Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-30-36
V. Tsymbaliuk, A. Popov
Objective — to investigate the dynamics of levodopa-therapy in patients with Parkinson's disease (PD) after unilateral stereotactic radiofrequency pallidotomy (USRP). Materials and methods. From 2008 to 2016 USRP was performed in 16 patients (7 men and 9 women from 48 to 73 years old, average — 56 years) with PD complicated by levodopa-induced dyskinesias and motor fluctuations (MF). The dynamics of the disease symptoms was interpreted on the basis of separate sections and points of the UPDRS. The levodopa-equivalent dose (LED) was calculated using standard conventers. Patients were evaluated before, one week and then one year after surgery. Results. One week after the USRP 43.2 % reduction of average daily LED was noted. The decrease of severity of MF and motor symptoms of the OFF-period on the contralateral side was traced. After 1 year of follow up the rate of reduction decline of the average daily LED compared to its preoperative level was 22.3 %. The recurrence of the MF and the steady positive effects on the motor symptoms of the OFF-period on the contralateral side were observed. Conclusions. Primary reduction of the daily LED effects of USRP decrease during one year of observation in the background of the MF recurrence, despite the steady positive effects on the motor symptoms of the OFF-period on the contralateral side.
{"title":"Dynamics of levodopa-therapy in patients with Parkinson’s disease afterunilateral pallidotomy","authors":"V. Tsymbaliuk, A. Popov","doi":"10.26683/2304-9359-2018-2(24)-30-36","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-30-36","url":null,"abstract":"Objective — to investigate the dynamics of levodopa-therapy in patients with Parkinson's disease (PD) after unilateral stereotactic radiofrequency pallidotomy (USRP). \u0000Materials and methods. From 2008 to 2016 USRP was performed in 16 patients (7 men and 9 women from 48 to 73 years old, average — 56 years) with PD complicated by levodopa-induced dyskinesias and motor fluctuations (MF). The dynamics of the disease symptoms was interpreted on the basis of separate sections and points of the UPDRS. The levodopa-equivalent dose (LED) was calculated using standard conventers. Patients were evaluated before, one week and then one year after surgery. \u0000Results. One week after the USRP 43.2 % reduction of average daily LED was noted. The decrease of severity of MF and motor symptoms of the OFF-period on the contralateral side was traced. After 1 year of follow up the rate of reduction decline of the average daily LED compared to its preoperative level was 22.3 %. The recurrence of the MF and the steady positive effects on the motor symptoms of the OFF-period on the contralateral side were observed. \u0000Conclusions. Primary reduction of the daily LED effects of USRP decrease during one year of observation in the background of the MF recurrence, despite the steady positive effects on the motor symptoms of the OFF-period on the contralateral side.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46734394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-44-51
A. Polkovnikov, V. Pertsov, A. Materukhin, E. Savchenko
Objective — to optimize the results of endovascular treatment of stenotic pathology of brachiocephalic arteries. Materials and methods. The results of surgical treatment of 112 patients, among whom there were 79 (70.5 %) men and 33 (29.5 %) women aged from 28 to 86 years with symptomatic stenotic lesions of brachiocephalic arteries treated in the neurosurgical department of the Zaporizhzhia regional hospital in the period from 2010 to 2018 were analyzed. Observations were divided into three groups depending on the localization of the defeat: internal carotid artery — 74 (66 %) cases (predominant stenosis of the mouth of the ICA (n = 71)), vertebral artery — 25 (22.4 %), a portion of the subclavian artery or brachiocephalic trunk — 13 (11.6 %). All patients underwent MRI of the brain in the preoperative period, as well as in 45 (40 %) cases of CTangiography. In all cases prior to surgery invasive angiography was performed with an assessment of the state and anatomy of the brachiocephalic and intracranial arteries, as well as the possibilities of collateral blood flow. Results. In the first group, which was conducted carotid stenting embolic protection device was used in 72 (97.2 %) cases. In the second group, distal protection device were used twice 2 (8 %) in the resolution of extended stenoses of the dominant vertebral artery mouth. In the third group, the distal protection device was used in 1 (7.7 %) case for stenting the critical extended stenosis of the brachiocephalic trunk with the transition to common carotid artery. Complications were noted in 9 observations. In one case there was a development of ischemic stroke, intraoperatively, in a patient with an echeloned lesion of the intracranial basin of a stenting internal carotid artery, probably against a background of hypotension of the stent developed during implantation. In 8 (7.1 %) cases the formation of the hematoma of the puncture site of the femoral artery was noted. Conclusions. The use of embolic protection device is mandatory in standard carotid stenting. The choice of method of protection depends on the severity of stenosis, as well as the individual features of collateral blood flow. When stenting subclavian artery, brachiocephalic trunk and vertebral artery, in some cases it is justified to use distal protection devices, the latter increases the safety of the operation.
