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Endovascular Neuroradiology / Ендоваскулярна нейрорентгенохірургія
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  This is an Open Access Journal Open Access journal
ISSN (Print) 2304-9359 - ISSN (Online) 2663-6964
Published by All Ukrainian Association of Endovascular Neuroradiology Homepage  [1 journal]
  • Clinical protocol of the ischemic stroke patients treatment

    • Authors: D.V. Shchehlov, S.V. Konotopchyk, O.A. Pastushyn
      Pages: 14 - 56
      Abstract: Today in Ukraine there is no single standardized protocol for the treatment of patients in the acute period of ischemic stroke using modern methods of diagnosis and treatment, which include thrombolytic therapy and endovascular treatment. This protocol was created and implemented in Scientific-practical Center of endovascular neuroradiology, NAMS of Ukraine and is based on the latest recommendations of AHA/ASA and ESO, as well as registers of patients with ischemic stroke.
      The main purpose of this publication is the creation and implementation of «instructions» for the diagnosis and selection of objective tactics for treating patients in the acute period of ischemic stroke.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-14-56
      Issue No: Vol. 37, No. 3 (2022)
       
  • Endovascular treatment of common hepatocellular carcinoma: the experience
           of one center

    • Authors: V.A. Kondratiuk, I.A. Mazanovych
      Pages: 57 - 61
      Abstract: Objective ‒ to determine the place of transarterial chemoembolization of the liver (TACE) in the modern protocol for treating patients with common hepatocellular carcinoma and by optimizing indications and contraindications to improve the results of complex treatment of these patients.
      Materials and methods. During the period 2011‒2021 242 TACE procedures were performed on 112 patients with inoperable hepatocellular carcinoma. Conventional lipidol embolization (c-TACE) was performed in 53 patients, procedures with drug eluting beads (DEB-TACE) ‒ in 58. All patients underwent a minimum of 1, a maximum of 5 TACE procedures. The decision to re-TACE was made individually, according the prevalence of the lesion (for bilobar lesions performed at least 2 unilobar TACE) and the tumor’s response to the intervention.
      Results. TACE results were evaluated according to mRECIST criteria: complete tumor response (CR) was noted in 3 (2.7 %) cases, partial (PR) ‒ in 68 (60.7 %) cases, process stabilization (SD) ‒ in 29 (25.9 %), progression (PD) ‒ 12 (10.7 %) cases. According by the obtained results, convincing data for the superiority of any of the applied TACE methods were not found. Repeated TACE courses increase the overall effectiveness of the treatment.
      Conclusions. The use of TACE in patients with inoperable hepatocellular carcinoma allows with minimal invasiveness to reduce or stabilize tumor growth in 89.3 % of cases. Repeated performance of the procedure allows to increase the treatment efficiency by 21.2 %.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-57-61
      Issue No: Vol. 37, No. 3 (2022)
       
  • Disturbances of cerebrospinal fluid dynamics as a complication of
           aneurysmal subarachnoid hemorrhage: predictors of development and
           influence of aneurysm occlusion method on the development of
           shunt-dependent hydrocephalus

