Antonio Chiaravalloti

Randomized control study of the outback LTD reentry catheter versus manual reentry for the treatment of chronic total occlusions in the superficial femoral artery

To assess the efficacy and safety of the Outback device in patients with a chronic total occlusion (CTO) of the superficial femoral artery and evaluate its impact on fluoroscopy and procedural times.

Treatment of type II endoleak after endovascular aneurysm repair: the role of selective vs. nonselective transcaval embolization.

Purpose To assess the technical and midterm results in the treatment of type II endoleaks comparing nonselective (nTCE) vs. selective (sTCE) transcaval embolization. Methods During a 4-year period, 26 patients (18 men; median age 73 years, range 68–78) underwent direct transcaval aneurysm puncture followed by embolization of the sac (nTCE, n=9) or of the feeding vessels (sTCE, n=17). Intrasac pressure was recorded immediately after aneurysm sac puncture and at the end of the procedure. Technical success was defined as successful deployment of embolization material in the sac or in the feeding vessel. Clinical success was defined as absence of endoleak with stabilization of the sac on follow-up CTA. Results Technical success was 100% in the 9 patients treated with nTCE. Mean intrasac pressures before and after nTCE were 58.6±18.4 (range 51–105) and 6.5±1.2 mmHg (range 4–9), respectively. Over a mean 25.9±11.0 months of follow-up, 4 patients developed recurrent endoleak at a mean 9.7±3.9 months. Three patients were subsequently treated with sTCE, while the last patient underwent emergency surgery for aneurysm rupture due to an enlarging sac 5 months after nTCE. The 20 patients in the sTCE group had a successful procedure with no recurrence in a follow-up of 24.1±7.2 months. Mean intrasac pressure was reduced after sTCE from 63.6±15.2 mmHg (range 43–120) to 7.8±2.3 mmHg (range 5–12). Conclusion The selective TCE approach appears to be a feasible and effective primary therapeutic option for treating type II endoleak.

Acute COPD exacerbation: 3 T MRI evaluation of pulmonary regional perfusion – Preliminary experience

OBJECTIVES To compare pulmonary perfusion parameters by means of dynamic perfusion magnetic resonance in patients affected by chronic obstructive pulmonary disease (COPD), during and after acute exacerbation. METHODS Fifteen patients were successfully evaluated with perfusional MRI during an acute exacerbation of COPD and upon clinical stabilization. Inclusion criteria were a PaCO2 > 45 mmHg and respiratory acidosis (arterial blood pH < 7.35) at admittance. RESULTS In the acute phase a reduction of pulmonary blood flow (PBF) and pulmonary blood volume (PBV), and a significant prolonging of the mean transit time (MTT) and time to peak (TTP) were observed in all patients. In the stabilization phase a significant increase of PBF and PBV and a significant reduction of MTT and TTP were observed in 6 patients; no significant variations were observed in the other 9 patients. CONCLUSION 3D time-resolved contrast-enhanced MRI allows quantitative evaluation of pulmonary regional perfusion in patients affected by COPD, identifying patients in which perfusion defects are resolved in the clinical-stabilization phase. This technique might allow the identification of patients in whom vasospasm may be the main responsible of pulmonary hypoperfusion during acute COPD exacerbation, with potential advantages on the clinical management of these patients.

Intracranial atheromatous disease treatment with the Wingspan stent system: Evaluation of clinical, procedural outcome and restenosis rate in a single-center series of 21 consecutive patients with acute and mid-term results

BACKGROUND Intracranial atherosclerosis may be the underlying pathology in up to 15% of ischemic strokes, but may account for about 40% of strokes in some populations. After an ischemic event determined by intracranial atherosclerosis, patients have a 12% annual risk of stroke recurrence, mostly during the first year. OBJECTIVE To evaluate procedural safety, clinical outcome and restenosis rate of Wingspan stent placement. METHODS Twenty-one caucasoid patients were enrolled. Target patients were affected by high-grade, symptomatic, intracranial atherosclerotic lesions, were on antithrombotic therapy and at high stroke risk. All patients were treated with the Wingspan stent system. RESULTS Technical success resulted 100%, with all target lesions being reduced to <50%. No stroke or death were observed at 30. The mean percent of stenosis was reduced from a middle value of 84% to a middle value of 17% after stent placement. Medium follow-up was 19.5months (range 6-36months). No stroke or death occurred in any patient. None of the patients presented a <50% stent patency rate at follow-up. CONCLUSIONS The short-term results and follow up analysis provide evidence demonstrating the safety of the Wingspan system when used in high-risk patient population. Due to concerns regarding long-term stent patency and ischemic events occurrence emerged from clinical trials such as the SAMMPRIS, intracranial angioplasty and stent with the Wingspan system should be considered only for high risk patients in which it may be considered the only viable therapeutic option.

