Journal articles: 'Sac thrombosis'

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Cojocari, Vladimir, Vasile Culiuc, Florin Bzovii, Dumitru Casian, and Eugen Gutu. "Giant thrombosed saphenofemoral junction aneurysm: A case report." SAGE Open Medical Case Reports 5 (January 1, 2017): 2050313X1774101. http://dx.doi.org/10.1177/2050313x17741012.

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Introduction: Although saphenofemoral junction aneurysms are not so rare, only scarce of the published cases reported thrombosis of the aneurysmal sac and saphenous trunk. Presentation of case: A 65-year-old male with varicose disease, developed acute ascending superficial vein thrombosis of the left greater saphenous vein, involving the 6-cm saphenofemoral junction aneurysm. The patient underwent common femoral vein thrombectomy, aneurysm removal, and greater saphenous vein excision with uneventful postoperative course. Conclusion: Thrombosed giant saphenofemoral junction aneurysms require emergent surgical intervention aimed at preventing potential progression to deep vein thrombosis and pulmonary embolism.

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Warschewske, G., G. Benndorf, Th Lehmann, and W. Lanksch. "Spontaneous Thrombosis of an Intracranial Giant Aneurysm." Interventional Neuroradiology 5, no. 4 (December 1999): 327–32. http://dx.doi.org/10.1177/159101999900500410.

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Spontaneous thrombosis in giant aneurysms is known, whereas complete occlusion of such aneurysms in a short period of time is rarely reported. We present the case of a 50-year-old man with a giant anuersym arising from the anterior communicating artery (ACA) producing significant mass effect with clinical consequences. The digital subtraction arteriogram (DSA) showed a patent lumen of about 20 mm and a very small neck leading to extremely slow blood flow inside the sac and stagnation of contrast. During catheterization for endovascular occlusion four weeks later, the arteriogram revealed complete disappearance of the aneurysm, while the patient remained clinically stable. The patient was operated upon and the thrombosed sac was removed with no complications. He was discharged one week later and recovered completely from his symptoms within three months.

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Victory, Jesse, Syed Ali Rizvi, Enrico Ascher, and Anil Hingorani. "Ruptured abdominal aortic aneurysm after endovascular aortic aneurysm repair thrombosis." Vascular 25, no. 3 (November 24, 2016): 333–35. http://dx.doi.org/10.1177/1708538116679330.

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Background Complete thrombosis of an aortic endograft after an endovascular aortic aneurysm repair is a rare complication. The majority of thrombotic events occur in the iliac limbs. Case presentation We present the case of a patient who presented with acute limb ischemia as the result of a thrombosed infra-renal aortic endograft. After restoration of blood flow to the lower extremities with an axillary to bi-femoral artery bypass, the patient was lost to follow-up. The patient returned two years later with a ruptured abdominal aortic aneurysm due to a type 1A endoleak. Discussion We propose that all patients after endovascular aortic aneurysm repair, including those with a thrombosed aortic endograft, continue to undergo regular graft surveillance. This case report highlights the importance of continued surveillance of the aortic sac, even after total thrombosis of the endovascular aortic aneurysm repair.

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Davis, Renee, Kurt Stahlfeld, and Harry W. Sell. "Congenital peritoneal encapsulation and superior mesenteric vein thrombosis: A case report." SAGE Open Medical Case Reports 10 (January 2022): 2050313X2211324. http://dx.doi.org/10.1177/2050313x221132436.

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Congenital peritoneal encapsulation is a rare entity characterized by an accessory peritoneal membrane that forms during embryonic development. Congenital peritoneal encapsulation is generally asymptomatic but can cause intermittent, colicky abdominal pain related to subacute small bowel obstruction. Diagnosis is made incidentally or upon surgical exploration for chronic abdominal complaints as preoperative imaging is typically nonspecific. We report a case of a 49-year-old male with epigastric abdominal pain, constipation, and superior mesenteric vein thrombosis on imaging. Upon exploratory laparotomy, the small bowel was covered by an accessory peritoneal sac consistent with congenital peritoneal encapsulation. The accessory sac was excised completely, and the patient recovered well. Although rarely causing significant gastrointestinal symptoms, congenital peritoneal encapsulation is an anomaly that requires surgical intervention.

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Papakostas, John C., Emmanouil Theodoropoulos, George Karydas, and Petros K. Chatzigakis. "Contained rupture of a celiac artery aneurysm treated with aortic endograft deployment and assisting percutaneous coil and thrombin infusion." Vascular 21, no. 3 (May 13, 2013): 183–88. http://dx.doi.org/10.1177/1708538113478735.

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In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard, could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.

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Antoniou, A., Schiro, V. Smyth, Murray, Farquharson, and Serracino-Inglott. "Multilayer stent in the treatment of popliteal artery aneurysms." Vasa 41, no. 5 (August 1, 2012): 383–87. http://dx.doi.org/10.1024/0301-1526/a000227.

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Endovascular repair of popliteal artery aneurysms is an emerging treatment in high risk surgical patients. The location in a functionally demanding anatomical area creates limitations in terms of endograft patency. Technological advancements have been conscripted in an effort to circumvent such constraints. The multilayer stent technology effects through haemodynamic modulation. We used the multilayer stent to treat 6 asymptomatic popliteal artery aneurysms in 3 patients. All procedures were successfully accomplished without any complications. Over a mean follow up period of 9 months, thrombosis occurred in two limbs, and blood flow was restored with thrombolysis, achieving a primary and secondary patency rate at 6 months of 67 % and 100 %, respectively. Partial or complete thrombosis of the aneurysm sac was achieved in all aneurysms. Even though the use of the multilayer stent in popliteal artery aneurysms was safe in the short term, our experience showed that close surveillance is required.

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Zhang, Xiaoxi, Qiao Zuo, Haishuang Tang, Gaici Xue, Pengfei Yang, Rui Zhao, Qiang Li, et al. "Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review." Journal of NeuroInterventional Surgery 11, no. 5 (March 6, 2019): 489–96. http://dx.doi.org/10.1136/neurintsurg-2018-014388.

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PurposeTo compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms.MethodsA meta-analysis that compared SAC with coiling alone and balloon assisted coiling was conducted by database searching. The primary outcomes of this study were immediate occlusion and progressive thrombosis rate, overall perioperative complication rate, and angiographic recurrence. Secondary outcomes included mortality at discharge, hemorrhagic and ischemic complications, and favorable clinical outcome at discharge and at follow-up.ResultsEight retrospective cohort studies with 1408 ruptured intracranial aneurysms (SAC=499; non-SAC=909) were included. The SAC group tended to show a lower immediate complete occlusion rate than the non-SAC group (54.3% vs 64.2%; RR 0.90; 95% CI 0.83 to 0.99; I2=17.4%) and achieved a significantly higher progressive complete rate at follow-up (73.4% vs 61.0%; RR 1.30; 95% CI 1.16 to 1.46; I2=40.5%) and a lower recurrence rate (4.8% vs 16.6%; RR 0.28; 95% CI 0.16 to 0.50; I2=0.0%). With respect to safety concerns, overall perioperative complications in the SAC group were significantly higher (20.2% vs 13.1%; RR 1.70; 95% CI 1.36 to 2.11; I2=0.0%). However, no significant difference was found for mortality rate at discharge (6.3% vs 6.2%; RR 1.29; 95% CI 0.86 to 1.94; I2=0.0%), or favorable clinical outcome rate at discharge (73.4% vs 74.2%; RR 0.95; 95% CI 0.88 to 1.02; I2=12.1%) and at follow-up (85.6% vs 87.9%; RR 0.98; 95% CI 0.93 to 1.02; I2=0.0%; P=0.338).ConclusionsSAC has a lower recurrence rate than non-SAC. Nevertheless, further validation by well designed prospective studies is warranted for determining whether stents improve angiographic outcome without an increased complication rate or unfavorable clinical outcome.

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Slater, Lee-Anne, Cathy Soufan, Michael Holt, and Winston Chong. "Effect of flow diversion with silk on aneurysm size: A single center experience." Interventional Neuroradiology 21, no. 1 (February 2015): 12–18. http://dx.doi.org/10.1177/1591019915576433.

