a Secondary Prophylaxis of Gastric Variceal Bleeding in a Patient Contraindicated for TIPS: Case Report

Background: Although bleeding from gastric varices is less observed than esophageal variceal bleeding (VB) (25% vs. 64%), it is associated with an exceedingly high mortality rate of up to 45%. Current guidelines suggest that endoscopic cyanoacrylate injection therapy (ECI) is the first-line treatment for gastric variceal bleeding (GVB). A major concern, however, is the possibility of embolic incidents, which are clinically evident in approximately 1% of cases. There are no guidelines for secondary prophylaxis of GVB. Radiological treatments using a transjugular intrahepatic portosystemic shunt (TIPS) or balloon occlusive transvenous obliteration (BRTO) are considered viable. However, they are not universally inapplicable; for instance, in the setting of pulmonary hypertension (TIPS). EUS-guided combined injection therapy (EUS-CIT) (embolization coils + cyanoacrylate) is an emerging procedure with a perceived reduced risk of systemic embolization. Case presentation: A patient with alcoholic liver cirrhosis was subjected to EUS-CIT as a secondary prophylaxis for GVB. He had three VB episodes of prior presentation treated by endoscopic band ligation (EBL) and ECI. Due to recurrent episodes of bleeding, he was referred to TIPS, but was considered contraindicated due to severe pulmonary hypertension. EUS-CIT was conducted with two embolization coils inserted into the varix, followed by an injection of 1.5 mL of cyanoacrylate glue. A 19 Ga needle, 0.035″ 14/70 mm coils, non-diluted n-butyl-caynoacrylate, and a transgastric approach were utilized. There were no immediate complications. Complete obliteration of the GV was observed in a follow-up endoscopy on day 30. Subsequent endoscopies in months three and six showed no progression of gastric varices. Conclusions: Our initial experience with EUS-CIT suggests that it can be successfully used as secondary prophylaxis for recurrent GVB.

Case Report: The application of amplatzer vascular plug to repair aortic dissection intimal tears and false lumen

In recent years, significant advancements have been made in endovascular therapy for aortic dissection, resulting in the development of various treatment methods. Nevertheless, there is a contentious discussion regarding the suitability of different treatment methods for addressing the unique features of individual lesions. Specifically, the matter of whether the presence of small intimal tears or multiple distal tears requires extensive aortic coverage with graft stents, which may block the blood supply to important organs, intercostal arteries, or lumbar arteries, remains unresolved. Further research is necessary to determine the need for complex fenestrated or branched endovascular aortic repair (F/B-EVAR) in the management of chronic post-dissection aneurysms involving visceral arteries. Our report highlights the successful endovascular repair of three patients with aortic dissection, encompassing one Stanford A type and two Stanford B types. Utilizing the Amplatzer Vascular Plug (AVP) alone or in combination with the coil embolization technique, we achieved favorable clinical outcomes. This article aims to provide valuable insights and new perspectives on the tailored management of aortic dissection by conducting a comprehensive examination of the subtle differences in the treatment processes and techniques applied to these three patients.

Comparison of endoscopic ultrasound-guided primary and secondary prophylaxis for gastric variceal bleeding

OBJECTIVES

Endoscopic ultrasound (EUS)-guided injection of cyanoacrylate (CYA) for primary prophylaxis (PP) of gastric varices (GV) is controversial. This study evaluates the safety and efficacy of this intervention.

METHODS

Patients treated for PP of GV bleeding by EUS injection of CYA with or without coils were identified. Endoscopic techniques, outcomes, and adverse events (AEs) were reviewed and compared with a group treated for secondary prophylaxis (SP). Patients were followed until: (i) loss to follow-up; (ii) GV bleeding; (iii) interventional radiology or surgery decompression; (iv) liver transplant; or (v) death or comfort care.

RESULTS

One hundred and nineteen patients (61 men; mean 59 ± 12 years) underwent EUS for PP (n = 24) or SP (n = 95). The PP group was treated with CYA alone (n = 18) or with coils (n = 4). Eight (33%) mild (n = 6) or moderate (n = 2) AEs and no index GV bleeding occurred during a mean of 6.1 ± 5.9 months follow-up. Repeat EUS in 22 (92%) PP patients showed 7 (32%) residual GVs, which were retreated with CYA alone (n = 6) or with coils (n = 1). Two (29%) mild (n = 1) or moderate (n = 1) AEs occurred after repeat EUS and 1/22 (5%) index GV bleed occurred during a mean 23 ± 25 months follow-up. Compared to the SP group, the PP group had lower Model for End-stage Liver Disease (MELD) score (P = 0.03), fewer GV stigmata (P < 0.001), required less CYA (P = 0.019) during index EUS, and had a longer time between index and surveillance EUS (P = 0.014). The incidence of AEs and GV bleeding between the two groups were similar.

CONCLUSION

Posttreatment GV bleeding and AEs are similar following EUS-guided primary and secondary GV prophylaxis.

Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study

A wide variety of coils are available for vascular embolization. This study aimed to evaluate the safety and efficacy of a new Prestige coil. We carried out retrospective analysis of a multicenter's registry data collected between February 2022 and November 2022. The choice of embolization agent used to treat peripheral vascular anomalies was left to the investigator's discretion. Patients for whom at least one Prestige coil was used were included in Series 1. All other patients were included in Series 2. Efficacy and safety were evaluated. Patients were followed up for one month. In total, 220 patients were included, 110 in each series. Patients included 149 men (67.7%) and 71 women (32.3%), with a median age of 62.5 years (IQR: 35.8-73). Patient ages were similar in the two series. Complete occlusion of the targeted vessel was reported in 96.4% (n = 106/110) of patients in Series 1 and in 99.7% (n = 109/110) in Series 2. Four patients experienced non-serious adverse events (1.8%, n = 4/220): one experienced back pain and one vomiting in Series 1; one patient had off-target embolization and one a puncture site hematoma in Series 2. Sixteen patients (7.2%, n = 16/220) were lost to follow up. Improvement in the patient's general state at one month was reported in 79.0% (n = 83/105) of patients in Series 1 and in 74.7% (n = 74/99) in Series 2. Ten deaths occurred, five in Series 1 (4.8%, n = 5/105) and five in Series 2 (5.1%, n = 5/99). These deaths all concerned critically ill patients embolized for emergent arterial bleeding. In conclusion, the 1-month follow-up showed that Prestige coils, alone or in combination, are efficient and safe.

