Endovascular Neuroradiology

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ISSN / EISSN : 2304-9359 / 2663-6964
Total articles ≅ 111
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D.V. Shchehlov, , I.V. Altman, N.V. Kiselyova, I.I. Kashkish
Endovascular Neuroradiology, Volume 34, pp 95-104; https://doi.org/10.26683/2304-9359-2020-4(34)-95-104

Abstract:
The objective – to presents the observation of combined treatment of a patient with arteriovenous malformation of the lower jaw.A man, 21 years old, was hospitalized in the Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine with complaints of bleeding from a tooth socket after an attempt to remove the 6th tooth (first painter) of the lower jaw on the left. According to the performed survey radiography of the lower jaw, an aneurysmal bone cyst was revealed in the body of the lower jaw on the left, corresponding to the localization of bleeding. According to cerebral angiography, an arteriovenous malformation of the lower jaw was revealed on the left, the afferent arteries of which were: the right facial artery (a branch of the right external carotid artery (ECA)), the left facial artery (a branch of the left ECA), the lower alveolar artery, the superior-posterior alveolar artery (branches of the maxillary artery ‒ the terminal branch of the left ECA) with drainage into a vein, which was located in the body of the lower jaw. In order to exclude the malformation from the bloodstream and prevent bleeding, a controlled embolization of the malformation was performed using non-spherical emboli – polyvinyl alcohol (PVA) particles from Cook, USA. Using a transfemoral approach, a guide catheter was inserted into the orifice of the ECA, then a Headway 27 microcatheter (Microvention, USA) was passed through it along a Traxes 14 guide wire (Microvention, USA), the afferent arteries of the malformation were selectively cathete-rized in turn, and embolization was performed after superselective angiography. The patient was discharged in a satisfactory condition. Two weeks after the operation, the bleeding resumed. The performed control cerebral angiography revealed a relapse of the malformation with a change in its angioarchitectonics ‒ the filling of the malformation in the late arterial and venous phases of cerebral blood flow was noted. Re-embolization was performed using PVA emboli (Cook), which was supplemented by transcutaneous puncture of the drainage vein in the mandible and its embolization with histoacryl (B. Braun, Germany) and lipiodol (Guerbet, France) in a 1 : 1 ratio. Results. As a result of using this technique, it was possible to turn off the malformation completely. For 6 months from the moment of surgery, no bleeding was noted, and subsequently the patient had a tooth removed without complications.Conclusions. The proposed method for treating arteriovenous malformation of the lower jaw, proposed in this case, showed the effectiveness of a combination of endovascular embolization in combination with transcutaneous embolization of the draining vein and can be successfully used to treat this pathology.
N.S. Turchina, T.м. Cherenko, V.A. Chernyak, L.V. Bondar
Endovascular Neuroradiology, Volume 34, pp 82-94; https://doi.org/10.26683/2304-9359-2020-4(34)-82-94

Abstract:
Objective ‒ to mark the quantity of herpes and flu infection detection of the none-stabil and stabil atherosclerotic (AS) plaques in patients with ischemic stroke (IS)/TIA and with the progressing AS and in the anamnesis after carotid endarterectomy.Materials and methods. 103 patients with IS/TIA after carotid endarterectomy were examined: 67 males 42‒82 years old (average age ‒ 66,1±1,4 years), 36 females 44‒81 years old (average age ‒ 63,0±1,3 years). Average age ‒ 65,1± 0,9 year. We examined the width of intima-media complex, presence of AS plaques, their constitution.Results. Among all viruses investigated with transfection and polymerase chain reaction in AS plaques and blood after carotid endarterectomy (HSV1,2, ЕВV, CMV, HHV6), the most prefer are with CMV and associated CMV + HSV1, CMV + HSV2, where patients, hwo have HHV6 and associated HSV1 + HHV6, HHV6 + HSV1 + HSV2.Conclusions. Presentation of CMV and associated CMV + HSV1, CMV + HSV2 increases the risk of development of the hypoechoic none-stabil AS plaques of internal carotid artery (ICA). Presentation of HHV6 and associated HSV1 + HHV6, HSV1 + HSV2 + HHV6 in AS plaques of ICA increases the relative risk of development of severe stenosis in the patients with symptomatic stenosis. The investigation confirms the necessary of periodical administration at exclusion of the stenosis of ICA.
Yu.V. Cherednychenko, A.Yu. Miroshnychenko, M.O. Zorin, L.A. Dzyak, O.S. Tsurkalenko
Endovascular Neuroradiology, Volume 34, pp 34-44; https://doi.org/10.26683/2304-9359-2020-4(34)-34-44