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Alterations in aneurysm size and mass effect can result in alleviation or aggravation of symptoms. We assessed the effects of flow diversion with SILK stents on aneurysm sac size and associated factors. A retrospective evaluation of 14 aneurysms treated with SILK stents alone with MRI follow-up was performed. Aneurysm sac size was measured using the sequence best demonstrating the sac. Aneurysm characteristics and flow-related enhancement on time of flight images were documented. Clinical histories were reviewed for evolution of symptoms. Complete collapse of the aneurysm sac was demonstrated at three and 18 months in 2/14 aneurysms. Increase in size was observed in 2/14 aneurysms with associated persistent flow on time of flight MRA. Blister formation with aggravation of symptoms was observed in one aneurysm, and subsequent decrease in size occurred after treatment with a second SILK. The other aneurysm which increased in size initially continued to enlarge asymptomatically despite retreatment with a second SILK, however at 24 months thrombosis of the sac and decrease in size was observed. The remaining 10/14 aneurysms decreased in size. Nine had corresponding MRA occlusion and the tenth demonstrated decreased but persistent flow on the time of flight MRA. No aneurysm with MRA occlusion increased in size. Decrease in sac size was associated with MRA occlusion in our study. Persistence of flow and blistering were associated with increased sac size. As previously demonstrated flow diversion may be effective in the treatment of large aneurysms presenting with mass effect, however rates of sac obliteration in this small series were not as high as previously reported.

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Motataianu, Anca, Smaranda Maier, Sebastian Andone, Laura Barcutean, Georgiana Serban, Zoltan Bajko, and Adrian Balasa. "Ischemic Stroke in Patients with Cancer: A Retrospective Cross-Sectional Study." Journal of Critical Care Medicine 7, no. 1 (January 1, 2021): 54–61. http://dx.doi.org/10.2478/jccm-2021-0002.

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Abstract Introduction An increasing trend of cancer associated stroke has been noticed in the past decade. Objectives To evaluate the risk factors and the incidence of neoplasia in stroke patients. Material and Method A retrospective, observational study was undertaken on 249 patients with stroke and active cancer (SAC) and 1563 patients with stroke without cancer (SWC). The general cardiovascular risk factors, the site of cancer, and the general clinical data were registered and evaluated. According to the “Oxfordshire Community Stroke Project” (OCSP) classification, all patients were classified into the clinical subtypes of stroke. The aetiology of stroke was considered as large-artery atherosclerosis, small vessel disease, cardio-embolic, cryptogenic or other determined cause. Results The severity of neurological deficits at admission were significantly higher in the SAC group (p<0.01). The haemoglobin level was significantly lower, and platelet level and erythrocyte sedimentation rate were significantly higher in the SAC group. Glycaemia, cholesterol and triglycerides levels were significantly higher in the SWC group. The personal history of hypertension was more frequent in the SWC group. In the SAC group, 28.9% had a cryptogenic aetiology, compared to 9.1% in SWC group. Cardio-embolic strokes were more frequent in the SAC group (24%) than the SWC group (19.6%). In the SAC group, 15,6% were diagnosed with cancer during the stroke hospitalization, and 78% of the SAC patients were without metastasis. Conclusions The most frequent aetiologies of stroke in cancer patients were cryptogenic stroke, followed by large-artery atherosclerosis. SAC patients had more severe neurological deficits and worse clinical outcomes than SWC patients. Stroke in cancer patients appears to be more frequently cryptogenic, probably due to cancer associated thrombosis. The association between stroke and cancer is important, especially in stroke of cryptogenic mechanism, even in the presence of traditional cardiovascular risk factors.

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Raval, Bharat, J. Timothy Hall, and Harris Jackson. "CT Diagnosis of Fluid in Lesser Sac Mimicking Thrombosis of Inferior Vena Cava." Journal of Computer Assisted Tomography 9, no. 5 (September 1985): 956–58. http://dx.doi.org/10.1097/00004728-198509000-00023.

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Ma, Wenjing, Zackary Rousseau, Sladjana Slavkovic, Chuanbin Shen, George M. Yousef, and Heyu Ni. "Doxorubicin-Induced Platelet Activation and Clearance Relieved by Salvianolic Acid Compound: Novel Mechanism and Potential Therapy for Chemotherapy-Associated Thrombosis and Thrombocytopenia." Pharmaceuticals 15, no. 12 (November 22, 2022): 1444. http://dx.doi.org/10.3390/ph15121444.

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Doxorubicin (Dox) is a widely utilized chemotherapeutic; however, it carries side effects, including drug-induced immune thrombocytopenia (DITP) and increased risk of venous thromboembolism (VTE). Currently, the mechanisms for Dox-associated DITP and VTE are poorly understood, and an effective inhibitor to relieve these complications remains to be developed. In this study, we found that Dox significantly induced platelet activation and enhanced platelet phagocytosis by macrophages and accelerated platelet clearance. Importantly, we determined that salvianolic acid C (SAC), a water-soluble compound derived from Danshen root traditionally used to treat cardiovascular diseases, inhibited Dox-induced platelet activation more effectively than current standard-of-care anti-platelet drugs aspirin and ticagrelor. Mechanism studies with tyrosine kinase inhibitors indicate contributions of phospholipase C, spleen tyrosine kinase, and protein kinase C signaling pathways in Dox-induced platelet activation. We further demonstrated that Dox enhanced platelet-cancer cell interaction, which was ameliorated by SAC. Taken together, these findings suggest SAC may be a promising therapy to reduce the risk of Dox-induced DITP, VTE, and the repercussions of amplified platelet-cancer interaction in the tumor microenvironment.

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Ucci, Alessandro, Ruggiero Curci, Matteo Azzarone, Claudio Bianchini Massoni, Antonio Bozzani, Carla Marcato, Enrico Maria Marone, et al. "Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator." Vascular 26, no. 5 (April 17, 2018): 556–63. http://dx.doi.org/10.1177/1708538118771258.

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Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.

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Amistà, P., D. Barbisan, M. Beghetto, N. Cavasin, P. Zucchetta, and M. Frego. "Three-Stent Placement for Treatment of Carotid Artery Pseudoaneurysm." Interventional Neuroradiology 12, no. 4 (December 2006): 339–43. http://dx.doi.org/10.1177/159101990601200408.

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Pseudoaneurysm treatment with overlapping stents may be a useful technique to reduce flow and enhance thrombosis in the aneurysmal sac. We treated a pseudoaneurysm of the left carotid artery in a patient with a history of bilateral carotid thromboendarterectomy by placing three stents and overlapping them at the level of the aneurysmal neck. Nine month follow-up revealed almost complete pseudoaneurysm exclusion and patency of the carotid artery.

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Kurniawan, Ricky Gusanto, Bambang Tri Prasetyo, Beny Rilianto, and Abrar Arham. "The Role of Dual Antiplatelet in Stent-Assisted Coiling in Wide-Neck Aneurysm." AKSONA 3, no. 1 (January 31, 2023): 48–53. http://dx.doi.org/10.20473/aksona.v3i1.37154.

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Highlight: Dual antiplatelet is the gold standard for endovascular treatment of wide-neck aneurysms. The role of dual antiplatelet is to prevent stent thrombosis after treatment. The thrombosis rate reported during stent-assisted coiling is quite high. ABSTRACT Stent-assisted coiling (SAC) in wide-neck aneurysm treatment is associated with antiplatelet use. Dual antiplatelet therapy (DAPT) has been the gold standard for protecting against thrombosis events and is widely accepted for endovascular embolization treatment with a stent-assisted or flow diverter. Some patients experience vascular events due to the reduced efficacy of antiplatelet agents despite taking DAPT. The reported thrombosis rates during stent-assisted coiling embolization range from 2% to 20%. Thromboembolic complications, such as in-stent thrombosis, can manifest in 4.6% of cases. The correlation between platelet reactivity during treatment and bleeding events remains unclear. However, the association between High Residual Platelet Reactivity (HRPR) or hyporesponsiveness and ischemic events is well established. Based on various laboratory definitions, hyperresponsiveness in patients with clopidogrel occurs in about 14–30% of patients due to major and minor bleeding. Therefore, the optimization of antiplatelet therapy has developed significantly in the neurointerventional community.

