Endovascular Neuroradiology

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ISSN / EISSN : 23049359 / 26636964
Total articles ≅ 87
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S.P. Grigoruk
Endovascular Neuroradiology, Volume 31, pp 14-18; doi:10.26683/2304-9359-2020-1(31)-14-18

Objective – to determine the effectiveness of endovascular revascularization of the carotid pool (carotid stenting) in patients with combined atherosclerotic lesions of the cerebral and coronary arteries, which showed coronary artery bypass grafting (CABG). Materials and methods. 40 patients with combined atherosclerotic lesions of the cerebral and coronary arteries were included in the study. All patients for 14 days before CABG were stented carotid artery. The number of complications and the treatments results were determined. Survival functions were determined to evaluate long-term treatment outcomes over a 10-year follow-up period. Results. 32.5 % of patients had complications after carotid pool revascularization: angina pectoris – 12.5 %, acute myocardial infarction – 2.5 %, transient ischemic attack – 12.5 %, ischemic stroke – 2.5 %, arterial hypotension – 2.5 %. 98.2 % of patients observed positive results of treatment for neurological status. After revascularization of the coronary pool, 45 % of patients had complications: angina – 27.5 %, cardiac arrhythmia – 27.5 %, acute myocardial infarction – 2.5 %, transient ischemic attack – 7.5 %, ischemic stroke – 7.5 %. 83.5 % of patients received positive results of treatment. The 10-year survival rate after surgery was 19 % [34 %; 7 %]. Decrease in survival function was observed uniformly throughout the observation period: 3-year survival – 83 % [92 %; 67 %], 5-year survival – 56 % [70 %; 39 %].Conclusions. Positive results of treatment in patients with combined atherosclerotic lesions of the cerebral and coronary arteries, which performed stenting of the carotid arteries before CABG, are observed in 98.5 % of patients. Carotid artery stenting before CABG is an effective method of preventing cerebral complications in the early postoperative and distant periods. Long-term results of treatment are accompanied by low rates of 5-year and 10-year survival after revascularization of the carotid and coronary pools.
B.B. Kravchuk, R.G. Malyarchuk, O.Z. Paratsii, A.V. Yakushev
Endovascular Neuroradiology, Volume 31, pp 19-25; doi:10.26683/2304-9359-2020-1(31)-19-25

Objective – to determine the effect of radiofrequency ablation (RFA) on the quality of life (QOL) of patients with ventricular premature beats (VPB).Materials and methods. We included 53 cases of treatment of patients with monomorphic VPB. There were no obvious structural diseases of the heart in them. The age of patients ranged from 16 to 57 years, and the median age was 35.3 ± 12.4. Among patients 37 (69.8 %) were women. All patients underwent RFA aiming to remove the arrhythmogenic substrate of VPB. The indication for intervention was symptomatic VPB, refractory to drug treatment. All patients underwent QOL assessment using the SF-36 questionnaire prior to the procedure at 2, 6, and 12 months after it. QOL was also evaluated in 18 healthy subjects (group of comparison).Results. Assessment of QOL was performed according to 8 criteria (scales): physical activity (PA), vital activity (VA), pain (P), general health (GH), viability (V), social activity (SA), the role of emotional problems in life-limiting (EP), mental health (MH). We noted a significant increase in indicators on the scales that are responsible for the physical component of health for 2 months and continued to increase further to the data of the comparison group: FA (before RFA – 70,24 ± 26,10; in 2 months – 80,32 ± 22.02; in 6 months – 88.58 ± 24.84; in 12 months – 87.38 ± 17.07; GP – 88.32 ± 4.51), RF (before RFA – 47.43 ± 38.95; in 2 months – 70.11 ± 28.83; in 6 months – 71.28 ± 29.51; in 12 months – 69.17 ± 24.12; GP – 70.03 ± 16.34). B (before RFA – 68.84 ± 23.91; in 2 months – 67.12 ± 16.37; in 6 months – 69.83 ± 17.63; in 12 months – 69.03 ± 28.58; GP – 71.83 ± 7.35), PZ (before RFA – 61.88 ± 21.48; in 2 months – 66.05 ± 14.03; in 6 months – 68.59 ± 19.27; in 12 months – 70.23 ± 20.3; GP – 69.04 ± 7.48). Scales responsible for the mental component of health began to respond only after 6 months: HR (before RFA – 56.68 ± 34.46; in 2 months – 62.72 ± 17.54; in 6 months – 61.83 ± 20.15; in 12 months – 63.28 ± 18.08; GP – 61.34 ± 8.03), CA (before RFA – 67.31 ± 28.01; in 2 months – 71.37 ± 16.84; in 6 months – 72.54 ± 24.41; in 12 months – 75.54 ± 17.03; GP – 74.35 ± 8.59). PE (before RFA – 58.41 ± 34.08; 2 months – 66.73 ± 27.63; in 6 months – 67.70 ± 34.05; in 12 months – 68.36 ± 15.03; GP – 69.45 ± 18.07), PZ (before RFA – 59.03 ± 19.81, in 2 months – 64.18 ± 19.58; in 6 months – 61.45 ± 25.21; in 12 months – 61.73 ± 16.7; GP – 59.78 ± 5.01). In the period 2–12 months after surgical treatment, a statistically significant increase in FA and RF compared to the original condition was registered. For the remainder of the QOL components positive changes were recorded that had no statistically significant differences compared to the original condition.Conclusions. The QOL indicators that characterize physical health in patients with VPB prior to interventional treatment are significantly lower than those of virtually healthy individuals. In 2 months after successful RFA of the arrhythmogenic focus in patients with VPB, the QOL parameters significantly improved compared to the comparison group. Complete recovery of physical and mental health occurs between 6 and 12 months after the intervention of arrhythmia.
S.V. Vereshchagin, A.V. Abramenko, O.A. Khomyachuk, K.S. Rosнchina, O.S. Chernyak
Endovascular Neuroradiology, Volume 31, pp 68-74; doi:10.26683/2304-9359-2020-1(31)-68-74

