Publications by authors named "Kıvılcım Yavuz"

29 Publications

  • Page 1 of 1

Secondary intra-arterial chemotherapy and/or intravitreal chemotherapy as salvage treatment for retinoblastoma.

Eur J Ophthalmol 2020 Sep 22:1120672120957587. Epub 2020 Sep 22.

Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.

Purpose: To evaluate the results of secondary intra-arterial chemotherapy (IAC) and/or intravitreal chemotherapy (IVC) as a salvage treatment for retinoblastoma (RB).

Materials And Methods: The medical records of 31 (20 male, 11 female) cases (with 38 eyes) who underwent secondary IAC and/or IVC between February 2010 and June 2019 were retrospectively reviewed.

Results: Thirteen (41.9%) cases had unilateral and 18 (58.1%) had bilateral RB. According to the International Classification of RB, 6 (15.8%) eyes had group B, 9 (23.7%) eyes had group C, 16 (42.1%) eyes had group D, and 7 (18.4%) eyes had group E RB at diagnosis. All patients underwent six-cycle intravenous chemotherapy as primary treatment and 8 eyes received external radiotherapy before IAC/IVC. Secondary IAC was performed in 21 (55.3%) eyes, IVC in 10 (26.3%) eyes, and IAC + IVC in 7 (18.4%) eyes. External radiotherapy was applied in 2 (5.3%) eyes after IAC/IVC, one of which was later enucleated. In total, 17 (44.7%) eyes undergoing secondary IAC/IVC treatments were enucleated. Metastasis and death were not observed in any case during the mean follow-up period of 59.3 (median 61, range: 10-98) months.

Discussion: Although 60.5% of the eyes undergoing IAC/IVC consisted of groups D and E RB, globe salvage and survival rates were 55.3% and 100.0%, respectively. External radiotherapy was required in 5.3% of the eyes after IAC/IVC. In conclusion, IAC and IVC are safe and effective treatment methods in eyes with RB unresponsive to other eye-preserving treatments and those demonstrating recurrence.
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http://dx.doi.org/10.1177/1120672120957587DOI Listing
September 2020

Chemotherapy in Retinoblastoma: Current Approaches.

Turk J Ophthalmol 2015 Dec 5;45(6):259-267. Epub 2015 Dec 5.

Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey.

Retinoblastoma (RB) is the most common childhood malignant intraocular tumor. Although enucleation and external beam radiotherapy have been historically used, today the most commonly used eye-sparing approach is chemotherapy. Chemotherapy can be used in both intraocular and extraocular RB cases. Chemotherapeutic agents may be applied in different ways, including systemic, subconjunctival, intra-arterial and intravitreal routes. The main purposes of application of systemic therapy are to reduce the tumor size for local treatment (chemoreduction), or to reduce the risk of metastasis after enucleation surgery (adjuvant therapy). Intra-arterial chemotherapy with the current name "super-selective intra-arterial infusion therapy" could be applied as primary therapy in tumors confined to the retina or as a secondary method in tumor recurrence. The most important advantage of intra-arterial therapy is the prevention of systemic chemotherapy complications. Intravitreal chemotherapy is administered in the presence of persistent or recurrent vitreous seeding. The term "extraocular RB" includes orbital invasion and metastatic disease. Current treatment for orbital invasion is neoadjuvant chemotherapy followed by surgical enucleation and adjuvant chemotherapy and radiotherapy after surgery. In metastatic disease, regional lymph node involvement, distant metastases, and/or central nervous system (CNS) involvement may occur. Among them, CNS involvement has the worst prognosis, remaining at almost 100% mortality. In metastatic disease, high-dose salvage chemotherapy and autologous hematopoietic stem cell rescue therapy are the possible treatment options; radiotherapy could also be added to the protocol according to the side of involvement.
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http://dx.doi.org/10.4274/tjo.06888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082265PMC
December 2015

Disappearance and reappearance of a cerebral aneurysm.

J Vasc Interv Neurol 2014 Nov;7(4):6-7

Hacettepe University Hospitals, Department of Neurology, Ankara, Turkey .

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241406PMC
November 2014

Does ventricular opening promote remote cerebellar haemorrhage?

Turk Neurosurg 2012 ;22(1):102-4

Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Cerebellar haemorrhage after supratentorial craniotomy is a rare complication Because of its significant morbidity and mortality rates, being aware of this complication is important for early diagnosis. In a 30-year-old male with multiple intracranial cavernomas, remote cerebellar haemorrhage (RCH) was observed after removal of symptomatic left temporal lesion. The lateral wall of the temporal horn that was tightly attached to the cavernoma was also opened and excessive drainage of the CSF occurred. The haemorrhage is attributed to opening of the ventricle wall and excessive drainage of cerebrospinal fluid (CSF) during the procedure.
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http://dx.doi.org/10.5137/1019-5149.JTN.3063-10.5DOI Listing
May 2012

Endovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique: long-term results in 350 consecutive patients with completed endovascular treatment course.

