Search Results (33)

The diagnosis of colorectal cancer in more advanced stages, especially in younger patients where the diagnosis usually occurs because of obstructive complications, has prompted the development of less invasive, more rapid and well tolerated methods of decompression as an alternative to the standard surgical approach. As such, self-expanding metal stents (SEMSs) have gained wide acceptance for the palliative alleviation of obstructive symptoms in patients with advanced colorectal cancer. The purpose of this study was to evaluate SEMS placement against various forms of palliative surgical procedures in terms of effectiveness, morbidity, mortality and oncologic results. We conducted a systematic search of PubMed, Web of Science, Cochrane Library and Medline for articles describing patients with incurable locally advanced obstructive colorectal cancer who underwent surgery or self-expanding metal stent placement as a palliative procedure for the alleviation of symptoms. Eighteen studies (1606 patients) were included in a pooled meta-analysis. In the surgery group the clinical success was slightly higher (98.62% vs. 94.92%; OR = 0.35, 95%CI [0.16–0.73], p = 0.005) and the late complications rate was lower (13.9% vs. 24.0%; OR = 3.01, 95%CI [2.06–4.39], p < 0.00001). The SEMS placement was associated with a lower early complication (11.3% vs. 28.1%; OR = 0.34, 95%CI [0.19–0.58], p = 0.0001) and a shorter length of hospital stay (SMD = −1.94, 95%CI [−2.76, −1.12], p < 0.00001). In terms of the oncologic results, surgery was significantly associated with an increased overall survival regardless of the type of procedure (OR = 1.24, 95%CI [1.08–1.42], p = 0.002). Although having lower early morbidity and mortality rates, SEMS placement was associated with an increased chance of late complications and a worse overall survival, thus making them avoidable when patients have longer life expectancies. Due to the lower early complications rates, SEMSs might still have a place in the management of selected cases with bowel obstruction. Full article

Background: Carotid web (CaW) usually presents as a shelf-like intimal flap at the beginning of the internal carotid artery. It has been proven that CaW is associated with ischemic stroke, particularly in young patients without other risk factors. This case report aimed to describe the carotid web that causes ischemic stroke due to embolic complications. Moreover, both pathologies were successfully treated with endovascular techniques in the presented case study. Methods: A 59-year-old male presented to the neurological department with motor aphasia, right-sided weakness, and hypoesthesia. Computer tomography (CT) of the head and computed tomography angiography (CTA) of the aortic arch and intracranial arteries were performed. Due to the unknown onset of the presented stroke symptoms, diagnostics were extended to magnetic resonance (MR), and based on this, the patient qualified for immediate mechanical thrombectomy (according to the DAWN trial protocol). Intraoperative digital subtraction angiography (DSA) revealed embolism material in the left middle cerebral artery (segment M1). The artery was recanalized via aspiration thrombectomy using the Penumbra system, and complete restoration of flow was obtained (according to the TICI scale). In addition, DSA revealed the presence of CaW changes in the left internal carotid artery (LICA). In the control CT scanning, an acute ischemic area in the left temporal lobe was found. After the treatment, the patient demonstrated complete neurological improvement from his initial presentation. He qualified for carotid artery stenting of the LICA, which was postponed to a later period due to the presence of an area of infarction. The angioplasty with stenting was performed 6 months later, and a carotid antiembolic “mesh” stent (Roadsaver, Terumo) was implanted into the LICA across the carotid web. Conclusions: CaW should be considered in the case of stroke resulting from unknown causes. The presented case study demonstrated that both carotid web and ischemic stroke pathologies can be effectively treated with emerging endovascular techniques. Full article

Subclavian artery pseudoaneurysms are rare but potentially life-threatening vascular injuries frequently associated with trauma such as clavicle fractures. In this paper we describe the case of a 49-year-old male who developed a post-traumatic pseudoaneurysm of the subclavian artery after a bicycle accident. The diagnosis was delayed due to non-specific symptoms and an initially missed aneurysm on computed tomography imaging. Persistent pain, swelling, and erythema in the subclavian region prompted further detailed diagnostics, which ultimately revealed the pseudoaneurysm. The patient was successfully treated with endovascular stent–graft implantation. We screened the PubMed database to identify similar cases managed exclusively through endovascular intervention. Reports of iatrogenic pseudoaneurysms and those treated with open surgery were excluded. Variables such as time to diagnosis, clinical presentation, features of pseudoaneurysms, and complications were analyzed to highlight the role of endovascular techniques as a minimally invasive and effective treatment option. These cases pose both a diagnostic and a therapeutic challenge, as early recognition of symptoms is crucial to prevent serious complications including thrombosis, neurological deficits, and even limb loss. Full article

