Abstract:

Article presents a retrospective analysis of using the modified way experience in removing the occlusive substrate from cerebral vessels in the ischemic stroke acute phase after failed standard thrombectomy.

Aim: to study the efficacy and advantages of thrombectomy technique from intracranial arteries in patients with acute ischemic stroke combining a stent-retriever with reperfusion catheter in comparison with the standard stent retriever thromboextraction.

Methods: we analyzed 54 hospital charts of patients who had underwent endovascular recanalization of intracranial large vessel occlusion in acute ischemic stroke. Patients were divided into two equal groups, depending on thrombus removal method. Standard stent-retriever thrombectomy with a balloon guide-catheter was performed as the first stage in both groups. In 27 cases (1st group), after standard stent-retriever technique failed, we carried out combination of retriever extraction with distal aspiration and a guiding balloon-catheter. If we couldn’t safely insert stent-retriever into catheter of distal approach (during thrombectomy), we switched to vacuum aspiration from guiding balloon-catheter (vacuum-blocked) and removed stent-retriever, microcatheter and distal approach catheter simultaneously without reducing tension. In 27 patients (2nd group) after standard thrombectomy failed we repeated this technique several times.

Results: embolic complications relative risk was 2,249, 95% CI (1,126 - 4,492) and reperfusion mTICI 3 100% versus 74,07% rate was higher in the first group, in comparison with the second group. Other complications and hospital outcomes of disease did not differ between groups.

Conclusion: a stent retriever combined with distal aspiration and a simultaneous transition to vacuum-blocked extraction using after an unsuccessful standard thrombectomy increases the efficiency of complete reperfusion by 25%. Its use is 1,8 times safer than standard thrombectomy in terms of embolic complications.

Abstract:

Pancreatic cancer (PC) is one of the most aggressive malignant neoplasms, results of treatment of which remain extremely unsatisfactory, in view of the low (20%) possibility of tumor resectability A relatively new method of treatment of pancreatic cancer, which showed in practice an increase in tumor resectability in patients with borderline resectable forms of the disease and an increase ir survival mediana of inoperable patients is transartorial chemoembolization (TACE).of pancreatic arteries.

Authors first used transradial vascular access for TACE of a malignant pancreatic tumor.

As the first stage of the intervention - performed redistribution embolization of the right gastroomental artery distally to branches feeding the tumor, with two pushable coils Azur (Terumo) sized 4x60 mm and 5x60 mm in order to prevent embolization of non-target vessels and achieve total embolization of the tumor.

The second stage - performed chemoembolization with lipiodol - 5 ml and gemcitabine - 1000 mg, as a result - accumulation of chemotherapy in the head of the pancreas.

The duration of the procedure and the radiation dose in the patient were 52 minutes, respectively and 0.57 mSv and were comparable to those for similar interventions through transfemoral access. At the same time, all the main advantages of access through the radial artery remained, including: a higher level of psychological and functional comfort for the patient, its early activation and a minimal risk of vascular complications. The patient's discharge was made on the 10th day after the intervention. 

References

1.    Kubyshkin V.A., Vishnevskiy V.A. Rak podzheludochnoi zhelezy [Pancreatic cancer]. Moscow. 2003: 375 [In Russ].

2.     Nitecki S.S., Sarr M.G., Colby T.V. et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann. of Surg. 1995; 221(1):59-66

3.     Ishikawa O., Ohigashi H., Imaoka S. et al. Is the longterm survival rate improved by preoperative irradiation prior to Whipple’s procedure for adenocarcinoma of the pancreatic head? Arch. Surg. 1994; 129(10):1075-1080.

4.     Pavlovskiy A.V. Maslyanaya khimioembolizatsiya arteriy podzheludochnoi zhelezy pri mestnorasprostranennom rake. [Oily chemoembolization of pancreatic arteries in patients with locally advanced cancer]. Prakticheskaya onkologiya. 2004; 5(2):108-114 [In Russ].