J Neurosurg 2011 Jul 8;115(1):78-88. Epub 2011 Apr 8.

Department of Interventional Neuroradiology, Hacettepe University Hospitals, Ankara, Turkey.

Object: The purpose of this study was to present the authors' clinical experience and long-term angiographic and clinical follow-up results in 350 patients with brain arteriovenous malformations (AVMs) treated using prolonged intranidal Onyx injection with a very slow "staged" reflux technique described by the authors.

Methods: Three hundred and fifty consecutive patients with brain AVMs treated using Onyx between 1999 and 2008 and in whom definitive status for endovascular treatment was reached are presented. There were 206 (59%) male and 144 (41%) female patients, with a mean age of 34 years. There were 607 endovascular sessions performed. Onyx was the only agent used for intranidal injections in all patients, but in 42 patients high-concentration N-butyl cyanoacrylate glue was used adjunctively to close high-flow direct arteriovenous intra- or perinidal fistulas, or when a feeding vessel or nidus perforation and/or dissection occurred.

Results: Angiographically confirmed obliteration was achieved in 179 patients (51%) with only endovascular treatment; 1 patient died due to intracranial hemorrhage after the treatment. Twenty-two patients underwent resection, and 136 patients were sent to radiosurgery after endovascular treatment. In 4 patients embolization therapy was discontinued, and 5 additional patients refused the suggested complementary surgery. In all 178 surviving patients who had angiographically confirmed AVM obliteration by embolization alone, 1-8 years of control angiography (mean 47 months) confirmed stable obliteration, except for 2 patients in whom a very small recruitment was noted in the 1st year on control angiography studies, despite initial apparent total obliteration (recanalization rate 1.1%). In the entire series, 5 patients died; the mortality rate was 1.4%. The permanent morbidity rate was 7.1%.

Conclusions: With the prolonged intranidal injection technique described herein, Onyx allows the practitioner to achieve higher rates of anatomical cures compared with the cure rates obtained previously with other embolic agents. More importantly, due to this technique's much more effective intranidal penetration, it allows high-grade AVMs to be made radiosurgically treatable in a group of patients for whom there has been no treatment alternative.
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http://dx.doi.org/10.3171/2011.2.JNS09830DOI Listing
July 2011

Bilateral Temporal Bone Xanthomas in Type II Hypercholesterolemia.

Turk Neurosurg 2010 Oct;20(4):533-5

Hacettepe University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.

We present a very rare case of intracranial xanthoma with bilateral temporal bone involvement. The lesion caused destruction and remodelling in mastoid air cells. On the right side, cerebellar compression was obvious. The patient was operated on the symptomatic side and the lesion was totally removed.
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http://dx.doi.org/10.5137/1019-5149.JTN.2896-10.0DOI Listing
October 2010

HyperForm balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic follow-up results in 800 consecutive patients.

J Neurosurg 2011 Apr 14;114(4):944-53. Epub 2010 May 14.

Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.

Object: The purpose of this paper was to present the safety, efficacy, and clinical/angiographic follow-up results of HyperForm balloon-assisted endosaccular coil occlusion of distal anterior circulation bifurcation aneurysms.

Methods: Over a 7-year period, the authors treated 864 middle cerebral artery, distal anterior cerebral artery bifurcation, and anterior communicating artery aneurysms by means of coil embolization with HyperForm balloon assistance in 800 patients. In 37 aneurysms, 2 HyperForm balloons were used simultaneously for remodeling.

Results: The overall mortality rate was 7.1%, including 1.4% procedural mortality. Various neurological deficits were present at discharge in 8.9% of the patients, and 4.4% had permanent disabling morbidity 6 months posttreatment (modified Rankin Scale score ≥ 2). Thromboembolic complications developed during the treatment of 15 aneurysms (1.7%) causing morbidity or mortality in 10 cases (1.3%). There were 14 intraoperative perforations (1.6%). In all 14 cases, the HyperForm balloon saved patients from severe bleeding. The perforation led to morbidity or mortality in 3 cases (0.4%); there were no negative consequences in 11. There were 726 patients with 757 aneurysms (87.6%) available for follow-up. Control angiograms were obtained at 6 months in 386 patients, at 1 year in 267, and at 2 years in 104, revealing an 82% complete obliteration rate according to the most recent follow-up angiograms.

