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Clinical Neuroscience

SEPTEMBER 30, 2016

[Dissections of the supraaortic arteries]

CSEH Tamás, SZUKITS Sándor, SZAPÁRY László

[Dissection of the cervical and intracranial vasculature is a rare but important cause of ischaemic stroke especially in young adults. In the majority of cases it affects the extracranial vessels, mostly the internal carotid artery. It might be categorized as spontaneous or traumatic, causing diverse clinical symptoms. Dissection might lead to ipsilateral stroke mainly by artery-to-artery embolisation. Due to its relative rarity compared to the classic ischaemic stroke of the elderly, there are much less clinically relevant information for the clinician to rely on. Several large, randomised, multicentered, prospective studies and some smaller, retrospective analyses have been published recently concerning the genetic background, epidemiology, acute care and secondary prevention of supraaortic arterial dissection which helps the neurologist to provide evidence-based care for his patient. Our aim is to give a short, up-to-date overview of arterial dissections with two case reports.]

Lege Artis Medicinae

MARCH 22, 2012

[Clinical aspects of ischaemic bowel disease]


[Decreased blood flow through the intestines leads to mesenteric ischaemia, which is characterised by cellular damage due to the lack of oxygen and nutrients. Extensive collateralisation between splanchnic vessels serves as a protective mechanism against ischaemia. Intestinal ischaemia can be classified on the basis of its timing, location and the vessels involved. Acute mesenteric ischaemia can result from arterial embolisation, arterial or venous thrombosis, or vasoconstriction secondary to systemic circulation disorder associated with hypovolaemia. Chronic mesenteric ischaemia develops as a consequence of partial or complete occlusion of splanchnic vessels. Colonic ischaemia is mainly caused by a limited circulation disorder of the inferior mesenteric artery. Mortality rates for the various forms of acute mesenteric ischaemia are different. However, early diagnosis before bowel infarction might improve survival. This paper summarises the cilical aspects, diagnosis and therapeutic options of intestinal ischaemia.]

Hungarian Radiology

DECEMBER 21, 2009

[The effect of endovascular intervention in the presence of rare celiac trunk developmental anomalies]


[INTRODUCTION - The congenital absence of celiac trunk and it’s subtotal stenosis are rare abnormalities and often recognised only during digital substraction angiography (DSA). This anomaly is significant when there is a need to perform local intraarterial chemoperfusion or chemoembolisation of malignant hepatic tumours. In these cases the liver is supplied with arterial blood through the superior mesenteric artery and the gastroduodenal arch. The direction of blood flow in the common hepatic artery is changed ensuring the flow to the splenic and left gastric artery. In such circumstances it is not possible to obtain local chemotherapy. CASE REPORT - Two male patients (61 and 75 years old) are reported. Both patients were candidates for chemotherapy due to hepatocellular carcinoma (HCC). In these two cases the planned therapy was impossible because of a stenosis of the celiac trunk in one, and atresia of the celiac trunk in the other. CONCLUSION - The recognition of vascular anomaly prior to endovascular intervention significantly affects the planning of the therapy.]

Lege Artis Medicinae

FEBRUARY 20, 2002

[Tumour therapy with the tools of interventional radiology]


[The author reviews the interventional radiological methods applicable in tumour therapy. The therapy of non-resectable primary and secondary liver tumours is discussed based on literature data and own experience. The possibilities of percutaneous tumour ablation are limited by the size and number of the tumours. Intra-arterial chemotherapy, chemoembolisation and feeding artery occlusion can be successful resulting in longer life and better quality of life in cases with advanced tumours. The results are better if these methods are combined with systemic chemotherapy.]

Hungarian Radiology

MARCH 22, 2008

[Gynecological malignancies: review of the radiological diagnostics and image-guided therapy - Onco Update 2008]


[The recent results of diagnostical imaging of gynecological tumours and the actual place of interventional radiological methods are discussed. Systematical reviews of articles published during the last year (2007) have been availed to discuss: cervical cancer, endometrial cancer, ovarian cancer, general and special imaging of the female pelvis, different uterine fibroid ablation methods (embolisation and high-intensity focused ultrasound [HIFU]). Experience of gynecological tumour imaging is growing rapidly, therefore, even the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are making their way into the daily routine. Some examinations become obsolete during the course of time and thus their further application should be avoided. In the meanwhile, some modalities prove their worth and become indespensable during the investigation of a given pathology.]

