PubMed Health⌕ Search

Biomedical subjects

M Piotin

Publications and source records attributed to M Piotin.

At least 19 recordsLinked to original sources
PubMed2006

Direct cervical arterial access for intracranial endovascular treatment.

INTRODUCTION: Tortuous vasculature is a cause of failure of endovascular treatment of intracranial vascular lesions. We report our experience of direct cervical accesses in patients in whom the arterial femoral route was not attainable. METHODS: In this retrospective study, 42 direct punctures of the carotid or the vertebral arteries at the neck were performed in 38 patients. The vessel harboring the intracranial lesion was punctured at the neck above the main tortuosity, a sheath was then positioned under fluoroscopic control to allow a stable access to the intracranial circulation. After the procedure, the sheath was removed and hemostasis was gained either by manual compression or by an arterial closure device (4 of 42, 9%). RESULTS: The cervical route allowed access to all intracranial lesions in all 42 procedures. A complication was encountered in six procedures (14%) related to the direct puncture. In 2 of the 42 procedures (4%), a transient vasospasm was encountered. A cervical hematoma formed in 3 of the 42 procedures (7%) after sheath withdrawal (one patient in whom an 8F sheath had been used, required surgical evacuation of a hematoma compressing the upper airways; the other patients did well without surgical evacuation). In the remaining patient (1 of 42 procedures, 2%), a small asymptomatic aneurysm at the puncture site was seen on the follow-up angiogram. CONCLUSION: Direct cervical arterial approaches to accessing the intracranial circulation is effective in patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters.

Adult↗
PubMed2006

[Transarterial embolisation of intracranial dural arteriovenous malformations with ethylene vinyl alcohol copolymer (Onyx18)].

OBJECTIVE: To report our recent experience in transarterial embolisation of dural arteriovenous malformations (DAVM) using a new liquid embolic agent, Onyx18. PATIENTS AND METHODS: 6 patients were enrolled in this series. Clinical presentation was separated into 2 groups: aggressive (n=2), non aggressive (n=4). The DAVM was located at the superior sagittal sinus (n=1), at the transverse sinus (n=2), at the condylian canal (n=1), in the lesser sphenoid wing region (n=1), and in the tentorium region (n=1). The DAVM drained directly into a condylian or a cortical vein for three patients and into a venous sinus with cortical venous reflux for the three others. In this latter situation, the sinus was anatomically excluded from the normal brain venous drainage. RESULTS: A full brain angiogram including both internal carotid arteries, both external carotid arteries and ipsilateral vertebral artery, was performed before and after each treatment. The feeder chosen after a selective catheterisation for Onyx18 injection was always meningeal. Each treatment consisted of a single Onyx injection after one unique feeder catheterisation. Complete anatomical exclusion of the DAVM was achieved and demonstrated by the post treatment angiogram in all cases. There was no clinical complication after the treatment. CONCLUSION: Onyx18 used is a safe treatment for DAVMs. When its injection is performed in optimal conditions, it fills the total DAVM and its drainage vein or sinus after a single arterial feeder catheterisation.

Aged↗
PubMed2006

Ellipsoid approximation versus 3D rotational angiography in the volumetric assessment of intracranial aneurysms.