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Yamakawa, Kazuma, Jumpei Yoshimura, Takashi Ito, Mineji Hayakawa, Toshimitsu Hamasaki, and Satoshi Fujimi. "External Validation of the Two Newly Proposed Criteria for Assessing Coagulopathy in Sepsis." Thrombosis and Haemostasis 119, no. 02 (December 28, 2018): 203–12. http://dx.doi.org/10.1055/s-0038-1676610.

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Background Two different criteria for evaluating coagulopathy in sepsis were recently released: sepsis-induced coagulopathy (SIC) and sepsis-associated coagulopathy (SAC). Although both use universal haemostatic markers of platelet count and pro-thrombin time, significance and usefulness of these criteria remain unclear. Objective This article validates and evaluates the significance of SIC and SAC criteria compared with the International Society on Thrombosis and Haemostasis (ISTH) overt disseminated intravascular coagulation (DIC) and Japanese Association for Acute Medicine (JAAM) DIC criteria. Methods Clinical characteristics of patients from a nationwide Japanese cohort were classified by SIC, SAC or DIC status and relations between criteria were examined. We evaluated associations between in-hospital mortality and anticoagulant therapy according to the SIC, SAC or DIC status to clarify the significance of criteria for introducing anticoagulants. Intervention effects were analysed by Cox regression analysis adjusted by propensity scoring. Results Incidences of coagulopathy diagnosed by SIC and JAAM DIC were similar, whereas those of SAC and ISTH overt DIC were about half of the former two (61.4%, 60.8% vs. 45.3%, 29.3%). Severity and mortality of all criteria were almost comparable. For validating initiation of anticoagulation, favourable effects of anticoagulant therapy were observed only in sub-sets with, and not without, coagulopathy diagnosed by all four criteria. Slight non-significant differences between anticoagulant groupings were found in ISTH overt DIC- and SAC-negative populations, suggesting that some patients even ‘without’ these criteria may benefit from anticoagulant therapy. Conclusion Newly developed SIC diagnostic criteria for coagulopathy may be valuable in detecting appropriate candidates for anticoagulant therapy in sepsis and a useful alternative to conventional DIC scoring systems.

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Ueno, Tatsuya, Tatsuya Sasaki, Masatoshi Iwamura, Tomoya Kon, Jin-ichi Nunomura, Hiroshi Midorikawa, and Masahiko Tomiyama. "Arterial Spin Labeling Imaging of a Giant Aneurysm Leading to Subarachnoid Hemorrhage following Cerebral Infarction." Case Reports in Neurology 10, no. 1 (March 7, 2018): 66–71. http://dx.doi.org/10.1159/000487587.

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An 83-year-old Japanese man was admitted with dysarthria and right hemiparesis. He had had a large intracranial aneurysm on the left internal carotid artery 5 years before admission and had been followed up under conservative treatment. On admission, diffusion-weighted imaging revealed a hyperintense signal on the left anterior choroidal artery territory. Time-of-flight magnetic resonance angiography demonstrated poor visibility of the middle and anterior cerebral arteries and the inferior giant aneurysm, suggesting distal emboli from aneurysm thrombosis or a reduction of blood outflow due to aneurysm thrombosis. Arterial spin labeling (ASL) signal increased in the giant aneurysm, suggesting blood stagnation within the aneurysmal sac, and decreased in the left hemisphere. We diagnosed cerebral infarction due to aneurysm thrombosis, and started antithrombotic therapy. On day 2, he suddenly died of subarachnoid hemorrhage due to rupturing of the giant aneurysm. When thrombosis occurs in a giant aneurysm, increasing ASL signal within the aneurysm and decreasing ASL signal with poor visibility on magnetic resonance angiography in the same arterial territory may indicate the danger of impending rupture of the giant aneurysm.

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Pacanowski, John P., Scott L. Stevens, Michael B. Freeman, Robert S. Dieter, Lance A. Klosterman, Stacy S. Kirkpatrick, John W. Ragsdale, S. Elizabeth Davis, and Mitchell H. Goldman. "Endotension Distribution and the Role of Thrombus following Endovascular AAA Exclusion." Journal of Endovascular Therapy 9, no. 5 (October 2002): 639–51. http://dx.doi.org/10.1177/152660280200900516.

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Purpose: To determine the pattern of strain and pressure transmitted to an aortic aneurysm wall before and after endovascular exclusion and to evaluate the role of sac thrombus on the conduction of pressure and wall strain. Methods: Three canine thoracic aortas were used to create abdominal aortic aneurysms (AAA). The segments were placed on a pulsatile pump system, and 8 strain transducers were positioned in the aneurysm sac. Baseline strain/pressure (S/P) was recorded in 1 animal, then the AAA was excluded with a stent-graft. Thrombin was injected into the sac, and strain/pressure was recorded at 7 systemic pressures (35 to 120 mmHg) over 6 hours. The thrombus was replaced with fibrin glue, and S/P was recorded over 4 hours. Additional trials using whole and 50% diluted unclotted blood were performed prior to sac thrombosis. Computed tomography and angiography were performed before and after aneurysm exclusion. Results: Pressure transmitted to the aneurysm wall decreased following stent-graft placement (p≤0.001). Strain/pressure was not distributed evenly in the sac (p≤0.05), and varying systemic pressures did not affect this distribution. Pressures near the stent-graft were higher than those laterally (p≤0.001) in all trials with interposed fresh thrombus and fibrin thrombus. The fibrin group had elevated baseline measurements, but correction for the elevated values did not influence the statistical significance (p≤0.001). Blood and fibrin thrombus reduced transmitted wall pressure to a similar degree. Overall S/P in the fluid-filled nonclotted sac was significantly lower (p≤0.001) than in the thrombus groups. Conclusions: Endovascular AAA exclusion reduced strain and pressure conducted to the aneurysm wall, and the distribution of transmitted pressure in the excluded sac without endoleak differed regardless of the sac contents. Fresh thrombus reduced transmitted S/P in all trials at all systemic pressures, as did fibrin thrombus but in a less predictable fashion.

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Xenos, Eleftherios S., Scott L. Stevens, Michael B. Freeman, John P. Pacanowski, David C. Cassada, and Mitchell H. Goldman. "Distribution of Sac Pressure in an Experimental Aneurysm Model after Endovascular Repair: The Effect of Endoleak Types I and II." Journal of Endovascular Therapy 10, no. 3 (June 2003): 516–23. http://dx.doi.org/10.1177/152660280301000317.

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Purpose: To study in an experimental aneurysm model the differential distribution of strain/pressure (S/P) on the aneurysm wall before and after endograft exclusion and in the presence of individual type I and type II endoleaks. Methods: Two tapered elliptical Gore-Tex patches were sutured to an anterior and posterior longitudinal arteriotomy of an 8-mm Gore-Tex tube graft, thus creating a fusiform aneurysm. Two S/P transducers were placed at the proximal sac adjacent to the proximal neck, 2 at the site of the widest sac diameter, and 2 at the sac adjacent to the distal neck. The aneurysm, which was connected to a pulsatile pump system, was excluded using a 10-mm endograft. Type I and type II endoleaks were created and tested individually. S/P measurements were obtained at systemic systolic pressures (BP) of 80, 110, and 150 mmHg. Thrombosis of the sac contents was induced by injection of thrombin and calcium in the sac. Angiography was used to verify presence or absence of flow in the sac. Results: Aneurysm exclusion resulted in significant S/P reductions at all 3 BP levels versus prior to exclusion (p<0.05). Thrombus in the sac did not alter S/P in the excluded sac (p>0.05 for all 3 BP levels). In the presence of a proximal type I endoleak, S/P distribution was not uniform, and S/P at the proximal neck was close to S/P prior to exclusion (p>0.05 no graft versus type I endoleak for all 3 BP levels). This was also true in the presence of thrombus. With a type II endoleak, S/P was more evenly distributed and was not significantly elevated compared to the pressure without an endoleak (p>0.05, graft versus type II endoleak for all 3 BP levels). Thrombus had no effect on intrasac S/P with a type II endoleak. Intrasac S/P was significantly higher in the presence of a type I endoleak compared to a type II endoleak when BP=150 mmHg (p=0.008). Conclusions: Endovascular exclusion of an aneurysm results in uniform S/P reduction in the aneurysm sac. Type I endoleak, but not type II endoleak, results in significantly higher S/P in an area of the sac adjacent to the proximal neck. Thrombus does not result in significantly different S/P distribution in the aneurysm sac.