Design and realization of a multi-coil array for B0 field control in a compact 1.5T head-only MRI scanner

PURPOSE

To design and implement a multi-coil (MC) array for B0 field generation for image encoding and simultaneous advanced shimming in a novel 1.5T head-only MRI scanner.

METHODS

A 31-channel MC array was designed following the unique constraints of this scanner design: The vertically oriented magnet is very short, stopping shortly above the shoulders of a sitting subject, and includes a window for the subject to see through. Key characteristics of the MC hardware, the B0 field generation capabilities, and thermal behavior, were optimized in simulations prior to its construction. The unit was characterized via bench testing. B0 field generation capabilities were validated on a human 4T MR scanner by analysis of experimental B0 fields and by comparing images for several MRI sequences acquired with the MC array to those acquired with the system's linear gradients.

RESULTS

The MC system was designed to produce a multitude of linear and nonlinear magnetic fields including linear gradients of up to 10 kHz/cm (23.5 mT/m) with MC currents of 5 A per channel. With water cooling it can be driven with a duty cycle of up to 74% and ramp times of 500 μs. MR imaging experiments encoded with the developed multi-coil hardware were largely artifact-free; residual imperfections were predictable, and correctable.

CONCLUSION

The presented compact multi-coil array is capable of generating image encoding fields with amplitudes and quality comparable to clinical systems at very high duty cycles, while additionally enabling high-order B0 shimming capabilities and the potential for nonlinear encoding fields.

Neqstent coil-assisted flow diverter (NQS) for the treatment of bifurcation aneurysms: the coil-assisted flow diversion safety and performance study (CAFI)

BackgroundThe Neqstent coil-assisted flow diverter (NQS) is a neck bridging device to facilitate coil occlusion of intracranial aneurysms. CAFI is a prospective, single-arm, multicenter study on the safety and performance of the NQS adjunctive therapy device together with platinum coils for treatment of unruptured intracranial aneurysms.

METHODS

Thirty-eight patients were enrolled. Primary endpoints were occlusion at 6 months for efficacy, and any major stroke or non-accidental death up to 30 days or major disabling stroke within 6 months for safety. Secondary endpoints were re-treatment rate, procedure time, and procedure/device-related adverse events. Procedural and follow-up imaging was reviewed by an independent core laboratory. Adverse events were reviewed and adjudicated by a clinical events committee.

RESULTS

The NQS was successfully implanted in 36/38 aneurysms, 2/38 in the intention-to-treat group did not receive a NQS and were excluded from follow-up after 30 days. In the per protocol group (PP), 33/36 patients were available for angiographic follow-up. Device related adverse events were recorded in 4/38 (10.5%) patients, one hemorrhagic and three thromboembolic. In the PP group, immediate post-treatment adequate occlusion (RR1 and RR2) was seen in 9/36 (25%) and progressed to 28/36 (77.8%) at 6 months. Complete occlusion (RR1) was achieved in 29/36 (80.6%) at the last available angiogram (3/36 were post procedure). The mean procedure time was 129 min (50-300 min, median 120 min).

CONCLUSION

The NQS in conjunction with coils appears to be effective in the treatment of intracranial wide-neck bifurcation aneurysms, but its safety remains to be proved in larger series.

TRIAL REGISTRATION NUMBER

NCT04187573.

Management of carotid cavernous fistulas: A single center experience

Purpose

Multimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes.

Materials and methods

From 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences.

Results

Etiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality.

Conclusion

Endovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.

Study of an Energy-Harvesting Damper Based on Magnetic Interaction

The saving and re-use of energy has acquired great relevance in recent years, being of great importance in the automotive sector. In the literature, it is possible to find different proposals for energy-harvesting damper systems (EHSA)-the electromagnetic damper being a highly recurrent but still poorly defined proposal. This article specifically focuses on studying the concept and feasibility of an electromagnetic suspension system that is capable of recovering energy, using a damper formed by permanent magnets and a system of coils that collect the electromotive force generated by the variation of the magnetic field. To study the feasibility of the system, it is necessary to know the maximum energy that can be recovered through the winding system; however, the difficulties in obtaining the derivative of the magnetic flux and its derivative for each position make the analytical method very tedious. This paper presents an experimental method with which to maximize energy recovery by defining the optimum relative position between magnet and coil.

Current status of interventional therapy for pulmonary emphysema with bronchoscopy

Pulmonary emphysema is one of phenotypes of lung disease that can progress to chronic obstructive pulmonary disease (COPD). The pathogenesis is unknown, which may be closely related to smoking, infection, gene mutation, and air pollution. Pathological features of emphysema include the decreased airway elasticity at the distal end of the bronchioles and over-hyperinflation. As the incidence and mortality of COPD increase, emphysema has become the focus of research. The efficacy of drugs for COPD is limited, and currently the treatment of emphysema mainly depends on surgery. Since the concept of lung volume reduction surgery was proposed in the 1990s, many studies have confirmed improvement of lung function and exercise capacity, but the large wound, high mortality, and high cost have reduced its benefits. Lung volume reduction surgery with bronchoscopy technology, including valves, coils, sclerosants, vapor thermal ablation, etc., has the advantages of minimal invasive and decreased mortality under the basis of effectiveness. This article aims to review the current status of interventional therapy for pulmonary emphysema with bronchoscopy, compare and summarize the characteristics and applicable populations of interventional therapy, and provide theoretical support for patients' early referral and clinicians' decision-making.

Impact of Pre-operative Embolization With Onyx for Brain Arteriovenous Malformation Surgery

Objective

To clarify the safety and efficacy of pre-operative embolization using Onyx liquid embolic agent (Onyx; ev3) compared with N-butyl cyanoacrylate (NBCA; Cordis Neurovascular, Inc.) or coils in cerebral arteriovenous malformation (AVM) surgery.

Methods

This was a retrospective review of a prospectively collected clinical database of brain AVMs treated at our institute from January 2005 to March 2021. A total of 38 consecutive patients who underwent AVM resection after pre-operative embolization were included. Based on pre-operative embolization materials, the patients were divided into the pre-Onyx group (n = 16), in which NBCA or coils were used for embolization, and the Onyx group (n = 22). Patient characteristics and treatment results were compared between the two groups.