Abstract:
Objective ‒ to develop a technique for endovascular treatment of symptomatic ostial stenosis of the vertebral arteries, which allows to minimize risks of delayed stent breakage and restenosis. Materials and methods. This is analysis of prospectively collected data from patients presenting from 2016 to 2019 in the endovascular center of the Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. One hundred four stents were placed in 99 patients using the author’s complex method, which is based on our modification of Szabo technique. The principles of the method were developed based on a literature review and in vitro tests using 7 silicone models of the initial segments of the subclavian and vertebral arteries with different angles of divergence of the vertebral arteries (30, 45, 60, 90, 120, 135, 150°) and 9 balloon mounted drug-eluting stents with open-cell design Resolute (Medtronic).Results. There were no cases of displacement of the stent proximally or distally during implantation. In all cases, stents were implanted in the affected segment exactly and did not prolapse more than 1 mm beyond the ostium of the vertebral artery into the subclavian artery. There were no «clinical» ischemic complications in the early postoperative period. In 5 cases, isolated subclinical ischemic lessions in the carotid circulation were revealed during one-session stenting of ostial stenosis of the vertebral arteries and carotid stenting. In the posterior circulation, ischemic lessions on MRI in the early postoperative period were not detected in any observations.Conclusions. Developed complex stenting method based on our modification of Szabo technique allows us to achieve optimal long-term results of stenting of symptomatic ostial stenosis of the vertebral arteries.
S.O. Rykov, I.V. Shargorodska, Yu.V. Barinov
Endovascular Neuroradiology, Volume 34, pp 12-18; https://doi.org/10.26683/2304-9359-2020-4(34)-12-18

Abstract:
Objective ‒ to analyze the tactics of flattening in women with varying degrees of myopia and to assess the incidence of complications in the postpartum period and the birth of children with congenital refractive errors in this category of patients. Materials and methods. The conclusions about absence of a causal relationship between pregnancy, delivery and retinal detachment on an example of 442 patients with myopia a various degrees have been developing. Results. To modern requirements the estimation of the methods applied to inspection by pregnant women with myopia is resulted in quality of rendering of the specialized ophthalmologic and obstetric help to the population. The basic stages of conducting pregnancy, delivery and the postnatal period at women with myopia according to last scientific achievements in the field of ophthalmology and obstetrics are certain. It is shown, delivery patients with myopia an average and high degree are expedient for conducting through natural patrimonial ways on a background long epidural the anesthesia allowing medical to switch off an attempt and to prevent occurrence of ophthalmologic complications. Conclusions. It is noted an urgency of a problem and necessity of the further perfection of tactics of conducting pregnancy, delivery and the postnatal period at women with myopia. The tactics of pregnancy, childbirth and the postpartum period in women with myopia need to be improved. The coefficients of the cornea and sclera rigidity measurement have to be included in to the standard examination of pregnant women with myopia different degrees. It’s allows to identify possible risk factors for reducing the strength properties of the eye fibrous capsule in these patients. It helps to calculate the possible risks of progression of myopia, ruptures, rhegmatogenous retinal detachment during prenatal and postpartum periods. These techniques using in routine practice would reduce the number of postpartum infectious and inflammatory complications in both mothers and newborns, as well as the number of cases of hypoxic lesions of the central nervous system in the early neonatal period.
Yu.V. Cherednichenko, L.A. Dzyak, E.S. Tsurkalenko
Endovascular Neuroradiology, Volume 33, pp 29-38; https://doi.org/10.26683/2304-9359-2020-3(33)-29-38