BACKGROUND AND PURPOSE: The purpose of this study was to compare the volumetric results of intracranial aneurysms obtained by calculation of the volume of an ellipsoid with those obtained with 3D rotational angiography (3D-RA). METHODS: First, the precision of 3D-RA in the assessment of volumetric measurement of intracranial aneurysm had to be established. The 3D-RA gave an overestimation of 4% to 5.5% of the actual volume of a spherical object. Then, 484 consecutive human intracranial aneurysms were studied with 3D-RA, allowing the determination of their volume. In the meantime, aneurysm dimensions (height and width) were measured on the 3D pictures generated by the 3D-RA. The aneurysm volumes were obtained by considering the aneurysm shape to be ellipsoidal, according to the formula: (formula in text). RESULTS: The calculated aneurysm volume (V(calc)) overestimated by 15 +/- 38% the volume given by 3D-RA. Taking into account a 10% margin of error, 227 (47%) aneurysms were overestimated by 44 +/- 34%, whereas 113 (23%) aneurysms were underestimated by 25 +/- 12%. Only 144 (30%) aneurysms had calculated and 3D-RA results within the limits of 10% of discrepancy. Concordance was good for pericallosal and basilar tip aneurysms (mean overestimation of 6 +/- 22% and 8 +/- 27%, respectively). Conversely, there was a high discrepancy between calculated and 3D-RA results for posterior communicating artery aneurysms (mean overestimation of 22 +/- 44%). CONCLUSION: The calculation of the volume based on aneurysm dimensions is relatively accurate for pericallosal and basilar tip aneurysms, probably owing to their spherical or elliptic shape. Conversely, this formula is not adequate for irregularly shaped lesions, such as posterior communicating aneurysms.

Angiography↗
PubMed2005

Preoperative devascularization of a circumferential osteogenic metastasis to the upper cervical spine by direct percutaneous needle puncture: a technical note.

Direct percutaneous needle puncture (DPNP) for presurgical devascularization of head and neck as well as skull base tumours is an established, yet not widespread method. We present a case of a large and highly vascularized metastasis with partial destruction of the first two cervical vertebrae and encasement of the spinal cord that was successfully treated by DPNP for preoperative devascularization after an attempted endovascular embolization had failed. The lesion was safely and effectively devascularized, which facilitated the surgical removal. The case presented illustrates the technique and furthermore demonstrates its value.

Aged↗
PubMed2005

[Endovascular treatment of unruptured middle cerebral artery aneurysms].

INTRODUCTION: Middle cerebral artery aneurysms (MCA) often present an unusual anatomical feature for the endovascular treatment and are frequently sent to surgery. We report our experience in the endovascular treatment of unruptured MCA aneurysms and compare it with results from the neurosurgical literature. PATIENTS AND METHODS: In this retrospective study were included all patients with unruptured MCA aneurysms treated in our institution between November 1998 and December 2003. 3D imaging was performed in all cases to determine precisely the relationship between aneurysm and parent artery. The degree of occlusion of the aneurysms was estimated according to Raymond's classification. The neurological state was evaluated according to the Rankin scale and was re-evaluated at the time of each follow-up. RESULTS: Eighty four patients with 100 aneurysms were analysed. Ninety aneurysms were treated by endovascular approach. Nine aneurysms were sent to surgery, after 3D imaging analyses or failed endovascular treatment. In one patient, related to the aneurysm configuration, a conservative attitude has been adopted. Four giant aneurysms were treated by parent vessel occlusion and 86 aneurysms were selectively occluded. The remodelling technique with balloon was performed in 58.1% of cases. Eight patients presented a new neurological deficit. The deficit was transient in six cases, and permanent in 2 cases. There was no mortality in this series. In 86 aneurysms selectively treated, there were 87.2% good results (grades A and B). Seventy one aneurysms (82.5%) treated were controlled between 3 and 58 months with a 19.6 months average. Recurrences were observed in 25.3% of cases. They were major in 9.8% and retreatment was performed. CONCLUSION: We report the feasibility of the endovascular treatment of MCA aneurysms previously estimated untreatable. Per procedural 3D imaging and remodelling technique were fundamental tools in the management of these aneurysms.

Adult↗
PubMed2004

Increasing the packing of small aneurysms with soft coils: an in vitro study.

The aim of this study was to determine whether or not the use of Soft and Ultra Soft Guglielmi detachable coils (GDCs) may improve the packing of cerebral aneurysms. Six coiling scenarios of a silicone aneurysm model were conducted using Standard, Soft, and Ultra Soft GDCs. Coils were introduced up to the point when the adjunct of one more coil caused protrusion out of the aneurysm sac. Packing ratios (volume of coils/aneurysm volume) ranged between 30 and 55%. The highest degree of packing was achieved with the combination of Soft GDC-18 coils and Ultra Soft GDC-10 coils. There is a positive relationship between the use of Soft and Ultra Soft GDC coils and greater aneurysm filling.