Results

Patient characteristics were comparable between the two groups in terms of age, sex, and rupture status. While the Spetzler-Martin grade was also similar between the two groups, the location of the AVM nidus in the eloquent area was slightly higher in patients in the Onyx group (72.7%) than in patients in the pre-Onyx group (43.8%) (P = 0.09). The embolization rate was higher in the pre-Onyx group (mean: 63.0%; range: 12.7-100%) than in the Onyx group (mean: 50.0%; range: 15.8-100%), but the difference was not statistically significant (P = 0.06). The time needed for surgical removal was shorter in the Onyx group (mean: 354.8 min; range: 144-884 min) than in the pre-Onyx group (mean: 457.9 min; range: 240-1,294 min); however, this difference was not statistically significant (P = 0.13). The amount of intraoperative bleeding was significantly lower in the Onyx group (mean: 129.8 ml; range: 20-540 mL) than in the pre-Onyx group (mean: 448.8 mL; range: 120-1,550 ml) (P = 0.0008). The surgical complication rates were comparable between the two groups (pre-Onyx group, 18.8%; Onyx group, 4.5%; P = 0.29).

Conclusions

Pre-operative embolization with Onyx can significantly reduce the amount of intraoperative bleeding in AVM resection and may contribute to safe AVM surgery.

Multiple Parallel Grafts for Urgent Endovascular Repair of a Ruptured Mycotic Aortic Aneurysm

A 73-year-old woman underwent urgent endovascular repair of a ruptured mycotic aortic aneurysm. A thoracic stent graft was employed as the main endograft, while the celiac trunk and superior mesenteric artery were revascularized by the chimney technique and the renal arteries through the periscope technique. Postoperative computed tomography revealed a Type A1 gutter, treated by detachable coils and peripheral occlusion devices. Six-month follow-up revealed patency of the stent grafts, without endoleak or stent graft infection signs.

Characterization of a Low-Profile, Flexible, and Acoustically Transparent Receive-Only MRI Coil Array for High Sensitivity MR-Guided Focused Ultrasound

Magnetic resonance guided focused ultrasound (MRgFUS) is a non-invasive therapeutic modality for neurodegenerative diseases that employs real-time imaging and thermometry monitoring of targeted regions. MRI is used in guidance of ultrasound treatment; however, the MR image quality in current clinical applications is poor when using the vendor built-in body coil. We present an 8-channel, ultra-thin, flexible, and acoustically transparent receive-only head coil design (FUS-Flex) to improve the signal-to-noise ratio (SNR) and thus the quality of MR images during MRgFUS procedures. Acoustic simulations/experiments exhibit transparency of the FUS-Flex coil as high as 97% at 650 kHz. Electromagnetic simulations show a SNR increase of 13× over the body coil. In vivo results show an increase of the SNR over the body coil by a factor of 7.3 with 2× acceleration (equivalent to 11× without acceleration) in the brain of a healthy volunteer, which agrees well with simulation. These preliminary results show that the use of a FUS-Flex coil in MRgFUS surgery can increase MR image quality, which could yield improved focal precision, real-time intraprocedural anatomical imaging, and real-time 3D thermometry mapping.

Varicocele embolization with sclerosing agents leads to lower radiation exposure and procedural costs than coils: Data from a real-life before and after study

Objectives

To investigate clinical outcomes, radiation exposure and procedural costs associated with percutaneous varicocoele embolization using coils and sclerosing agents (SAs) in a cohort of young‐adult men.

Materials and methods

Data from consecutive men treated with percutaneous varicocoele embolization using coils and SA between 2017 and 2021 were analyzed. The allocation was based on a change of policy occurred in June 2020 with the substitution of coils with SA (before and after study). Semen analysis values were based on 2010 WHO reference criteria. Anatomic variants of gonadal veins were categorized according to Jargiello et al. Intraoperative radiation dose and procedural costs were collected for each patient. Descriptive statistics and linear regression models were used to describe the association between clinical parameters with procedural costs and radiation exposure.

Results

One hundred sixteen men were included, of whom 76 (65.5%) received coils, and 40 (34.5%) received SA. Baseline characteristics of the two study groups did not differ. A type 3 Jargiello anatomic variation of left gonadal vein was found in 45.7% of cases. Radiation dose was lower in the SA group as compared to the coils one (13.2 [7–43] vs. 19.8 [12–57] Gy/cm²; p < 0.001). Similarly, procedural costs were lower for the SA group (169.6 [169–199] € vs. 642.5 [561–775] €; p < 0.001). At follow‐up, pain and sperm variables significantly improved in both groups (p < 0.01), without differences among the embolic materials. Linear regression model revealed that coils use was associated with higher radiation exposure (beta 8.8, p = 0.02) than SA after accounting for anatomic variation of gonadal vein, body mass index, and vascular access.

Conclusions

SA and coils for varicocoele embolization are equally safe and effective. The use of SA was associated with lower radiation exposure and procedural costs than coils. These results should be considered in terms of public health cost and patient's safety.

"It's Cool, Modifying and All, but I Don't Want Anything Blowing Up on Me:" A Focus Group Study of Motivations to Modify Electronic Nicotine Delivery Systems (ENDS)

Introduction: Modifications to electronic nicoti ne delivery systems (ENDS) can pose health risks to users. This study explored users’ motivations for modifying ENDS devices and how perceived risks of modifications influenced modification behaviors as product availability and device characteristics changed over time. Method: We conducted nine focus groups (February–June 2020) with 32 current ENDS users (18+, used ENDS in the past 30 days, and had been using ENDS for more than 2 months). Results: Participants primarily modified ENDS devices to improve their experiences, such as experimenting with flavor, controlling nicotine levels, or using cannabis products with ENDS. Another reason for modifying was routine maintenance to ensure a satisfactory experience, including maintaining coils and keeping batteries charged. The broader availability of ENDS products shifted modification behaviors over time, with newer devices making some modifications (e.g., coil replacement) easier and making more intricate modifications (e.g., building coil from scratch) less common. Participants were aware of modification dangers and cited perceived risk as the reason for avoiding certain modifications, such as battery alterations. Conclusions: Modifications of ENDS are ongoing and evolving among users and should be considered by the Food and Drug Administration (FDA) and other regulatory decision-makers as product authorization reviews are conducted and product standards are developed.

Endovascular Embolization of Pulmonary Sequestration Presenting With Hemoptysis: A Promising Alternative to Surgery

Pulmonary sequestration is abnormal lung parenchyma separated from the normal tracheobronchial system and supplied by an aberrant systemic artery. It is usually asymptomatic; however, it can present with hemoptysis and recurrent pulmonary infections. Although surgery is the classical treatment, arterial embolization is recently established as an alternative treatment to avoid surgical complications. We present a case of left lower lobe intralobar pulmonary sequestration presented with hemoptysis and was successfully treated with coil embolization.