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Ansari, Sameer A., Jeffrey P. Lassig, Ewen Nicol, B. Gregory Thompson, Joseph J. Gemmete, and Dheeraj Gandhi. "Thrombosis of a Fusiform Intracranial Aneurysm Induced by Overlapping Neuroform Stents Case Report." Neurosurgery 60, no. 5 (May 1, 2007): E950—E951. http://dx.doi.org/10.1227/01.neu.0000255427.08926.dc.

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Abstract OBJECTIVE To present a case of a true fusiform basilar artery aneurysm that underwent spontaneous thrombosis after placement of two overlapping Neuroform stents (Boston Scientific/Target, Fremont, CA). CLINICAL PRESENTATION A 45-year-old woman with transient syncopal episodes experienced a fall and presented to the emergency room. Incidentally, a non-contrast head computed tomographic scan and digital subtraction angiography demonstrated an unruptured, fusiform mid-basilar artery aneurysm. INTERVENTION Endovascular treatment was initiated by using a stent-assisted coil embolization technique with placement of a self-expanding, dedicated intracranial, Neuroform stent in the basilar artery across the aneurysm's fusiform neck. Attempts to access the aneurysm for coil embolization resulted in transient migration of the stent into the aneurysm sac. A second Neuroform stent was advanced in telescoping fashion for salvage and stable coverage across the entire aneurysm; therefore, coil embolization was deferred to allow stent endothelialization. After 6 weeks on dual antiplatelet therapy, the patient presented with transient ischemic symptoms suggesting top of the basilar artery syndrome. Subsequent magnetic resonance imaging scans and angiography indicated circumferential thrombus formation in the aneurysm sac but patent flow in the basilar artery. A computed tomographic scan at 6 months and digital subtraction angiography at 12 months confirmed complete thrombosis of the fusiform mid-basilar artery aneurysm with basilar artery reconstruction. CONCLUSION Overlapping Neuroform stents may induce spontaneous thrombosis of intracranial aneurysms and facilitate parent artery reconstruction through flow remodeling and stent endothelialization. Double stent placement may be a viable option in dissecting or fusiform intracranial aneurysms that are not amenable to open surgical treatment or endovascular coil embolization.

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Vigliotti, G., E. Franco, G. Cimino, P. Valitutti, R. Russo, P. Angrisani, M. Stabile, and A. Munno. "Popliteal Aneurysm in Middle-Aged Identical Twins." Acta geneticae medicae et gemellologiae: twin research 43, no. 1-2 (1994): 124. http://dx.doi.org/10.1017/s0001566000003123.

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AbstractFamilial aggregation of isolated abdominal aortic and isolated intracranial aneurysms have been described. Therefore, districtual aneurysm without a systemic genetic disease (e.g. Marfan, Ehlers Danlos etc.) can have a genetic basis. The authors are reporting on the development, in the sixth decade of life, of popliteal aneurysm in two identical twins E.U. and E.C. Zygosity was established on the basis of blood-group determinations, HLA haplotypes and cytogenetic variants. Mild clinical symptoms (intermittent claudication, calf cramps) had begun in E.C. at 21 years of age. Later, at 52 years of age, a thrombosis of the aneurysmatic sac on one side required surgical treatment. E.U. showed no clinical symptoms until the age of 60, when, within the interval of a few months, bilateral thrombosis had developed. The weight difference in the two subjects (E.C. 72 Kg, E.U. 64 Kg) may explain the difference between them as regards the age of onset of symptoms and body sides (one or both) affected. Angiographic, macroscopic and histologic aspects are documented. On surgical intervention, the aneursym was found at the biforcation of the popliteal artery, but no anomalous insertion of gas-trocnemii appeared to cause pressure on the artery leading to aneurysmatic dilatation. The aneurysmatic sac measured 2.5 cm in diameter and on histological examination, using haematoxylin-eosin and Van Gieson stain, showed fragmented elastic, collagen fibres.

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Ling, F., H. Zhang, D. Wang, M. Li, Z. Miao, Q. Song, M. Hao, and X. Li. "The Role of Controlled Anticoagulation in Balloon Occluding Vertebral Arteries to Treat Giant Fusiform Aneurysms of the Basilar Artery." Interventional Neuroradiology 5, no. 2 (June 1999): 145–50. http://dx.doi.org/10.1177/159101999900500206.

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We suggest and discuss the role of controlled anticoagulation therapy after the balloon occlusion of vertebral arteries to treat giant fusiform aneurysms in the basilar trunk. Two cases of giant fusiform aneurysms were treated with balloon occlusion of vertebral arteries. Both of these patients suffered severe brain stem ischaemia. Anticoagulants were used to adjust the PTT to 1.5–2.5 times the normal level to control the formation speed of thrombosis inside the aneurysms. Case 1 was obliged to suspend the anticoagulation therapy one week after occlusion because of digestive tract haemorrhage, and died of severe brain stem ischaemia. On autopsy, the sac of the aneurysm was totally occupied by the thrombus. Two perforating arteries feeding the brain stem arising from the wall of the aneurysm and infarction in the brain stem were found. Case 2 was anticoagulated strictly and progressively improved after three weeks. Anticoagulation was terminated after one month. Follow-up MRI showed the aneurysm had disappeared six months later. Giant fusiform aneurysms in the basilar artery trunk can be treated with the balloon occlusion of vertebral arteries which induces thrombosis in the sac of aneurysm. Controlled anticoagulation should be given to slow down the thrombotic obliteration in the perforators arising from the aneurysm wall to the brain stem and give the brain stem have enough time to establish the sufficient collateral circulation.

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Wilson, Stephanie R., Robert G. Atnip, Harjit Singh, Ryan H. Wilson, and William A. Zang. "Ultrasound and Computed Tomography-Guided Thrombin Injection of a Type 2 Endoleak." Journal for Vascular Ultrasound 33, no. 1 (March 2009): 23–25. http://dx.doi.org/10.1177/154431670903300105.

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Introduction Type II endoleaks are a well-documented complication of endovascular aortic aneurysm repair. This case demonstrates the successful combined use of duplex ultrasound to assist in the percutaneous treatment of type II endoleaks. Case report A 75 year-old man who had previously undergone endovascular aortic aneurysm repair was found to have a type II endoleak. As the result of failure of the transfemoral endovascular coil embolization to repair the leak, the patient underwent computed tomography-and ultrasound-guided thrombin injection of the aneurysm sac via a trans-lumbar approach. Duplex ultrasound proved useful in guiding the placement of the translumbar needle, in confirming the thrombosis of the endoleak, and in demonstrating continued patency of the endograft. Conclusion The two imaging modalities worked in a complementary fashion to guide needle placement and to enable real-time imaging of color-enhanced flow within the aneurysm sac.

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Piepgras, David G., Vini G. Khurana, and Douglas A. Nichols. "Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis." Journal of Neurosurgery 95, no. 1 (July 2001): 132–37. http://dx.doi.org/10.3171/jns.2001.95.1.0132.

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✓ The authors describe a unique clinicopathological phenomenon in a patient who presented with an unruptured giant vertebral artery aneurysm and who underwent endovascular proximal occlusion of the parent artery followed, several days later, by surgical trapping of the aneurysm after delayed subarachnoid hemorrhage (SAH). The intraoperative finding of a thrombus extruding from the wall of the aneurysm at a site remote from the origin of the SAH underscores the possibility that occult rupture of an aneurysmal sac can occur in patients with thrombosed giant aneurysms.

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Gabriel, Sthefano Atique, Marcia Fayad Marcondes de Abreu, Guilherme Camargo Goncalves de Abreu, Claudio Roberto Cabrini Simoes, Antonio Claudio Guedes Chrispim, and Otacilio de Camargo Junior. "True posttraumatic radial artery aneurysm." Jornal Vascular Brasileiro 12, no. 4 (October 25, 2013): 320–23. http://dx.doi.org/10.1590/jvb.2013.047.