{"title":"The use of embolic protection device in the stenting of brachiocephalic arteries","authors":"A. Polkovnikov, V. Pertsov, A. Materukhin, E. Savchenko","doi":"10.26683/2304-9359-2018-2(24)-44-51","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-44-51","url":null,"abstract":"Objective — to optimize the results of endovascular treatment of stenotic pathology of brachiocephalic arteries. \u0000Materials and methods. The results of surgical treatment of 112 patients, among whom there were 79 (70.5 %) men and 33 (29.5 %) women aged from 28 to 86 years with symptomatic stenotic lesions of brachiocephalic arteries treated in the neurosurgical department of the Zaporizhzhia regional hospital in the period from 2010 to 2018 were analyzed. Observations were divided into three groups depending on the localization of the defeat: internal carotid artery — 74 (66 %) cases (predominant stenosis of the mouth of the ICA (n = 71)), vertebral artery — 25 (22.4 %), a portion of the subclavian artery or brachiocephalic trunk — 13 (11.6 %). All patients underwent MRI of the brain in the preoperative period, as well as in 45 (40 %) cases of CTangiography. In all cases prior to surgery invasive angiography was performed with an assessment of the state and anatomy of the brachiocephalic and intracranial arteries, as well as the possibilities of collateral blood flow. \u0000Results. In the first group, which was conducted carotid stenting embolic protection device was used in 72 (97.2 %) cases. In the second group, distal protection device were used twice 2 (8 %) in the resolution of extended stenoses of the dominant vertebral artery mouth. In the third group, the distal protection device was used in 1 (7.7 %) case for stenting the critical extended stenosis of the brachiocephalic trunk with the transition to common carotid artery. Complications were noted in 9 observations. In one case there was a development of ischemic stroke, intraoperatively, in a patient with an echeloned lesion of the intracranial basin of a stenting internal carotid artery, probably against a background of hypotension of the stent developed during implantation. In 8 (7.1 %) cases the formation of the hematoma of the puncture site of the femoral artery was noted. \u0000Conclusions. The use of embolic protection device is mandatory in standard carotid stenting. The choice of method of protection depends on the severity of stenosis, as well as the individual features of collateral blood flow. When stenting subclavian artery, brachiocephalic trunk and vertebral artery, in some cases it is justified to use distal protection devices, the latter increases the safety of the operation.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45290598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-87-96
Y. Cherednychenko, A.Yu. Miroshnychenko, L. Dzyak, N. A. Zorin, S. Grygoruk, E. Gavva, A. N. Tolubaiev
A case of treatment of a patient with type 4 of Ehlers–Danlos syndrome and bilateral dissection stenoses and aneurysms in V3and V4-segments of vertebral arteries is described. Also another vascular anomaly was verified: the aberrant right subclavian artery (arteria lusoria). Сerebral angiography with dynamic rotation of the neck revealed a bow hunter's syndrom, which consists in the restriction of blood flow in the right vertebral artery when the head is turned to the left. Stage-by-stage endovascular reconstruction of both vertebral arteries was performed. Firstly, LVIS stent was implanted in the left vertebral artery on the level of the dissection lesion. Then, the aneurysm of the left vertebral artery was embolized by detachable coils. Balloon angioplasty was performed in the stented segment with the compliance balloon-catheter Scepter. On the series of angiograms: the aneurysm is totally excluded, the stenosis of the artery is eliminated. After 1 month, the second stage of endovascular treatment in the same volume in the right vertebral artery was performed. At attempts of a hemostasis with the vascular closure device Аngioseal were unsuccessful in both operations. Hemostasis was successfully performed by manual compression of the puncture site. A mutation in the gene COL3A1, responsible for the synthesis of procollagen III type, was confirmed by Ehlers–Danlos syndrome of type 4 (vascular type) at the subsequent genotyping of the patient. The patient's neurological symptoms regressed to a great extent. Endovascular methods can be effective in the treatment of vertebral arteries dissection lesions in patients with vascular type of Ehlers–Danlos syndrome.