Cerebral vasospasm resulted in "stent shortening" after pipeline assisted coil embolization for blood blister aneurysms

Blood blister aneurysms (BBAs) are intracranial arterial lesions appearing in nonbranching sites of the supraclinoid internal carotid artery as well as the basilar artery. Endovascular treatment of BBAs is still not well established because of the rarity of these lesions. We report incidences of BBAs with associated vasospasms. Treatment of the BBAs and associate vasospasms with single Pipeline Flex embolization device (PLED) assisted coiling resulted in seemly shorting of the PLEDs in 3 patients.A retrospective analysis of patients with BBAs who were treated with single PLED assisted coiling from July 2018 to October 2019 was conducted. Patients' ethnic and medical records, aneurysmal characteristics, intraoperative-rupture, cerebral vasospasm (CVS), postprocedure contrast filling, follow-up imaging, and results were analyzed. Neurological examination at baseline and outcome based on modified Rankin scale (mRS) at discharge as well as follow-ups were also documented.Six patients consisting of 5 females and 1 male, with a mean age of 48.3 years (range from 34-67) were identified during our analysis. All the BBAs were located in nonbranching site of supra-clinoidal segment of internal carotid artery with a mean neck width of 4.5 mm and mean aneurysm size of 4.23 mm. PLED assisted coiling's were performed in all of them. CVS was observed in 3 patients while 1 patient had an intraoperative-rupture of the BBA. Postprocedure contrast filling was still present in 1 patient. All the patients had good outcomes with discharge and follow-up mRS scores ≤ 2 except 1 patient with mRS score = 3 with aphasia.PLED assisted endovascular coiling is very safe and efficient in treating patients with BBAs. Resolution of CVSs after treatment made the PLEDs seemly shorter. Furthermore, a combination of arterial lengthening after gaining their tensile strength back and radical expansion of the PLED could account for the shortening.

Risk Factors for Recanalization after Coil Embolization

The aim of our study was to identify risk factors for recanalization 6 months after coil embolization using clinical data followed by computational fluid dynamics (CFD) analysis. Methods: Firstly, clinical data of 184 patients treated with coil embolization were analyzed retrospectively. Secondly, aneurysm models for high/low recanalization risk were generated based on ROC curves and their cut-off points. Afterward, CFD was utilized to validate the results. Results: In multivariable analysis, aneurysm filling during the first embolization was an independent risk factor whilst packing density was a protective factor of recanalization after 6 months in patients with aSAH. For patients with unruptured aneurysms, packing density was found to be a protective factor whilst the aneurysm neck size was an independent risk factor. Complex flow pattern and multiple vortices were associated with aneurysm shape and were characteristic of the high recanalization risk group. Conclusions: Statistical analysis suggested that there are various factors influencing recanalization risk. Once certain values of morphometric parameters are exceeded, a complex flow with numerous vortices occurs. This phenomenon was revealed due to CFD investigations that validated our statistical research. Thus, the complex flow pattern itself can be treated as a relevant recanalization predictor.

Bioactive refinement for endosaccular treatment of intracranial aneurysms

Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and material science have led to a novel generation of coil technologies for aneurysm embolisation that address clinical challenges of aneurysm recurrence. This review presents an overview of modified surface coil technologies and summarises the state of the art regarding their efficacy and limitations based on experimental and clinical results. We also present potential perspectives to develop biologically optimised devices.

Embolization for Carotid Blowout in Head and Neck Cancer: Case Report of Five Patients

Carotid blowout syndrome (CBS) is defined as a rupture of common carotid artery or its branches. Endovascular intervention has been advocated as first line of treatment for CBS. This Case Report describes 5 patients with prior history of head and neck cancer who presented with CBS. Two patients presented as acute, 2 as impending, and one as threatened CBS. The lesions found were pseudoaneurysm and focal vascular irregularities involving the common carotid artery, cervical internal carotid artery and lingual artery. Embolization and occlusion with detachable coils of the artery was used in all patients. Technical success and immediate hemostasis were achieved in all patients. One patient presented transient cranial nerve palsy. No recurrent CBS was reported during the follow-up. In our experience, coil embolization, if possible, is a safe and efficient technique in treatment of CBS secondary to head and neck cancers.

Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.

FeSiCr Alloy Powder to Carbonyl Iron Powder Mixing Ratio Effects on the Magnetic Properties of the Iron-Based Alloy Powder Cores Prepared Using Screen Printing

A screen printing process was used to substitute dry molding to solve the uneven compaction problem in the coil center column during molding in this study. FeSiCr alloy powders (FSC) with a large particle size were mixed with fine spherical carbonyl iron powder to increase the compaction density. FSC to carbonyl iron powder (CIP) mixing ratio effects on magnetic paste rheological behaviors and magnetic properties of the molding coil prepared using screen printing were investigated. A magnetic paste with the lowest viscosity can be obtained using 3C7F (30% CIP + 70% FSC) due to the small-sized CIP adsorbed onto the FSC surface. This process reduces the interlocked network formation resulting from the CIP. The toroidal core with 3C7F exhibited the highest relative density and highest inductance. The coils with pure CIP and higher CIP content exhibited the better DC superposition characteristic. The toroidal core loss increased rapidly as the FSC content was increased. A proper trade-off between the inductance, DC-bias superposition characteristic, and magnetic core loss can be reached by choosing a suitable powder mixing ratio.

Endovascular Treatment of Tiny Aneurysms With Low-Profile Visualized Intraluminal Support Devices Using a "Compressed" Stent Technique

Objective: To investigate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling of intracranial tiny aneurysms using a "compressed" stent technique. Methods: We retrospectively analyzed patients with tiny aneurysms treated in our hospital with LVIS devices using a compressed stent technique. We analyzed patients' imaging outcomes, clinical outcomes, and complications. Results: Forty-two tiny aneurysms in 42 patients were included in this study cohort; 8 patients presented with subarachnoid hemorrhage at admission. The immediate postoperative complete embolization rate was 76.2% (32/42). After an average of 8.5 months of imaging follow-up, the complete embolization rate was 90.5% (38/42), and no aneurysm recanalization occurred. After an average of 24.4 months of clinical follow-up, 95.2% (40/42) of the patients achieved favorable clinical outcomes (modified Rankin scale = 0/1). Operation-related complications occurred in two patients (4.8%); one intraoperative acute thrombosis, and one significant unilateral decreased vision during the postoperative follow-up. Conclusion: LVIS stent-assisted coiling of intracranial tiny aneurysms using a compressed stent technique is safe and effective. Combined stent compression technology is beneficial to maximize the complete embolization of aneurysms and reduce aneurysm recanalization. This study expands the clinical applicability of LVIS stents.