A case of endovascular treatment of a patient with a large false aneurysm of the splenic artery resulting from arrosion of its wall into the cavity of a previously existing pancreatic pseudocyst is described. In addition to the rather rare occurrence of this pathology, a feature of this clinical case was the patient’s sharp tortuosity of the access vessels, including the iliac arteries, abdominal aorta, and the splenic artery. Thus, both the endovascular prosthetics of the affected splenic artery and its embolization according to the traditional method using standard angiographic catheters and Gianturco coils turned out to be technically impossible because of the inability to reach the lesion site, especially with access through the common femoral artery that typical for such interventions, which was used by us when performing diagnostic selective arteriography. The second stage was the embolization of the splenic artery by access through the left axillary artery by means of conducting of guiding catheter into the celiac trunk. Through the lumen of this catheter, we introduced a microcatheter, through which detachable microcoils (usually used in interventional neuroradiology) were introduced into the splenic artery proximal and distal to the aneurysm cavity. As a result, the affected area of ​​the splenic artery with aneurysm was completely turned off from the bloodstream and thrombosed, that allowed to avoid extremely risky open surgical intervention and eliminated the risk of rupture of the aneurysm. Medication support included hypotensive therapy to reduce the risk of rupture of the aneurysm (before and after surgery), analgesics for the relief of post-embolization pain, and antibiotics for the prevention of infectious complications associated with pancreatitis and the possible development of spleen infarction. Monitoring the effectiveness of the intervention in the postoperative period was carried out using ultrasound dopplerography.
M.V. Globa
Endovascular Neuroradiology, Volume 31, pp 56-67; doi:10.26683/2304-9359-2020-1(31)-56-67

The review summarizes available information regarding the method of Transcranial doppler sonography (TCD) usage to record microembolism in patients with carotid artery stenosis, search for information was carried out in literature 1997–2020 (PUBMED, MEDLINE).History overview of TCD with embolodetection implementation is presented, as well as ways of its technical and methodological improvement. Evidence-based studies of the method clinical relevance in atherosclerotic carotid stenoses and their surgical treatment are outlined. Observation results of the intraoperative cerebral embolization during carotid endarterectomy and carotid artery stenting are presented along with comparison of TCD-embolodetection data, neuroimaging and clinical outcomes. Individual centres and multicenter study ACES data on prognostic value of registration of embolic signals in asymptomatic carotid stenosis, risk assessment of vascular events in diffe-rent groups of patients and in varying degrees of stenosis of the vessel lumen was analyzed. The role of embolodetection in predicting repeated cerebrovascular disorders in symptomatic carotid stenosis and its importance for monitoring antiplatelet therapy is set out (multicenter study CARESS). The evidence of the reliability of TCD embolodetection as tool for verificarion of at-risk patients with carotid stenosis who may benefit ftom surgical treatment is presented.Recent advances in ultrasound and other imaging techniques for assessing unstable plague are outlined along with prospects for the use of TCD monitoting for cerebrovascular disorders forecasting.
D.V. Shchehlov, M.S. Gudym, O.E. Svyrydiuk, M.B. Vyval
Endovascular Neuroradiology, Volume 31, pp 34-41; doi:10.26683/2304-9359-2020-1(31)-34-41