{"title":"Endovascular treatment of the patient with vascular type of Ehlers–Danlos syndrome with bilateral dissection stenoses and aneurysms in V3- andV4- segments of vertebral arteries","authors":"Y. Cherednychenko, A.Yu. Miroshnychenko, L. Dzyak, N. A. Zorin, S. Grygoruk, E. Gavva, A. N. Tolubaiev","doi":"10.26683/2304-9359-2018-2(24)-87-96","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-87-96","url":null,"abstract":"A case of treatment of a patient with type 4 of Ehlers–Danlos syndrome and bilateral dissection stenoses and aneurysms in V3and V4-segments of vertebral arteries is described. Also another vascular anomaly was verified: the aberrant right subclavian artery (arteria lusoria). Сerebral angiography with dynamic rotation of the neck revealed a bow hunter's syndrom, which consists in the restriction of blood flow in the right vertebral artery when the head is turned to the left. Stage-by-stage endovascular reconstruction of both vertebral arteries was performed. Firstly, LVIS stent was implanted in the left vertebral artery on the level of the dissection lesion. Then, the aneurysm of the left vertebral artery was embolized by detachable coils. Balloon angioplasty was performed in the stented segment with the compliance balloon-catheter Scepter. On the series of angiograms: the aneurysm is totally excluded, the stenosis of the artery is eliminated. After 1 month, the second stage of endovascular treatment in the same volume in the right vertebral artery was performed. At attempts of a hemostasis with the vascular closure device Аngioseal were unsuccessful in both operations. Hemostasis was successfully performed by manual compression of the puncture site. A mutation in the gene COL3A1, responsible for the synthesis of procollagen III type, was confirmed by Ehlers–Danlos syndrome of type 4 (vascular type) at the subsequent genotyping of the patient. The patient's neurological symptoms regressed to a great extent. \u0000Endovascular methods can be effective in the treatment of vertebral arteries dissection lesions in patients with vascular type of Ehlers–Danlos syndrome.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46372835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-52-68
S. O. Lytvak
Objective — to determinate clinical and anatomical options of influence of strategy and tactics of microsurgical treatment cerebral arterial aneurysms (AA) to increase the effectiveness of clipping surgery. Materials and methods. A retrospective analysis of the results of a comprehensive clinical and instrumental examination of 437 adult patients who were operated by clipping cerebral AA, which were on screening and treatment in the department of «Institute of Neurosurgery named after acad. A.P. Romodanov NAMS of Ukraine» in the period from 2009 to 2018 (results of treat of AA distal part anterior cerebral artery (ACA) were analyzed for the period from 1998 to 2015). Men were 235 (53.8 %), women — 202 (46.2 %). In all age groups men dominated. All patients performed a comprehensive clinical and instrumental study in accordance with the supplement to the Order of the Ministry of Health of Ukraine No. 317 dated 13.06.2008. The code for ICD-10: І60.1. Survey results for unification were evaluated according to international scales and classifications. Results. Often, AA was affected by the complex anterior communicating artery (145 (33.2 %)), bifurcation of the M1–M2-segment of the middle cerebral artery (112 (25.6 %)), C5–C6-segments of the internal carotid artery (98 (22.4%)), A2–A5-segments of ACA (79 (18.1 %)). AA of the basilar bifurcation were only 3 (0.7 %) cases. Clinically, cerebral AA was found after ruptured in 382 (87.6 %). Most of AAs were «berry»-type of shape — 364 (83.3 %). Complex AA was detected in 73 (16.7 %) patients. Extended basal craniotomy was used in 46 (10.5 %) cases, pterional craniotomy — in 323 (73.9 %), and other accesses — in 68 (15.6 %). The technique of simple clinging of aneurysms was used in 273 (57.4 %) cases, multiple clipping with clip reconstruction — in 148 (39.0 %), other methods — in 16 (3.6 %). Temporary clip proximally before final dissection was performed in 319 (73.0 %) patients, «pilot» clipping — 76 (17.4%), without proximal control — 42 (9.6 %). Conclusions. When choosing the appropriate strategy and tactics of the microsurgical devascularization of cerebral AA should take into account clinical manifestations and features of the course of the disease. The choice of the optimal microsurgical corridor and AA clinging technique depends on the anatomic-topographic and hemodynamic parameters of AA and the affected arterial segment cerebral artery.