[Embolization of arteriovenous malformation of the scrotum]

The authors report a rare disease at the junction of urology and cardiovascular surgery (arteriovenous malformation (AVM) of the scrotum). The options for correction of this disease are discussed. The authors describe the complications of natural course of disease and their treatment. Treatment strategy with AVM embolization is substantiated. Postoperative regression of symptoms is emphasized. The authors concluded safety and effectiveness of interventional correction of this disease.

Aortocoronary saphenous vein graft aneurysm misdiagnosed as aortic arch aneurysm

Coronary artery bypass grafting is the mainstay of revascularization worldwide. However, the most widely used saphenous vein grafts are related to a number of late sequelae. Aortocoronary saphenous vein graft aneurysms mainly diagnosed incidentally are one of these complications. Although rare, given the fatal risk of rupture if left untreated, management either with percutaneous intervention or open redo surgery should be considered. However, no guidelines are established in current scarce literature. Hereby, we present the successful percutaneous management of a huge saphenous vein graft aneurysm via coiling, avoiding the risks of repeat sternotomy.

Multiple Dural Arteriovenous Fistulas Manifesting as Progressive Otalgia and Tinnitus and Treated Using a Single Session of Endovascular Embolization

Background

Multiple cranial dural arteriovenous fistulas (dAVFs) are considered to be an uncommon vascular condition. dAVFs usually manifest with vague symptoms, which are related to the site of occurrence of the lesion and present with complex angio-architectural features, which in turn can render treatment procedures difficult. Appropriate treatment that aims to reduce the risk of intracranial bleeding and manage the patient’s symptoms requires a multidisciplinary approach.

Case Presentation

The patient was a 62-year-old man who developed symptoms of progressive right-sided otalgia and tinnitus. Cross-sectional imaging revealed long-standing venous congestion with intracranial hemorrhage in the right parieto-occipital region. Moreover, cerebral angiography demonstrated multiple complex dAVFs at the right transverse sinus-sigmoid sinus (TS-SS) junction, right posterior condylar confluence (PCC), and torcula. Treatment consisted of one session of endovascular treatment, in which transarterial Onyx embolization was used to treat the dVAF at the right TS-SS junction, transvenous coil embolization for the dVAF at the right PCC, and particle embolization for both occipital arteries feeding the torcular dAVF. Postoperative improvement with favorable clinical outcomes was observed at the patient’s last follow-up visit.

Conclusion

Multiple cranial dAVFs are an uncommon vascular lesion, which can present with unusual symptoms such as otalgia. Moreover, a single session of endovascular therapy can treat this lesion, ie, it can improve the patient’s symptoms and provide a beneficial long-term outcome.

Pipeline Embolization Device With Adjunctive Coils for the Treatment of Unruptured Large or Giant Vertebrobasilar Aneurysms: A Single-Center Experience

Objective: To evaluate effectiveness and safety of Pipeline embolization device (PED) for large or giant verterbrobasilar aneurysms (LGVBAs), and to compare the therapeutic effects of PED with and without adjunctive coils. Methods: We retrospectively analyzed 21 cases of unruptured LGVBAs who were treated in our hospital with PED. These cases were divided into "PED group" and "PED with adjunctive coils group." We compared the aneurysm characteristics and treatment outcomes between the two groups. Results: The overall neurological complication rate was 28.6% (6/21) and the mortality rate was 4.8% (1/21). There were 12 patients in the PED group and nine in the PED with adjunctive coils group. There were no significant differences in age, smoking, hypertension, aneurysm size, aneurysm location, or operation time between the two groups. The complete aneurysm embolization rate and favorable outcome rate (modified Rankin Scale = 0,1) of the PED with adjunctive coils group was 78% (7/9) and 100% (9/9), respectively, which were both better compared with the PED group with 63.6% (7/11) and 83% (10/12), respectively. However, these differences were not statistically significant. Conclusion: The effectiveness and safety of PED for LGVBAs is acceptable. Treatment results did not differ between the PED and PED with adjunctive coils groups; therefore, whether coils should be used may depend the operator. Our results suggest that correct use of the coils does not increase complications. We suggest that PED with adjunctive coils should be used for some selected LGVBAs.

Characterization of E-cigarette coil temperature and toxic metal analysis by infrared temperature sensing and scanning electron microscopy - energy-dispersive X-ray

INTRODUCTION

Electronic cigarettes (e-cigarettes) have rapidly evolved since their introduction to the U.S. market. The rebuildable atomizer (RBA) offers user-driven modification to the heating element (coil) and wicking systems. Different coil materials can be chosen based on user needs and preferences. However, the heating element of an e-cigarette is believed to be one-source for toxic metal exposure.

METHODS

E-cigarette coils from Kanthal and nichrome wires were constructed in a contact and non-contact configuration and heated at four voltages. The maximum temperatures of the coils were measured by infrared temperature sensing when dry and when saturated with 100% vegetable glycerin or 100% propylene glycol. The metal composition of each coil was analyzed with Scanning Electron Microscopy-Energy-Dispersive X-Ray (SEM-EDX) when new, and subsequently after 1, 50, and 150 heat cycles when dry.

RESULTS

The coils reached temperatures above 1000 °C when dry, but were below 300 °C in both liquid-saturated mediums. Metal analysis showed a decrease of 9-19% chromium and 39-58% iron in Kanthal wire and a decrease of 12-14% iron and 39-43% nickel in nichrome wire after 150 heat cycles. Significant metal loss was observed after one heat cycle for both coil alloys and configurations.

CONCLUSIONS

The loss of metals from these heat cycles further suggests that the metals from the coils are potentially entering the aerosol of the e-cigarette, which can be inhaled by the user.

microcatheter of the triaxial system

Background

A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has been reported to allow super-selective catheterization. A 1.6-Fr. microcatheter has recently become available as the small microcatheter for the triaxial system, in addition to 0.014-in. pushable bare platinum coils that may be introduced into the 1.6-Fr. microcatheter.

Purpose

The purpose of the present study was to evaluate the feasibility of 0.014-in. pushable bare platinum coils in embolization through the 1.6-Fr. microcatheter of the triaxial system.