Background/Objectives: Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke, disproportionately affecting populations with significant vascular risk factors. Although ICAS imposes a considerable health burden, research on this condition in Central Asia remains scarce, especially among the Kazakh population. This study analyzes demographic characteristics, treatment outcomes, and procedural challenges associated with ICAS in 216 patients treated at a single institution. Methods: This retrospective study included patients with ≥70% intracranial artery stenosis confirmed by imaging and presenting with ischemic symptoms. All patients underwent angioplasty and stenting with dual antiplatelet therapy (DAPT). Data collected included demographics, comorbidities, stenosis characteristics, procedural details, and outcomes assessed by the modified Rankin Scale (mRS). Results: The median age was 63.5 years (IQR: 57–68.6), and 73.7% were male. Hypertension was the most common comorbidity (98%), followed by ischemic heart disease (58%) and diabetes mellitus (40.9%). Multi-location ICAS was significantly associated with patients over 75 years of age (p = 0.025). Additionally, obesity and stenosis severity greater than 70% showed trends toward significance, with p-values of 0.064 and 0.079, respectively. Stenosis predominantly affected the internal carotid artery (54.5%) and vertebrobasilar system (31.6%). The average hospital stay was longer for posterior circulation stenosis (7.1 days) compared to anterior circulation (4.7 days). The periprocedural complication rate was 0.7%, with two deaths attributed to ischemic complications. At follow-up, four patients experienced worsening mRS scores (>2), particularly those with severe stenosis in the basilar artery and M1 segment. Conclusions: ICAS in the Kazakh population is strongly associated with hypertension and aging, with posterior circulation stenosis contributing disproportionately to worse outcomes. The low complication rates highlight the safety of modern endovascular techniques. However, further research is needed to optimize treatment strategies for severe and multi-location ICAS, particularly in Central Asian populations. Full article

Background and Objectives: Double-J stents are urinary catheters that are frequently used in urology. They are now also used in other specialist areas such as obstetrics and gynecology. However, the use of double-J stents is not without side effects. The aim of this review was to highlight the indications and possible adverse effects of the use of these stents in obstetrics and gynecology. Materials and Methods: We analyzed works published after 1995 in the PUBMED, SCOPUS, and Web of Science databases related to the use of double-J stents in obstetrics and gynecology, as well as reported adverse events. We carried out a narrative review of the available literature on this topic. Results: We identified 69 relevant publications that we included in the review. In obstetrics, indications include the treatment of gestational hydronephrosis, some urological conditions during pregnancy, such as obstructive urinary calculi, with or without superinfection, or intraoperative use for cesarean section or hysterectomy after cesarean section, to protect from, or to solve, ureteral lesions. In gynecology, they are used preoperatively or intraoperatively to protect the ureter during gynecological operations in the pelvic area or postoperatively to repair some ureteral injuries. They are also indicated for ureteral obstructions that occur after pelvic radiotherapy for gynecological neoplasms. Complications associated with the use of double-J stents include more frequent urinary tract infections, lower urinary tract symptoms, calcifications and misplacements. Conclusions: Double-J stents are widely used in obstetrics and gynecology and are characterized by good efficiency and safety, although some side effects may occur (lower urinary tract symptoms, hematuria, complications in birth outcomes), which do not limit their use. Summary of evidence: In this review, we analyzed the indications and complications of double-J ureteral stenting in obstetric and gynecologic patients. We found that the procedure is safe, both in the treatment of ureteral obstruction and in the resolution of postoperative complications. No serious complications of ureteral stenting have been noted that would constitute a contraindication to its use. Future prospective studies in large patient cohorts are necessary to validate our data. Full article

