Objectives. The aim was to determine the prevalence of aortic arch variations in 881 patients who underwent neck CT angiography for various reasons.Material and Methods. 881 patients were included in the study who had undergone neck CT angiography between 2010 and 2013.Results. Of 881 patients, 770 (87.4%) patients with classic branching pattern of the aortic arch (AA) were observed. Variations in branching pattern were seen in 111 (12.6%) patients. The most common variation was the origination of the left common carotid artery (LCCA) from the brachiocephalic trunk (BCT). This pattern was observed in 64 (7.2%) cases. In 25 (2.8%) cases, the left vertebral artery (LVA) originated directly from the AA between the origin of the LCCA and left subclavian artery (SCA). 17 (1.9%) cases had aberrant right subclavian artery. Three (0.3%) cases showed right aortic arch. Two cases had right aortic arch with aberrant left subclavian artery.Conclusions. Variations in the branching pattern of the AA are not rare. Head and neck surgeons and interventional radiologists should be aware of aortic arch variations. CTA is a reliable imaging method for demonstrating anatomical features and variations of the AA.

Objective: To investigate shoulder-rotator strength, internalrotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury.Design: Cross-sectional study. Setting: University laboratory. Participants: Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age ¼ 16.0 6 1.4 years, height ¼ 179.2 6 9.0 cm, mass ¼ 67.1 6 10.9 kg, body mass index ¼ 20.7 6 2.6 kg/m 2 ). Main Outcome Measure(s): Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally.Results: External-rotation ROM was greater (t 38 ¼ 4.92, P , .001), but IR ROM (t 38 ¼ À8.61, P , .001) and total ROM (t 38 ¼ À3.55, P ¼ .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss . 188). We observed greater concentric internal-rotator (t 38 ¼ 2.89, P ¼ .006) and eccentric external-rotator (t 38 ¼ 2.65, P ¼ .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t 38 ¼ À3.60, P , .001).Conclusions: Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries.Key Words: ultrasonography, sports, glenohumeral joint, muscle strength Key PointsAsymptomatic adolescent volleyball attackers demonstrated less internal-rotation range of motion (ROM), total ROM, and acromiohumeral distance and more external-rotation ROM in the dominant than in the nondominant shoulder, which might put them at risk for shoulder injuries. Routinely screening adolescent athletes and designing training programs to address hazardous adaptive changes could help prevent shoulder injuries.

The aim of the present study was to analyze our experience with a new liquid embolic agent, Squid, for the treatment of cerebral vascular lesions. MATERIAL and METHODS:We present 28 patients who were treated with two formulations of Squid (Squid 18 and Squid 12). The lesions included 16 arteriovenous malformation (AVM)s (Spetzler-Martin grade 2 in 8, 3 in 6 and 4 in 2), 9 arteriovenous (AV) fistulas, 2 tumors (glomus tumor and angiofibroma) and 1 AICA aneurysm. Of the 9 patients presenting with hemorrhage, 6 were AVM, 2 were AVF and 1 was aneurysm. RESULTS:The total obliteration rate of the AVMs was 37.5%. Fistulas were closed completely after combined treatment with surgery in 6 out of 9 patients, and one was sent to radiotherapy. There was no mortality. Two reported hemorrhages and thromboembolic complications resulted in permanent deficits in 3 patients. Pathologic examination revealed mild inflammatory reaction with infiltration of polymorphonuclear cells in 5 patients in whom surgery was performed immediately after embolization. Technical problems such as rupture, inability to remove or premature occlusion of the microcatheter related to the embolic agent were not recorded. CONCLUSION:Squid is a safe and effective embolic agent for treatment of cerebral AVMs, AV fistulas, tumors and aneurysms with satisfactory obliteration rate.KEywORDS: Squid, Cerebral arteriovenous malformation, Intracranial AVM, Intracranial AV fistula, Tumor, Embolization ÖZ AMAÇ: Çalışmada amaç yeni bir sıvı embolik ajan olan Squid'in serebral vasküler lezyonların tedavisindeki deneyimimizi analiz etmektir. yÖNTEM ve GEREÇLER: Çalışmada Squid 18 ve Squid 12 olmak üzere iki ayrı Squid formülasyonu ile tedavi edilen 28 hasta sunulmaktadır. Lezyonlar arasında 16 arteriyovenöz malformasyon (AVM) (Spetzler-Martin Evre 2 olan 8, Evre 3 olan 6 ve Evre 4 olan 2 olgu), 9 arteriyovenöz (AV) fistül, 2 tümör (glomus tümörü ve anjiyofibrom) ve 1 AICA anevrizması yer almaktadır. Kanama ile prezente olan 9 hastanın 6'sı AVM, 2'si AV fistül ve 1'si anevrizmadır.BULGULAR: AVM lezyonlarında toplam kapanma oranı %37,5 olarak hesaplandı. Fistüllerin 9'undan 6'sı cerrahi ile kombine tedavi sonrası kapatıldı, 1 olgu radyoterapiye gönderildi. Mortalite izlenmedi. Bildirilen iki kanama ve tromboembolik komplikasyonlar 3 hastada kalıcı defisite neden oldu. Embolizasyon sonrası hemen cerrahi yapılan 5 hastadaki patolojik incelemeler, polimorfonükleer hücreleri içeren hafif enflamatuvar reaksiyonu gösterdi. Rüptür, mikrokateterin çıkarılamaması veya erken oklüzyonu gibi teknik problemler izlenmedi. SONUÇ:Squid serebral AVM, AV fistül, tümör ve anevrizmaların tedavisinde güvenli ve efektif bir embolik ajan olup tatminkar obliterasyon oranlarına sahiptir.