Material and Methods

Between November 2015 and October 2019, 19 embolizations were performed on 18 patients, 9 males and 9 females with a median age of 77 years (range, 41-88 years), using 0.014-in. pushable bare platinum coils through the 1.6-Fr. microcatheter of the triaxial system. The technical success rate, clinical success rate, and complications associated with the procedure were assessed. Technical success was defined as the successful delivery and placement of 0.014-in. pushable bare platinum coils, and clinical success as the immediate postembolic complete cessation of blood flow confirmed by digital subtraction angiography.

Results

Eighty-four 0.014-in. pushable bare platinum coils were delivered and 19 arteries were successfully embolized. The median number of 0.014-in. pushable bare platinum coils was 4 (range, 1-12). The technical success rate was 100% (84/84) and the clinical success rate was also 100% (19/19). There were no complications associated with the procedures.

Conclusion

The use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system appears to be feasible and safe.

Bilateral pediatric pial arteriovenous fistulas accompanying a giant arachnoid cyst with torticollis: A case report

RATIONALE

Pial arteriovenous fistula (PAVF) occurs when intracranial arteries communicate directly with veins. PAVFs are very rare congenital vascular lesions that are commonly seen in infants and children. Arachnoid cysts are congenital cavitation often filled with cerebrospinal fluid. We present a very rare associated occurrence of bilateral pediatric PAVF and a giant arachnoid cyst presenting as torticollis in a child. So far, this is the first case.

PATIENT CONCERNS

A 6-year-old male child was referred to our facility from a local hospital due to severe torticollis.

DIAGNOSES

An enhanced computed tomography scan revealed 2 slightly high-density masses at the anterior pontine cistern, right circumferential cistern, as well as left posterior occipital region. The same computed tomography scan revealed a giant arachnoid cyst in the left occipital as well as the temporal region with a thin cerebral cortex adjacent to the cyst.

INTERVENTIONS

Digital subtraction angiography confirmed that the 2 high-flow lesions were PAVFs. The patient was treated with a combination of detachable coils and Onyx Liquid Embolic System (Onyx HD-500) (Covidien/ev3 Neurovascular) via the transarterial endovascular route while the giant arachnoid cyst was managed conservatively.

OUTCOMES

The torticollis resolved 2 days after the procedure. He is currently well with no neurologic deficit.

LESSONS

We advocate that in cases of PAVF with accompanying cyst, the cyst should be managed conservatively if it is not associated with intracranial hemorrhage or focal neurologic deficit.

Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Videos

BACKGROUND

As user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking.

OBJECTIVE

This study aimed to analyze the content of YouTube videos depicting modifications of ENDS.

METHODS

YouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos.

RESULTS

Videos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative).

CONCLUSIONS

This study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.

The Jailed Coiling Technique for the Treatment of Penetrating Ulcers and Saccular Aneurysms of the Aortic Arch

OBJECTIVE

To evaluate the technical success and short-term outcome of patients with penetrating aortic ulcers (PAUs) and saccular aneurysms (SAs) of the aortic arch treated with the jailed coiling technique.

METHODS

A retrospective review of 9 patients (mean age 70 years, 9 males) treated for PAUs and SAs of the aortic arch between 2018 and 2019 at our institution. Treatment included thoracic endovascular aneurysm repair (TEVAR) with a short (1cm) proximal landing zone, followed by coiling of aneurysm through a jailed extraluminal catheter.

RESULTS

All 9 patients underwent TEVAR followed by jailed coiling of the lumen of the aneurysms. Debranching of supra-aortic vessels was performed in 4 patients in order to create a proximal landing zone of at least 10 mm. Technical success was achieved in all cases. Coils were placed accurately within the aneurysm lumen in all patients. No distal embolization occurred. One patient expired in the perioperative period from a cardiac event. No patient developed spinal cord ischemia or stroke in the perioperative period. Mean follow-up was 10 months (range 3-18). On follow-up imaging, complete thrombosis of the aneurysm lumen was seen in all patients. None experienced enlargement of ulcer dimensions and none required reintervention.

CONCLUSION

PAUs and SAs of the aortic arch with a very short landing zone can be treated successfully by jailed coiling of the aneurysm and TEVAR. The procedure is technically feasible and can be performed with minimal morbidity. Long-term durability of the repair needs to be determined.

Magnetic Proximity Sensor Based on Magnetoelectric Composites and Printed Coils

Magnetic sensors are mandatory in a broad range of applications nowadays, being the increasing interest on such sensors mainly driven by the growing demand of materials required by Industry 4.0 and the Internet of Things concept. Optimized power consumption, reliability, flexibility, versatility, lightweight and low-temperature fabrication are some of the technological requirements in which the scientific community is focusing efforts. Aiming to positively respond to those challenges, this work reports magnetic proximity sensors based on magnetoelectric (ME) polyvinylidene fluoride (PVDF)/Metglas composites and an excitation-printed coil. The proposed magnetic proximity sensor shows a maximum resonant ME coefficient (α) of 50.2 Vcm⁻¹ Oe⁻¹, an AC linear response (R² = 0.997) and a maximum voltage output of 362 mV, which suggests suitability for proximity-sensing applications in the areas of aerospace, automotive, positioning, machine safety, recreation and advertising panels, among others.

Users' Modifications to Electronic Nicotine Delivery Systems (ENDS): Interviews with ENDS Enthusiasts

Users' modifications to electronic nicotine delivery systems (ENDS) products could increase initiation, inhibit cessation, or change the toxicity of the product. This study aims to begin to identify consumers' common ENDS modification behaviors. We conducted audio-recorded, in-depth one-on-one interviews with 13 adult ENDS users in the metropolitan Atlanta area, who self-reported extensive modification experience. Modifications to coils, batteries, and e-liquids were commonly mentioned. Participants indicated that users modified devices to produce large clouds, change levels of nicotine delivery, alter tastes of e-liquids, and experience different throat hits. Because manufacturers have changed product characteristics to be in line with consumer preferences, interviewees indicated that fewer users currently engage in modifications to coils and batteries compared to the more widespread practice a few years ago. Hobbyists continue to perform modifications and many users continue to misuse or abuse e-liquids, despite the view that fewer users currently alter their ENDS than in the past. The Food and Drug Administration (FDA) regulatory actions that limit certain product characteristics may unintentionally increase the likelihood that users will once again make more extensive modifications to their products, and this should be considered as part of the FDA's regulatory decision-making process.