{"title":"Individualization of microsurgical tactics during clipping cerebral arterial aneurysms","authors":"S. O. Lytvak","doi":"10.26683/2304-9359-2018-2(24)-52-68","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-52-68","url":null,"abstract":"Objective — to determinate clinical and anatomical options of influence of strategy and tactics of microsurgical treatment cerebral arterial aneurysms (AA) to increase the effectiveness of clipping surgery. \u0000Materials and methods. A retrospective analysis of the results of a comprehensive clinical and instrumental examination of 437 adult patients who were operated by clipping cerebral AA, which were on screening and treatment in the department of «Institute of Neurosurgery named after acad. \u0000A.P. Romodanov NAMS of Ukraine» in the period from 2009 to 2018 (results of treat of AA distal part anterior cerebral artery (ACA) were analyzed for the period from 1998 to 2015). Men were 235 (53.8 %), women — 202 (46.2 %). In all age groups men dominated. All patients performed a comprehensive clinical and instrumental study in accordance with the supplement to the Order of the Ministry of Health of Ukraine No. 317 dated 13.06.2008. The code for ICD-10: І60.1. Survey results for unification were evaluated according to international scales and classifications. \u0000Results. Often, AA was affected by the complex anterior communicating artery (145 (33.2 %)), bifurcation of the M1–M2-segment of the middle cerebral artery (112 (25.6 %)), C5–C6-segments of the internal carotid artery (98 (22.4%)), A2–A5-segments of ACA (79 (18.1 %)). AA of the basilar bifurcation were only 3 (0.7 %) cases. Clinically, cerebral AA was found after ruptured in 382 (87.6 %). Most of AAs were «berry»-type of shape — 364 (83.3 %). Complex AA was detected in 73 (16.7 %) patients. Extended basal craniotomy was used in 46 (10.5 %) cases, pterional craniotomy — in 323 (73.9 %), and other accesses — in 68 (15.6 %). The technique of simple clinging of aneurysms was used in 273 (57.4 %) cases, multiple clipping with clip reconstruction — in 148 (39.0 %), other methods — in 16 (3.6 %). Temporary clip proximally before final dissection was performed in 319 (73.0 %) patients, «pilot» clipping — 76 (17.4%), without proximal control — 42 (9.6 %). \u0000Conclusions. When choosing the appropriate strategy and tactics of the microsurgical devascularization of cerebral AA should take into account clinical manifestations and features of the course of the disease. The choice of the optimal microsurgical corridor and AA clinging technique depends on the anatomic-topographic and hemodynamic parameters of AA and the affected arterial segment cerebral artery.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45734270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-77-86
Y. Cherednychenko, A.Yu. Miroshnychenko, L. Dzyak, N. A. Zorin, S. Grygoruk, E. Gavva, A. N. Tolubaiev
The observation of endovascular treatment of a 34-year-old woman with bilateral dissection lesions of vertebral arteries in V4-segments with occlusion of the right vertebral artery and right posterior inferior cerebellar artery, severe stenosis of the left vertebral artery caused by chiropractic manipulation in the neck region is described. There are intensive staticolocomotor and dynamic coordinating insufficiency, severe neck pain, headache, severe dizziness, Wallenberg syndrome, moderate central tetraparesis. MRI of the brain on the DWI Isotropic identified the hyperintensive round-shaped foci in the right hemisphere of the cerebellum, in the right side of cerebellum worm, in the right side of the medulla oblongata and in the right side of the pons (DWI BSS 3). Selective cerebral angiography was performed an hour after the clinic manifestation. Simultaneously, balloon angioplasty of severe dissection stenosis was performed in the V4-segment of the left vertebral artery by the compliant balloon-catheter Scepter C. In 18 hours from the development of vertebral artery dissection, self-expending stent LVIS was implanted into the left vertebral artery in the zone of dissection lesion. On the control angiograms: the left vertebral artery patency is restored without stenosis all along. The stent is fully opened. A second contrast contour is determined outside the stent in the dissection zone. All the arteries of the vertebrobasilar basin above the vertebrobasilar junction are passable. The V4-segment of the right vertebral artery is contrasted through