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Radial artery aneurysms are rare and mostly secondary to traumatic events (posttraumatic pseudoaneurysms). Radial artery aneurysms should be treated due to the high risk of embolization, thrombosis, and compression of adjacent nerves. The authors describe a case of a 49-year-old patient complaining of a progressively growing tumor in the left wrist after a dog bite. The tumor proved to be a true posttraumatic aneurysm. Treatment consisted of removal of the aneurysm sac and ligation of the radial artery.

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Mustafa, W., K. Kadziolka, R. Anxionnat, and L. Pierot. "Direct Carotid-Cavernous Fistula following Intracavernous Carotid Aneurysm Treatment with a Flow-Diverter Stent." Interventional Neuroradiology 16, no. 4 (December 2010): 447–50. http://dx.doi.org/10.1177/159101991001600412.

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A 39-year-old woman presented with a right intra-cavernous carotid aneurysm measuring 1.76 cm×1.33 cm. The aneurysm was treated with a self-expandable flow-diverter stent. Follow-up MRI showed normal flow in the internal carotid artery with partial thrombosis of the aneurysmal sac. Two weeks later, the patient developed a right direct carotid-cavernous fistula. The fistula was treated by transvenous route. We concluded that rupture of a previously unruptured aneurysm can occur after treatment with a flowdiverter stent.

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Low, Christopher, Daneyal Syed, Daniel Khan, Sermin Tetik, Amanda Walborn, Debra Hoppensteadt, Michael Mosier, and Jawed Fareed. "Modulation of Interleukins in Sepsis-Associated Clotting Disorders." Clinical and Applied Thrombosis/Hemostasis 23, no. 1 (July 28, 2016): 34–39. http://dx.doi.org/10.1177/1076029616659696.

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Interleukins play a central role in the immune system and are involved in a variety of immunological, inflammatory, and infectious disease states including sepsis syndrome. Levels of interleukins may correlate with overall survival and may directly or indirectly affect some of the regulators of coagulation and fibrinolysis, thereby disrupting hemostasis and thrombosis. Our hypothesis is that in sepsis-associated coagulopathies (SACs), interleukins may be upregulated, leading to hemostatic imbalance by generating thrombogenic mediators. We profiled the levels of interleukins IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, and IL-10 in addition to d-dimer (DD) in patients with SAC and in normal donors. We observed the highest increase in interleukins IL-6 (322-fold), IL-8 (48-fold), IL-10 (72-fold), and DD (18-fold). This suggests that interleukins such as IL-6 and IL-10 have a close association with coagulopathy and fibrinolytic dysregulation in sepsis and can be considered as candidates for potential therapeutic targets in SAC.

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Nestorovic, Dragoslav, Igor Nikolic, Svetlana Milosevic-Medenica, Aleksandar Janicijevic, and Goran Tasic. "Internal carotid artery “donut” aneurysm treated using DERIVO flow-diverting stent." Srpski arhiv za celokupno lekarstvo 150, no. 1-2 (2022): 96–99. http://dx.doi.org/10.2298/sarh210718101n.

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Introduction. Intracranial aneurysms with a radiological sign of a donut are a medical priority and have been described in a small number of cases. This radiological sign occurs in aneurysms in which there is partial thrombosis inside aneurismal sac and circular laminar flow between the aneurismal wall and the thrombus in its center. Consequently, there is a central contrast-filling defect of the aneurysm sac observed on different angiographic imaging methods. Case outline. We present a 35-year-old female patient admitted for examination due to frequent headaches, visual disturbances on the left and loss of sight on the right eye. Digital subtraction angiography (DSA) showed an aneurysm on the right internal carotid artery measuring 25.6 ? 25 mm, while neck measured 11 mm and included part of the C6 and C7 segments. Treatment decision was made that placing a flow-diverting stent across the aneurysm neck would be most beneficial in this case. After the procedure, the patient was discharged in the same general condition as she was before admission to the hospital. Seven months after the intervention, she reported for her first DSA control examination. Normal position of the left A1 segment was demonstrated, suggesting shrinkage of the aneurysm sac. An improvement of vision on both eyes was stated. Conclusion. We present a patient with a ?donut? aneurysm on the internal carotid artery, successfully treated with a flow-diverting stent.

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Statz, Stephen, Giselle Sabal, Amanda Walborn, Mark Williams, Debra Hoppensteadt, Michael Mosier, Matthew Rondina, and Jawed Fareed. "Angiopoietin 2 Levels in the Risk Stratification and Mortality Outcome Prediction of Sepsis-Associated Coagulopathy." Clinical and Applied Thrombosis/Hemostasis 24, no. 8 (July 11, 2018): 1223–33. http://dx.doi.org/10.1177/1076029618786029.

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It has been well established that angiopoietin 2 (Ang-2), a glycoprotein involved in activation of the endothelium, plays an integral role in the pathophysiology of sepsis and many other inflammatory conditions. However, the role of Ang-2 in sepsis-associated coagulopathy (SAC) specifically has not been defined. The aim of this study was to measure Ang-2 plasma levels in patients with sepsis and suspected disseminated intravascular coagulation (DIC) in order to demonstrate its predictive value in SAC severity determination and 28-day mortality outcome. Plasma samples were collected from 102 patients with sepsis and suspected DIC at intensive care unit (ICU) admission. The Ang-2 plasma levels were quantified using a sandwich enzyme-linked immunosorbent assay method. The International Society on Thrombosis and Haemostasis DIC scoring system was used to compare the accuracy of Ang-2 levels versus clinical illness severity scores in predicting SAC severity. Mean Ang-2 levels in patients with sepsis and DIC were significantly higher in comparison to healthy controls ( P < 0.0001), and median Ang-2 levels showed a downward trend over time ( P = 0.0008). Baseline Ang-2 levels and clinical illness severity scores were higher with increasing severity of disease, and Ang-2 was a better predictor of DIC severity than clinical illness scores. This study demonstrates that Ang-2 levels are significantly upregulated in SAC, and this biomarker can be used to risk stratify patients with sepsis into non-overt DIC and overt DIC. Furthermore, the Ang-2 level at ICU admission in a patient with sepsis and suspected DIC may provide a predictive biomarker for mortality outcome.

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Alderazi, Yazan J., Darshan Shastri, Tareq Kass-Hout, Charles J. Prestigiacomo, and Chirag D. Gandhi. "Flow Diverters for Intracranial Aneurysms." Stroke Research and Treatment 2014 (2014): 1–12. http://dx.doi.org/10.1155/2014/415653.

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Flow diverters (pipeline embolization device, Silk flow diverter, and Surpass flow diverter) have been developed to treat intracranial aneurysms. These endovascular devices are placed within the parent artery rather than the aneurysm sac. They take advantage of altering hemodynamics at the aneurysm/parent vessel interface, resulting in gradual thrombosis of the aneurysm occurring over time. Subsequent inflammatory response, healing, and endothelial growth shrink the aneurysm and reconstruct the parent artery lumen while preserving perforators and side branches in most cases. Flow diverters have already allowed treatment of previously untreatable wide neck and giant aneurysms. There are risks with flow diverters including in-stent thrombosis, perianeurysmal edema, distant and delayed hemorrhages, and perforator occlusions. Comparative efficacy and safety against other therapies are being studied in ongoing trials. Antiplatelet therapy is mandatory with flow diverters, which has highlighted the need for better evidence for monitoring and tailoring antiplatelet therapy. In this paper we review the devices, their uses, associated complications, evidence base, and ongoing studies.

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Chandra, Ankur, and Niren Angle. "Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli." Vascular 14, no. 3 (May 1, 2006): 156–60. http://dx.doi.org/10.2310/6670.2006.00029.

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Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.

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Strittmatter, Catherine, Lukas Meyer, Gabriel Broocks, Maria Alexandrou, Maria Politi, Maria Boutchakova, Andreas Henssler, et al. "Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience." Journal of Clinical Medicine 11, no. 12 (June 16, 2022): 3469. http://dx.doi.org/10.3390/jcm11123469.

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Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55–71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11–0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51–0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68–11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration.