Endovascular Management of Massive Hemoptysis Secondary to Systemic Collaterals in Previously Treated Pulmonary Arteriovenous Malformation

Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary artery and vein through a thin-walled aneurysmal sac, leading to a right-to-left shunt. These are commonly associated with hereditary hemorrhagic telangiectasia, and treatment guidelines have been set on how to approach their management. Incorrect proximal placement of an embolization device can lead to delayed recruitment of systemic collaterals leading to presentation with hemoptysis. We are presenting a case of a 17-year-old male with treated PAVMs and with fresh hemoptysis. In this case report, we attempt to explain the management of such a complication and follow the principles of arteriovenous malformation embolization on the left side.

High-Definition Zoom Mode: A High Resolution X-ray Microscope for Neurointerventional Treatment Procedures

BACKGROUND AND PURPOSE

Visualization of structural details of treatment devices during neurointerventional procedures can be challenging. A new true two-resolution imaging X-ray detector system features a 194 µm pixel conventional flat-panel detector (FPD) mode and a 76 µm pixel high-resolution high-definition (Hi-Def) zoom mode in one detector panel. The Hi-Def zoom mode was developed for use in interventional procedures requiring superior image quality over a small field of view (FOV). We report successful use of this imaging system during intracranial aneurysm treatment in 1 patient with a Pipeline-embolization device and 1 patient with a low-profile visualized intramural support (LVIS Blue) device plus adjunctive coiling.

METHODS

A guide catheter was advanced from the femoral artery insertion site to the proximity of each lesion using standard FPD mode. Under magnified small FOV Hi-Def imaging mode, an intermediate catheter and microcatheters were guided to the treatment site, and the PED and LVIS Blue plus coils were deployed. Radiation doses were tracked intraprocedurally.

RESULTS

Critical details, including structural changes in the PED and LVIS Blue and position and movement of the microcatheter tip within the coil mass, were more readily apparent in Hi-Def mode. Skin-dose mapping indicated that Hi-Def mode limited radiation exposure to the smaller FOV of the treatment area.

CONCLUSIONS

Visualization of device structures was much improved in the high-resolution Hi-Def mode, leading to easier, more controlled deployment of stents and coils than conventional FPD mode.

Intraspecific polyploidy correlates with colonization by arbuscular mycorrhizal fungi in Heuchera cylindrica

PREMISE

Polyploidy is known to cause physiological changes in plants which, in turn, can affect species interactions. One major physiological change predicted in polyploid plants is a heightened demand for growth-limiting nutrients. Consequently, we expect polyploidy to cause an increased reliance on the belowground mutualists that supply these growth-limiting nutrients. An important first step in investigating how polyploidy affects nutritional mutualisms in plants, then, is to characterize differences in the rate at which diploids and polyploids interact with belowground mutualists.

METHODS

We used Heuchera cylindrica (Saxifragaceae) to test how polyploidy influences interactions with arbuscular mycorrhizal fungi (AMF). Here we first confirmed the presence of AMF in H. cylindrica, and then we used field-collected specimens to quantify and compare the presence of AMF structures while controlling for site-specific variation.

RESULTS

Tetraploids had higher colonization rates as measured by total, hyphal, and nutritional-exchange structures; however, we found that diploids and tetraploids did not differ in vesicle colonization rates.

CONCLUSIONS

The results suggest that polyploidy may alter belowground nutritional mutualisms with plants. Because colonization by nutritional-exchange structures was higher in polyploids but vesicle colonization was not, polyploids might form stronger associations with their AMF partners. Controlled experiments are necessary to test whether this pattern is driven by the direct effect of polyploidy on AMF colonization.

A novel measurement strategy to evaluate the human head as a transition medium for inductive ear-to-ear communication

This manuscript introduces a novel concept for measuring coil coupling for extremely loose-coupled coils (coupling factors k<10-6; mutual inductance values M<10-10 H). Such a coupling is found everywhere where the ratio of solenoid diameter to coil spacing is >50. Measuring these quantities with a low-power technology requires a sophisticated setup that goes beyond the sensitivity of state-of-the art approaches. The methodology is validated using laboratory measurements with three sets of solenoids (two ferrite-cored, one air-cored) and numerical simulations with COMSOL Multiphysics 5.2a, Stockholm, Sweden. The concept is then employed to investigate the channel characteristics for inductive through-the-head communication within the 3.155-3.195 MHz band. This selected part of the spectrum is in accordance with International Telecommunication Union Radio Regulation 5.116 for low-power wireless hearing aids. By applying a phantom solution, we demonstrate that human tissue layers are transparent for magnetic fields within these frequencies. However, the influence from the relative coil arrangement is evaluated in detail as it restricts the communication range significantly. The coupling results for off-the-shelf Sonion, Roskilde, Denmark, RF 02 AA 10 solenoids considering both lateral and axial displacements might be of special interest for a number of near-field applications.

Endoscopic ultrasound-guided injection of coils and cyanoacrylate glue for the treatment of gastric fundal varices with abnormal shunts: a series of case reports

Gastric varices are found in approximately 20% of patients with portal hypertension. Endoscopic procedures involving the injection of cyanoacrylate (CYA) have proven to be the therapies of choice for primary treatment of gastric varices and have resulted in higher hemostasis rates and lower recurrent bleeding rates compared with band ligation and sclerotherapy. Nevertheless, serious adverse events associated with CYA injection, including glue embolization, have been reported in numerous articles and have occasionally led to fatal adverse events. Gastric fundal varices with abnormal shunts are higher-risk than those without abnormal shunts, and their treatment is more challenging. Endoscopic ultrasound (EUS)-guided puncture is an important technique in the field of digestive endoscopy. EUS has advantages that include improved therapeutic targeting, enhanced variceal detection, the ability to confirm varix obliteration with Doppler examination, and the ability to perform accurate observations of gastric varices that are not affected by blood in the stomach. The coils currently used for intravascular embolization can be precisely delivered into a varix through fine-needle puncture under EUS guidance, and this technique has provided a new approach for varix obliteration. We herein describe two patients with severe gastric fundal varices who were treated with EUS-guided coil injection and CYA embolization.

Superior ophthalmic vein and ophthalmic artery in immediate evaluation after endovascular treatment of carotid-cavernous fistulas

Purpose

To validate superior ophthalmic vein (SOV) and ophthalmic artery (OA) usefulness in immediate evaluation of new endovascular approaches to treat carotid-cavernous fistulas (CCFs).