Embolization, Therapeutic↗
PubMed2004

[Intracranial arteriovenous malformations: review of epidemiologic and genetic data].

Estimation of prevalence and incidence rates in a disease is crucial to estimate the risk of the natural evolution of the disease. We have reviewed published data on intracranial AVM and have noted that reported estimated risks were quite variable mainly due to the lack of population-based prospective data. Nonetheless, estimation of these parameters can be made from selected populations. We will note also that there is no published data confirming a genetic origin for the most frequent group of sporadic AVM.

Cross-Sectional Studies↗
PubMed2004

[Cerebral arteriovenous malformations and pregnancy: management of a dilemma].

Cerebral arteriovenous malformations (AVM) infrequently complicate pregnancy. The epidemiology and various treatment options of AVM complicating pregnancy are outlined. Although the medical treatment of the pregnant patient with an AVM is similar to that of nonpregnant patients, there are specific conditions that are relevant to these patients. Due to its rarity, no specific recommendations exist for the management of the pregnant AVM-patients. We propose some guidelines for the evaluation and treatment of pregnant patients with AVM.

Cerebral Angiography↗
PubMed2003

CT angiography, MR angiography and rotational digital subtraction angiography for volumetric assessment of intracranial aneurysms. An experimental study.

The purpose of our experimental study was to assess the accuracy and precision of CT angiography (CTA), MR angiography (MRA) and rotational digital subtraction angiography (DSA) for measuring the volume of an in vitro aneurysm model. A rigid model of the anterior cerebral circulation harbouring an anterior communicating aneurysm was connected to a pulsatile circuit. It was studied using unenhanced 3D time-of-flight MRA, contrast-enhanced CTA and rotational DSA angiography. The source images were then postprocessed on dedicated workstations to calculate the volume of the aneurysm. CTA was more accurate than MRA (P=0.0019). Rotational DSA was more accurate than CTA, although the difference did not reach statistical significance (P=0.1605), and significantly more accurate than MRA (P<0.00001). CTA was more precise than MRA (P=0.12), although this did not reach statistical significance. Rotational DSA can be part of the diagnosis, treatment planning and support endovascular treatment of intracranial aneurysms. The emerging endovascular treatment techniques which consist of using liquid polymers as implants to exclude aneurysms from arterial circulation would certainly benefit from this precise measurement of the volume of aneurysms.

Angiography, Digital Subtraction↗
PubMed2002

[Endoluminal dilatations and stenosis of symptomatic vertebral arteries].

Surgical treatment of symptomatic atherosclerotic stenosis of vertebral arteries has been proposed for many years but this technique remains quite confidential due to technical difficulties and relatively high risks. Transluminal angioplasty has been proposed and we developed a simplified technique using coronary stent placement. The aim of this study was to evaluate the feasibility and efficacy of transluminal angiography with primary stenting for proximal stenosis for vertebral arteries. Eleven patients with symptomatic atherosclerotic stenosis of vertebral arteries were treated by trans luminal angioplasty with primary stent placement. Two patients, one with stenosis of the proximal vertebral artery and one with distal stenosis of the vertebral artery where only treated by transluminal angioplasty. In all cases transluminal angioplasty and stenting were feasible with restitution ad integrum of the diameter of the artery in 98 cases and with residual moderate stenose (<20%) in 5 cases. All patients were followed for more than one year, only one patient had recurrence of symptoms, but he stopped spontaneously the anti platteless drugs. Vertebro basilar symptoms disappeared completely in 12/13 cases and were improved in 1/13 cases. No restenose of the artery was observed on control (echodoppler) excepted in one case, where a tight stenose of pre vertebral sub clavian artery developed. Transluminal angioplasty for symptomatic stenosis of vertebral artery appears as a very successful technique with a low complication rate. It should be proposed in many cases of vertebrobasilar insufficiency related with tight vertebral artery stenosis.

