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Biomedical subjects

Menno Sluzewski

Publications and source records attributed to Menno Sluzewski.

At least 19 recordsLinked to original sources
PubMed2007

Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome.

INTRODUCTION: We report imaging and clinical characteristics of patients with aneurysms that repeatedly reopened over time and were coiled three times or more during a follow-up period of 2-11 years. METHODS: At angiographic follow-up of 624 of 827 aneurysms coiled between 1995 and 2005, 74 aneurysms (8.9%) reopened and were additionally coiled. During an extended follow-up, 12 aneurysms (1.5%) in 12 patients repeatedly reopened and were repeatedly coiled. Initial aneurysm sizes ranged from 15 to 30 mm. Four aneurysms contained intraluminal thrombus. Eight aneurysms were associated with subarachnoid hemorrhage and two with a mass effect, and two were incidentally discovered. The locations of aneurysms were basilar artery (eight), carotid artery (two), anterior communicating artery (one) and middle cerebral artery (one). RESULTS: Altogether, 49 coil treatments were performed in the 12 aneurysms, ranging from three to six coil treatments per aneurysm. Of the 49 coil treatments, 20 (41%) were performed with a supporting device. There were no procedural complications (0%, 97.5% CI 0-5.7%). The mean clinical follow-up period was 70.6 months (median 60, range 25-135 months). All 12 patients are neurologically doing well (GOS 5). Reopening was by compaction in nine aneurysms and by migration of coils into intraluminal thrombus in three aneurysms. In two aneurysms, late regrowth became apparent at 76 and 95 months after the previous coiling. CONCLUSION: Aneurysms that reopen over time and need to be coiled for a second time should be imaged at regular intervals to detect repeated reopening or regrowth. The treatment strategy of regular follow-up and additional treatments when necessary is effective and safe.

Adult↗
PubMed2006

Tentorial artery embolization in tentorial dural arteriovenous fistulas.

INTRODUCTION: The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. METHODS: Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. RESULTS: All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. CONCLUSION: Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas.

Adult↗
PubMed2006

Limited uterine artery embolization for leiomyomas with tris-acryl gelatin microspheres: 1-year follow-up.

PURPOSE: To assess the safety and efficacy of uterine artery embolization (UAE) using large calibrated tris-acryl gelatin microspheres. MATERIALS AND METHODS: One hundred fifty-eight women with symptomatic uterine fibroids underwent UAE. Embosphere was used in 105 women and Embogold microspheres in 53 women. Major and minor complications were assessed. At 12 months, relief of symptoms and patient satisfaction were assessed and volume reductions of the uterus and dominant fibroid were calculated. RESULTS: Median age of the subjects was 43 years (mean, 42.3 y; range, 23-53 y). Preprocedural symptoms were heavy menstrual bleeding in 89%, pain in 64%, and bulk related symptoms in 57%. At 12 months follow-up, the proportion of women with heavy menstrual bleeding, pain, and bulk-related symptoms had decreased to 9%, 8%, and 8%, respectively. Patient satisfaction was grouped as follows: very satisfied 57%, satisfied 36%, and not satisfied 7%. Mean uterine and dominant fibroid volumes before UAE were 532 cm(3) and 201 cm(3), respectively. At 12-month follow-up MR imaging, mean uterine volume decreased to 260 cm(3) and mean dominant fibroid volume to 78 cm(3). These differences were statistically significant (P < .0001). There were no procedure-related deaths. No emergency hysterectomy was needed. Permanent amenorrhea occurred in 11% of women. Transient amenorrhea occurred in 13% of women, and fibroid expulsion occurred in 10% of women. Twelve women (7.6%) had additional therapy: nine underwent additional embolization and three had hysterectomy. CONCLUSION: Targeted UAE using large calibrated microspheres is safe and effective in the relief of symptoms in the majority of patients. At 12 months, a marked fibroid and uterine volume reduction is obtained.

Adult↗
PubMed2006

Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results.