studies, experimental studies in the literature consist of studies where other adjunct devices other than flow diverters are not used and they do not represent the small narrownecked aneurysms frequently seen in routine daily practice. In these studies, flow diverter stents direct the blood flow along the parent artery (13) and provide stasis of the blood inside the aneurysm to promote thrombosis of the aneurysm █ INTRODUCTION Flow diverter (FD) devices have been the current endovascular treatment option for the hardly treated intracranial widenecked, fusiform and giant aneurysms (7). Recently, flow diverter stents have been the most important treatment modality because of acceptable morbidity, mortality and high aneurysm occlusion rates (5). Except for a few small AIM: To report patient and procedure-related factors affecting the angiographic and clinical outcome in patients treated with the Silk device. MATERIAL and METHODS:All patients with intracranial aneurysms in whom treatment was attempted with the Silk flow diverter by our neurovascular team between October 2010 and November 2013 were included consecutively. The data was analyzed by an independent stroke neurologist not involved in the treatment of the patients. RESULTS:A total of 96 patients (64 female) with ages range from 3 to 78 were included in this study. We found that 54 of the patients were asymptomatic and 42 of them symptomatic, while 21 had a prior history of subarachnoid hemorrhage (SAH). Mean aneurysm size was 10.2 mm (range 2 to 40 mm). 2 patients died due to consequences of SAH. 3 patients developed visual decline on the follow-up, 2 of these were procedure-related. Symptomatic thromboembolic events were noted in 7 cases. Patients with aneurysms smaller than 13 mm had significantly less complications and higher occlusion rates. The complication rate was significantly high in patients admitted with symptoms. Adjunctive coiling had no impact on outcome.CONCLUSION: Safety and efficacy of flow diversion in this series was closely related to aneurysm size and presenting symptoms. A size cut-off for safety and efficacy has not been reported before and will be useful not only for future studies but also for patient counseling in daily practice. The futility of adjunctive coiling in this series calls for reappraisal of the current recommendations for this specific device.

Failure of these treatments led the physicians and the industry to investigate new techniques for better success rates to treat these large complex aneurysms. With the development of low-profile microcatheter-delivered self-expanding stents, intracranial parent artery reconstruction became feasible. Initially used technique was stent assisted coiling that resulted in better packing of the coils. With stenting, recurrence rates █ INTRODUCTION Endovascular aneurysm embolization with coils have been criticised for inability to achieve durable aneurysm exclusion when compared to surgical clipping. With coil embolization, this is valid especially for large and wide neck aneurysms that cannot be occluded completely during the procedure and at follow-up they usually show high rates of re-canalization (8,27). AIM:We evaluated the procedural outcomes of intracranial aneurysm treatment with the Silk device and its relation with operator experience. We also detailed some technical points we learned throughout our experience. MATERIAL and METHODS:One hundred and six consecutive patients with intracranial aneurysms treated using Silk (BaltExtrusion, Montmorency, France) stent between October 2010 and November 2013 were included. Patients were evaluated in terms of age, sex, aneurysm size, location, technical success, and adverse events. RESULTS:There were 106 patients (71 female) undergoing 116 procedures with a mean age of 49.8 (range: 3-78 years). Mean aneurysm size was 10.7±8.0 (range, 2-40 mm). Technical success of the procedures was 96.5%. Adverse event rate was 11.2%. Among adverse events, there were 4 adverse events without complications, 2 mild complications, 7 severe complications, 4 of which resulted with death. The adverse event rate was significantly higher during the first half of the operator's experience. The rate of adverse events seemed to stabilize after around 50 patients. Adverse events, regardless of the presence or absence of a clinical complication, were more frequent in aneurysms larger than 18.5 mm. CONCLUSION:Safety of flow-diverter (FD) placement for intracranial aneurysms increases with operator experience. Training programs in endovascular management of cerebrovascular diseases and relevant fellowship curricula must be adapted to include sufficient flow diverter experience. The learning curve needs to be kept in mind when studies comparing different FD devices or those comparing other treatments to FDS are planned.