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Biomedical subjects

Tobias Struffert

Publications and source records attributed to Tobias Struffert.

6 recordsLinked to original sources
PubMed2007

Reversal of flow during carotid artery stenting: use of the Parodi antiembolism system.

INTRODUCTION: To evaluate the flow reversal efficacy of the Parodi antiembolism system (PAES) in the prevention of distal emboli during carotid stenting. METHODS: A total of 90 patients were treated for internal carotid artery (ICA) stenosis with a stent device. A PAES device was used in 31 symptomatic and 5 asymptomatic patients (total 36 patients) with ICA stenosis, and 54 patients were stented without any protection device. Diffusion-weighted (DW) imaging was performed before and after stenting. RESULTS: In the group without PAES protection, 23 out of 54 patients showed new lesions on DW images after stenting. Of the lesions seen, 147 (2.72 lesions/patient) were in the vessel-dependent area. In the group with protection, 19 out of 36 patients had new lesions, and only 34 (0.94 lesions/patient) were noted in the vessel-dependent area. The number of new lesions in the nondependent vessel area did not differ if a protection system was used (P = 0.671). The use of PAES led to a significant reduction (P = 0.024) in the incidence of the most frequently seen lesions (size <2 mm). The stroke death rate was 3.3% overall, 3.7% in the group without protection device, and 2.7% in the PAES group. There were no permanent neurological deficits after 3 months. CONCLUSION: The PAES is a safe and effective tool to reduce the incidence of embolic complications during carotid stenting. Older patients and patients with higher grade stenosis seem to profit more.

Aged↗
PubMed2006

Recanalization after endovascular treatment of intracerebral aneurysms.

INTRODUCTION: The aim of this study was to evaluate the risks of endovascular therapy, aneurysm regrowth, recanalization and the need for reembolization. METHOD: A prospective analysis was performed on 211 aneurysms treated endovascularly from February 2000 to December 2003. Of these 211 aneurysms, 81 were asymptomatic and 130 were ruptured. The risks of endovascular therapy, aneurysm regrowth, recanalization and the need for reembolization were evaluated. RESULTS: The mean observation time was 10 months (ranging from 178 to 830 days). Complete occlusion (100%) in the initial intervention was achieved in 171 of 201 aneurysms (85%), 80-95% occlusion in 24 aneurysms (12%), and <80% occlusion in 6 aneurysms (3%). Recanalization had occurred at the first follow-up in 34 of all 153 aneurysms reassessed (22.2%). Of 133 aneurysms with initial 100% occlusion, 107 (80.4%) remained completely occluded, 17 (12.7%) showed recanalization, and 9 (6.7%) showed neck regrowth. Among those with 80-95% occlusion, 20 were reassessed, and of these 2 showed spontaneous occlusion, 10 (50%) still showed the initial neck, and 8 (40%) showed increased recanalization. One aneurysm which initially showed <80% occlusion remained unchanged, and another showed showed recanalization. Of the 153 aneurysms, 12 (7.8%) were recoiled, 2 initially <80% occluded, 7 initially 80-95% occluded and 3 initially totally occluded. CONCLUSION: In spite of low morbidity and mortality, one in four aneurysms will show recurrence. The initial degree of occlusion seems to have an influence on the likelihood of recanalization.

Aneurysm, Ruptured↗
PubMed2006

Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events.

OBJECTIVE: The purpose of this study was to evaluate the frequency and causes of thromboembolic events associated with endovascular embolization of asymptomatic aneurysms. Correlations between radiological findings (aneurysm size, localization, embolization time, number of coils used, as well as patient age) were evaluated with the occurrence of thromboembolic events and clinical findings. METHODS: Sixty-eight patients treated for unruptured intracranial aneurysms (mean age, 49 yr) were evaluated. Hyperintense lesions on diffusion weighted imaging were analyzed in 50 patients. Aneurysm size was 3 to 15 mm. RESULTS: Complete occlusion of the aneurysms was achieved in 55 of 68 (82%). One patient had a transient paresis. There was one infarction and one aneurysm rupture during the procedure with no consecutive neurological symptoms. We found new hyperintense lesions in 21 of 50 (42%) diffusion weighted imaging studies. In 43% of these, there was only one lesion smaller than 2 mm. In 33%, there was more than one lesion less than 2 mm; in 19%, we found a lesion of 2 to 10 mm in size. In one case, a lesion greater than 10 mm occurred. There was no correlation between aneurysm location and the occurrence of lesions or among the number of coils used, the size of the aneurysm, patient age, or embolization time. Mortality rate was 0%, morbidity 4.0%. If the 18 aneurysms where no diffusion weighted imaging was obtained are included, morbidity is 2.9%. CONCLUSION: The high rate of thromboembolic events suggests that heparin is not sufficient to prevent ischemic lesions. An antiplatelet therapy, started before or during intervention, might diminish thrombus formation.

Adult↗
PubMed2005

Anticoagulation regimes and their influence on the occlusion rate of aneurysms: an experimental study in rabbits.

OBJECTIVE: Our purpose was to determine whether anticoagulation has an influence on the occlusion rate and thromboembolic occurrence in saccular aneurysms treated with Guglielmi detachable coils. METHODS: Aneurysms in the right CCA were created in rabbits. Group 1 served as a control group (n = 6) without embolization or anticoagulation. In Groups 2 to 5, aneurysms were embolized. In Group 2, no anticoagulation was given (n = 5). Group 3 received heparin before the placement of the first coil, then low molecular weight heparin (LMWH) for the next 2 days (n = 7). In Group 4, additional aspirin was administered after 2 days until sacrifice (n = 10). Group 5 received heparin before the placement of the first coil, then a LMHW was administered daily until sacrifice (n = 5). Angiography was performed 3 months after coiling, followed by a histological examination. RESULTS: Histopathological evaluation showed thrombus formation with neovascularization, regardless of the anticoagulation regime used. Only in the group with LMWH over 3 months was the thrombus not focally, properly organized, especially in the dome. The coils in the neck showed, however, the same fibrous scar tissue as in the other groups. CONCLUSION: Anticoagulation with heparin during the first days, followed by aspirin, appears unlikely to affect the occlusion rate in aneurysms. LMWH over a long period, however, could impair thrombus organization. Therefore, in regard to thrombus organization, an anticoagulation regime with aspirin seems to be superior to LMWH. This could play an important role in the prevention of thromboembolic events in humans treated with Guglielmi detachable coils.

Animals↗
PubMed2005

Intraosseous hemangioma of the skull with dural tail sign: radiologic features with pathologic correlation.

Osseous hemangiomas of the calvaria account for about 0.2% of bone neoplasms. We report a case of an extensive intraosseous cavernous hemangioma in a 46-year-old woman. MR imaging showed a mass in the right frontal bone with intra- and extracranial extension and a dural tail sign after gadopentetate dimeglumine administration, mimicking a meningioma in which the dural tail sign was due to a direct noninvasive superficial growth of the lesion.

Carotid Arteries↗