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Ravindran, Krishnan, Amanda M. Casabella, Juan Cebral, Waleed Brinjikji, David F. Kallmes, and Ram Kadirvel. "Mechanism of Action and Biology of Flow Diverters in the Treatment of Intracranial Aneurysms." Neurosurgery 86, Supplement_1 (December 16, 2019): S13—S19. http://dx.doi.org/10.1093/neuros/nyz324.

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Abstract Flow diverters have drastically changed the landscape of intracranial aneurysm treatment and are now considered first-line therapy for select lesions. Their mechanism of action relies on intrinsic alteration in hemodynamic parameters, both at the parent artery and within the aneurysm sac. Moreover, the device struts act as a nidus for endothelial cell growth across the aneurysm neck ultimately leading to aneurysm exclusion from the circulation. In silico computational analyses and investigations in preclinical animal models have provided valuable insights into the underlying biological basis for flow diverter therapy. Here, we review the present understanding pertaining to flow diverter biology and mechanisms of action, focusing on stent design, induction of intra-aneurysmal thrombosis, endothelialization, and alterations in hemodynamics.

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Szajner, M., T. Jargiello, T. Trojanowski, and M. Szczerbo-Trojanowska. "Spontaneous Thrombosis of the Pseudoaneurysm of Right SCA after an Attempt at Embolisation." Interventional Neuroradiology 8, no. 2 (June 2002): 205–8. http://dx.doi.org/10.1177/159101990200800214.

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Spontaneous thrombosis of intracranial aneurysms rare, mostly affecting giant aneurysms with narrow necks. We present the case of 34 y/o man with pseudoaneurysm that developed in the course of SAH. The initial CT scan showed an isolated, well-defined hematoma within the right cerebellar hemisphere, digital subtraction angiogram (DSA) performed in a regional hospital showed an irregular shaped aneurysm of the distal segment of the right SCA. The patient was sent to our department, where diagnostic DSA, performed before embolisation revealed an entirely different morphology of the aneurysm. It became larger, round and no other functional branches distal to it were found (picture of “a balloon on a string”). During supraselective catheterization, when microcatheter and microguidewire were already in the right SCA a technical problem of our angio-machine occurred, so the intervention had to be postponed. A week later, a second attempt at embolisation was made. This time an initial DSA showed a lack of filling of the aneurysm sac and thrombosis of the main trunk of the right SCA. The patient remained clinically stable. He was discharged from our hospital five days later.

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Pasarikovski, CR, J. Ku, J. Ramjist, Y. Dobashi, SM Priola, L. da Costa, A. Kumar, and VX Yang. "GP.3 Examining Aneurysmal Healing After Flow Diversion Treatment Using Endovascular Optical Coherence Tomography." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S12—S13. http://dx.doi.org/10.1017/cjn.2021.259.

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Background: The mechanism of aneurysmal healing after flow-diversion treatment of cerebral aneurysms remains unknown. The purpose of this research to is to utilize a novel technology called endovascular optical coherence tomography (OCT) to characterise and improve our understanding of aneurysmal healing after flow-diversion using a rabbit aneurysm model. Methods: Saccular aneurysms were created in 10 New Zealand white rabbits. The aneurysms were treated with a flow-diverting stent 28 days after creation. OCT and histopathologic examinations included: luminal thrombosis, endothelial loss, inflammation, fibrin, smooth muscle cell loss, disruption of the internal and external elastic lamina, and tunica adventitia changes Results: OCT revealed endothelialization across the stent, appearing to originate from the parent vessel, along with small amounts of thrombus on the stent-struts. Minimal thrombus was visualized within the aneurysm sac. Histologic examination revealed that OCT can accurately define endothelialization across the sent, and define patent segments across the neck. Conclusions: Aneurysmal healing appears to originate at the parent vessel/stent interface, and use the stent as a scaffold to grow across the neck of the aneurysm. Minimal thrombus was visualized within the aneurysm sac, with ongoing flow observed in the setting of incomplete neck endothelialization. This technology has great potential for assessing aneurysmal healing in real-time.

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Valle, Edison P., Rafael J. Tamargo, and Philippe Gailloud. "Thrombosis and subsequent recanalization of a ruptured intracranial aneurysm in 2 children, demonstrating the value of repeating catheter angiography after an initial negative study." Journal of Neurosurgery: Pediatrics 5, no. 4 (April 2010): 346–49. http://dx.doi.org/10.3171/2009.10.peds0966.

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The cases of 2 children with true aneurysmal subarachnoid hemorrhages (SAHs) and initial false-negative angiograms are reported. In both cases, the initial angiogram was of adequate technical quality and included the projections on which aneurysms were later documented. There was no significant vasospasm at the time of initial angiography; therefore, transient aneurysm sac thrombosis was the most likely explanation for the initial false-negative studies. It is particularly interesting to note that 1 of the 2 patients had a pattern of hemorrhage compatible with the most limited definition of a perimesencephalic SAH, that is, a small prepontine cistern hemorrhage. If a second angiogram had been deemed unnecessary based on that criterion alone, a ruptured basilar tip aneurysm would have escaped detection and treatment.

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Gory, Benjamin, Joachim Klisch, Alain Bonafé, Charbel Mounayer, Remy Beaujeux, Jacques Moret, Boris Lubicz, Roberto Riva, and Francis Turjman. "Solitaire AB Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms." Neurosurgery 75, no. 3 (May 12, 2014): 215–19. http://dx.doi.org/10.1227/neu.0000000000000415.

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Abstract BACKGROUND: Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms. OBJECTIVE: To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent. METHODS: SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score. RESULTS: The mean width of the aneurysm sac was 7.5 mm, and the mean diameter of the aneurysm neck was 4.7 mm. Angiographic mid-term follow-up was obtained in 55 of 65 aneurysms (85.9%). Complete occlusion was achieved in 33 aneurysms (60%); a neck remnant was seen in 16 aneurysms (29.1%) and an aneurysm remnant in 6 aneurysms (10.9%). Of 55 aneurysms, recanalization was observed in 8 aneurysms (14.5%), and progressive thrombosis was observed in 17 aneurysms (30.9%). No bleeding or rebleeding was observed during the follow-up period. CONCLUSION: Stent-assisted coiling of wide-necked intracranial aneurysms was found to be safe and effective with the Solitaire AB stent at 6-month follow-up. Angiographic results improve with time due to progressive thrombosis of the aneurysm.

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de Andrade, Guilherme Cabral, Helvercio P. Alves, Valter Clímaco, Eduardo Pereira, Alexandre Lesczynsky, and Michel E. Frudit. "Two-stage reconstructive overlapping stent LEO+ and SILK for treatment of intracranial circumferential fusiform aneurysms in the posterior circulation." Interventional Neuroradiology 22, no. 5 (July 11, 2016): 516–23. http://dx.doi.org/10.1177/1591019916656475.

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Intracranial circumferential fusiform aneurysms of the posterior circulation involving arterial branches or perforating vessels are difficult to treat. This article shows an endovascular reconstruction technique not yet described, using a telescoping self-expandable stent (LEO+) and flow-diverter device (SILK) at different surgical times. Two patients with circumferential fusiform aneurysm, one being an aneurysm of the segments P2 and P3 of the posterior cerebral artery, diagnosed after a headache, and the other a partially thrombosed aneurysm of the lower basilar artery, diagnosed following ischemia of the brain stem. Endovascular treatment was performed by means of a vascular reconstruction technique that used at different surgical times: overlapping; a telescoped self-expandable stent, LEO+; and a flow-diverter device, SILK. Angiographic control was carried out at 6 and 12 months, to evaluate arterial patency, flow maintenance in the arterial branches and perforating vessels, and thrombosis of the aneurysm. The combined use at different surgical times of the self-expandable stent and flow-diverter device was technically successful in both patients. There were no complications during the procedure, nor in the long-term follow-up with full arterial vascular reconstruction, maintenance of cerebral perfusion and complete aneurysm occlusion at the 6- and 12-month angiographic follow-up. There was no aneurysm recanalization nor intra-stent stenosis. Circumferential fusiform aneurysm of the posterior circulation involving arterial branches or perforating vessels to the brain stem may be treated with this arterial reconstruction technique at different surgical times, using the self-expandable stent called LEO+ and the flow-diverter device SILK, minimizing the risk of complications and failure of the endovascular technique, with the potential for arterial reconstruction with thrombosis of the aneurysmatic sac, as well as flow maintenance in the eloquent arteries, in this type of cerebral aneurysm.