Coronaric Stent-Graft Deployment in the Treatment of Carotid Blowout

“Carotid blowout syndrome” is defined as a hemorrhage caused by rupture of the carotid artery and its branches, and may be a severe complication of rhinopharyngeal carcinoma. This study aimed to highlight the usefulness and versatility of endovascular stent-graft placement as a rescue treatment in life-threatening carotid blowout syndrome. We describe the unconventional use of a 6×5 mm balloon-expandable coronaric covered stent in a patient with a diagnosis of spinocellular rhinopharyngeal carcinoma, followed by carotid blowout syndrome. Although long-term follow-up is needed to assess the eventuality of bleeding recurrence, the immediate clinical results were satisfactory.

Degenerative lumbar spinal stenosis treatment with Aperius™ PerCLID™ system and Falena® interspinous spacers: 1-year follow-up of clinical outcome and quality of life

Purpose Evaluation of the efficacy of the Falena® and Aperius™ PerCLID™ interspinous devices in the treatment of degenerative lumbar spinal stenosis with neurogenic intermittent claudication refractory to conservative treatment. Materials and methods We retrospectively analyzed data from 24 patients (20 male and 4 female patients; 61 ± 7 years old), treated with an implantation of the AperiusTM PerCLID™ system, and from 35 patients (29 male and 6 female patients; 65 ± 9 years old) treated with the Falena® interspinous device. Patient pain intensity was evaluated by a 10-point visual analog scale (VAS), with a score (ranging from 0 = no pain to 10 = unbearable pain) that was collected before the procedure, at baseline; and at months 1, 6 and 12 after the interventional procedure. The assessment of quality of life (QOL) impairment was evaluated by the Oswestry Disability Index (ODI) questionnaire, which was administered beforehand at baseline; and at months 1, 6 and 12 after the interventional procedure. The vertebral canal area was measured by magnetic resonance imaging (MRI) scans before the treatment and at the one-year follow-up. Results All patients completed the study with no complications. Both the Falena group and Aperius group of surgery patients showed a statistically significant reduction of their VAS and ODI scores at the 6- and 12-month follow-up (p < 0.0001). A statistically significant increase in the vertebral canal area was observed both in the group that received Falena (p < 0.0001) and in the group that received Aperius (p = 0.0003). At the 1-year follow-up, we observed that there was a higher increase of vertebral canal area in those patients whom were treated with the Falena device (p < 0.001). Conclusions The implantation of Falena® and Aperius™ PerCLID™ interspinous devices is an effective and safe procedure, in the medium term.

Intravascular ultrasound assisted carotid artery stenting: randomized controlled trial. Preliminary results on 60 patients.

Aims The primary aim is the evaluation of the usefulness of intravascular ultrasound (IVUS) in the identification of otherwise unnoticed complications during carotid stenting. The secondary aim is the evaluation of the impact of IVUS assistance in the procedural outcomes and long-term patency rates of carotid artery stenting. Materials and methods Sixty patients who underwent carotid artery stenting (CAS) during a 14-month period were evaluated prospectively. Thirty patients (50%) underwent IVUS assisted CAS, 30 patients (50%) underwent CAS using angiography as the unique diagnostic tool. All patients were enrolled through a primary duplex ultrasound evaluation; as a secondary evaluation, 54 patients (90%) underwent a preprocedural magnetic resonance angiography, whereas six patients (10%) underwent computed tomography-angiography. Patients with preocclusive stenoses (>85%) were excluded. Mean follow-up was 23 W 5.3 months. Results No periprocedural or late complications were observed. No statistical significance was observed in long-term stent patency between the two groups. Mean procedural time length of IVUS-assisted procedures was 10.3 W 5 min longer than non-IVUS-assisted procedures. Virtual histology (VH) IVUS evaluation of plaque morphology led to a different stent choice in three patients. In two cases, the IVUS assessment revealed a suboptimal stent deployment, solved by angioplasty; in one patient VH-IVUS detected plaque protrusion through stent cells, immediately treated by manual aspiration. Conclusions Though not recommended as a routine intraprocedural evaluation, IVUS may be useful for a real-time CAS control when treating challenging plaques, such as ‘soft’ or lipidic ones or those prone to rupture, or whenever an intraprocedural morphologic evaluation is required for the appropriate stent choice, or when higher embolic risk is evaluated.

Transient MR-angiography changes associated with morphological alterations in epileptic seizure: A short case series

• MRI is extremely helpful in detecting structural brain abnormalities associated with seizures