5.     A.A., Tarazov P.G., Ivanova A.A., Alejnikova O.V. Diagnostika I lechenie toksicheskih oslozhnenij regionarnoj himioterapii, provodimoj cherez chreskozhno implantiruemye sistemy. [Diagnostics and treatment of toxic complications of regional chemotherapy through port-system] Diagnosticheskaya i intervencionnaya radiologiya. 2007; 1 (3): 46-51. [In Russ].

6.     Chandrasekar B., Doucet S., Bilodeau L. et al. Complications of cardiac catheterization in the current era: a single-center experience. Catheter Cardiovasc. Interv. 2001; 52(3):289-295.

7.     Sherev D.A., Shaw R.E., Brent B.N. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005; 65(2): 196-202.

8.     Tavris D.R., Gallauresi B.A., Lin B. et al. Risk of local adverse events following cardiac catheterisation by hemostasis device use and gender. J. Invasive Cardiol. 2004; 16(9):459-464.

9.     Mclvor J., Rhymer J.C. 245 transaxillary arteriograms in arteriopathic patients: success rate and complications. Gin. Radiol. 1992; 45: 390-394.

10.   Jolly S.S., Yusuf S., Cairns J. et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775):1409-1420.

11.   Kanei Y, Kwan T.,  NakraN.C. et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011.

12.   Caputo R.P., Tremmel J.A., Rao S. et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc. Interv. 2011.

Abstract:

Traumatic lesions of peripheral arteries which lead to pseudoaneurysm formation is the rare pathology Originally surgical treatment was the main method of pseudoaneurysms' treatment. However, now endovascular procedures are preferable as a method such patients' treatment. The case of successful endovascular treatment of posttraumatic pseudoaneurysm of subclavian artery with stent-graft implantation is shown This clinical case report demonstrates main advantages of endovascular method of such location pseudoaneurysms treatment.

Abstract:

We present case report of patient, with recurrent pulmonary bleeding of malignant genesis and ineffective previous endoscopic hemostasis. During embolization of bronchial artery, to stop massive life-threatening pulmonary bleeding, transradial approach was used for the first time. Full bleeding control was reached after embolization of right bronchial artery with use of microspheres through microcatheter 2,8 Fr. During hospital stage, recurrence of bleeding was not notices; patient discharged on the 7th day in satisfactory condition.

Duration of procedure and radiation exposure at this patient were comparable with same parameters in case of transfemoral approach. Main advantages of this vascular access are increased comfort of the patient after the procedure and the possibility of early activization. Besides, use of transradial vascular approach provides decreased frequency of complications, that is very important among patients with signs of respiratory insufficiency, because of the inability of these patients to stay in bed within a day. 

References 

1.    Cowling M.G., Belli A.M. A potential pitfall in bronchial artery embolization. Clin. Radiol. 1995; 50: 105-107.

2.    Haponik E.F., Fein A., Chin R. Managing life-threatening hemoptysis: has anything really changed? Chest. 2000; 118: 1431-1435.

3.    Hirshberg B., Biran I., Glazer M. et al. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest. 1997; 112: 440-444.

4.    Saluja S., Henderson K.J., White R.I. Embolotherapy in the bronchial and pulmonary circulations. Radiol. Clin. North Am. 2000; 38: 425-448.

5.    Chandrasekar B., Doucet S., Bilodeau L. et al. Complications of cardiac catheterization in the current era: a single-center experience. Catheter Cardiovasc. Interv. 2001; 52(3): 289-295.

6.    Sherev D.A., Shaw R.E., Brent B.N. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005; 65(2): 196-202.

7.    Tavris D.R., Gallauresi B.A., Lin B. et al. Risk of local adverse events following cardiac catheterisation by hemostasis device use and gender. J. Invasive Cardiol. 2004; 16(9): 459-464.

8.    Mc. Ivor J., Rhymer J.C. 245 transaxillary arteriograms in arteriopathic patients: success rate and complications. Gin. Radiol. 1992; 45: 390-394.

9.    Jolly S.S., Yusuf S., Cairns J. et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775): 1409-1420.

10.  Kanei Y, Kwan T., Nakra N.C. et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011.

11.  Caputo R.P., Tremmel J.A., Rao S. et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc. Interv. 2011.

Article exists only in Russian.