Objective ‒ to evaluate peculiarities and results of microsurgical treatment of intracranial dural arteriovenous fistulas (DAVF).Materials and methods. A retrospective analysis of microsurgical treatment of 7 patients with DAVF (4 (57. 1%) women and 3 (42.9 %) men, average age ‒ 43.4 years), who were hospitalized and surgically treated at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» from 2016 to 2020, was made. DAVF was drained into the superior sugittal sinus in 4 (57.1 %) patients, transverse and sigmoid sinuses in 2 (28.6 %) cases, in the middle cranial fossa in 1 (14.3 %). According to the Cognard classification there were 3 (42.9 %) DAVFs belong to type IIb, 2 (28.6 %) ‒ to type IIa + b, 1 (14.3 %) DAVF ‒ to type II, 1 (14.3 %) DAVF ‒ to type IV.Results. In 3 (42.9 %) patients were primarily treated with endovascular method. Follow up studies revealed a recurrence of the disease, and microsurgical disconnection was performed. In 4 (57.1 %) cases, endovascular access to superficial DAVF was risky due to anatomical features, and microsurgery was preferred. In all patients, surgical treatment aimed the disconnecting of the shunt. In 1 (14.3 %) case of DAVF the transverse sinus was ligated. In all cases angiographic confirmation of the DAVFs exclusion was performed. In the postoperative period, there was no evidence of an increasing of clinical symptoms. All patients with pulsatile tinnitus and headache noted their regression after surgery.Conclusions. Considering the efficacy of modern endovascular techniques, microsurgery of DAVF has been indicated in cases where endovascular embolization has proven to be no-n-efficient or technically impossible. Among surgical methods of DAVF treatment, there are disconnection of the meningeal arteries directly at the site of the fistula, resection of the abnormal dura mater with feeding vessels, ligation and intersections of the injured venous sinus, skeletonization of the sinus with the feeding dural vessels. Treatment should be performed in all cases of DAVF with cortical venous drainage and progressive symptoms of the disease. The choice of optimal treatment should be made in a multidisciplinary manner, and all possible methods should be taken into consideration.
D.V. Shchehlov, O.E. Svyrydiuk, A.B. Naida, Yu.M. Samonenko, O.V. Slobodian
Endovascular Neuroradiology, Volume 31, pp 26-33; doi:10.26683/2304-9359-2020-1(31)-26-33

Objective – to study the prevalence, clinical manifestations, features of diagnostics and effectiveness of treatment of rare arteriovenous spinal fistulas.Materials and methods. From 2004 to 2019 in SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» were examined and treated 43 patients with spinal dural arteriovenous fistulas (DAVF) – type I arteriovenous malformations according to the Anson and Spetzler classification (1992). Only 2 (4.6 %) patients had an afferent effusion from the internal iliac artery with fistula at L5-S1 level. Magnetic resonance imaging and spinal selective subtraction angiography were used to diagnose arteriovenous fistulas. Liquid cyanoacrylate embolizant and transfemoral access were used for endovascular intervention, and posterior median access and single-level hemilaminectomy for microsurgical intervention.Results. Total DAVF exclusion from blood flow was achieved in both patients. One patient underwent microsurgical separation of DAVF, the other one was operated by a combination of endovascular and microsurgical techniques. Neurological improvement in the postoperative period was noted in both patients.Conclusions. Arteriovenous fistulas are diverse in clinical manifestations and radiographs. Verification of venous hypertensive myelopathy with the presence of pronounced perimedullary vessels on data of magnetic resonance imaging is the most specific feature of DAVF. If standard spinal angiography does not allow DAVF afferents to be verified it should be supplemented by selective catheterization of the internal iliac arteries, from where the arterial fistula can originate. The study of angioarchitectonics of arteriovenous fistula, according to angiography, makes it possible to choose surgical treatment to ensure effective and radical separation of arteriovenous fistula.
V.V. Moroz
Endovascular Neuroradiology, Volume 31, pp 42-55; doi:10.26683/2304-9359-2020-1(31)-42-55