    • Authors: O.Yu. Polkovnikov, V.I. Pertsov, М.V. Yeleynyk, N.V. Izbytska
      Pages: 62 - 68
      Abstract: Objective ‒ to study the effect of ruptured aneurysm localization, severity of hemorrhage and aneurysm occlusion method on the probability of developing shunt-dependent hydrocephalus (SDH) and to assess the prognostic sensitivity of clinical and radiological scales.
      Materials and methods. The results of treatment of 597 patients with aneurysmal subarachnoid hemorrhage (SAH) of varying severity were analyzed. In 282 cases endovascular occlusion of the aneurysm was performed, in 315 ‒ microsurgical clipping. A group of 63 patients who required implantation of the ventriculoperitoneal shunt system within 3 to 15 weeks after aneurysm rupture was selected.
      Results. Of the patients who underwent coiling of the ruptured aneurysm, 22 (7.8 %) required implantation of the cerebrospinal fluid shunt system, and 41 (13.0 %) of the patients who underwent microsurgery. The mean age of patients in the endovascular occlusion group was 64.28 years, in the microsurgical clipping group ‒ 50.64 years. The localization was dominated by aneurysms of the anterior communicating artery (ACA) complex ‒ 37 (58.7 %) observations, internal carotid artery ‒ 15 (23.8 %), vertebrobasilar basin (VBB) ‒ 9 (14.3 %) and the middle cerebral artery ‒ 2 (3.2 %). The predominance of aneurysms of the ACA complex among those operated by microsurgical method (29 (70.7 %)) and VBB aneurysms among those operated on endovascularly (9 (40.9 %)) was revealed. Rupture of the aneurysm was complicated by massive SAH in 20 (31.7 %) cases, subarachnoid-parenchymal hemorrhage ‒ in 7 (11.1 %), subarachnoid-ventricular ‒ in 4 (6.4 %), subarachnoid-parenchymal-ventricular ‒ in 32 (50.8 %). The distribution by severity of hemorrhage on the Hunt‒Hess scale was as follows: grade II ‒ 10 (15.9 %) cases, grade III ‒ 26 (34.9 %), grade IV ‒ 27 (49.2 %). According to the Fisher radiological scale, grade III hemorrhage was noted in 20 (31.7 %) cases, IV ‒ in 43 (68.3 %) cases. Analysis using the Graeb scale showed the absence of blood in the ventricular system in 27 (42.9 %) cases, 1‒3 points ‒ in 9 (14.3 %), 4‒6 points ‒ in 12 (19.0 %), 7–12 points ‒ in 15 (28.8 %).
      Conclusions. Rupture of aneurysms of the ACA complex, accompanied by severe complicated SAH in patients operated on by microsurgery, and aneurysms of the VBB in persons operated on endovascularly, increases the risk of SDH. Endovascular occlusion of ruptured aneurysms does not increase the risk of SDH. The severity of hemorrhages of III–IV degree on the Hunt‒Hess scale and III–IV degree on the Fisher scale are predictors of SDH development.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-62-68
      Issue No: Vol. 37, No. 3 (2022)
       
  • Endovascular embolization of cerebral arteriovenous malformations

    • Authors: D.V. Shchehlov, O.Ye. Svyrydiuk, S.V. Chebanyuk, M.B. Vyval
      Pages: 69 - 76
      Abstract: Endovascular embolization is a critical component in the treatment of cerebral arteriovenous malformations. It can be used as an independent treatment modality or as an adjunct to microurgery or radiosurgery. The published literature in the PubMed database until September 2021 was reviewed with reference to the results of cerebral arteriovenous malformations embolization using liquid embolic agents. More scientific data reporting about total embolization of the cerebral arteriovenous malformations with a final cure. Although complications and mortality after arteriovenous malformations embolization have decreased significantly, but they still exist, and decisions about it usage should be weighed against its benefits during the planning phase. Treatment of arteriovenous malformations of the brain requires a multidisciplinary approach involving vascular neurosurgeons, endovascular interventionists and radiation oncologists, with a deep understanding of the natural course and combination of risks of multimodal treatment. Only such approach can increase the likelihood of a positive outcome of the cerebral arteriovenous malformations treatment.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-69-76
      Issue No: Vol. 37, No. 3 (2022)
       
  • Multidisciplinary approach to the diagnosis and treatment of hemobilia
           (Clinical case)

    • Authors: S.V. Plemyanik, A.D. Dembyk, S.V. Vereschagin, B.G. Bondarchuk
      Pages: 77 - 81
      Abstract: Today, thanks to the development and implementation of new modern instrumental research methods in the daily practice of doctors, such as computed tomography with angiography, multispiral computed tomography, ultrasound examination of vessels with duplex scanning, celiacography, upper and lower mesentericography, etc. Every year, the information content of the above examination methods is growing, which will certainly lead to an increase in the frequency of detecting rare vascular pathologies that cause hemobilia. The method of treatment for this vascular pathology is endovascular embolization using embolizing coils and substances. A clinical case of a multidisciplinary approach to diagnosis and endovascular treatment is presented. a. gastroduodenalis with the formation of a pseudo-aneurysm (40 × 20 mm) with antegrade blood flow along a.pancreaticoduodenalis superior and a.gastroepiploica dextra distal to the aneurysm of a 28-year-old patient who was urgently hospitalized in the surgical department of Kyiv Regional Clinical Hospital. After the surgical treatment against the background of conservative treatment, the patient’s general condition improved and the hemoglobin level increased. A multidisciplinary approach helps to choose the right tactics for managing a patient, even with such a rare vascular pathology that has led to hemobilia. The gold standard for diagnosis and treatment hemobilia is angiography and endovascular embolization, which can be an alternative to open surgery, minimizes the risk of postoperative complications and reduces the rehabilitation period. If it is impossible to carry out the above technique or its ineffectiveness, further treatment is surgical.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-77-81
      Issue No: Vol. 37, No. 3 (2022)
       