the vertebrobilar junction. There was a rapid regression of neurological symptoms in the postoperative period. Only mild hypoesthesia on the right side in the outer Sölder’s zone, light coordination disorders on the right were remained. Control selective cerebral angiography revealed recanalization of the right vertebral artery and the right posterior cerebellar artery. But distal basin of the right posterior cerebellar artery is very poorly. The left vertebral artery is passable all over, but in the place of the former dissection, two equivalent arterial «sleeves» were formed according to the fenestration type. One «sleeve» is formed by a stent, the other — outside. All arteries of the vertebrobasilar basin are contrasted. The mild hemihepesthesia on the right side of the face in the outer Sölder’s zone, light coordination disorders on the right are remained. Implantation of the self-expanding stent LVIS allowed to restore the dominant vertebral artery and restrict ischemic brain damage in the brain stem and cerebellum in a patient with a both vertebral arteries dissection lesion caused by chiropractic neck manipulations.
{"title":"Endovascular treatment of a patient with traumatic dissection lesions of both vertebral arteries obtained during chiropractic manipulation","authors":"Y. Cherednychenko, A.Yu. Miroshnychenko, L. Dzyak, N. A. Zorin, S. Grygoruk, E. Gavva, A. N. Tolubaiev","doi":"10.26683/2304-9359-2018-2(24)-77-86","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-77-86","url":null,"abstract":"The observation of endovascular treatment of a 34-year-old woman with bilateral dissection lesions of vertebral arteries in V4-segments with occlusion of the right vertebral artery and right posterior inferior cerebellar artery, severe stenosis of the left vertebral artery caused by chiropractic manipulation in the neck region is described. There are intensive staticolocomotor and dynamic coordinating insufficiency, severe neck pain, headache, severe dizziness, Wallenberg syndrome, moderate central tetraparesis. MRI of the brain on the DWI Isotropic identified the hyperintensive round-shaped foci in the right hemisphere of the cerebellum, in the right side of cerebellum worm, in the right side of the medulla oblongata and in the right side of the pons (DWI BSS 3). Selective cerebral angiography was performed an hour after the clinic manifestation. Simultaneously, balloon angioplasty of severe dissection stenosis was performed in the V4-segment of the left vertebral artery by the compliant balloon-catheter Scepter C. In 18 hours from the development of vertebral artery dissection, self-expending stent LVIS was implanted into the left vertebral artery in the zone of dissection lesion. On the control angiograms: the left vertebral artery patency is restored without stenosis all along. The stent is fully opened. A second contrast contour is determined outside the stent in the dissection zone. All the arteries of the vertebrobasilar basin above the vertebrobasilar junction are passable. The V4-segment of the right vertebral artery is contrasted through the vertebrobilar junction. There was a rapid regression of neurological symptoms in the postoperative period. Only mild hypoesthesia on the right side in the outer Sölder’s zone, light coordination disorders on the right were remained. Control selective cerebral angiography revealed recanalization of the right vertebral artery and the right posterior cerebellar artery. But distal basin of the right posterior cerebellar artery is very poorly. The left vertebral artery is passable all over, but in the place of the former dissection, two equivalent arterial «sleeves» were formed according to the fenestration type. One «sleeve» is formed by a stent, the other — outside. All arteries of the vertebrobasilar basin are contrasted. The mild hemihepesthesia on the right side of the face in the outer Sölder’s zone, light coordination disorders on the right are remained. \u0000Implantation of the self-expanding stent LVIS allowed to restore the dominant vertebral artery and restrict ischemic brain damage in the brain stem and cerebellum in a patient with a both vertebral arteries dissection lesion caused by chiropractic neck manipulations.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43768617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-20-29
А.М. Netliukh, V. Shevaga, A. Payenok, В.M. Salo, О.Ya. Kobyletskyi
Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.