Objective: Patients with chronic idiopathic intracranial hypertension (IIH) commonly experience a high level of disability and low satisfaction with medical treatment. We aim to evaluate long-term functional improvement and patient satisfaction in IIH patients with similar symptoms by comparing venous sinus stenting (VSS) to standard medical therapy. Methods: We conducted a cross-sectional questionnaire study of 111 IIH patients, comparing 37 adult female patients who underwent venous sinus stenting with 74 patients treated medically. Propensity score matching was used to balance age and presence of papilledema at presentation between groups. Headache-related disability was evaluated using the Migraine Disability Assessment Scale (MIDAS), while general function and treatment satisfaction were assessed using custom questionnaires. Electronic medical records and the results of imaging upon diagnosis were reviewed retrospectively. Results: The stented group reported significantly better outcomes in physical well-being (median 4.0 vs. 1.0, p < 0.001), task completion (4.0 vs. 1.0, p < 0.001), work/school persistence (5.0 vs. 1.0, p < 0.001), and mental well-being (4.0 vs. 1.0, p < 0.001). Additionally, the stented group had a lower proportion of patients with severe MIDAS (MIDAS > 4, 24.3% vs. 47.9%, p = 0.017). Logistic regression suggested venous stenting as a protective factor against severe MIDAS scores (OR = 0.174, p = 0.004). Conclusion: Cerebral venous stenting in patients with IIH is associated with lower disability and higher patient satisfaction from medical treatment compared to those treated with medications only. These findings suggest that venous sinus stenting may be a valuable treatment option for selected IIH patients. However, larger prospective studies are needed to further validate our results. Full article

Background and Objectives: Robot-assisted extravesical ureteral reimplantation (REVUR) has been described as valuable alternative to open reimplantation in the pediatric population. This study aimed to report the outcome of REVUR in children with complex obstructed megaureter (COM) needing ureteral dismembering and/or tapering. Materials and Methods: The records of patients with COM, who received REVUR with ureteral dismembering and/or tapering over the last 3 years (2021–2024), were retrospectively reviewed. The inclusion criteria for COM included previous surgery, paraureteral diverticula, or ectopic megaureter. Results: A total of 16 patients (15 boys), with a median age of 7.8 years (range 2–16), were treated over the study period. COM was associated with paraureteral diverticula (n = 6), previous failed endoscopic balloon dilation (n = 4), ectopic megaureter (n = 2), and previous bulking agent endoscopic injection causing iatrogenic ureteral obstruction (n = 4). Presentation symptoms included febrile urinary tract infections (n = 8), flank pain (n = 4), hematuria (n = 2), and pseudo-incontinence (n = 2). All surgical procedures were accomplished robotically without conversions or intra-operative complications. Ureteral tapering was performed in 7/16 (43.7%). The median operative time (including robot docking) was 220 min (range 155–290). The median length of stay was 3.8 days (range 3–7). The indwelling double J stent was removed 4–6 weeks postoperatively. Clavien 2 grade complications occurred postoperatively in 2/16 (12.5%). At median follow-up of 34.5 months, all patients were asymptomatic and showed improved hydroureteronephrosis on ultrasound and improved drainage on diuretic renogram. Conclusions: This study demonstrates that robot-assisted extravesical ureteral reimplantation is a safe and effective treatment for primary obstructive megaureter and other complex ureteral anomalies in our patient cohort. The procedure showed low complication rates, high success rates, and favorable long-term outcomes, supporting the feasibility and effectiveness of robotic surgery for these conditions. Full article

Background/Objectives: The Naples prognostic score (NPS), reflecting inflammation and nutritional status, has prognostic value, especially in cancer. This study evaluated its ability to predict in-hospital mortality in acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). Methods: We retrospectively studied 244 patients with AIS who were admitted between April 2020 and December 2023. Patients were included if they presented within 6 h of symptom onset with evidence of intracranial proximal arterial occlusion. The EVT was performed using aspiration catheters, stent retrievers, or both. The NPS was calculated based on the neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, and albumin and total cholesterol levels. Results: We found a significant association between higher NPS scores and in-hospital mortality. Patients with a high NPS (3 or 4) had a mortality rate of 41.6% compared to 21.0% in the low-NPS group (0, 1, or 2). The full model incorporating NPS showed superior predictive ability for in-hospital mortality compared with the baseline model (areas under the curve 0.881 vs. 0.808). A receiver-operating characteristic analysis at a cutoff of >2.5 for the NPS showed a sensitivity of 86.6% and specificity of 41.9%. This study demonstrated that incorporating the NPS into the predictive model improved the accuracy and calibration for predicting in-hospital mortality. A decision curve analysis showed the net benefit of using the full model incorporating NPS over the baseline model, emphasizing its potential clinical application in prognostication. Conclusions: NPS is a reliable predictor of in-hospital mortality in AIS patients undergoing EVT. Incorporating NPS into clinical practice could help to identify high-risk patients and improve outcomes through tailored interventions. Full article

