BackgroundThe primary goal of conventional endovascular and microvascular approaches is the clinical and radiological resolution of the symptomatic aneurysm-induced mass effect. This study assessed the volume changes and mass effect reduction due to sac shrinkage after treatment with flow diverter stents (FD) for unruptured cerebral aneurysms.MethodsWe analyzed retrospectively 36 symptomatic aneurysms that were larger or equal to 25 mm in diameter in patients treated at our center from January 2016 to April 2022. Radiological and clinical outcomes were analyzed, including aneurysmal volume changes and resolution of aneurysm-related symptoms.ResultsAt 6 months, 25 aneurysms decreased in size, 2 remained unchanged, and 9 aneurysms demonstrated a post-treatment dimensional increase. At 12 months, 30 aneurysms showed a progressive radiological volume reduction. Either no change or negligible shrinkage was observed in the remaining six aneurysms. At 24 months, 32 aneurysms showed aneurysmal shrinkage by a mean 47% volume loss with respect to baseline. At the last follow-up, all 13 patients who had presented with third cranial nerve palsy showed improvements. Complete reversal of the pretreatment edematous changes was confirmed in all cases. The overall post-treatment complication rate was 8.3%, as 3 patients experienced non-fatal delayed rupture of their aneurysm. There was no mortality in this study.ConclusionFlow diversion could effectively induce progressive aneurysmal shrinkage and resolution of the mass effect associated with giant symptomatic cerebral aneurysms.
BackgroundEndovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus.MethodsClinical and radiological data were retrospectively collected for all patients treated with the Nautilus for an unruptured or ruptured intracranial aneurysm at our center between March 2021 and March 2022. Clinical outcomes (modified Rankin Scale (mRS) scores), Raymond–Roy angiographic occlusion, recanalization, and complications were measured immediately post-procedure and at 3–6-month follow-up.ResultsA total of 41 patients of mean age 56.7 years (range 37–83 years) were treated with the Nautilus, with 41 saccular aneurysms (18 (43.9%) unruptured and 23 (56.1%) ruptured). The majority of aneurysms (39/41 (95.1%)) were located in the anterior circulation. We experienced no technical complications. One patient had an asymptomatic post-procedural minor stroke related to the procedure. Immediate Class I occlusion was achieved in 30 (73.1%) patients. The rate of all-cause mortality was 7.3% (3/41). One patient was lost to follow-up. At follow-up, 94.5% (35/37) of patients achieved Class I occlusion and 94.5% (35/37) had an mRS score of 0. There were no procedural-related deaths or permanent morbidities at discharge or follow-up.ConclusionThis study demonstrates good safety and effectiveness using the Nautilus Intrasaccular System to treat both ruptured and unruptured intracranial aneurysms. Larger studies are needed to confirm these findings.
Angesichts der Unsicherheiten, mit denen die Schadensschätzung im Kartellschadensersatzverfahren verbunden ist, entscheiden sich Vertragsparteien immer häufiger für eine vertragsrechtliche Alternative – die Pauschalierung von Kartellschäden in Allgemeinen Geschäftsbedingungen. Das Werk untersucht die Möglichkeiten der Schadenspauschalierung und gibt praktische Empfehlungen für die Gestaltung von Lieferverträgen. Den Schwerpunkt der Untersuchung bildet die Wirksamkeit der Schadenspauschalierungsklausel. Zunächst wird der Prüfungsmaßstab festgelegt. Dabei wird die strenge Inhaltskontrolle von AGB-Klauseln in B2B-Verträgen kritisch beleuchtet. Besonderes Augenmerk wird auf den Anwendungsbereich der Klausel sowie auf die Höhe der Schadenspauschale gelegt. Schließlich wird die Rolle der Klausel im Rahmen von internationalen Verträgen untersucht. Ihr kann eine entscheidende Bedeutung bei der Auslegung von allgemein formulierten Gerichtsstands- und Schiedsvereinbarungen zukommen.
We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confi rmed the diagnosis -a direct carotid-cavernous fi stula (CCF), with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fi stula. During the fi rst 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were signifi cantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classifi cation of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fi stula and maintain adequate blood fl ow through the carotid artery.
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