Abstract:

Treatment of massive hemoptysis represents a major and important medical problem in surgery. Development of endovascular surgery allows to introduce principle new methods of minimally invasive treatment of this pathology Current review represents information about bronchial artery anatomy, pathologic features of the bronchial artery, material used during embolization procedure and possible complications of treatment.

Abstract:

We have analyzed long-term results of different revascularization strategies in 171 patients with multivessel coronary artery defeat. Duration of follow up observation ranged from 12 to 18 months. Complete revascularization of the myocardium was performed in 63 pts, culprit vessel revascularization - in 86 and incomplete revascularization - in 22 patients. All patients undervwent SYNTAX scoring analysis to find out possible risks of transcutaneus coronary interventions. Survival rate, incidence of myocardial infarction, repeat myocardial revascularization procedures and major adverse cardiac events were comparable among the patients with low and intermediate SYNTAX Score. Among the patients with high SYNTAX Score the incidence of myocardial infarction (8,82%, р = 0,002), repeat PCI procedure (32,35%, р = 0,001) and major adverse cardiac events (32,35%, р = 0,002) was reliably higher compared to patients with low and intermediate SYNTAX Score. The mpact of the SYNTAX Score rate on the long-term results in the different revascularization strategy groups was also analyzed. In the 1st group the incidence of major adverse cardiac events among the patients was comparable. In the 2nd group patients with the high SYNTAX Score rate had reliably higher rate of major adverse cardiac events (43,75%, р = 0,002). The rate of major adverse cardiac events were higher in the 3rd group of patients with the high SYNTAX Score rate compared in patients with low and intermediate SYNTAX Score rate, but this difference didn't reach statistically reliable difference. Use of the strategy of culprit vessel revascularization in the patients with high SYNTAX Score rate, leads to increased rate of major adverse cardiac events and repeat PCI procedures in the long-term follow up period.

References 

1.    Silber S. et al. Guidelines for percutaneous        coronary interventions. Eur. Heart. J.2005; 26: 804-847.

2.    Bourassa M.G. et al. Strategy of complete revascularization in patients with multivessel coronary artery disease (a report from the 1985-1986 NHLBI PTCA Registry).

3.    Am. J. Cardiol. 1992; 70: 174. Bourassa M.G. et al. Long-term outcome of 5 patients with incomplete vs complete revascularization after multivessel PTCA (a report from NHLBI PTCA Registry). Eur. Heart. J. 1998; 19: 103-111.

4.    Hannan E.L. et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation. 2006; 113; 2406-2412.

5.    Hannan E.L. et al. Incomplete revascularization in the era of drug-eluting stents. Impact on adverse outcomes. J. Am. Coll. Cardiol. Intv. 2009; 2: 17-25.

6.    Ijsselmuiden A.J.J. et al. Complete versus culprit vessel percutaneous coronary intervention in multivessel disease. A randomized comparison. Am. Heart. J.2004; 148: 467-474.

7.    Martuscelli E. et al. Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded. Data from the CABRI trial. Eur. J. of Card.Thorac. Surg. 2008; 33: 4-8.

8.    Van den Brand M.J.B.M. et al. The effect of completeness of revascularization on event-free survival at one year in the arts trial. J. Am. Col. Cardiol. 2002; 39; 559-564.

9.    Беленков Ю.Н., Акчурин Р.С., Савченко А.П. и др. Результаты коронарного стентирования и хирургического лечения у больных ИБС с многососудистым поражением коронарного русла. Кардиология. 2002; 5: 42-45.

10.  Ong A.T.L., Serruys P.W. Coronary artery bypass graft surgery versus percutaneous coronaryintervention. Circulation. 2006; 114: 249-255.

11.  Patil C.V. et al. Multivessel coronary artery disease. Current revascularization strategies. Eur. Heart. J. 2001; 22: 1183-1197.

12.  Buda A.J. et al. Long-term results following coronary bypass operation. Importance of preoperative factors and complete revascularization. J. Thorac. Cardiovasc. Surg. 1981; 82: 383-290.

13.  Rodriguez A.E. et al. Revascularization strategies of coronary multiple vessel disease in drug eluting stent era. One year follow-up results of ERACI III trial. Eurointervention. 2006; 2: 53-60.