Hungarian Radiology

OCTOBER 20, 2009

[Portal embolisation prior to liver resection]

MÓZES Péter, MÉSZÁROS György, TÓTH Judit, SÁPY Péter

[INTRODUCTION - By partial embolisation of the vena portae the number of the patients suitable for radical liverresection can be enhanced, the safety of the operation can be increased, the subsequent results improved. The method is based on the experience that when blocking the circulation of the portal system in special segments of the liver, the other part of the organ tries to substitute the functional deficiency by hypertrophy. Vena portae embolisation is justified in cases when the liver substance remaining after the planned operation is critically small. PATIENTS AND METHODS - The authors carried out vena portae embolisation at Debrecen University Medical and Health Science Centre since October 2003 on six patients. Assessments were made studying the volume of the whole liver, the lobe affected by embolisation and that of the unaffected lobe, by CT-volumetry. The average age of the patients (four men and two women) was 63 years (51-67 years). The hepatic tumour was an extended metastasis localised to one lobe in five cases, and HCC in one of the patients. In each case we carried out closing the right lobe’s portal system. RESULTS - In five cases the left lobe showed increase following the portal embolisation of the right lobe intended to be removed. On the average four-six weeks passed between the two CT-examinations. The growth of the left lobe was an average of 42% (min. 11.8%, max. 75.6%). CONCLUSION - In selected patients the embolisation of the vena portae system of the tumorous liver-segments is a suitable method for enlargening the size of the liver substance remaining after an extensive resection.]

Hungarian Radiology

MARCH 22, 2008

[Use of covered stents in the endovascular treatment of extracranial stenosis of the internal carotid artery]


[INTRODUCTION - Significant stenosis of the internal carotid artery is frequently treated with stent placement. With growing clinical experience and usage of finer instrumentation, the incidence of periprocedural complications have reduced in larger centers. Two-thirds of the complications are postprocedural, due to the embolisation through the stent structure. Covered stents seem to be a good option against such embolisation. Our study demonstrates the efficiency, safety and feasibility of covered stent grafts, and the long term outcome of patients who underwent endovascular treatment of extracranial internal carotid artery stenoses, caused by highly embologenic plaques. MATERIALS AND METHODS - Between 2002 and 2003, 30 patients (22 male, 8 female, aged 50-89yrs, mean: 66 yrs) with 30 internal carotid artery stenoses having ipsilateral symptoms and/or stenotic lesions caused by irregular or ulcerated soft plaques or restenosis were treated with self-expanding covered stents (Symbiot, Boston Scientific). Predilatation and protecting devices were not used. Postdilatation was applied in every patient. Mean followup was 60 months (range 57-66 months), by Doppler ultrasonography as well as clinical examination. RESULTS - The degree of stenosis was found to range from 70% to subtotal occlusion. The plaque surfaces were irregular or ulcerated in 70%. The stenotic lesions were up to 30 mm in length. The narrowing of the internal carotid artery never extended to the common carotid artery. The technical success rate of stenting was 100%. The stents could be positioned with an accuracy of 2-3 mm. Periprocedurally, there were no neurological complications or deaths. During follow-up no strokes or stroke-related deaths occurred. Restenosis was found in two patients (6,6%) who underwent successful balloon dilatation. CONCLUSION - Our experience indicates that the covered stent is an efficient periprocedural and postprocedural “protecting device” to prevent neurological complications due to embolizations caused by high-risk plaques in stenotic lesions of extracranial internal carotid artery.]