Abstract:
Objective ‒ to evaluate the possibility of endovascular embolization using non-adhesion of liquid embolic agents as monotherapy for the treatment of cerebral arteriovenous malformations (AVM), its reliability and safety.Materials and methods. examination and gradual endovascular treatment of 64 patients (120 sessions) using non-adhesive liquid embolic agents. Patients were divided into two groups: with ruptured AVM (n = 43) and with unruptured (n = 21). In all cases of unruptured AVM, signs indicating an increased risk of rupture of the AVM were verified.Results. the average decrease in volume after embolization was 79.5 % (up to 50 % ‒ in 7 cases, 50‒75 % ‒ in 14, 75‒99 % ‒ in 29). Complete exclusion of AVM was achieved in 14 (22 %) patients. On average, 2–3 feeders were embolized on the AVM to achieve such results. It was found that the number of feeders was directly proportional to the number of sessions required. Malformations of small size (up to 3 cm) often managed to close in one session. Clinically significant deficiency (2 on the modified Rankin scale) after embolization was found in 2 (3 %) patients. The deficit regressed within 7 days. The angiographic frequency of complete obliteration of AVM at the end of all embolization procedures was 22 % (14 AVM).Conclusions. knowledge of the angioarchitectural characteristics of AVM, which are suitable for the treatment with liquid embolic agents, and their careful selection allow to achieve a high frequency of occlusion with a low frequency of complications. The use of superselective intranidal or perinidal positions of the catheter, slow controlled injections that protect the draining veins, the gradual embolization make the therapy safer.
A. Filioglo, J.E. Cohen, N. Simaan, A. Honig, R.R. Leker
Endovascular Neuroradiology, Volume 33, pp 78-82; https://doi.org/10.26683/2304-9359-2020-3(33)-78-82

Abstract:
Background and aims. Stent retriever based thrombectomy is the mainstay of treatment of acute ischemic stroke caused by large vessel occlusion. However, recanalization is sometimes not achieved even after multiple passes of the thrombectomy device. Whether revascularization becomes futile or harmful with an increasing number of passes as well as criteria for when to halt attempting recanalization remain unknown. The purpose of our work is to analyze literature data on this issue. Materials and methods. We performed a short review of the literature and summarized evidence on the impact of repeated stentriever attempts on outcome.Results. Despite some controversies, the published data indicate that up to 30 % of patients still reach favorable outcome even when ≥5 stentriever passes are performed. Probability of obtaining functional independence after multiple stentriever attempts is even higher in patients with lower baseline NIHSS score. Patients who achieve successful reperfusion after ≥5 passes have significantly higher rates of functional independence and significantly lower rates of hemorrhagic transformation compared with those who do not achieve reperfusion. Rate of target recanalization after ≥4 passes may reach 19 %. Number of passes alone is not an independent negative predictor of functional independence. The impact of multiple stentriever attempts on hemorrhagic transformation has not been well-established.Conclusions. Target vessel recanalization is an essential goal of mechanical thrombectomy, which should be pursued despite the additional number of passes and procedural time required. Number of stentriver attempts is not a game- changing factor in the decision to abort the procedure for technical futility. Treatment decisions need to be individualized for each patient based on operator’s experience and preferences, patient and clot-specific characteristics.
S.V. Chebanyuk, O.E. Svyrydyuk, O.F. Sydorenko, M.Yu. Mamonova
Endovascular Neuroradiology, Volume 33, pp 19-28; https://doi.org/10.26683/2304-9359-2020-3(33)-19-28