Conclusions: The satisfactory results obtained in this experience demonstrate that HyperForm balloon remodeling provides strong benefits for the endovascular management of middle cerebral, anterior cerebral, and anterior communicating artery aneurysms without increasing the risk of treatment. Not only does this technique allow for the safe treatment of these aneurysms, but it also expands the indications of endovascular treatment to include aneurysms that otherwise cannot be treated with simple coil embolization.
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http://dx.doi.org/10.3171/2010.3.JNS081131DOI Listing
April 2011

Comparison of bioactive coils and bare platinum coils for treatment of intracranial aneurysms: a matched-pair analysis.

J Neurosurg 2010 Apr;112(4):709-13

Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.

Object: The primary goal of this matched-pair analysis was to evaluate the durability of the treatment results with Cerecyte coils in comparison with that of bare platinum coils in terms of angiographic occlusion rates at follow-up.

Methods: Eighty aneurysms treated with Cerecyte coils were included in this study to carry out a matched-pair analysis. Every aneurysm treated with Cerecyte coils was matched with an aneurysm treated with bare platinum coils. Matching of the aneurysms was done according to the aneurysm size, location, neck size, initial occlusion grade, and clinical presentation.

Results: The initial treatment results were similar in both groups as part of a matching protocol. Subgroup analysis revealed a significant difference in the durability of occlusion in aneurysms that showed Raymond Class I obliteration on follow-up angiograms (69 [86.2%] in the Cerecyte group vs 51 [63.8%] in the control group, p = 0.002). Further thrombosis to Raymond Class I occlusions was higher in the Cerecyte group (17 [77.3%] of 22 vs 8 [36.4%] of 22 aneurysms).

Conclusions: Cerecyte coils provide further thrombosis and more durable results than bare platinum coils following coil embolization of cerebral aneurysms.
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http://dx.doi.org/10.3171/2009.8.JNS081372DOI Listing
April 2010

Ruptured aneurysm at the perforating artery supplying the insula: case report.

Neurosurgery 2009 Jul;65(1):E206-7; discussion E7

Department of Neurosurgery, School of Medicine, Hacettepe University, Ankara, Turkey.

Objective: Aneurysms originating from perforating branches of the middle cerebral artery are quite rare. Most of them arise from the lenticulostriate arteries, frequently located within the basal ganglia. We report a perforating artery aneurysm that was entirely embedded within the limen insulae.

Clinical Presentation: A 41-year-old man presented with an insular hematoma without subarachnoid hemorrhage caused by rupture of a small aneurysm on a perforating artery of the proximal middle cerebral artery supplying the insula.

Intervention: This rare aneurysm was resected via the transsylvian-insular approach.

Conclusion: Although very rare, perforating artery aneurysms should be considered in young or middle-aged patients with an atypical intracerebral hematoma. This report discusses radiological and surgical characteristics of this unusual aneurysm.
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http://dx.doi.org/10.1227/01.NEU.0000346270.89755.1EDOI Listing
July 2009

Spinal cord infarction in congenital afibrinogenemia: a case report and review of the literature.

J Stroke Cerebrovasc Dis 2009 Jul-Aug;18(4):298-303

Department of Neurology, Hacettepe University Hospitals, Ankara, Turkey.

A 22-year-old woman with congenital afibrinogenemia presented with acute-onset rapidly progressive quadriparesis as a result of spinal cord infarction caused by vertebral artery dissection. Magnetic resonance imaging scans showed microhemorrhages in addition to edematous swelling suggesting acute ischemia throughout cervical and upper thoracic portions of the spinal cord. Fat-saturated T1-weighted magnetic resonance examination and digital subtraction angiography studies demonstrated cervical vertebral artery dissection on the right. This case provides an example of how a primary bleeding disorder could result in a severe ischemic complication caused by an occlusive vessel wall hematoma. Along with other reports, diagnostic and therapeutic aspects of this paradoxical situation were discussed in the particular setting of acute spinal cord ischemia.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2008.11.005DOI Listing
September 2009

An unusual central nervous system involvement in rheumatoid arthritis: combination of pachymeningitis and cerebral vasculitis.

Rheumatol Int 2009 Sep 18;29(11):1349-53. Epub 2008 Dec 18.

Department of Neurology, Hacettepe University Hospitals, Ankara, Turkey.