Objective ‒ to determine the main x-ray anatomical characteristics of arterial aneurisms (AA) of bifurcation of basilar artery (BA) and predictors of hemorrhagic transformation, taking into account the main options for the course of the disease.Materials and methods. Total on examination and treatment in the vascular departments of Romodanov Neurosurgery Institute for the period from 1998 to 2019 there were 687 (100 %) patients with AA of vertebrobasilar basin. AA of bifurcation of BA was diagnosed in 210 (30.6 %) patients. The hemorrhagic type of the course of the disease, in the presence of AA of bifurcation of BA occurred in 138 (65.7 %) cases. Asymptomatic unbroken AA of bifurcations of BA were detected in 58 (27.6 %) patients. The pseudotumor type of disease was diagnosed in 12 (5.7 %), ischemic in 2 (0.9 %) patients. Results. The main variants of the clinical course of AA of bifurcation of BA are established. Given the X-ray and anatomical features, certain prevailing for a particular variant of the course of the disease, the most stable characteristics of AA of bifurcation of BA, including the size, shape, neck and the ratio of the height of the dome to the diameter of the neck of AA.Conclusions. According to the results of the study, the main variants of the clinical course of AA of bifurcation of BA were identified: hemorrhagic (65.7 %), asymptomatic (27.6 %), pseudotumor (5.7 %) and ischemic (0.9 %). Localization of AA in the area of ​​BA bifurcation is a rather formidable predictor of a possible hemorrhagic variant of the course of the disease (138 (65.7 %)) out of 210 patients). Based on the analysis of the results of the examination of patients with AA of bifurcation of BA with hemorrhagic disease, it should be considered that convincing factors (predictors) of a possible rupture of AA of bifurcation of BA are its sizes from 4 to 15 mm (81 %) in combination with complex (incorrect) form AA (76 %). With the size of AA of bifurcation of BA 3.0, according to the results of our study, is not a predictor of the hemorrhagic course of AA of bifurcation of BA, in the presence of a narrow neck of AA. In the presence of a small size of AA of bifurcation of BA (
D.V. Shchehlov, O.A. Pastushyn, O.E. Svyrydiuk
Endovascular Neuroradiology, Volume 31, pp 75-82; doi:10.26683/2304-9359-2020-1(31)-75-82

For the first time in Ukraine, Woven EndoBridge (WEB) (Microvention – Terumo) for the treatment of intracranial arterial aneurysms was applied at Scientific and Practical Centre of Endovascular Neuroradiology of NAMS of Ukraine on November 29, 2018. To the end of 2019 4 patients were treated with WEB. In all patients aneurysms were accidental findings, diagnosed by magnetic resonance imaging, and confirmed by angio-graphy. Men were 2 (50 %), women – 2 (50 %). The average age of patients was 49 years. All aneurysms were complex for endovascular treatment. In 3 (75 %) cases, the aneurysm was located on the anterior cerebral/anterior connective arteries, in 1 (25 %) case – on the middle cerebral artery. All patients received double disaggregated therapy at the standard dosage (75 mg of clopidogrel and 75 mg of acetylsalicylic acid) during 5 days before surgery in case of an additional intracranial stent implantation. The efficacy of dual disaggregation therapy was monitored by light transmission agrigometry. The size of the WEB depended on the angioarchitectonics of the aneurysm. All surgeries were performed in a routine manner, under general anesthesia. In all cases, the WEB was implanted successfully, there were no intra- and postoperative complications. The next day after surgery, double disaggregation therapy was canceled. All patients were discharged from the hospital in satisfactory condition, under the supervision of a neurologist at the place of residence. A control examination in the form of angiography after 6 months passed all patients. The efficacy of aneurysm occlusion using the WEB embolization device was evaluated on the WEB occlusion scale. Grade 0 and 0’ were achieved in 2 (50 %) patients, Grade 1 – 1 (25 %), Grade 2 – 1 (25 %).
K.Yu. Polkovnikova
Endovascular Neuroradiology, Volume 30, pp 31-37; doi:10.26683/2304-9359-2019-4(30)-31-37