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Hwang, G., C. Jung, S. H. Sheen, H. Park, H. S. Kang, S. H. Lee, C. W. Oh, Y. S. Chung, M. H. Han, and O. K. Kwon. "Two-Year Follow-Up of Contrast Stasis within the Sac in Unruptured Aneurysm Coil Embolization: Progressive Thrombosis or Enlargement?" American Journal of Neuroradiology 31, no. 10 (July 15, 2010): 1929–34. http://dx.doi.org/10.3174/ajnr.a2203.

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Schurink, G. W. H., N. J. M. Aarts, J. M. van Baalen, L. J. Schultze Kool, and J. H. van Bockel. "Experimental study of the influence of endoleak size on pressure in the aneurysm sac and the consequences of thrombosis." British Journal of Surgery 87, no. 1 (January 2000): 71–78. http://dx.doi.org/10.1046/j.1365-2168.2000.01319.x.

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Arbănaşi, Emil-Marian, Eliza Russu, Adrian Vasile Mureşan, Eliza-Mihaela Arbănaşi, and Reka Kaller. "Ulnar-basilic arteriovenous fistula with multilocular gigantic aneurysmal dilatation: a case report." Acta Marisiensis - Seria Medica 67, no. 4 (December 1, 2021): 244–46. http://dx.doi.org/10.2478/amma-2021-0035.

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Abstract Introduction: Arteriovenous fistula dysfunction has been associated with a range of problems such as thrombosis, stenosis, dilatation, and infection. Case presentation: We present the case of a 64-year-old patient with chronic kidney disease on hemodialysis and with aneurysmal dilatation of the ulnar-basilic arteriovenous fistula, having an increased risk of rupture. A temporary dialysis catheter is placed in the left femoral vein, an aneurysmal basilic vein is ligated at the anastomosis, aneurysmal dilatation is emptied by compression, and a right radiocephalic arteriovenous fistula is performed. The patient undergoes hemodialysis on the second day and subsequently three times a week for six weeks until the new arteriovenous fistula develops. He returns for aneurysmal sac resection. Conclusion: The purpose of this paper is the presentation and management of a 15-year-old ulnar-basilic arteriovenous fistula with multilocular aneurysmal development and an imminent rupture.

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Holder, Rebecca, Derek Hilton, Janis Martin, Peter L. Harris, Peter C. Rowlands, and Richard G. McWilliams. "Percutaneous Thrombin Injection of Carotid Artery Pseudoaneurysm." Journal of Endovascular Therapy 9, no. 1 (February 2002): 25–28. http://dx.doi.org/10.1177/152660280200900105.

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Purpose: To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection. Case Report: A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications. Conclusions: Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.

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Sablani, Naveen, Gary Jain, Maryam Mumtaz Hasan, Keithan Sivakumar, Solomon Feuerwerker, Karthikeyan Arcot, and Jeffrey Farkas. "Republished: A novel approach to the management of carotid blowout syndrome: the use of thrombin in a case of failed covered stenting." Journal of NeuroInterventional Surgery 8, no. 12 (March 1, 2016): e49-e49. http://dx.doi.org/10.1136/neurintsurg-2015-012121.rep.

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Acute hemorrhage relating to an expanding pseudoaneurysm of the carotid artery is referred to as carotid blowout syndrome (CBS). CBS is associated with a high morbidity and mortality. We describe the case of a patient who presented with dysphagia and a pulsatile mass in the neck. Imaging revealed a pseudoaneurysm originating from the bifurcation of the distal right common carotid artery. On neuroangiography the patient lacked sufficient collaterals to allow for vessel sacrifice. A decision was made to use covered stents to prevent flow into the pseudoaneurysm while maintaining vessel patency. Despite placement of multiple covered stents there was residual slow filling of the pseudoaneurysm. We augmented this therapy with direct percutaneous thrombin injection into the pseudoaneurysm. This resulted in complete thrombosis of the pseudoaneurysm. For recalcitrant lesions in which the usual methods of stopping blood flow to the pseudoaneurysmal sac fail, an adjuvant approach with thrombin should be considered.

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Appelboom, Geoffrey, Khaled Kadri, Farouk Hassan, and Xavier Leclerc. "Infectious Aneurysm of the Cavernous Carotid Artery in a Child Treated With a New-Generation of Flow-Diverting Stent Graft." Neurosurgery 66, no. 3 (March 1, 2010): E623—E624. http://dx.doi.org/10.1227/01.neu.0000365370.82554.08.

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Abstract OBJECTIVE To report a unique case of wide-necked mycotic cerebral aneurysm treated with a new generation of intracranial stent. CLINICAL PRESENTATION A 10-year-old girl presented with meningitis complicated by an infectious intracavernous large aneurysm revealed by cranial nerve palsy. INTERVENTION The aneurysm was treated by a new-generation, flow-diverting, endoluminal implant (SILK; BALT EXTRUSION, Montmorency, France) placed across the aneurysm neck without coiling. Angiographic controls showed complete thrombosis of the aneurysmal sac with dramatic improvement of symptoms a couple of weeks after the procedure. Follow-up magnetic resonance imaging and digital subtraction angiography 3 months after the procedure, confirmed total occlusion of the aneurysm with normal circulation in the parent vessel CONCLUSION This is a simple and highly effective way to exclude an aneurysm from the parent vessel without the difficulties observed with the semi-rigid stents. Flow-disrupting stent grafting may be a safe and effective alternative treatment for large intracranial aneurysms.

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Zenteno, Marco, Angel Lee, Jennifer Lorena Herrera Bejarano, Guru Dutta Satyarthee, Hernando Raphael Alvis-Miranda, and Luis Rafael Moscote-Salazar. "When flow diverters fail: short review and a case illustration of a device failure." Romanian Neurosurgery 30, no. 4 (December 1, 2016): 467–74. http://dx.doi.org/10.1515/romneu-2016-0075.

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Abstract The ultimate aims of treatment of the intracranial aneurysms are reconstruction the vessel wall and correcting the hemodynamic disturbance. A flow diverter (FD) is a stent placed inside lumen of the parent artery with aim to blood flow reduction into the aneurysms sac to the extent of almost stagnation leading to gradual onset of progressive thrombosis and neointimal lining of arterial wall remodeling to maintain blood outflow into perforators the side and branches. Flow diverter is considered as an effective treatment for fusiform, wide-necked, large and giant intracranial unruptured aneurysms. However, FD implantation may also be associated with growth and rupture of residual aneurysms. The most frequent complication of endovascular aneurysms management is thromboembolic events and less common are intra and postoperative hemorrhagic aneurysmal rupture. Authors report a case where a lack of operation of the device as illustration is presented to demonstrate the shortcomings of this new type of devices.

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Purakal, Alixandra S., Daniel Thomas Ginat, and Seon-Kyu Lee. "Republished: Successfully treated symptomatic fusiform basilar artery aneurysm in a patient with hindbrain malformation via inverted Y-stenting." Journal of NeuroInterventional Surgery 8, no. 3 (February 2, 2015): e10-e10. http://dx.doi.org/10.1136/neurintsurg-2014-011590.rep.

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A double overlapping reverse Y-stent approach to creating flow diversion using traditional open-cell stent technology was evaluated as a treatment option symptomatic fusiform basilar aneurysms. A 36-year-old man with a complex hindbrain malformation presented with acute ocular dysmotility due to a rapidly enlarging fusiform basilar artery aneurysm. The aneurysm was treated by insertion of two stents into the vertebrobasilar system in an inverted Y-configuration from the basilar tip to the V4 segments of the bilateral vertebral arteries, essentially creating flow diversion without using a dedicated flow diversion device. This resulted in immediate symptomatic improvement. The stents remained patent and the aneurysm was obliterated at 6 months follow-up. Furthermore, the patient remained free of associated symptoms at 10 months follow-up. Thus, the double stenting technique can be used instead of a flow diversion device to effectively create flow diversion, promote aneurysm sac thrombosis, and lead to resolution of symptoms in large fusiform basilar artery aneurysms.