{"title":"Recent guidelined for the early endovascular management of patients with acute ischemic stroke and practical aspects of their implementation","authors":"А.М. Netliukh, V. Shevaga, A. Payenok, В.M. Salo, О.Ya. Kobyletskyi","doi":"10.26683/2304-9359-2018-2(24)-20-29","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-20-29","url":null,"abstract":"Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. \u0000Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). \u0000Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. \u0000Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49233431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-69-76
O. Nikishin, M. Muz, A. I. Gavretskiy, I. Altman, S. I. Savoluk
Currently, direct re-vascularization for the management of critical limb ischemia (CLI) is effectuated through open and hybrid surgical treatments. At the same time, therapeutic recommendations for one of the methods appear as a subject of lasting discussions. Today TASC II (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease) adopted in 2007 is the most popular document that provides justifications for endovascular and surgical treatment of peripheral arterial disease. Clinical practice provides evidence that there is a significant number of patients having critical limb ischemia who suffer from vascular bed disorders and are classified as C or D-type according to TASC classification. Meanwhile, there also are cases when these patients have no other alternative than re-vascularization by means of open surgery, which is why endovascular invasion appears as the only method of re-vascularization for them. The article presents some results of comparative studies within endovascular and surgical tools aimed at revascularization in the area of femoral-popliteal segment, including cases where patients are classified as C and D-type. The results of shunting operations are compared to angioplasty and remote endarterectomy, whereas technical methods for re-entry during subintimal angioplasty are regarded apart. Despite the fact that there are medical recommendations for the use of endovascular and surgical methods depending on TASC II classification, today there is no evidence that these tools can be efficient in revascularization of femoral-popliteal segment. In order to identify the efficiency of distinct methods in revascularization of femoral-popliteal segment there a need in a number of extended randomized studies designed to evaluate the role of such factors, as anatomic location of the vascular bed disorder, the extent of a disease, the location of purolo-necrotic areas as well as other pathologies on the results of the study.
{"title":"Endovascular invasions for femoral-popliteal segment disorders of C andD-type according to TASC-II classification","authors":"O. Nikishin, M. Muz, A. I. Gavretskiy, I. Altman, S. I. Savoluk","doi":"10.26683/2304-9359-2018-2(24)-69-76","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-69-76","url":null,"abstract":"Currently, direct re-vascularization for the management of critical limb ischemia (CLI) is effectuated through open and hybrid surgical treatments. At the same time, therapeutic recommendations for one of the methods appear as a subject of lasting discussions. Today TASC II (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease) adopted in 2007 is the most popular document that provides justifications for endovascular and surgical treatment of peripheral arterial disease. Clinical practice provides evidence that there is a significant number of patients having critical limb ischemia who suffer from vascular bed disorders and are classified as C or D-type according to TASC classification. Meanwhile, there also are cases when these patients have no other alternative than re-vascularization by means of open surgery, which is why endovascular invasion appears as the only method of re-vascularization for them. The article presents some results of comparative studies within endovascular and surgical tools aimed at revascularization in the area of femoral-popliteal segment, including cases where patients are classified as C and D-type. The results of shunting operations are compared to angioplasty and remote endarterectomy, whereas technical methods for re-entry during subintimal angioplasty are regarded apart. Despite the fact that there are medical recommendations for the use of endovascular and surgical methods depending on TASC II classification, today there is no evidence that these tools can be efficient in revascularization of femoral-popliteal segment. In order to identify the efficiency of distinct methods in revascularization of femoral-popliteal segment there a need in a number of extended randomized studies designed to evaluate the role of such factors, as anatomic location of the vascular bed disorder, the extent of a disease, the location of purolo-necrotic areas as well as other pathologies on the results of the study.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43463965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-14-19