  • Application of a combined approach in the patient treatment with
           aggressive hemangiomas of the spine

    • Authors: Yu.M. Samonenko, O.Ye. Svyrydiuk, A.V. Nayda, О.V. Slobodian
      Pages: 82 - 88
      Abstract: Aggressive hemangioma of the spine is a benign vascular tumor. Stabilization, vertebroplasty, partial resection or total corpectomy of the affected vertebra, radiation therapy are known methods of treatment. Vertebral hemangiomas are more likely to be asymptomatic. Accordind to literature review 3–5 % of hemangiomas are symptomatic (pain). In 1.0 % of cases, hemangiomas cause symptoms of compression of nerve structures, spreading epidurally around the spinal cord and / or radicular nerves. A clinical case of a 63-year-old patient who underwent surgery in 2016 at another clinic for aggressive vertebral hemangiomas Th4 was presented. Bisphosphonate treatment was performed. Despite treatment, progressive lower extremities paraparesis was observed. Spinal angiography and total embolization of hemangiomas with liquid embolizing substances were performed. Immediately after embolization, the patient noted a pain intensity decrease. Surgery was performed in 40 minutes after transarterial embolization (removal of transpedicular stabilizing metal system, laminectomy of Th4 vertebra, decompression of the spinal cord, partial removal of Th4 hemangioma biopsy). The volume of intraoperative blood loss was 200 ml. Wound suction drainage was removed on the second postoperative day. No systemic complications (deep vein thrombosis, pneumonia) were noted. The patient was verticalized on the second postoperative day. After surgery, neurological function corresponded to the preoperative level (Frankel C). Regression of neurological deficit was observed (increased strength and range of motion of the lower extremities, bladder function improvement) the 5th postoperative day (Frankel D-E), Histological examination confirmed the diagnosis of hemangiomas. The patient was discharged from hospital with neurological improvement. Radiation therapy was recommended. 3 months after surgery, neurological function was assessed as Frankel E.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-82-88
      Issue No: Vol. 37, No. 3 (2022)
       
  • Supporting sustainable development goals and the challenge of reusing of
           the single use instruments in interventional radiology

    • Authors: M.B. Vyval, D.V. Shchehlov, S.V. Chebanyuk
      Pages: 89 - 94
      Abstract: Interventional radiology has traditionally been at the forefront of the modern medicine, offering minimally invasive alternatives to surgical treatment with reducing of the length of hospital stay. The problem of medical waste and the recycling of medical supplies to support sustainable development goals in the health sector has entred a “green revolution” that aims to overcome global warming and fight with environmental pollution. Operating waste accounts for 20 to 70 % of all hospital waste, and many of them require special disposal. On the other hand, revenues for health care companies continue to rise, as do patient care costs, which are a huge burden for families and health systems, especially in low-income countries during COVID-19 pandemic. The issue of disposal and reuse of unique, expensive disposable radiological profile instruments is not widely reported in the scientific literature, but surveys among interventionists indicate that reuse exists even in countries where it is officially prohibited. Despite the emergence of regulations on the reuse of disposable instruments, it is largely carried out outside the quality standards. Also, manufacturers are not interested in reusing disposable instruments and often refuse to provide information on how they can be properly recycled and sterilized. Although well-remanufactured tools have significant promise, both for reducing healthcare costs and environmental pollution, and for spreading modern interventional technologies to the critical places where resources are limited and they can save lives.
      PubDate: 2022-02-03
      DOI: 10.26683/2786-4855-2021-3(37)-89-94
      Issue No: Vol. 37, No. 3 (2022)
       
 
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