Hungarian Radiology

MARCH 20, 2007

[Transcranial Doppler monitoring of distal embolism during of carotid stenting]


[INTRODUCTION - Reducing the risk of embolisation during endovascular treatment of internal carotid artery stenosis is very important. The rate of embolisation is affected by the different steps of stenting manipulation. Using transcranial Doppler equipment we studied the embolic signals during the different phases of carotid dilatation and stenting. MATERIAL AND METHOD - 50 patients (33 male, 17 female; mean age 64 years) were intraproceduraly monitorized with transcranial Doppler. Predilatation was necessary in nine cases, postdilatation was performed in 39 cases. The number of emboli were measured in seven different steps of endovascular treatment of carotid stenosis. Different type of commercial available endovascular devices were used. RESULTS - Intraprocedural embolisation was observed in every case. In different phases of carotid stenting the rate of embolisation showed marked differences in each phase of carotid stenting. Crossing the stenosis with stent delivery system were accompanied by a low rate of embolism (5.3) compared to the level during stent opening (9.16) and balloon dilatation (9.96). The highest level of embolisation was observed during predilatation (15.9) without the protection of the stent. CONCLUSIONS - We detected embolisation in all of the cases, however the number of embolic signals varied in different phases of carotid artery stenting. Embolisation can be reduced if the most dangerous steps (i.e. pre- and postdilatation) are avoided. Using TCD monitorisation the physician can be informed by the degree of embolisation that may alarm the interventionalist to perform the procedure more carefully, furthermore it can be employed during the training of carotid stenting.]

Hungarian Radiology

OCTOBER 10, 2005

[The force transmission of the distal endings of stent delivery systems]


[INTRODUCTION - In cases of endovascular treatment of internal carotid artery stenosis, one of the most important aspects is to minimise embolic complications. Dislodging emboli may be influenced by the shape and size of tapered endings of stent delivery systems. Our team performed measurements and calculations on the emergence of force of the various tapered endings. MATERIAL AND METHOD - Five different commercially available stent dilivery systems were investigated. The thickness of the devices were measured and taking 5 mm normal artery diameter, the lumen size was calculated, above which the delivery system should dilate the lumen mechanically. By means of geometrical computer-constructions and measurements, we analysed the forces directed ahead and laterally, emerging on the surface of tapered endings during the passing through the stenosis. RESULTS - The stent delivery systems were between 5.0 and 5.9 F in diameter, and even the stent delivery system of lowest profile would dilate a stenosis of over 89%. The different endings are tapered with variable lengths. The force transmission on the vessel wall of different directions was distinct at the various points of the cone surfaces. The forces directed ahead were less than those directed laterally on the larger part of a cone surface. Irregularity of the cone surfaces distributed the forces unfavorably. Considering the features of tapered endings, the atraumatic introduction of the devices required a range of upper limits of stenoses between 89.76-98.04%, which are more feasible values than those deternined by shaft sizes. CONCLUSIONS - Our experimental work suggests, that the shape and size of the endings of stent delivery systems influence the forces affecting vessel wall plaques, and in this manner, embolic complications, during carotid stenting. The lowest risk of embolisation could be induced by using the longest and smoothest tapered endings.]

Hungarian Radiology

JANUARY 20, 2003

[Stroke prevention: Experience with endovascular therapy of carotid artery stenosis]


[INTRODUCTION - Carotid artery stenting as an alternative to carotid endarterectomy is still not accepted by many Hungarian vascular surgeons. The purpose of our study was to prove that carotid artery stenting is effective in the treatment of primary atherosclerotic lesions and it carries a low risk of complications. PATIENTS AND METHODS - 149 patients (86 men, 63 women, 33-82 years old, mean age 57.5 years) were evaluated angiographically. 146 primary atherosclerotic lesions, and 8 post-endarterectomy restenoses were considered for carotid artery stenting. All patients had significant, over 60% stenosis according to NASCET criteria. Atherosclerotic plaques were classified as smooth, irregular and ulcerated. Subtotal occlusions (stenoses over 95%) were noted. The necessity of pre- or postdilation and the types of stent used were registered. Procedural success and periprocedural complication rates were noted. Followup colour Doppler sonography was performed at 1, 6 and 12 months. RESULTS - Subtotal occlusions were detected in 28% of the lesions. Procedural success rate was 149/150 (99%). Stenting was carried out in 86% with Monorail Carotid Wallstent. Predilation or use of protecting device was avoided in 96%. Postdilation was avoided in 6 cases of ulcerated plaques to prevent distal embolisation. Residual stenosis was always less than 30%. Stroke occured in 2.6%, TIA in 0.7%. Two of our patients developed restenosis. CONCLUSION - Carotid artery stenting is a safe alternative to carotid endarterectomy for most patients with primary atherosclerotic stenosis, as it can be carried out with clinical complication rate as low as published in the ACAS.]