Background Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. Methods Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. Results 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2–82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5–6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. Conclusions The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.
Aims Histiocytoses are a heterogeneous group of localized or disseminated diseases. Clinical presentation and patients' outcome vary greatly, ranging from mild to life‐threatening disorders. Rare cases of systemic or localized histiocytosis harboring ALK rearrangement have been reported. Methods Two cases of CNS histiocytosis were thoroughly investigated by implementing multiple molecular tests, i.e. FISH, RT‐qPCR, NGS analysis. Results In a 10‐month old girl (patient #1), MRI showed two left hemispheric lesions and a right fronto‐mesial lesion histologically consisting of a moderately cellular infiltrative proliferation, composed by CD68(PGM1)+/CD163+ spindle cells. ALK 5’/3’‐imbalance and a KIF5B(exon 24)‐ALK(exon 20) fusion were documented by RT‐qPCR and NGS analysis, respectively. A subsequent CT scan showed multiple hepatic and pulmonary lesions. The patient was started on chemotherapy (vinblastine) associated to an ALK‐inhibitor (Alectinib) with remarkable response. In a 11‐year‐old girl (patient #2), MRI showed a right frontal 1.5 cm lesion. Neuropathological examination revealed a histiocytic proliferation composed by medium sized CD68(PGM1)+/HLA‐DR+ cells, showing moderate ALK1 positivity. ALK rearrangement and a KIF5B(exon 24)‐ALK(exon 20) fusion were demonstrated also in this case. Subsequent CT, 18F‐FDG‐PET and MRI scans showed the presence of a single right femoral lesion, proved to be a fibrous cortical defect. Conclusions In ALK‐histiocytoses, CNS involvement may occur as part of a systemic disease or, rarely, as its only primary disease localization, which could remain otherwise asymptomatic. The diagnosis often relies on neuropathological examination of brain biopsy, which may pose a diagnostic challenge due to the variable histopathological features. An integrated histological and molecular approach in such cases is recommended.
HighlightsHemobilia is a very rare emergency. Among non-iatrogenic causes pseudoaneurysm of cystic artery should be considered.Knowledge of anatomical variations of cystic artery is fundamental in hepatobiliary surgical and radiologic procedures.Because of extreme rarity of the aneurysms of cystic artery there are no guidelines about their management and treatment.
Endovascular treatment of brain aneurysms with flow diverter device can be technically difficult. Obtaining distal access through the wide neck of a large or giant aneurysm may be challenging and sometimes the microcatheter needs to be looped inside the aneurysm. However, the inability to resolve this loop and to straighten the microcatheter can preclude flow diverter placement. This brief report presents four cases of large/giant aneurysms treated with flow diverter device, in which our innovative stent-retriever anchor technique was used to obtain the distal access of the parent artery. All procedures were technically successful, and no complications were recorded.
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