Endovascular Neuroradiology

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ISSN / EISSN : 2304-9359 / 2663-6964
Total articles ≅ 102
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Yu.V. Cherednichenko, L.A. Dzyak, E.S. Tsurkalenko
Endovascular Neuroradiology, Volume 33, pp 29-38; doi:10.26683/2304-9359-2020-3(33)-29-38

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; doi:10.26683/2304-9359-2020-3(33)-78-82

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; doi:10.26683/2304-9359-2020-3(33)-19-28

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, L.D. Liubich , D.M. Egorova
Endovascular Neuroradiology, Volume 33, pp 83-93; doi:10.26683/2304-9359-2020-3(33)-83-93

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; doi:10.26683/2304-9359-2020-3(33)-56-65

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; doi:10.26683/2304-9359-2020-3(33)-39-55

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.
A.V. Byndiu, M.Yu. Orlov, M.V. Yelieinyk, S.O. Lytvak
Endovascular Neuroradiology, Volume 33, pp 66-77; doi:10.26683/2304-9359-2020-3(33)-66-77

Objective ‒ to analyze the effectiveness of intraoperative contact Doppler, repositioning the clip on the aneurysm and pilot clipping of the cervical aneurysm as the main methods of prevention of inadequate clipping of the cervical aneurysm in patients with intraoperative rupture of aneurysms. Materials and methods. Due to the use of intraoperative contact ultrasound Doppler control it was possible to avoid inadequate clipping of cerebral aneurysms in 16 cases, of which in 12 (75.00 %) cases ‒ incomplete clipping of cerebral aneurysms, in 3 (18.75 %) cases ‒ compression of the aneurysm’s artery-carrier, in 1 (6.25 %) case ‒ slipping of the clip with cerebral aneurysm. Perioperative examination of patients, in addition to intraoperative contact ultrasound Doppler control of radical clipping cerebral aneurysms, included clinical and neurological examination, computed tomography of the brain, cerebral angiography, ultrasound duplex scanning of the main vessels of the head and neck. In the analysis of observations of inadequate clipping of cerebral aneurysms (according to contact intraoperative Doppler), the following parameters were considered: size, location of cerebral aneurysm, timing of surgery after subarachnoid hemorrhage, anatomical forms of intracranial hemorrhage. Results. The purpose of the operations was to devascularize saccular aneurysm to prevent its re-rupture, to reduce the mass effect caused by intracerebral hematoma; reduction of intracranial pressure, rehabilitation of basal cisterns of the brain., But in the postoperative period there was a tendency to worsen the results of treatment, the appearance of focal neurological symptoms on the background of cerebral vasospasm with subsequent development of ischemic complications in patients with III‒V degree according to the Hunt‒Hess Scale on admission, in patients with prolonged temporary clipping of the cerebral aneurysm-artery and prolonged mechanical manipulation of the cerebral arteries and cerebral aneurysm. It should be noted that all patients in our sample, with complicated clipping of cerebral saccular aneurysms, had an intraoperative rupture of the MA, which complicated the process of clipping the saccular aneurysm and prolonged the time of surgery and was one of the inducers of postoperative aggravating consequences. There was a tendency to worsen the results of treatment in patients with III–IV degree according to the Hunt‒Hess Scale. Thus, patients with 1 point according to the Glasgow Outcome Scale, there were 2 patients who had II and III degrees according to Hunt–Hess Scale at hospitalization; among discharged patients with 3 point according to Glasgow Outcome Scale was dominated by patients from the second century according to Hunt‒Hess Scale at hospitalization, among patients with 5 point according to Glasgow Outcome Scale dominated patients who had I degree according to the Hunt‒Hess Scale at hospitalization. Conclusions. Inadequate clipping of the cervix cerebral aneurysm is the main type of non-hemorrhagic complications in the surgery of cerebral aneurysms. The Inadequate clipping of the cervix of the cerebral aneurysm includes the presence of residual blood flow in the cerebral aneurysm after its clipping, stenosis/compression of the main and perforating cerebral arteries with a clip, slipping of the clip from the aneurysm. Among the factors influencing the radical and adequate clipping of the cervix cerebral aneurysm are the size, location of the aneurysm, atherosclerotic lesions of the walls of the arteries and neck of the aneurysm and transferred subarachnoid hemorrhage. Reliable methods of prevention of inadequate clipping of saccular aneurysm are the use of intraoperative Doppler blood flow control, pilot clipping of complex aneurysms, optimization and individualization of surgical access. Aggravating factors that lead to unsatisfactory results of treatment of patients and negative clinical dynamics after the operation of clipping cerebral saccular aneurysm are: severe condition of the patient before surgery (III‒V gr. according to the Hunt‒Hess Scale), severe cerebral edema, intraoperative rupture of saccular aneurysm, long-term mechanical manipulations on cerebral arteries (long-term temporary clipping of saccular aneurysm, isolation of saccular aneurysm and «neighboring» cerebral arteries from arachnoid adhesions, frequent repositioning of the clip).
Yu.V. Barinov, L.O. Lysytsia
Endovascular Neuroradiology, Volume 33, pp 12-18; doi:10.26683/2304-9359-2020-3(33)-12-18