Background: EUS-guided gastroenterostomy (EUS-GE) is a novel and effective procedure for the management of malignant gastric outlet obstruction (GOO) with more durable results when compared to enteral stenting (ES). However, data comparing EUS-GE to ES in patients already treated with EUS-guided choledocoduodenostomy (EUS-CDS) for distal malignant biliary obstruction (DMBO) are lacking. We aimed to compare outcomes of EUS-GE and ES for the palliation of GOO in this specific population of patients. Methods: A multicenter, retrospective analysis of patients with DMBO treated by EUS-CDS and subsequent GOO treated by EUS-GE or ES from 2016 to 2021 was conducted. Primary outcomes were overall AEs rate and dysfunction of the EUS-CDS after GOO treatment. Secondary outcomes included clinical success, technical success, procedure duration, length of hospital stay and relapse of GOO symptoms. Results: A total of 77 consecutive patients were included in the study: 25 patients underwent EUS-GE and 52 underwent ES. AEs rate and patency outcomes of the EUS-CDS after GOO treatment were comparable between the two groups (12.5% vs. 17.3%; p = 0.74). No recurrence of GOO symptoms was registered in the EUS-GE group while 11.5% of ES patients had symptoms recurrence, even if not statistically significant (p = 0.16), after a mean follow-up period of 63.5 days. Conclusion: EUS-GE and ES are both effective and safe for the palliation of GOO in patients already treated by EUS-CDS for DMBO with no difference in the biliary stent dysfunction rate and overall AEs. EUS-GE is associated with less recurrence of GOO symptoms. Full article

Cancer-associated venous thromboembolism (CAT) poses a severe threat, disrupting ongoing cancer management and adversely impacting treatment outcomes. CAT often leads to a two- to six-fold increase in mortality rates when it progresses to venous total occlusion. The primary modalities employed in addressing this life-threatening complication include anticoagulant therapy only or coupled with strategic endovascular interventions. Aggressive endovascular interventions, such as mechanical thrombectomy and venous stent implantation, are crucial in mitigating thrombotic complications, relieving symptoms, and improving this vulnerable population’s overall quality of life and life expectancy. This case report presents a CAT case extending to the total occlusion of the inferior vena cava. Our goal is to provide valuable insights into the evolving management of CAT and its sequelae, showcasing treatment approaches that lead to improved outcomes and a better quality of life for cancer patients facing these additional challenges. Full article

Purpose: Reporting gender-related outcomes for symptomatic carotid lesion revascularization after both endarterectomy (CEA) and carotid artery stenting (CAS) procedures in an unselected group of patients treated by Italian Vascular Specialists. Material and Methods: A retrospective study was conducted on patients presenting with recently symptomatic carotid stenosis treated by CAS and by CEA. The primary endpoint was the 30 days any stroke occurrence rate; secondary endpoints were technical success, occurrence of transient ischemic attack (TIA), acute myocardial infarction (AMI) and death. Demographic, clinical and procedural data were all noted in order to identify the outcome’s determining factor. Results: A total of 265 patients (193 males and 72 females) were enrolled, and of these 134 (50.5%) underwent CEA and 131 CAS (49.5%). At 30 days, the overall new stroke rate was 3.4% (one fatal), and no TIA, AMI or deaths were observed. Among strokes, seven major and two minor strokes were reported, with six after CEA and three after CAS (p = 0.32; OR: 2; CI95%: 0.48–8.17). The timing of revascularization has been found to be slightly associated with new stroke occurrence: seven out nine strokes were observed in patients treated within 14 days from symptom onset (5.5% vs. 1.4%; p = 0.08, OR: 3.8, CI95%: 0.77–18.56). Lastly, female patients presented a significantly higher risk of post-operative stroke compared to male patients: 6.9% vs. 2.1% (p: 0.05; OR: 3.52; CI95%: 0.91–13.52). Conclusions: Our experience seems to suggest that both CEA and CAS provide safe and effective results in treating patients presenting with symptomatic carotid stenosis. Regardless of the type of revascularization, female sex is an independent risk factor for stroke recurrence after treatment. Full article