Aged↗
PubMed2001

Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy.

Intracranial aneurysm rupture is responsible for important morbidity and mortality during pregnancy. We report 2 cases of subarachnoid hemorrhage in pregnant women resulting from ruptured aneurysms. Both patients were treated by endovascular approach. Successful maternal and fetal outcome were achieved in both cases without craniotomy and aneurysmal surgical exposure.

Acute Disease↗
PubMed2001

Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment.

PURPOSE: To evaluate the results of endovascular treatment of patients having both arteriovenous malformations and aneurysms. MATERIALS AND METHODS: Two hundred seventy consecutive patients underwent pretherapeutic selective and superselective angiography. In each patient, the following were recorded: demographic information; clinical symptoms; location of the arteriovenous malformation, including presence of aneurysms; therapeutic interventions and immediate anatomic results; and clinical and angiographic follow-up data. Every patient who had at least one angiographically confirmed arterial aneurysm at presentation was included in the study. RESULTS: Arterial aneurysms were found in 30 (11%) of 270 patients in the population with arteriovenous malformations. Fifteen (50%) of 30 patients with aneurysms had a hemorrhage at presentation. Only 66 (27.5%) of 240 patients without aneurysms had a hemorrhage at presentation. The coexistence of arteriovenous malformations and aneurysms correlated significantly with intracranial hemorrhage at presentation (P <.05). When an aneurysm was believed to be responsible for a hemorrhage and whenever possible, it was treated before the arteriovenous malformation was treated. Treatments were protective against hemorrhage or recurrence of hemorrhage in all cases. Five of 30 patients had neurologic deficits as a result of endovascular treatment of both aneurysms and arteriovenous malformations. CONCLUSION: Findings in this study highlight the importance of recognizing aneurysms in patients with arteriovenous malformations. A strategic focus on the circulatory exclusion of associated aneurysms, especially when such lesions have been responsible for a hemorrhagic episode, is recommended.

Adult↗
PubMed2001

Endovascular treatment of cerebral aneurysms: An in vitro study with detachable platinum coils and tricellulose acetate polymer.

OBJECTIVE: The purpose of our experimental study was to determine the effectiveness of filling the cavity of in vitro aneurysms with detachable platinum coils and the combination of detachable platinum coils and liquid embolic agent. MATERIALS AND METHODS: Silicone aneurysm models were connected to a circulatory system to simulate arterial flow. A microcatheter was used to introduce detachable coils into the aneurysm cavities. First, platinum coils were introduced until the point of minimal dense packing, indicated by aneurysmal circulatory exclusion. Packing was continued up to maximal dense packing, indicated by protrusion of the coil into the parent artery. Volumetric ratios (coil volume-aneurysm volume) were calculated for minimal and maximal dense packing. Then, after purposeful undercoiling of aneurysm models, a micropump system was used to fill the aneurysm by stepwise injection of tricellulose acetate polymer through the coil mesh until angiographic aneurysm exclusion was completed. The volumetric ratios of maximal packing with coils and tricellulose acetate polymer in relation to the aneurysm volume were calculated. RESULTS: Maximal dense packing ratios with coils (mean, 32.5%; standard deviation [SD], 3%) were slightly higher than those with the minimal dense packing (mean, 28. 2%; SD, 3%) but were always less than 37%. The ratios of packing with the combined use of coils and tricellulose acetate polymer were greater than 100% (mean, 124.4%; SD, 15%). CONCLUSION: Knowledge of the volumetric ratio of maximal dense packing was useful for effective filling with coils and tricellulose acetate polymer. The combined use of coils and liquid polymer appeared more effective than the use of coils alone for the complete occlusion of the aneurysm lumen.

Cellulose↗
PubMed2000

Basilar artery occlusion in a child: "clot angioplasty" followed by thrombolysis.