Abstract:
Objective ‒ to determine the features of the functioning of the circulatory system in patients with arteriovenous malformations (AVM) of the brain after endovascular operations with long-term observation.Materials and methods. 479 patients with cerebral AVM were examined and treated, of which 377 (78.7 %) were men and 102 (21.3 %) were women. The average age of patients was (27.5±3.5) years. Patients aged 18‒30 years predominated (75.4 %). A dynamic observation of 347 patients after endovascular treatment after 3, 6, 12 and 24 months and more was carried out. Patients underwent cerebral angiography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, echocardiography, Doppler cardiography, electrocardiography, duplex scanning of cerebral vessels.Results. The study shows the effect of arteriovenous shunting on cerebral and systemic hemodynamics in general. Switching off AVM from the cerebral blood flow improved cerebral hemodynamics already in the early postoperative period, the changes were more significant after 3‒6 months of observation and in some cases reached values ​​in healthy individuals 2 years after the operation. In 52.8 % of patients with AVM, systemic circulation disorders occurred due to an increase in heart rate, minute and stroke blood volumes, left ventricular ejection fraction with an increase in mechanical load on the heart, which led to changes in systolic contraction and diastolic relaxation of the left ventricle of the heart with the development of heart failure. Switching off the AVM from the cerebral blood flow did not cause significant changes in heart functions in the early postoperative period; positive changes occurred over a long period. Dynamic observation showed a positive restructuring of the functioning of the circulatory system in patients after endovascular exclusion of the malformation.Conclusions. Arteriovenous malformations are hemodynamically active systems that lead to hemodynamic-perfusion changes, both at the local and at the general hemodynamic level. The exclusion of the malformation from the bloodstream contributes to the regression of disorders of cerebral and intracardiac blood flow caused by the anatomical and functional characteristics of the malformation itself and its clinical course.
E.G. Pedachenko, V.V. Moroz, V.A. Yatsyk, U.I. Malyar, , D.M. Egorova
Endovascular Neuroradiology, Volume 33, pp 83-93; https://doi.org/10.26683/2304-9359-2020-3(33)-83-93

Abstract:
Stroke is a global medical and socio-economic problem and a great demand for alternative therapies, the leading one being stem cell (SC) therapy. Pathogenetic processes in ischemic stroke (II) trigger the mechanisms of necrotic and apoptotic death of neurons with the formation of the central infarct zone («core of ischemia») and the ischemic «penumbra» zone; the severity and reversibility of the injury directly depends on the duration of ischemia. In parallel with pathogenetic processes, endogenous neurogenesis occurs – the proliferation of neurogenic stem and progenitor cells (NSC/NPC) and their migration into the ischemic focus; however, most NSCs and newly formed neurons undergo apoptosis and recovery of lost functions does not occur. Significant efforts are being made to find ways to control neurogenesis, in particular through the transplantation of exogenous SCs. The main factors preventing the use of SCs in humans are moral, ethical, religious and legal aspects related to the source and method of obtaining cells, as well as possible immunocompromised complications due to incompatibility of donor cells with the recipient of the main histocompatibility complex antigens. The safest is the use of autologous SCs (the patient’s own cells), as it does not require the use of immunosuppressive protocols. Due to the relative safety and ease of production, the most common are multipotent mesenchymal stem cells (MSCs), namely MSCs of the bone marrow (BM). Numerous preclinical studies in experimental animals with modeled II, as well as clinical trials conducted over the past 15 years, have shown the safety and feasibility of transplantation of autologous MSCs in patients with severe neurological deficits after II. Two different approaches to the use of MSCs are discussed: neuroprotection in the acute phase and neurorestoration in the chronic phase II. Proposals are currently being developed for phase II/III clinical trials in acute and chronic stroke using BM MSCs, the results of which will form the basis for certified standardized II treatment protocols.
L.V. Havrylova
Endovascular Neuroradiology, Volume 33, pp 56-65; https://doi.org/10.26683/2304-9359-2020-3(33)-56-65