Introduction: The application of double-J ureteral stents in urology is widespread, but their use is often accompanied by complications and bothersome symptoms, affecting patients’ quality of life (QoL). While various medications have been tested for alleviating the symptoms associated with double-J stents, consensus on their effectiveness remains elusive. This study aims to investigate the effectiveness of tamsulosin, solifenacin, mirabegron, desloratadine, and combination therapy using a Romanian-adapted version of the Ureteral Stent Symptom Questionnaire (USSQ). Materials and Methods: A prospective, observational, randomised trial was conducted at the Urology and Renal Transplant Clinic of Dr. “C.I. Parhon” Clinical Hospital in Iasi between 1 January 2022 and 1 August 2023. Three hundred twenty seven patients who underwent their first double-J stent insertion were evaluated with the Romanian-adapted USSQ at baseline and 30 days post-insertion. Patients were randomly divided into six groups based on the prescribed medications: control, tamsulosin, mirabegron, solifenacin, desloratadine, and combination therapy. Results: The data suggest a significant reduction in symptoms in patients who received medication compared with the control group. Furthermore, the combined medication of solifenacin 10 mg and tamsulosin 0.4 mg was particularly effective in reducing pain with statistical significance compared to the control group (p = 0.001). The highest mean scores for urinary symptom severity were observed in the control group (12.37 ± 6.82), and the lowest was in the mirabegron group (9.94 ± 5.82). The individuals who received a daily dose of 50 mg of mirabegron saw the most notable influence on their job. Conclusions: While no single medication emerged as a “miracle drug” for managing symptoms related to double-J stent insertion, the combination therapy of solifenacin and tamsulosin is the most promising option for improving symptoms related to double-J stent insertion and QoL. Additional extensive research is required to validate these initial results. Full article

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2–3% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from the cardiopulmonary and nervous system. It is important to remember this in the differential diagnosis of complications of ERCP, as early detection is crucial. In the case presented here, the diagnostic CT scan performed immediately after the incident brings awareness of how massive an air embolism can be. The CT results showed gas bubbles entering both the superior and inferior vena cava. The presence of air has been captured in the bile ducts, duodenum wall, heart, femoral veins and intracranially. Risk factors for this complication include previous biliary surgeries, the presence of prostheses and stents, cholangitis, liver tumors and anatomical anomalies such as hepatobiliary fistulas, as well as intrahepatic and extrahepatic anatomical leaks. As gas embolism is associated with serious health consequences, knowledge of the problem and adequate preparation may reduce the occurrence of the problem. Attention should be paid to basic and easily obtainable precautions when performing the procedure, such as the patient’s hemodynamic status, adequate hydration and positioning during the procedure. Full article

The link between the mind and cardiac disease has been studied throughout the ages. Patients diagnosed with ischemic heart disease may develop psychological and psychiatric symptoms such as depressed mood, anxiety, and insomnia that can drastically affect life quality. Unfortunately, during cardiac rehabilitation, there is a lack of psychiatric care. To improve a patient’s quality of life, this intriguing relationship between ischemic heart disease and depression must be closely monitored, because risk factors and pathophysiological mechanisms may be common. This case report article is about a 47-year-old Romanian woman with acute coronary syndrome revascularized with angioplasty and stent implantation 3 months ago, admitted to the Arad Emergency County Clinical Hospital, Psychiatric Department, with depressive symptoms. Our patient was treated with an antidepressant, an anxiolytic, a mood stabilizer, a hypnotic, a nootropic, aspirin, dual platelet inhibition, a beta-blocker, a converting enzyme inhibitor, a statin, and oral antidiabetics medication, as well as having psychotherapy sessions. The treatment was well tolerated, with an improvement in the social and professional functionality of the patient. In conclusion, people with ischemic heart disease have a higher risk of developing depression, but patients with depression also have a higher risk of developing ischemic heart disease. This confirms the importance of an individualized multidisciplinary approach to management because the collaboration between psychiatrists and cardiologists can be an additional benefit to patients. This article may pave the way for further research into the association between ischemic heart disease and depressive disorders, which could provide significant advantages to patients. Interdisciplinarity contributes to the development of innovative techniques of prevention and treatment, reducing worldwide morbidity and mortality. Full article

Objectives: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a short half-life antiplatelet agent. This retrospective analysis focused on the safety and efficacy of low-dose eptifibatide administration in stroke patients with tandem lesions. Methods: We evaluated the results of endovascular treatment in 148 stroke patients with tandem lesions. Patients in whom balloon angioplasty alone resulted in satisfactory cerebral flow did not receive eptifibatide (33 patients); others received this drug together with stent implantation (115 patients). Eptifibatide was given as an intravenous bolus of 180 μg/kg and then in a modified low dose of 1 μg/kg/min for 24 hours. Results: There were no statistically significant differences between both groups regarding 30-day mortality, frequency of thrombotic events, or hemorrhagic complications. An analysis of clinical status at 30-day follow-up revealed that the administration of eptifibatide was associated with a statistically significant better outcome: a higher rate of either no neurological symptoms or only mild symptoms (4 NIHSS points maximally). Conclusions: The administration of eptifibatide in stroke patients presenting with tandem lesions is relatively safe. Moreover, treatment with this drug can improve clinical outcomes in these challenging patients. Full article