The simplest method of screening eye pathology in infant is red reflex examination. Present, absence or change of red reflex is key point in early detection of eye pathology. Objective – establish possibility using of mobile phone camera for eye pathology screening at home.Materials and methods. 750 children were included in research. Patient parents allowed photo their child before ophthalmology exam. First step was taking photo on parent’s mobile telephone in playing room from different distance and lighting. Second step was photo in exam room in mesopic condition in 1, 2 and 4 m distance with using maximum zoom and then ophthalmologic exam. After that, all photos was analysed by next signs: present or absence of red reflex, intensive of red reflex, present or absence pathology shadow, in case of red reflex changing, distance where changing is best viewed, comparison photo with result of ophthalmology exam. Results. After analysing photos all children was divided in three groups depending on red reflex chan-ging. In the first group red reflex was even without additional shadow, same in both eye. In this group after ophthalmology exam ametropy low level and eyelid pathology was diagnosed. In the second group red reflex was irregular by colour with additional light shadow or different intensity of red reflex in both eye. Ametropy high level was diagnosed in this group. In the third group we observed absence or colour change of red reflex. Cataract, congenital glaucoma, retinoblastoma, retinal and choroidal coloboma, Coats retinitis was diagnosed. Changing of red reflex possible to find on all photos from different distance, but the most informative was photo that was done from 1 m in mesopic condition. Conclusion. By equability and colour changing of red reflex on photo, all children may divided in three groups: 1 – children require only prophylactic ophthalmology exam, 2 – children require additional ophthalmology exam, 3 – children require immediate ophthalmology exam.
D.V. Shchehlov, O.E. Svyrydiuk, I.M. Bortnik, O.A. Pastushyn, Ya.E. Kudelskyi, O.V. Slobodian
Endovascular Neuroradiology, Volume 32, pp 58-66; doi:10.26683/2304-9359-2020-2(32)-58-66

Objective ‒ to improve the quality of treatment and endovascular occlusion techniques in case of distal vertebrobasilar (VB) aneurysms with implementation of flow coils usage.Materials and methods. Retrospective analysis of 4 patients (3 women and 1 man, mean age 53.5 years) with VB aneurysms in a 2-year period treated in Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine. Pretreatment clinical status was recorded from the patient files, any new neurologic symptoms after the treatment were recorded. Clinical outcome of the patients was established from the patient files. We describe the case of distal superior cerebellar artery aneurysm, 3 cases of posterior inferior cerebellar artery neurysms treated successfully with flow coils with 3-month follow-up at least. All patients underwent cerebral angiography with transfemoral access. Subsequently, coiling of the most distal to the aneurysm segment of the artery was performed.Results. All patients presented with subarachnoid hemorrhage with vestibulo-atactic disorder, diplopia in the case of an aneurysm of the superior cerebellar artery. Endovascular deconstructive occlusion of the aneurysm was performed, according to the data of cerebral angiography, anatomy of the involved artery. In postprocedure Reversible neurological decline in one patient after performing deconstructive occlusion was observed, the symptom completely recovered within 2 weeks of the post-procedural period. Three patients noted the regression of static-coordination disorders in the first 5 days after surgery. No cases of extravasation during coiling and recanalization of the artery during the control examination were observed.Conclusions. Aneurysms of posterior inferior cerebellar artery and superior cerebellar artery are rare. Technical availability to reach the distal to the aneurysm segment of the artery is the key of successful procedure. In comparison with general microcatheters used to insert detachable coils, A microcatheter that is congruent to flow coils is a better navigated in a flow and has lower risk of damaging the artery wall because its physical properties. When the favorable positioning of the tip of the microcatheter is achieved, the flow coils effectively and in a controlled manner occlude the eligible segment of the artery.
Y.V. Flomin , V.G. Gurianov, M.V. Guliaieva, L.I. Sokolova
Endovascular Neuroradiology, Volume 32; doi:10.26683/2304-9359-2020-2(32)-35-46

Objective ‒ to determine independent predictors and develop a prognostic model for asses-sing the likelihood of lack of a good outcome (dependence) in cerebral stroke patients with severe disabilities who were admitted to a comprehensive stroke unit in a subacute or chronic phase.Materials and methods. A retrospective observational study enrolled patients with a verified cerebral stroke, who were admitted to the Stroke Center (SC) over 2010‒2018 in the early subacute (from Day 8 to Day 90 from onset), the late subacute (from Day 91 to Day 180 from onset) or chronic (after 180 days from onset) phase of the disease and had severe disabilities upon admission (i.e. a modified Rankin scale (mRS) 4 or 5). There were included 290 patients (38.7 % of women) aged from 20.4 to 91.2 years (median ‒ 64.9 years, interquartile range ‒ 56.6‒74.6). Care in the SC was provided in accordance with guidelines and included active interdiscipli-nary rehabilitation. The restoration of independence in daily living at discharge was considered a good outcome (mRS 0‒2). We assessed the relationship of the risk of failure to achieve a good outcome with five clinical variables: age, sex, stroke period, and baseline mRS score and the amount (dose) of rehabilitation (total time of physical therapy, ergotherapy or mechanotherapy).Results. 81 (28.0 %) participant had intracerebral hemorrhage, whereas 209 (72.0 %) had cerebral infarction. The total National Institutes of Health stroke scale (NIHSS) score on admission ranged from 1 to 36 (median 14 points, interquartile range 10–20). While 188 (64.8 %) of the patients were hospitalized to the SC during the early subacute, 34 (11.8 %) and 68 (23.4 %) study participants were admitted only in the late subacute and chronic phase of stroke, respectively. In the analysis of generalized linear regression models, three features had a significant relationship with a decrease in the mRS score: sex, time from stroke onset to SC admission, and the total time of mechanotherapy. According to the multivariate analysis, four factors were significantly associated with a need for assistance in activities of daily living at SC discharge: the risk of dependence was significantly (p = 0.004) lower in men, was directly depended on the initial mRS score and the time elapsed from the estimated stroke onset to the SC admission, but was inversely related to the amount (dose) of certain rehabilitation interventions (the odds ratio of not achieving a good outcome was 0.93 (95 % CI 0.89‒0.97) for every additional 100 minutes of mechanotherapy). The logistic regression model based on the selected set of features turned out to be adequate (χ2 = 60.7 at 7 degrees of freedom, p
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