S. Didenko
Objective — to study the features of performing arteriography in patients with diabetes mellitus with chronic critical ischemia of the lower limb with stenotic-occlusive lesions of the arteries of the popliteo-tibial segments. Materials and methods. The arteriography experience in 108 patients with diabetes mellitus 2 type with chronic critical ischemia of the lower limb has been analyzed. All patients had stenotic-occlusive lesions of the arteries of the popliteo-tibial segments for the passable arteries of the ilio-femoral segments.The first group included 56 patients, who performed arteriography according to the proposed methodology (Ukrainian patent for utility model No. 114970 dated March 27, 2017, «Method of angiographic examination of lower extremity arteries in patients with ischemic form of diabetic foot syndrome»), the second group included 52 patients, who performed arteriography by Seldinger’s method. Results. With the help of ultrasound examination it was proved that 63.1 % of the common femoral artery blood volume in patients with diabetes mellitus with chronic critical ischemia of the lower limb with stenotic-occlusive lesions of the arteries of the popliteo-tibial segments is divided to the superficial femoral artery and 36.9 % in the deep femoral artery. Application of the developed method of arteriography has allowed to reduce the amount of active ingredient of contrast, which was administered to patients in the first group 2.16 times in comparison with the second group. In the first group the percentage of hemorrhagic complications was significantly lower than in the second group. Conclusions. The developed method of performing arteriography should be used in patients with diabetes mellitus with chronic critical ischemia of the lower limb with stenotic-occlusive lesions of the arteries of the popliteo-tibial segments.
{"title":"Features of performing arteriography in patients with diabetes mellitus with critical ischemia of the lower limb","authors":"S. Didenko","doi":"10.26683/2304-9359-2018-2(24)-14-19","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-14-19","url":null,"abstract":"Objective — to study the features of performing arteriography in patients with diabetes mellitus with chronic critical ischemia of the lower limb with stenotic-occlusive lesions of the arteries of the popliteo-tibial segments. \u0000Materials and methods. The arteriography experience in 108 patients with diabetes mellitus 2 type with chronic critical ischemia of the lower limb has been analyzed. All patients had stenotic-occlusive lesions of the arteries of the popliteo-tibial segments for the passable arteries of the ilio-femoral segments.The first group included 56 patients, who performed arteriography according to the proposed methodology (Ukrainian patent for utility model No. 114970 dated March 27, 2017, «Method of angiographic examination of lower extremity arteries in patients with ischemic form of diabetic foot syndrome»), the second group included 52 patients, who performed arteriography by Seldinger’s method. \u0000Results. With the help of ultrasound examination it was proved that 63.1 % of the common femoral artery blood volume in patients with diabetes mellitus with chronic critical ischemia of the lower limb with stenotic-occlusive lesions of the arteries of the popliteo-tibial segments is divided to the superficial femoral artery and 36.9 % in the deep femoral artery. Application of the developed method of arteriography has allowed to reduce the amount of active ingredient of contrast, which was administered to patients in the first group 2.16 times in comparison with the second group. In the first group the percentage of hemorrhagic complications was significantly lower than in the second group. \u0000Conclusions. The developed method of performing arteriography should be used in patients with diabetes mellitus with chronic critical ischemia of the lower limb with stenotic-occlusive lesions of the arteries of the popliteo-tibial segments.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48935740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-27DOI: 10.26683/2304-9359-2018-2(24)-37-43
V. Sichinava