14.  Rodriguez A.E. et al. Late loss of early benefit from drug-eluting stents when compared with bare-metal stents and coronary artery bypass surgery. 3 years follow-up of the ERACI III registry. Eur. Heart. J. 2007; 28: 2118-2125.

15.  Serruys P.W. et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent. Insights from the Arteкial Revascularization Therapies Study Fart II (ARTS II). Eur. Heart. J. 2007; 28 (4): 433-442.

16.  Serruys P.W. et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N. Engl. J. Med. 2009; 360: 961-972.

17.  Serruys P.W. Sirolimus-eluting stents for the treatment of patients with multivessel de novocoronary artery lesions. EuroInterv. Arterial, Revascularis. Therap. Study PartII. 2005; 2: 147-156.

18.  Serruys P.W. et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009; 5 (1): 50-56.

Abstract:

Recently one can see higher incidence rate of fatty liver. The purpose of our study was to examine the abilities of raiodiagnostics (computed tomography and bolus contrast-enhanced CT angiography) in patients with different stages of non-alcoholic hepatic steatosis. Seventy four patients with morphologically verified diagnosis of non-alcoholic hepatic steatosis were included into the study. Hepatic parenchyma density was assessed quantitatively, as well as blood flow parameters at time-dencity curve in stages 1 (initial), 2 (moderate), and 3 (severe) of the disease. It was shown that hepatic time-dencity curve in patients with fatty liver was lower than splenic one. Thus, computed tomography and CT angiography are highly informative methods in diagnostics of hepatic steatosis, defying not only presence of the disease, but differentiating its stage and optimizing the therapeutic strategy.

References 

1.    Буеверов А.О. Некоторые патогенетические и клинические вопросы неалкогольного стеатогепатита. В кн. Клинические перспективы гастроэнтерологии, гепато-логии А.О. Буеверова, М.В. Маевской. 2003; 3: 2-7.

2.    Северов М.В. Неалкогольная жировая болезнь печени. В кн. Практическая гепа-тология под ред. акад. Н.А. Мухина. 2004; 145-149.

3.    Подымова С.Д. Болезни печени. Руководство для врачей. 2-е изд., перераб. и доп. М.: Медицина. 1993; 267-278.

4.    LudvigJ., Viggiano T.R., McGill D.B., Oh B.J. Nonalcoholic   steatohepatitis.   May   Clinic experiences with a hitherto unnamed disease. Мayo Clin. Proc. 1980; 55: 434-438.

5.    Ивашкин И.Т. Неалкогольный стеатогепатит. Российский медицинский журнал. 2000; 2:41-46.

6.    Логинов А.С., Аруин Л.И., Шепелева С.Д., Ткачев В.Д. Пункционная биопсия в диагностике хронических заболеваний печени.Тер. арх. 1996; 68 (2): 5-8.

7.    Логинов А.С., Аруин Л.И. Возможности и ограничения морфологической диагностики заболеваний печени.  Тер. арх. 1980; 2:3-8.

8.    Joe D. Diagnosis of fatty liver disease: is biopsy necessary? D. Joy, V.R. Thava, B.B. Scott. Eur. J.   Gastroenterol. Hepatol.  2003;   15   (5):         13.539-543.

9.    Кармазановский Г.Г., Вилявин М.Ю., Никитаев Н.С. Компьютерная томография печени  и желчных путей.  М.:   «ПАГАНЕЛЬ-БУК». 1997; 357.

10.  Мизандари М., Мтварадзе А., Урушадзе О. ,Маисая К., Тодуа Ф. Комплексная лучевая  диагностика диффузной патологии печени.   Медицинская   визуализация.   2002;   1:60-66.

11.  Габуния Р.И., Колесникова Е.К. Компьютерная томография в клинической диагностике. Руководство. М.: Медицина.   1995;234.

12.  Китаев В.М., Белова И.Б., Китаев СВ. Компьютерная томография при заболеваниях печени. М. 2006; 110-115.

13.  Лучевая диагностика заболеваний печени (МРТ, КТ, УЗИ, ОФЭКТ и ПЭТ) под ред. проф. Г.Е. Труфанова. М.: Изд. Группа «ГЭОТАР-Медиа». 2007; 193.