Material and methods

A retrospective review of 597 intracerebral malformation embolisations yielded 40 embolisations of CCF in the treatment of 18 patients. Two interventional radiologists performed detailed radiological angiographic assessments.

Results

Mean age at initial admission was 58.9 years (SD 18.5 years, range 24-85 years). Patients presented with: chemosis (50%), ocular bruit (50%), exophthalmos (61%), diminished visual acuity (77.8%), headache (16.7%), and intracerebral haemorrhage (5.55%), and 5.55% were asymptomatic. Unilateral fistulas (10-55.5%) showed more diversified venous drainage pattern than bilateral ones (8-44.4%). There were statistically significant differences in post-traumatic and spontaneous CCF regarding age (p = 0.036), type of fistula (p = 0.0008), and presence of pseudoaneurysm (p = 0.036). 77.8% of patients had increased ipsilateral SOV diameter. SOV enlargement was not associated with type of fistula, history of trauma, or degree of exophthalmos. Ipsilateral ophthalmic artery was visible in all patients on both pre- and postprocedural angiography on lateral projection. Pre- and post-procedural SOV diameter was significantly different. Internal carotid artery patency was 100%, while the overall final angiographic or clinical success was 85.7%. We had three cases of peri-procedural complications.

Conclusions

We reported changeable dynamics of SOV and OA after endovascular treatment of CCFs and proved the feasibility of coils and Onyx-18 in the treatment thereof.

Bronchoscopic treatment of emphysema: an update

Chronic obstructive pulmonary disease (COPD) is the major causes of disability and mortality. The efficacy of maximal medical treatment, although effective at the early stages of the disease, becomes limited when extensive alveolar destruction is the main cause of respiratory failure. At this stage of the disease more aggressive options, when feasible, should be considered. Lung transplantation and lung volume reduction surgery (LVRS) are currently available for a selected group of patients. Endoscopic alternatives to LVRS have progressively gained acceptance and are currently employed in patients with COPD. They promote lung deflation searching the same outcome as LVRS in terms of respiratory mechanics, ameliorating the distressing symptom of chronic dyspnea by decreasing the physiological dead space.

Endobronchial coil therapy in severe emphysema: 6-month outcomes from a Swiss National Registry

BACKGROUND

Endobronchial coils have been demonstrated in three randomized, controlled trials to improve quality of life, exercise tolerance, and lung function in patients with severe emphysema. This therapy is CE-marked and commercially available in Switzerland. Coil treated patients are followed in a post-market Swiss registry to collect safety and effectiveness data in routine clinical practice.

METHODS

The Swiss coil registry was initiated in October 2013. At the end of November 2016, an interim analysis of all 64 patients treated in five centers was performed to evaluate safety and effectiveness at six months post treatment.

RESULTS

patients had completed bilateral treatment with 6-month follow up at the time of data analysis. Patients had very severe, symptomatic emphysema and hyperinflation [38% male, mean age 66 years, BMI 24, FEV1 30% pred., residual volume (RV) 247% pred., 6-minute walking distance (6-MWD) 272 m, St. George Respiratory Questionnaire (SGRQ) 57 points]. Up to 6 months following treatment, seven serious adverse events (SAE) were reported in 6/29 patients. No device removals were necessary. At 6 months, responder rates [% achieving the minimal clinically important difference (MCID)] were as follows: RV (-0.35 L) 76%; FEV1 (+10%) 57%; SGRQ (-4 points) 87%; 6MWD (+26 m) 60%.

CONCLUSIONS

Endobronchial coil therapy performed in expert centers in Switzerland yields high 6-month responder rates across all relevant outcome.

Lung volume reduction with endobronchial coils for patients with emphysema

The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. The treatment is aimed at a large group of patients where lung volume reduction surgery and bronchoscopic lung volume reduction using endobronchial valves are no option, or alternatively, can be offered as a bridge to lung transplantation. The nitinol coil exhibits a shape memory effect and is biologically inert. The lung volume reduction coil procedure is performed in two separate treatment sessions, targeting one lobe per session, with the contralateral lobe being treated 4 to 8 weeks after the first session. In one treatment session, around 10 to 14 coils, thereby treating an entire lobe, are being placed. Selecting optimally treated, symptomatic chronic obstructive pulmonary disease (COPD) patients with emphysema and severe hyperinflation, while avoiding significant airway disease such as asthma, chronic bronchitis and bronchiectasis, is key to achieve treatment success. Three randomized clinical trials investigating lung volume reduction coil treatment have been published until now, reporting the results of 452 treated patients up to 12 months after coil treatment. Lung volume reduction coil treatment results in significant improvement of pulmonary function outcomes and quality of life in patients with severe hyperinflation. The most common complications of lung volume reduction coil treatment are: COPD exacerbations, pneumonia, Coil Associated Opacity and an increased risk of pneumothorax. The purpose of this article is to describe the coil technique and review the available literature regarding effect, safety and future perspectives of lung volume reduction with coils for emphysema patients.

Building and environmental factors that influence bacterial and fungal loading on air conditioning cooling coils

We investigated bacterial and fungal concentrations on cooling coils of commercial AC units and quantified associations between microbial loads and AC unit or building operational parameters. A field campaign was conducted to sample 25 AC units in the humid, subtropical climate of Southern CT, USA and 15 AC units in the hot-summer Mediterranean climate of Sacramento, CA, USA. Median concentrations (with interquartile range) of bacteria and fungi on the cooling coils were 1.2 × 107 (5.1 × 106 -3.9 × 107 ) cells/m2 and 7.6 × 105 (5.6 × 104 -4.4 × 106 ) spore equivalents (SE)/m2 , respectively. Concentrations varied among units with median unit concentrations ranging three orders of magnitude for bacteria and seven orders of magnitude for fungi. Controlled comparisons and multivariable regressions indicate that dominant factors associated with AC coil loading include the nominal efficiency of upstream filters (P = .008 for bacteria and P < .001 for fungi) and coil moisture, which was reflected in fungal loading differences between top and bottom halves of the AC coils in Southern CT (P = .05) and the dew points of the two climates considered (P = .04). Environmental and building characteristics explained 42% (P < .001) of bacterial concentration variability and 66% (P < .001) of fungal concentration variability among samples.

Role of Interventional Radiology in the Management of Peripheral Vascular Malformations: A Tertiary Care Center Experience

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs.

Purpose

The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach.

Materials and methods

A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications.

Results

Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up.

Conclusion

PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100%.