Abstract:
Objective ‒ to maintain the adequate sedation and analgesia without respiratory depression in children up to 4 years old with spinal cord pathology in early postoperative period (first 3 days) in inpatient department; to decrease digestive system motor function depression; to exclude aspiration possibility; to start early children’s natural feeding in postoperative period.Materials and methods. From October 2019 to January 2020 dexmedetomidine sedation was performed by the prolonged infusion administration to 10 children (6 children aged 6 month to 1 year and 4 children up to 4 years) with spinal cord and vertebral pathology (spina bifida, meningomyelocele, myelocele, teratoma, lipoma of lumbar spine) in early postoperative period at intensive observation ward of neurosurgical department. During the first three days after the surgery and dexmedetomidine prescription the vital functions monitoring was being performed for 24 hours. Arterial blood pressure, heart rate, blood saturation have been scheduled by one of the parents. The immediate access to oxygen and parent’s permission for using this sedation method were the obligatory requirements.Results. The appropriate sedation target was achieved after the dexmedetomidine prescription for the children with the spinal cord and vertebral pathology in early postoperative period at intensive observation ward of neurosurgical department; the dosage of opioid analgesics was successfully decreased by 50 %. The respiratory depression was not observed. The blood pressure and bradycardia were not haemodynamically significant. Swallowing reflex was saved, which led to early physiological nutrition and excluded aspiration risk. The following transfer of patients after the surgery to the neurosurgical department bypassing ICU reduced the financial expenditure of the hospital.Conclusions. Dexmedetomidine provides with the adequate sedation in early postoperative period and can be recommended for the usage in children with the spinal cord and vertebral pathology as the safest medication due to minimal cardio-respiratory complications during moderately prolonged prescribed period.
Endovascular Neuroradiology, Volume 33, pp 39-55; https://doi.org/10.26683/2304-9359-2020-3(33)-39-55

Abstract:
Objective – to improve the selection criteria and the algorithm for examining patients with chro-nic pelvic pain syndrome caused by varicose pelvis veins. Optimize the technique of embolization of ovarian veins and veins of the pelvic venous plexus, to improve the results of endovascular treatment and prevent possible complications that may arise during the embolization procedure.Materials and methods. The analysis of 24 sources of scientific and medical literature on the problem of etiology, pathogenesis, diagnostic and endovascular treatment of chronic pelvic pain syndrome in women by embolization of ovarian veins and veins of the pelvic venous plexus. The authors present their own results of endovascular treatment of 31 patients with varicose veins of the small pelvis and ovarian veins.Results. The improved patient selection criteria based on careful history taking, preoperative confirmation of ovarian and pelvic varicose veins. The technique of phlebographic examination, embolization of ovarian veins and veins of the pelvic venous plexus was optimized. The causes of complications that arise during the embolization procedure have been analyzed. Practical recommendations for endovascular surgeons are given for the prevention of such complications in the future.Conclusions. The failure of the ovarian and pelvic veins underlies the etiology of pelvis veins varicose. Pain syndrome against the background of pelvis veins varicose is the main reason for referring to gynecologists in 10–30 % of cases. Selective phlebography of the ovarian and pelvic veins has become the gold standard in the diagnosis of venous pelvic insufficiency, since only this technique is most likely to show the connection between the incompetent ovarian and internal iliac veins. Conservative therapy of pelvic congestion syndrome often turns out to be ineffective, and surgical approaches do not exclude organ loss. Endovascular surgery showed a disappearing or decrease in the clinical manifestations of chronic pelvic pain syndrome by up to 94 %, while maintaining a positive treatment result for up to 12–36 months. The main complication during embolization is the migration of the coils to the right heart and pulmonary artery. Careful adherence to the embolization technique, the correct selection of the length and diameter of the coil can minimize the occurrence of embolic complications and improve the results of treatment of chronic pelvic pain syndrome.
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