OBJECT: The aim of this study was to assess the incidence, indications, complications, and angiography results associated with balloon-assisted coil embolization (BACE) of intracranial aneurysms and to compare these factors with those for conventional coil embolization (CE). METHODS: Between 1995 and 2005, 827 intracranial aneurysms in 757 consecutive patients were packed with coils. Balloon-assisted coil embolization was used in 8.6% (71 of 827) of the coil insertion procedures and was more frequently used in large aneurysms, unruptured lesions, and those located on the vertebrobasilar system and carotid artery. Procedure-related complications leading to death or dependency were significantly higher in BACEs (14.1%) compared with those in CEs (3%). Packing densities and the results of 6-month follow-up angiography studies did not differ significantly between the two types of treatments. There was a strong trend for a higher retreatment rate in the aneurysms treated with BACE. CONCLUSIONS: Balloon-assisted coil embolization of intracranial aneurysms is associated with a high complication rate and should only be used if conventional CE of these lesions is impossible or has failed and if anticipated surgical risks are too high. The BACE procedure does not improve the occlusion rates of the aneurysms on follow-up evaluation.

Catheterization↗
PubMed2005

The relation between packing and reopening in coiled intracranial aneurysms: a prospective study.

We evaluated prospectively the relation between packing and reopening in coiled intracranial aneurysms. Packing, defined as the ratio between the volume of inserted coils and volume of the aneurysm expressed as percentage, was calculated for 82 intracranial aneurysms treated with detachable coils. Aneurysm volume was assessed from 3D angiography. Reopening of the aneurysmal lumen at the 6-month follow-up angiography was dichotomized into present or absent. We assessed whether packing above 24% protected against reopening. Twenty-three of 82 aneurysms (28%) showed reopening. Reopening was caused by compaction in 20 aneurysms and by partial thrombosis, undetected at the time of initial treatment in three aneurysms. Three of 29 aneurysms (10%) with a packing of more than 24% showed reopening. These three aneurysms contained partially intraluminal thrombosis undetected at the time of treatment. We conclude that in coiled intracranial aneurysms packing above 24% protects against reopening by compaction in non-thrombosed aneurysms. Since intraluminal thrombosis may go undetected at the time of treatment, follow-up angiography is still warranted in aneurysms with packing densities greater than 24%.

Adult↗
PubMed2005

Influence of coil thickness on packing, re-opening and retreatment of intracranial aneurysms: a comparative study between two types of coils.

OBJECTIVES: To compare packing, re-opening and retreatment of intracranial aneurysms treated with two types of coils with different wire thickness and different shapes. MATERIALS AND METHODS: Packing, defined as the ratio between volume of inserted coils and volume of aneurysm, was calculated for 235 aneurysms-120 treated with predominantly helical-shaped coils of 0.010-inch diameter wire (GDC 10) and 115 treated with predominantly complex shaped coils of 0.012-inch diameter wire (Cordis TruFill). Aneurysm packing, re-opening and retreatment during follow-up were compared for aneurysms treated with either type of coils. RESULTS: Mean packing was significantly higher (absolute value 6.8%, relative value 23.0%, p<0.0001) in aneurysms treated with Cordis TruFill coils compared with aneurysms coiled with GDC 10 coils. Six month follow-up angiography was available in 194 of 235 aneurysms. Re-opening occurred in 22 of 99 aneurysms (22.2%) treated with GDC 10 coils and in 15 of 95 aneurysms (15.8%) treated with Cordis TruFill coils. Retreatment was performed in 16 of 120 aneurysms (13.3%) treated with GDC 10 coils and in nine of 115 aneurysms (7.8%) treated with Cordis TruFill coils. CONCLUSION: Coiling of intracranial aneurysms using complex shaped Cordis TruFill coils with a wire diameter of 0.012 inch results in significantly better packing compared with helical GDC 10 coils of 0.010-inch diameter wire. The retreatment rate was lower for aneurysms treated with Cordis TruFill coils compared with aneurysms treated with GDC 10 coils.

Cerebral Angiography↗
PubMed2005

Embolization of spinal dural arteriovenous fistulas: importance of occlusion of the draining vein.