Basilar artery occlusions are rare but have a very poor prognosis. Intra-arterial thrombolysis may produce recanalization and better clinical outcome. A short delay between the onset of symptoms and thrombolysis is considered essential for successful recanalization and for the smallest possible risk of haemorrhagic complications. We present a case of basilar artery occlusion in an 8-year-old child, which was treated by "clot angioplasty" followed by intra-arterial thrombolysis. Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child became comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemic lesions. Angiography (performed 36 h after the onset of symptoms) showed a total occlusion of the basilar artery. A clot angioplasty was performed by placing a balloon catheter within the thrombus and inflating it several times in the occluded segment of the basilar artery. Thrombolysis was then performed through the balloon catheter. The basilar artery was only partially recanalized at the end of the procedure, but the perforating arteries of the brain stem had reappeared on angiography. Three months later the child had completely recovered to a normal clinical status. In conclusion, the very poor natural prognosis of basilar artery occlusion requires aggressive management. Recanalization of the basilar artery may be performed even late after the onset of symptoms. Clot angioplasty allows partial recanalization, which may increase the efficiency of thrombolysis.

Acute Disease↗
PubMed2000

Endovascular treatment of distally located giant aneurysms.

OBJECTIVE: Because giant aneurysms (GAs) can be technically difficult to clip, the endovascular approach is becoming increasingly popular. Endovascular treatment of distally located GAs, which often requires parent vessel occlusion, is particularly challenging because limited pathways are available for collateral flow. We aimed to determine the outcomes of endovascular attempts to treat GAs downstream from the circle of Willis. METHODS: Between 1991 and 1998, 27 patients with 27 distally located very large aneurysms or GAs were evaluated for possible endovascular treatment. Ten underwent selective embolization and 9 were treated with primary parent vessel occlusion, with or without distal bypass. Eight patients could not be treated endovascularly. RESULTS: Selective embolization resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage during the follow-up period. One coil-treated patient, who underwent subsequent spontaneous parent vessel occlusion, and all nine patients treated primarily with parent vessel occlusion were considered cured after their treatments. Only two patients treated with parent vessel occlusion experienced periprocedural ischemia, which did not result in a major deficit in either case. Of the eight patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up monitoring. CONCLUSION: Selective aneurysm embolization is usually not curative in these situations. For selected patients, however, endovascular parent vessel occlusion is usually safe and effective in preventing the progression of symptoms and bleeding.

Adult↗
PubMed2000

The retrograde approach: a consideration for the endovascular treatment of aneurysms.

BACKGROUND AND PURPOSE: The traditional endovascular approach to a cerebral aneurysm is anterograde, with the embolization and balloon protection catheters introduced via the parent vessel. Unfortunately, this approach may be restrictive, because these catheters cannot always be navigated at an optimal angle into the arterial branch that needs balloon protection or the part of the aneurysm that needs coiling. The purpose of this study was to determine the efficacy of a retrograde approach. METHODS: Twelve patients, seven women and five men, 28 to 65 years old (mean age, 45 years), were treated via the retrograde approach between March 1998 and February 1999. Three patients were treated for acutely ruptured aneurysms following subarachnoid hemorrhage. The rest had asymptomatic, unruptured aneurysms. RESULTS: We were able to accomplish endovascular treatment in 10 cases. In the other two, the attempted retrograde route of access could not be achieved. The treatment afforded complete embolization in nine of the 10 patients. Symptomatic distal clot embolization occurred in one patient who had some residual, albeit improving, deficits at discharge. No other patients worsened with the treatment. There were two intraprocedural aneurysmal ruptures. None of the aneurysms restudied within 6 months (eight of 12) showed evidence of recanalization. CONCLUSION: Our results indicate that it is possible to safely and effectively access a cerebral aneurysm via a retrograde approach. We believe that the anatomic benefits afforded by this technique outweigh the potential risks associated with the catheterization of another major cerebral arterial feeder.

Aneurysm, Ruptured↗