Search Results (3)

Background and Objectives: Vein of Galen aneurysmal malformations (VGAMs) represent the most common vascular malformations of the brain at the pediatric age. Comprehension of its angioarchitecture and clinical features may influence their treatment options and functional outcomes. The aim of this review is to give an update of the anatomical and technical aspects of the management of VGAMs after endovascular treatment. Materials and Methods: We conducted a systematic review of original articles published between 1 January 2014 and 1 February 2024 in Pubmed, Web of Science (WOS), and Scopus databases following PRISMA guidelines. Variables such as age, sex, angioarchitecture of the malformation, clinical presentation, embolization technique, rate of occlusion, post-procedural complications, follow-up time, and mortality were collected. Random-effect meta-analysis of proportions was performed. Results: Fifteen studies on a total of 400 patients with VGAMs were collected. A total of 65.1% was male. The age at diagnosis was 12% prenatal, 35.5% neonates, 34.1% infants, 15.1% children, and 3.3% adults. Clinical presentation included 31.4% increased head size, 25.7% congestive heart failure, 12.9% neurological deficits, 10% seizures, 9.3% prominence of facial veins, and 8.9% developmental delay. A total of 339 patients underwent endovascular treatment (84.8%) with an average of 2.1 procedures per patient. The embolization technique was defined by transarterial access and glue material. Radiological occlusion was complete in 62.3% of the patients. The most frequent periprocedural incidents included hemorrhagic events (28.4%), embolization material migration (25.7%), and death (22%). The functional outcome was good in 68% of the surviving patients. The average follow-up time was 43.18 months. High heterogeneity was found in all outcomes but mortality rate. Conclusions: The angioarchitecture of VGAMs is significantly important when planning endovascular treatment and may have an influence on functional outcomes. More research into endovascular techniques and the risks of periprocedural complications must be performed. Indeed, a homogeneous protocol for the assessment of surviving VGAM patients during follow-up is necessary. Full article

Despite growing evidence over the last few years of the efficacy and safety of direct thrombus aspiration using a large bore distal access catheter as a type of mechanical thrombectomy procedure in acute stroke large-vessel occlusion patients, the experience and evidence of this technique for managing thromboembolic complications in endovascular aneurysm treatment is still limited and little research is available regarding this topic. We present a case of a thromboembolic occlusion of the left middle cerebral artery during the preprocedural angiograms of a large and fusiform left internal carotid artery aneurysm. This complication was successfully managed by navigating an already-placed distal access catheter intended for support during the opening of the flow-diverting stent; therefore, the thrombus was manually aspirated for two minutes, and Thrombolysis in Cerebral Infarction (TICI) scale 3 flow was restored. This case should encourage the use of a distal access catheter, already placed for aneurysm treatment, to perform zero-delay direct thrombus aspiration as a rescue approach for thromboembolic complications during endovascular treatments. Full article

Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts. Full article