OBJECT: The aim of this study was to assess whether glue-induced occlusion of the draining vein predicts permanent closure of the fistula following embolization of spinal dural arteriovenous fistulas (SDAVFs). METHODS: Between 1994 and 2004, 36 consecutive patients with an SDAVF were treated at the authors' institution. Twelve patients underwent surgery and 24 glue-based embolization. In 12 of 24 embolization procedures the draining vein was occluded and no recurrence or persistent fistula was seen during the follow-up period. In the other 12 patients the glue had not reached the draining vein and in eight of these the fistula recurred, necessitating additional treatment. CONCLUSIONS: In embolization of SDAVFs penetration of the glue into the draining vein predicts permanent closure of the fistula. When penetration of the glue into the draining vein can be expected, embolization is the preferred treatment option. In other cases surgery should be the treatment of choice.

Adult↗
PubMed2005

Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery.

BACKGROUND AND PURPOSE: Controversy exists on how to assess a patient's tolerance before permanent carotid artery occlusion. We sought to determine the positive predictive value of synchronous opacification of hemispheric cortical veins at angiography of the contralateral carotid or vertebral artery as a predictor of tolerance to permanent carotid artery occlusion without development of ischemic injury. METHODS: Seventy-six angiographic test occlusions were performed in 74 consecutive patients considered for therapeutic occlusion. Angiography of collateral cerebral vessels was performed during test occlusion. Synchronous filling (a < 0.5-second delay of opacification between the cortical veins of the occluded and collateral vascular territories) was considered a predictor for tolerance to permanent occlusion. To detect clinically silent ischemic defects, MR imaging was performed before and 6-12 weeks after permanent occlusion. Positive predictive value (95% confidence interval [CI]) of synchronous venous filling for absence of ischemic deficits after permanent occlusion was calculated. RESULTS: No procedural complications of the test occlusion occurred. In 51 of 54 patients who passed the test, permanent occlusion was performed. Two patients, both in poor clinical condition after subarachnoid hemorrhage, died of diffuse vasospasm after permanent occlusion. Of the 49 surviving patients, one developed a transient discrete hemiparesis with small new hypoperfusion infarctions on MR images. All other patients remained neurologically unchanged with no new ischemic lesions on follow-up MR images. Positive predictive value of tolerance to carotid artery occlusion after passing the angiographic test was 98% (95% CI: 89-100%). CONCLUSION: The angiographic test occlusion protocol reliably predicts tolerance to therapeutic carotid artery occlusion. It is safe and easy to perform.

Adolescent↗
PubMed2005

Coil thickness and packing of cerebral aneurysms: a comparative study of two types of coils.

BACKGROUND AND PURPOSE: In coiling cerebral aneurysms, high packing prevents reopening over time. The purpose of this study was to compare packing of cerebral aneurysms treated with two types of coils with different wire thickness and different shapes. METHODS: Packing, defined as the ratio between the volume of inserted coils and the volume of an aneurysm, was calculated for 144 cerebral aneurysms treated in 130 patients. Seventy-two aneurysms were treated with predominantly helical-shaped coils of 0.010-inch-diameter wire, and 72 aneurysms were treated with predominantly complex-shaped coils of 0.012-inch-diameter wire. Aneurysm volume was assessed from three-dimensional angiography. Aneurysm packing, inserted coil lengths, and numbers of coils were compared for both types of coils. RESULTS: Mean packing was significantly higher (absolute value, 6.4%; relative value, 26.6%; P < .0001) in aneurysms coiled with 0.012-inch-diameter coils than aneurysms coiled with 0.010-inch-diameter coils. Inserted coil length per cubic millimeter of aneurysmal volume was equal for both types of coils. CONCLUSION: Use of complex-shaped coils with a wire diameter of 0.012 inch to coil cerebral aneurysms results in significantly better packing than is achieved with helical coils of 0.010-inch-diameter wire.

Adult↗
PubMed2005

Early rebleeding after coiling of ruptured cerebral aneurysms: incidence, morbidity, and risk factors.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of early rebleeding after coiling of a ruptured cerebral aneurysm, assess the clinical outcome, and identify risk factors for this event. METHODS: Early rebleedings occurred in 6/431 (1.4%) consecutive patients after coiling of a ruptured aneurysm. Clinical condition at the time of treatment, aneurysm location and size, initial aneurysm occlusion, timing of coiling, and the presence of an adjacent intracerebral hematoma in the six patients with early rebleedings were compared with the remaining 425 patients. RESULTS: Incidence of early rebleeding after coiling of a ruptured aneurysm was 1.4%, and mortality was 100%. Independent risk factors are the presence of an adjacent intracerebral hematoma and small aneurysm size. Dependent risk factors are location on the anterior communicating artery, initial incomplete aneurysm occlusion, and poor clinical condition at the time of treatment. CONCLUSION: Early rebleeding after coiling of ruptured aneurysms is a major concern, in particular because the mortality is very high. A more restricted postembolization anticoagulation strategy in high-risk aneurysms may possibly prevent the occurrence of this devastating event.

