An increase in flow-diverter oversizing values as an independent risk factor for developing more severe in-stent stenosis. A retrospective single-center study based on flow diversion of supraclinoid internal carotid artery aneurysms

IntroductionIn the past decade, flow diverters (FDs) have increasingly been used to treat cerebral aneurysms with unfavorable morphology in which other endovascular techniques fall short of being as effective. In-stent stenosis (ISS) is one of the most puzzling and frequent risks of flow diversion therapy observed on follow-ups. This complication, although mostly placid in its clinical course, can have dire consequences if patients become symptomatic. ISS is associated with many factors, none of which have been demonstrated to date to be solely responsible for the phenomenon.MethodsThis study was aimed at evaluating ISS incidence in patients in our clinic who were treated with flow-diverters for aneurysms, located on the supraclinoid segments of the internal carotid artery between September 2022 and May 2023. A retrospective analysis was conducted, which included 137 patients with a total of 142 aneurysms being treated. The main hypothesis was that oversizing of the implant might play a role in ISS development. The performed statistical analysis, aimed at finding a correlation between it and vessel lumen narrowing on the follow-ups. The effects of other known risk factors, such as sex, age, smoking, and hypertension, were also analyzed.ResultsStent oversizing with respect to the parent artery was positively correlated with subsequent ISS occurrence and severity. Older age was a protective factor against ISS. Patients who actively smoked had diminished risk of developing severe ISS.DiscussionStent oversizing can lead to ISS development, which might be more pronounced with larger implant-to-vessel sizing discrepancies. To achieve optimal results, the choice of implant diameter should consider all segments of the vessel in which it will be implanted. In cases of severe symptomatic ISS, continuation of dual anti-platelet therapy is a reasonable and effective option to address this complication

Cortical laminar necrosis after subarachnoid hemorrhage

Кортикалната ламинарна некроза е рядко наблюдавана при пациент след емболизиране на мозъчна аневризма. Съобщаваме случай на 51-годишна пациентка, която след емболизация на мозъчната аневризма на дясната средна мозъчна артерия остава в коматозно състояние.От извършения ядрено-магнитен резонанс имаше висок интензитет на сигнала в темпоралния лоб на мозъка на T2- изображенията, и линеарен хиперинтензитет по протежение на мозъчните кората на T1-изображенията с дифузно усилване на мозъчната кора.Cortical laminar necrosis has rarely been observed in a patient after coil embolization. We report a 51-year-old female patient who became comatose after the embolization of an aneurysm in the right middle cerebral artery. There were high signal intensities in the temporal brain on T2-weighted MRI images and linear hyperintensities along the cerebral cortices on T1-weighted images with a diffuse gyriform enhancement

Embolization of bronchial arteries in cases of life-threatening bleeding

Massive hemoptysis is a frightening and potentially life-threatening clinical event. Hemoptysis represents a sig­nificant clinical entity with high morbidity and potential mortality. Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage

Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies

Отворената хирургия е златен стандарт за лечение на хепатоцелуларен карцином (НСС) и чернодробни метастази от рак на дебелото черво. Днес чернодробната резекция е все още само лечебен вариант за пациенти с рак на черния дроб, с 5-годишната преживяемост между 25-60%, в сравнение с 0% 5-годишна преживяемост без никакви лечение. Само 5-15% от пациентите с НСС или с чернодробни метастази могат да бъдат подложени на чернодробна резекция поради различни противопоказания: голям брой тумори, тумори на труднодостъпни места, недостатъчен чернодробен обем за резекция.Open surgery is a gold standard for treating hepatocellular carcinoma (HCC) and hepatic metastases of colorectal cancer. Today, liver resection is still only a radically option for patients with liver cancer, with a 5-year survival rate of 25-60%, compared with 0% 5-year survival without any treatment. Only 5-15% of patients with HCC or liver metastases may undergo hepatic resection due to different contraindications: a large number of tumors, tumors in hard-to-reach places, insufficient hepatic volume for resection

Neurotoxicity of cancer agents

Невротоксичните ефекти на химиотерапията се появяват относително често и са причина за модификация на дозата на медикаментите - дозолимитираща токсичност. Рискът от развитие на невротоксичност се увеличава с повишаване на приложената доза и за разлика от миелотоксичността (основния ограничаващ фактор при повечето химиотерапевтични режими), която може да бъде преодоляна с растежни фактори или трансплантация на костен мозък, няма стандартно поведение, което да я ограничи.Противотуморните препарати водят до два типа токсичност - периферна невротоксичност, състояща се основно от периферна невропатия и централна невротоксичност, която включва от незначителни когнитивни увреждания и дефицити до енцефалопатия с деменция или дори кома.Не съществуват утвърдени алгоритми за поведения и профилактика на невротоксичността, причинена от противотуморните препарати. Поведението основно се свежда до редукция на дозата или отлагане във времето на приложението, особено при пациенти, които са с по-висок риск от развитие на невротоксични странични ефекти. На този етап не съществуват невропротективни агенти, които се препоръчват за стандартна употреба при развитие на невротоксичност.Neurotoxic side effects of chemotherapy occur frequently and are often a reason to limit the dose of chemotherapy. Chemotherapy dosing is often limited due to a frequently occurring side effect of the treatment - neurotoxic. The risk of neurotoxicity is increased by the possibility of higher dose usage, since bone marrow toxicity (the major limiting factor in most chemotherapeutic regimens) can be overcome with growth factors or bone marrow transplantation.Chemotherapy may cause both peripheral neurotoxicity, consisting mainly of a peripheral neuropathy, and central neurotoxicity, ranging from minor cognitive deficits to encephalopathy with dementia or even coma. Neurotoxicity caused by the chemotherapy can be of two types - peripheral, mainly consisting of peripheral neuropathy and central, from minor cognitive deficits through encephalopathy with dementia to even coma.Data management and neuroprotective agents are still in discussion and there are no current accepted guidelines yet. Management mainly consists of cumulative dose-reduction or lower dose-intensities, especially in patients who are at higher risk to develop neurotoxic side effects. None of the specific neuroprotective agents can be recommended in daily practice for standard use at the moment, and further studies are needed to confirm their beneficial effects

Minimally invasive ablative techniques of liver tumors

Само 5-15% от пациентите с НСС или с чернодробни метастази могат да бъдат подложени на чернодробна резекция, поради различни противопоказания: голям брой тумори, тумори на трудно достъпни места, недостатъчен чернодробен обем за резекция. Вариантите за перкутанно лечение могат да бъдат: Химичната аблация: инжектиране на етанол или оцетна киселина; Термалната аблация: (а) криохирургични аблация (CSA/КХА): използване на течен азот, аргон, или NO2; (б) коагулационната: използване на радиочестотен ток (RFA/РФА); Микровълнова аблация (MWA/МВ); лазерна интерстициална термотерапия (ЛИТТ) или високоинтензивен фокусиран ултразвук (HIFU/ ВФУ); Необратима електропорация (IRE).Only 5-15% of patients with HCC or liver metastases may undergo hepatic resection due to different contraindications: a large number of tumors, tumors in hard-to-reach places, insufficient hepatic volume for resection. The options for percutaneous treatment can be: Chemical Ablation: Injection of Ethanol or Acetic Acid; Thermal ablation: (a) cryosurgical ablation (CSA): use of liquid nitrogen, argon, or NO2; (b) Coagulation: Radio Frequency Ablation (RFA); Microwave ablation (MWA); Laser Interstitial Thermotherapy (LITT) or High Intensive Focused Ultrasound (HIFU); Irreversible electroporation (IRE)