14.  Berland L.L. Slip-ring and conventional dynamic hepatic CT: contrast material and timing consideration. Radiology. 1995; 195: 1-8.

15.  Яковенко Э.П., Григорьев П.Я., Агафонова Н.А. и др. Метаболические заболевания печени: проблемы терапии. Фарматека. 2003; 10: 47-53.

16.  Петухов В.А., Каралкин А.В., Ибрагимов Т.И. и др. Нарушение функции печени и дисбиоз при жировом гепатозе и липидном дистресс-синдроме и их лечение препаратом Дюфалак (лактулоза). Российский гастроэнтерологический журнал. 2001; 2: 93-102.

Abstract:

The article is devoted to one of the most modern methods of treatment of benign prostatic hyperplasia (BPH) - endovascular prostatic artery embolization (PAE). This kind of intervention is performed, usually, with approach through the common femoral artery Transradial vascular approach has many advantages over the femoral approach, but its use in this type of intervention is currently limited.

Aim: was to conduct a comparative analysis of the use of transradial and transfemoral vascular approach when performing PAE.

Materials and methods: in a group of transradial approach included 24 patients, and in the femoral approach group - 23 patients

Results: success rate of the procedure and the frequency of complications of vascular approach were comparable between groups. The total duration of the procedure, the time spent on catheterization of internal iliac and prostatic arteries, radiation exposure dose were significantly lower in the group of transradial approach. Using the transradial approach is associated with a significant reduction in the incidence and severity of the discomfort associated with the procedure.

References

1.     Lee C., Kozlowski J.M., Grayhack J.T. Intrinsic and extrinsic factors controlling benigh prostatic growth. Prostate. 1997; 31(2):131-138.

2.     American Urological Association: Guideline on the Management of Benigh Prostatic Hyperplasia (BPH). Revised 2010.

3.     Appleton D.S., Sibley G.N., Doyle P.T. Internal iliac artery embolisation for the control of severe bladder and prostate haemorrhage. Br. J. Urol. 1988;61(1):45-47.

4.     Michel F., Dubruille T., Cercueil J.P. et al. Arterial embolization for massive hematuria following transurethral prostatectomy. J. Urol. 2002; 168(6):2550-2551.

5.     Rastinehad A.R., Caplin D.M., Ost M.C. et al. Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology. 2008;71(2):181- 184.

6.     DeMeritt J.S., Elmasri F.F., Esposito M.P. et al. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J. Vasc. Interv. Radiol. 2000;11(6):767-770.

7.     Carnevale F.C., Antunes A.A., da Motta Leal Filho J.M. et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc. Intervent. Radiol. 2010;33(2): 355-361.

8.     Worthington-Kirsch R.L., Andrews R.T., Siskin G.P. et al. Uterine fibroid embolization: technical aspects. Tech. Vasc. Interv. Radiol. 2002;5:17-34.

9.     Carnevale F.C., da Motta-Leal-Filho J.M., Antunes A.A. et al. Quality of life and symptoms relief support prostatic artery embolization for patients with acute urinary retention due to benign prostatic hyperplasia. J. Vasc. Interv. Radiol. 2012;24:535-542.

10.   Bilhim T., Pisco J., Rio Tinto H. et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc. Intervent. Radiol. 2013;36(2):403-411.

11.   Mclvor J., Rhymer J.C. 245 transaxillary arteriograms in arteriopathic patients: success rate and complications. Clin. Radiol. 1992;45(6):390-394.

12.   Jolly S.S., Yusuf S., Cairns J. et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775):1409-1420.

13.   Tavris D.R., Gallauresi B.A., Lin B. et al. Risk of local adverse events following cardiac catheterisation by hemostasis device use and gender. J. Invasive Cardiol. 2004; 16(9):459-464.

14.   Kanei Y, Kwan T., Nakra N.C. et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011;78(6):840-846.

15.   Caputo R.P, Tremmel J.A., Rao S. et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc. Interv. 2011;78(6):823-839.

16.   Sherev D.A., Shaw R.E., Brent B.N. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005;65(2):196-202.