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Uncomplicated Type B Aortic Dissection: A European Multicentre Cross-Sectional Evaluation

Bashir, Mohamad
Autor Bashir, Mohamad Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK. Electronic address: mohamad.bashir@southwales.ac.uk
Jubouri, Matti
Autor Jubouri, Matti Hull York Medical School, University of York, York, UK
Surkhi, Abdelaziz O
Autor Surkhi, Abdelaziz O Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
Williams, Ian M
Autor Williams, Ian M Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
Davidovic, Lazar B
Autor Davidovic, Lazar B Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Koncar, Igor
Autor Koncar, Igor Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Baltrūnas, Tomas
Autor Baltrūnas, Tomas Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Kunt, Aysegul
Autor Kunt, Aysegul Tepecik Education and Research Hospital, Izmir, Turkey
Tanyeli, Ömer
Autor Tanyeli, Ömer Necmettin Erbakan University, Medicine Faculty, Department of Cardiovascular Surgery, Konia, Turkey
Bayram, Muhammed
Autor Bayram, Muhammed Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Istanbul, Turkey

Annals of vascular surgery. 2025 ; 114 (-) : 340-349. [pub] 20241218

Ann Vasc Surg
ISSN 1615-5947
Medvik
Zdroj

BACKGROUND: A multicentre European randomized control trial - European Uncomplicated Type B Aortic Repair (EU-TBAR) is being developed to compare pre-emptive thoracic endovascular aortic repair (TEVAR) with custom-made devices versus conventional optimal medical therapy. The pretrial set-up is confluent on different pillars, including evaluation of 1) European activity, trends, and governance; 2) outcome reporting; and 3) cost evaluation. This article aimed to demonstrate the observational cross-sectional survey results from participating centers and highlight the risk assessment, activity, practices, and governance of uncomplicated type B aortic dissection (uTBAD). METHODS: This observational cross-sectional European survey used a questionnaire that examined the understanding, risk assessment, local governance oversight, and clinical activity of uTBAD. The data were collected and managed using Research Electronic Data Capture (REDCap). RESULTS: Out of 43 surveyed surgeons, 37 (86%) responded within a month from 14 European countries. Most reported low annual uTBAD encounters, with autumn being the most common season for cases. Pre-emptive TEVAR was recommended by 43.2% of participants, who favored subacute intervention timing. The Gore TAG was the most used TEVAR device, and custom devices were available for 73% of respondents. Risk factors for uTBAD were ranked, with 'Rapid Aortic Enlargement' deemed most critical. A majority of centers had protocols and multidisciplinary teams, with most having readily available radiology services. Only 45.9% had transfer services to specialized centers. CONCLUSIONS: uTBAD remains a misnomer of a dynamic, ongoing disease process requiring early diagnosis and intervention. Pre-emptive TEVAR in high-risk uTBAD is becoming more common, with encouraging results prompting an expansion of indication criteria to a broader uTBAD population managed conservatively. Nevertheless, further evidence is needed through large randomized controlled trials, mainly European collaboratives, to reach a definitive conclusion on the optimum surgical management of uTBAD.

MeSH
aneurysma hrudní aorty * chirurgie diagnostické zobrazování ekonomika MeSH
časové faktory MeSH
cévní protézy trendy MeSH
cévy - implantace protéz * škodlivé účinky přístrojové vybavení trendy ekonomika MeSH
chirurgové * trendy MeSH
disekce aorty * chirurgie diagnostické zobrazování ekonomika MeSH
endovaskulární výkony * škodlivé účinky přístrojové vybavení trendy ekonomika MeSH
hodnocení rizik MeSH
lékařská praxe - způsoby provádění * trendy MeSH
lidé MeSH
protézy - design MeSH
průřezové studie MeSH
průzkumy zdravotní péče MeSH
rizikové faktory MeSH
výsledek terapie MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH
multicentrická studie MeSH
pozorovací studie MeSH
Geografické názvy
Evropa MeSH

Článek

Long-term safety and efficacy of distal aneurysm treatment with flow diversion in the M2 segment of the middle cerebral artery and beyond

Journal of neurointerventional surgery. 2021 ; 13 (7) : 631-636. [pub] 20201020

J Neurointerv Surg
ISSN 1759-8486
Medvik
Zdroj

BACKGROUND: Indications for flow diversion stent (FDS) treatment are expanding. However, there is still a lack of evidence for the long-term outcome in distally located aneurysms in the M2 segment of the middle cerebral artery (MCA) and beyond. METHODS: Consecutive subjects (from June 2013 to August 2020) with MCA aneurysms in the M2 segment or beyond treated with FDS were reviewed retrospectively. The primary endpoints for clinical safety were the absence of mortality, stroke event, re-rupture of the aneurysm, and worsening of clinical symptoms. The primary endpoint for treatment efficacy was complete/near-complete occlusion at follow-up after 12 months. RESULTS: 23 patients were identified: 7 aneurysms were located in the M2 segment of the MCA, 4 in the M2-M3 bifurcation, 2 in M3, 3 in M3-4 branching, and 2 in M4; 5 aneurysms were located in M2 with extension into the M1-M2 bifurcation. 13 aneurysms were of fusiform morphology, 8 sacculofusiform, and 2 saccular. 16 aneurysms were of highly suspected dissecting etiology. The median diameter of the parent vessel was 2.1 mm proximally and 2 mm distally. The median time of the follow-up was 30 months (range 16 months to 6 years). Complete/near complete occlusion was observed in 14/20 patients (70%) and one stable remodeling (5%) was seen at 12 months. 22 patients (95.6%) had an excellent clinical outcome (mRS 0-1) at 6 months. Technical challenges associated with the deployment of FDS occurred in 8.7% of cases. Severe complications, intraparenchymal hemorrhage and re-rupture of the aneurysm occurred in 2 patients (8.7%). CONCLUSION: Flow diversion of distally located aneurysms is technically feasible with low morbidity and mortality.

Článek

Tele-robotics and artificial-intelligence in stroke care

Journal of clinical neuroscience. 2020 ; 79 (-) : 129-132. [pub] 20200805

J. clin. neurosci.
ISSN 1532-2653
Medvik
Zdroj

In the last forty years, the field of medicine has experienced dramatic shifts in technology-enhanced surgical procedures - from its initial use in 1985 for neurosurgical biopsies to current implementation of systems such as magnetic-guided catheters for endovascular procedures. Systems such as the Niobe Magnetic Navigation system and CorPath GRX have allowed for utilization of a fully integrated surgical robotic systems for perioperative manipulation, as well as tele-controlled manipulation systems for telemedicine. These robotic systems hold tremendous potential for future implementation in cerebrovascular procedures, but lack of relevant clinical experience and uncharted ethical and legal territory for real-life tele-robotics have stalled their adoption for neurovascular surgery, and might present significant challenges for future development and widespread implementation. Yet, the promise that these technologies hold for dramatically improving the quality and accessibility of cerebrovascular procedures such as thrombectomy for acute stroke, drives the research and development of surgical robotics. These technologies, coupled with artificial intelligence (AI) capabilities such as machine learning, deep-learning, and outcome-based analyses and modifications, have the capability to uncover new dimensions within the realm of cerebrovascular surgery.