Objective — optimize the technique of radiofrequency destruction of the medial branch of the spinal nerve and evaluate its effectiveness in the treatment of reflex pain syndromes of the cervical spine. Materials and methods. In 30 patients with chronic pain in the neck and upper extremities who were treated in the department of neurosurgery N 2 of the Kyiv City Clinical Emergency Hospital from 2014 to 2017, the effectiveness of the radiofrequency neurotomy of the medial branch of the spinal cord back root and the clinical significance of diagnostic blockades. There were 14 men (46.7 %), women — 16 (53.3 %). The age of the patients is from 38 to 75 years (the average age is 53.7 years). Neurotomy was performed in patients with chronic neck pain with irradiation in the upper limbs, in which diagnostic blockades were effective. The study did not include patients with myelopathy and radiculopathy. Preoperative pain intensity ranges from 5 to 9 points (on average, 7.50 ± 0.86 points) on a visual analog scale (VAS). The duration of pain before surgery ranged from 6 months to 20 years (an average is 3.5 years). In 21 patients, the pain was one-sided (9 in the right, 12 in the left), and the others with a bilateral one. All patients underwent clinical and neurological examination, roentgenography of the cervical spine and magnetic resonance imaging. The efficacy of the therapy was assessed with the help of the VAS, the functional state using the NDI (Neck Disability Index) questionnaire. Results. The pain intensity was assessed after 1, 3, 6 and 12 months. The pain intensity according to the VAS decreased from (7.50 ± 0.86) point before the operation to (2.07 ± 0.74) points after 12 months. A significant statistically significant (p < 0.05) improvement in the functional state compared with the baseline was noted in the postoperative period. Preoperative functional status was assessed on average (27.80 ± 1.19) points on the NDI scale. A week after the neurotomy, there was a statistically significant decrease in the total score on the NDI scale to an average of 12.90 ± 0.69, after 12 months to 13.10 ± 1.01. Conclusions. Factors affecting the effectiveness of radiofrequency destruction include the proper selection of patients, the accuracy of diagnostic tests and the technically correct installation of the electrode. Knowledge of the anatomical features of the medial branch of the spinal nerve, the X-ray anatomy, the characteristics and size of the damage during radiofrequency destruction ensure the effectiveness of neurotomy.
{"title":"Features of conducting medial branches radiofrequency neurotomy in the cervical spine","authors":"V. Sichinava","doi":"10.26683/2304-9359-2018-2(24)-37-43","DOIUrl":"https://doi.org/10.26683/2304-9359-2018-2(24)-37-43","url":null,"abstract":"Objective — optimize the technique of radiofrequency destruction of the medial branch of the spinal nerve and evaluate its effectiveness in the treatment of reflex pain syndromes of the cervical spine. \u0000Materials and methods. In 30 patients with chronic pain in the neck and upper extremities who were treated in the department of neurosurgery N 2 of the Kyiv City Clinical Emergency Hospital from 2014 to 2017, the effectiveness of the radiofrequency neurotomy of the medial branch of the spinal cord back root and the clinical significance of diagnostic blockades. There were 14 men (46.7 %), women — 16 (53.3 %). The age of the patients is from 38 to 75 years (the average age is 53.7 years). Neurotomy was performed in patients with chronic neck pain with irradiation in the upper limbs, in which diagnostic blockades were effective. The study did not include patients with myelopathy and radiculopathy. Preoperative pain intensity ranges from 5 to 9 points (on average, 7.50 ± 0.86 points) on a visual analog scale (VAS). The duration of pain before surgery ranged from 6 months to 20 years (an average is 3.5 years). In 21 patients, the pain was one-sided (9 in the right, 12 in the left), and the others with a bilateral one. All patients underwent clinical and neurological examination, roentgenography of the cervical spine and magnetic resonance imaging. The efficacy of the therapy was assessed with the help of the VAS, the functional state using the NDI (Neck Disability Index) questionnaire. \u0000Results. The pain intensity was assessed after 1, 3, 6 and 12 months. The pain intensity according to the VAS decreased from (7.50 ± 0.86) point before the operation to (2.07 ± 0.74) points after 12 months. A significant statistically significant (p < 0.05) improvement in the functional state compared with the baseline was noted in the postoperative period. Preoperative functional status was assessed on average (27.80 ± 1.19) points on the NDI scale. A week after the neurotomy, there was a statistically significant decrease in the total score on the NDI scale to an average of 12.90 ± 0.69, after 12 months to 13.10 ± 1.01. \u0000Conclusions. Factors affecting the effectiveness of radiofrequency destruction include the proper selection of patients, the accuracy of diagnostic tests and the technically correct installation of the electrode. Knowledge of the anatomical features of the medial branch of the spinal nerve, the X-ray anatomy, the characteristics and size of the damage during radiofrequency destruction ensure the effectiveness of neurotomy.","PeriodicalId":33226,"journal":{"name":"Endovaskuliarna neirorentgenokhirurgiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47393603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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