Adult↗
PubMed2004

Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils.

PURPOSE: To assess the relation between aneurysm volume, packing, and compaction in cerebral aneurysms treated with coils. MATERIALS AND METHODS: The volumes of 145 aneurysms that were treated with coils were calculated with biplanar angiographic images and a custom-designed method. Partially thrombosed aneurysms were excluded. Packing was defined as the ratio between the volume of the inserted coils and the volume of the aneurysm and was calculated for all 145 aneurysms. Results at 6-month follow-up angiography were dichotomized into presence or absence of compaction. RESULTS: Aneurysm volume, packing, and compaction at 6-month follow-up were closely related. Large aneurysm volume was associated with low packing and frequent compaction. High packing prevents compaction. If the aneurysm volume was packed for 24% or more with coils, compaction did not occur in aneurysms with a volume of less than 600 mm(3). In small aneurysms with volumes of less than 200 mm(3), compaction did not occur when packing was above 20%. CONCLUSION: The common practice of inserting as many coils as possible in cerebral aneurysms is sensible in trying to avoid compaction. In aneurysms with packing of 24% or more, no compaction occurred at 6-month angiographic follow-up. In aneurysms with a volume of more than 600 mm(3), high packing could not be achieved, which resulted in compaction in the majority of aneurysms.

Adult↗
PubMed2004

Emergency stenting to control massive bleeding of injured iliac artery following lumbar disk surgery.

The purpose of this study was to demonstrate the use of endovascular stenting to repair an iliac artery injury following lumbar discectomy, thus obviating the need for major surgery. A 57-year-old woman developed a distended abdomen and signs of hypovolemic shock immediately following discectomy at the L4-L5 level. Ultrasound showed a large amount of abdominal fluid. Angiography revealed a laceration of the right iliac artery bifurcation with extravasation of contrast material. After occlusion of the internal iliac artery with fibered coils to prevent retrograde flow to the iliac bifurcation, a self-expanding covered stent was inserted to seal the iliac laceration. The leakage of blood stopped immediately. The clinical condition of the patient gradually improved and she was discharged home 5 weeks later. Sealing of arterial laceration as a complication of lumbar disc surgery with a covered stent is a simple and effective alternative to major pelvic surgery.

Angioplasty↗
PubMed2004

Additional coiling of previously coiled cerebral aneurysms: clinical and angiographic results.

BACKGROUND AND PURPOSE: Some cerebral aneurysms that have been coiled reopen over time and additional treatment should be considered to reduce the risk of recurrent hemorrhage. Our purpose was to assess procedural complications and angiographic results of additional coiling in patients with previously coiled but reopened aneurysms and to evaluate protection against (re)bleeding. METHODS: We compared procedural complications of initial coiling of 488 aneurysms in 439 patients with those of 53 additional coiling procedures in 41 reopened aneurysms in 40 patients. Angiographic results of additional coiling were assessed. We compared episodes of (re)bleeding in patients with complete or near-complete aneurysm occlusion after additional coiling with those of patients with incomplete aneurysm occlusion at 6-month follow-up angiography who were not additionally treated or who still had incomplete occlusion after additional coiling. RESULTS: Thirty-five procedural complications occurred in 488 initial coiling procedures, and no complications occurred in 53 additional procedures. Complete or near-complete angiographic occlusion after additional coiling was obtained in 31 (76%) of 41 aneurysms. Rebleeding occurred in two of 29 patients with incomplete aneurysm occlusion but in none of the 31 patients with complete or near-complete occlusion after additional coiling. CONCLUSION: Additional coiling of previously coiled aneurysms has a low procedural complication rate and leads to sufficient occlusion in most aneurysms. The data indicate that successful additional coiling decreases the risk of rebleeding.

Adult↗