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Taki, Waro, Shogo Nishi, Kohsuke Yamashita, Akiyo Sadatoh, Ichiro Nakahara, Haruhiko Kikuchi, and Hiroo Iwata. "Selection and combination of various endovascular techniques in the treatment of giant aneurysms." Journal of Neurosurgery 77, no. 1 (July 1992): 37–42. http://dx.doi.org/10.3171/jns.1992.77.1.0037.

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✓ Between April, 1989, and January, 1991, a total of 19 cases of giant aneurysm were treated by the endovascular approach. The patients included seven males and 12 females aged 15 to 72 years. Detachable balloons, occlusion coils, and ethylene vinyl alcohol copolymer liquid were used as embolic materials. In seven cases, thrombosis of the aneurysmal sac and/or base was achieved while sparing the parent arterial flow; complete obliteration of the aneurysm was achieved in four of these. Of these four patients, the thrombotic material was a detachable balloon in two, a combination of a detachable balloon and coils in one, and occlusion liquid in one. In the other three cases, complete occlusion was not achieved; one aneurysm was occluded with a detachable balloon and two with coils. In 11 patients, the parent artery was occluded either by trapping or by proximal arterial occlusion, and all patients showed complete occlusion of the aneurysms. In one patient, a combined bypass procedure and parent artery occlusion was performed. Among the 19 cases in this series there were four transient ischemic attacks, one reversible ischemic neurological deficit, and one death due to aneurysmal rupture during the procedure. Two patients died in the follow-up period, one from pneumonia 2 months postoperatively and the other from acute cardiac failure 2 weeks following surgery. Both deaths were unrelated to the endovascular procedure. It is concluded that the endovascular treatment of giant aneurysms remains difficult because of the large and irregular shape of the aneurysmal base and thrombus in the aneurysmal sac. The proper selection and combination of the available endovascular techniques is therefore of critical importance.

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Barat, Sorin, and Dumitru Casian. "Off-Label Use of a Double-Layer Micromesh Carotid Stent for Hybrid Treatment of Popliteal Artery Aneurism Complicated by Chronic Distal Embolization." Case Reports in Vascular Medicine 2021 (June 21, 2021): 1–6. http://dx.doi.org/10.1155/2021/5546194.

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We report our initial experience in off-label use of the double-layer micromesh (DLM) Roadsaver® stent for the hybrid treatment of a fusiform popliteal artery aneurism complicated by distal embolization and chronic limb threatening ischemia in a COVID-19-positive young male. A 36-year-old male patient was admitted with chronic limb threatening ischemia of the left lower limb. The duplex ultrasound and computer tomography angiography (CTA) demonstrated a fusiform popliteal artery aneurism with a maximal diameter of 14 mm and distal occlusion of peroneal and both tibial arteries. Urgent hybrid intervention was performed, starting with an open thrombectomy from the distal posterior tibial artery via a retromalleolar access followed by percutaneous deployment of the DLM Roadsaver® stent (Terumo, Tokyo, Japan) for the exclusion of the popliteal artery aneurism. The flow diverting effect was observed immediately with contrast stagnation in the asymmetrical part of the aneurism sac (grade C2 of the O’Kelly-Marotta flow diversion scale). The procedure was uneventful, with the regaining of an adequate foot perfusion and palpable pulse at the posterior tibial artery. On the 2nd postoperative day, the patient was diagnosed with a symptomatic form of COVID-19 infection and transferred to a dedicated facility. At a one-month follow-up, the patient had no symptoms of limb ischemia and CTA showed complete thrombosis of the aneurism sac, absence of endoleaks, and patency of the treated arterial segment. This case demonstrates the possibility of off-label use of the DLM Roadsaver® stent for hybrid treatment of popliteal artery aneurism complicated by distal embolization and critical limb ischemia.

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Boyle, E., SM McHugh, A. Elmallah, M. Lynch, D. McGuire, Z. Ahmed, C. Canning, et al. "Explant of aortic stent grafts following endovascular aneurysm repair." Vascular 27, no. 5 (March 16, 2019): 487–94. http://dx.doi.org/10.1177/1708538119832727.

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Background Failure of endovascular aneurysm repair may require explant of the stent graft in a subset of patients. We sought to assess outcomes in a cohort of patients undergoing explant of endovascular aneurysm repair in both emergency and elective settings. Methods Patients undergoing explant of endovascular aneurysm repair were identified from a prospectively maintained database, with additional information obtained through retrospective analysis of medical records. Results Over a 21-year period, 1997–2018 (May), there were 597 endovascular aneurysm repair procedures performed in our institution for abdominal aortic aneurysm. There were 19 endovascular aneurysm repair explants; five of these were referrals from other vascular centres. The median age was 73 years (range 46–81). The median length of time from insertion to explant was 39.2 months (range 0–153). Indications for elective explant were type Ia endoleak (n = 4), type 1b endoleak (n = 1), type II endoleak with increasing sac size (n = 1), type I/III endoleak (n = 1), type IV endoleak (n = 1), and increasing sac size without evident endoleak (type V, n = 2). The remaining nine cases were emergency procedures, with four patients presenting with rupture post endovascular aneurysm repair, four patients presenting with acute stent thrombosis, of which one also had a type 1a endoleak and one aorto-enteric fistula. There were no mortalities in the elective group and three mortalities in the emergency group (0 vs 33.3%, p = 0.087). Overall 30-day mortality was 15.8% Conclusion Explant of aortic stent grafts can be associated with high mortality and morbidity rates, especially in the emergent setting. Patient and device selection and post-operative surveillance remain vitally important to optimise outcomes post endovascular aneurysm repair.

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Cohen-Gadol, Aaron A., and Dennis D. Spencer. "Harvey W. Cushing and cerebrovascular surgery: Part I, aneurysms." Journal of Neurosurgery 101, no. 3 (September 2004): 547–52. http://dx.doi.org/10.3171/jns.2004.101.3.0547.

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✓ The development of surgical techniques for the treatment of intracranial aneurysms has paralleled the evolution of the specialty of neurological surgery. During the Cushing era, intracranial aneurysms were considered inoperable and only ligation of the carotid artery was performed. Cushing understood the limitations of this approach and advised the need for a more thorough understanding of aneurysm pathology before further consideration could be given to the surgical treatment of cerebral aneurysms. Despite his focus on brain tumors, Cushing's contributions to the discipline of neurovascular surgery are of great importance. With the assistance of Sir Charles Symonds, Cushing described the syndrome of subarachnoid hemorrhage. He considered inserting muscle strips into cerebral aneurysms to promote aneurysm sac thrombosis and designed the “silver clip,” which was modified by McKenzie and later used by Dandy to clip the first intracranial aneurysm. Cushing was the first surgeon to wrap aneurysms in muscle fragments to prevent recurrent hemorrhage. He established the foundation on which pioneers such as Norman Dott and Walter Dandy launched the modern era of neurovascular surgery.

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Ghosh, Arunima, Andy Vo, Beverly K. Twiss, Colin A. Kretz, Mary A. Jozwiak, Robert R. Montgomery, and Jordan A. Shavit. "Characterization of Zebrafish von Willebrand Factor Reveals Conservation of Domain Structure, Multimerization, and Intracellular Storage." Advances in Hematology 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/214209.

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von Willebrand disease (VWD) is the most common inherited human bleeding disorder and is caused by quantitative or qualitative defects in von Willebrand factor (VWF). VWF is a secreted glycoprotein that circulates as large multimers. While reduced VWF is associated with bleeding, elevations in overall level or multimer size are implicated in thrombosis. The zebrafish is a powerful genetic model in which the hemostatic system is well conserved with mammals. The ability of this organism to generate thousands of offspring and its optical transparency make it unique and complementary to mammalian models of hemostasis. Previously, partial clones of zebrafishvwfhave been identified, and some functional conservation has been demonstrated. In this paper we clone the complete zebrafishvwfcDNA and show that there is conservation of domain structure. Recombinant zebrafish Vwf forms large multimers and pseudo-Weibel-Palade bodies (WPBs) in cell culture. Larval expression is in the pharyngeal arches, yolk sac, and intestinal epithelium. These results provide a foundation for continued study of zebrafish Vwf that may further our understanding of the mechanisms of VWD.

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Journal articles on the topic 'Sac thrombosis'

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