Objective – to evaluate of diagnostic informativeness of сopeptin serum values in determining the risk of complications in patients with subarachnoid hemorrhage.Materials and methods. A prospective cohort study of 82 patients (40 men and 42 women) with spontaneous (non-traumatic) subarachnoid hemorrhage (SAH) from the age of 23 to 72 years (average age – (49,6 ±1,3) year) was conducted.Results. Complications were recorded in 31 (74.20 %) patients with a serum level of copeptin ≥ 0.605 ng/ml on the third day of the SAH, which was in 9.49 times higher (95 % CI 3.60–24.80, р ˂0.0001) than in patients with a serum level of copeptin < 0.605 ng/ml. When determining the cumulative risk of developing complications of SAH, the values ​​of positive and negative predictive values ​​of serum levels of copeptin on third day of SAH were 74.19 % and 92.20 % respectively, the accuracy of prediction (the sum of correctly classified observations) was 85.39 %.Conclusions. ROC-analysis suggests that the serum level of copeptin on third day of SAH ≥ 0.605 ng/ml is characterized by an optimal ratio of sensitivity and specificity in assessing the cumulative risk of developing such SAH complications as secondary ischemia combined with cerebral angiospasm.
Yu.V. Cherednichenko
Endovascular Neuroradiology, Volume 30, pp 68-78; doi:10.26683/2304-9359-2019-4(30)-68-78

Case of endovascular treatment of a patient with tandem left internal carotid artery (ICA) and middle cerebral artery (MCA), which was a complication of carotid endarterectomy, are presented. The rupture at the location of the suture in the bulb of the ICA during endovascular intervention required implantation of a graft-stent and subsequent removal of the hematoma in the neck soft tissues.A 51 year old man in the residual period of ischemic stroke in the left carotid basin with elements of sensory speech disorders, with subtotal stenosis in the bulb of the left ICA, stenosis 35 % in the bulb of the right ICA and severe hypoplasia of the A1-segment of the left anterior cerebral artery underwent left-side carotid endarterectomy. The next morning after surgery, 1 hour after awakening, a right-sided hemiparesis progressing to hemiplegia, total aphasia. The level of consciousness deteriorated to the sopor. A computer tomography was performed immediately. New ischemic lesions were not identified. Cerebral angiography revealed the occlusion from the mouth of the left ICA, occlusion in the M1-segment of the left MCA. Thrombospiration from MCA and ICA was performed with Sofia Plus distal approach catheter. The MCA was recanalized in one pass (mTICI 3), but the patency of the left ICA was not recovered. The anti-embolic device SpiderFX was introduced and opened in the C2-segment of the left ICA. Then, a slow inflation of the Submarine 5 × 20 mm balloon catheter was performed in the left ICA bulb. At a pressure of 4.0 atm, the balloon opened like an hourglass, indicating a rough rigid stenosis in the ICA bulb. At a pressure of 4.5 atm, the balloon fully opened. Immediately after balloon deflation, intense contrast extravasation is determined at the level of the ICA bulb. Inflation of the balloon at a pressure of 4 atm was performed again. Intubation of the trachea of ​​the patient was performed. Intravenous administration of 300 mg acetylsalicylic acid was initiated. The balloon catheter is deflated and withdrawn from vessels, the carotid stent Protégé 8–6×40 mm was implanted into the left ICA bulb and the left common carotid bifurcation segment. The bloodstream above the stent is not determined, but extravasation through the stent cells at the level of the former defect is determined. Stent graft Graftmaster 4×15 mm was implanted into the carotid stent at the level of the defect in the ICA. Stent graft was additionally opened in its lower part by a 5×20 mm balloon-catheter. Thrombaspiration from the left ICA was performed again. Patency of the ICA and intracranial arteries was totally restored – mTICI3, stenosis in the left ICA bulb was completely eliminated. The patient’s neurological status was restored to baseline. A large hematoma in the soft tissues of the neck to the left was determined. Only “old” ischemic foci in the left temporal lobe were determined on brain CT, a large hematoma laterally and anteriorly to the carotid artery was determined in the soft tissues of the left side of the neck on computer tomography. Ticagrelor was added to aspirin therapy. Hematoma was removed surgically. The postoperative period was unremarkable. The patient was discharged from the clinic in good condition with an level modified Rankin scale 1.In the presented case, the friendly work of different profiles specialists avoided the devastating consequences of such a relatively rare complication of carotid endarterectomy as cerebral arteries tandem thrombosis. The availability of graft-stents in access to interventional neuroradiologists is extremely important in such cases.
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