Severe primary central nervous system (CNS) involvement such as vasculitis and pachymeningitis can rarely occur in rheumatoid arthritis (RA) even in the absence of systemic disease activation. The authors illustrate a female patient with well-controlled RA who presented with headaches, encephalopathy, seizures and relapsing focal neurological deficits. Primary rheumatoid cerebral vasculitis and pachymeningitis were diagnosed based on suggestive brain magnetic resonance (MR) imaging, MR angiography, cerebrospinal fluid analysis and cerebral angiography. MR showed abnormal leptomeningeal enhancement and hyperintense FLAIR signal in the cortical subarachnoid spaces consistent with pachymeningitis. Cerebral angiography findings were consistent with vasculitis. Aggressive treatment resulted in significant clinicoradiological resolution. Cerebral vasculitis is a rare but certain manifestation of RA. This complication can be diagnosed in the presence of suggestive angiographic and CSF findings. The condition may be steroid resistant, and needs to be treated more aggressively.
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http://dx.doi.org/10.1007/s00296-008-0810-6DOI Listing
September 2009

WingSpan Stent System in the endovascular treatment of intracranial aneurysms: clinical experience with midterm follow-up results.

J Neurosurg 2008 Sep;109(3):445-53

Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.

Object: The WingSpan stent is a new self-expandable neurovascular stent designed for endovascular treatment of intracranial atheromatous lesions. The authors report their experience with the use of this stent for the endovascular treatment of intracranial aneurysms.

Methods: Thirty-seven patients with 40 wide-necked intracranial aneurysms were treated using the WingSpan stent. Twenty-two aneurysms (55%) were small and 18 (45%) were large or giant. In all but 4 aneurysms, embolization was completed by packing the aneurysm sac with platinum coils. In 4 dissecting aneurysms that were fusiform or too small and wide necked to be catheterized, the stent was used alone. In these cases, the stent bridged the aneurysm neck to allow for flow redirection and the potential stent-induced endothelization effect.

Results: Follow-up angiograms obtained in 3 of 4 aneurysms, treated with only stent placement, demonstrated aneurysmal thrombosis and parent artery remodeling in 2 patients and moderate decrease in size in 1. Follow-up angiography obtained at 6 months to 1 year in 31 aneurysms after stent-supported coil embolization demonstrated complete occlusion in 23 aneurysms (74.2%) with a progressive thrombosis rate of 66.7% (10 of 15 aneurysms), and a recanalization rate of 16.1%.

Conclusions: In treating wide-necked intracranial aneurysms, the WingSpan Stent System is very flexible, secure, and effective. Its delivery system is very easy and exact in that it exerts higher outward radial force, thus providing an excellent conformability and a strong scaffold to hold the coils in place. It may offer an effective treatment when used alone in some fusiform or very wide-necked, small dissecting aneurysms in which other surgical or endovascular treatment strategies are not deemed feasible.
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http://dx.doi.org/10.3171/JNS/2008/109/9/0445DOI Listing
September 2008

Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability.

Neuroradiology 2008 Sep 16;50(9):787-93. Epub 2008 May 16.

Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.

Introduction: The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up.

Materials And Methods: Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck (>or=4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling.

Results: Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively.

Conclusions: Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial.
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http://dx.doi.org/10.1007/s00234-008-0399-1DOI Listing
September 2008

Venous thromboembolism after retrieval of inferior vena cava filters.

J Vasc Interv Radiol 2008 Apr;19(4):504-508

Dotter Interventional Institute, Oregon Health & Science University, Mail Code L-605, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.

Purpose: To determine the incidence of venous thromboembolism (VTE) after removal of retrievable inferior vena cava (IVC) filters.

Materials And Methods: Retrospective study was conducted of 67 patients who underwent 72 consecutive filter retrievals at a single institution. Data collected included VTE status at the time of filter placement, anticoagulant medications at the time of filter retrieval and afterward, new or recurrent VTE after filter removal, and insertion of subsequent filters. Patient questionnaires were completed in 50 cases, chart review in all patients.

Results: At the time of filter placement, 30 patients had documented VTE, 19 had a history of treated VTE, and 23 were at risk for but had neither previous nor present VTE. Mean duration of follow-up after filter removal was 20.6 months +/- 10.9. A total of 52 patients (57 filters) received anticoagulation and/or antiplatelet medications after filter removal. There were two documented episodes of recurrent deep vein thrombosis (2.8% of filters removed), both in patients who had VTE at the time of filter placement and underwent therapeutic anticoagulation at the time of filter removal. One of these patients (1.4% of filters removed) also experienced pulmonary embolism. Of the 23 patients without VTE when the filter was placed, none developed VTE after filter removal. Four patients (5.5% of filters removed) required subsequent permanent filters, three for complications of anticoagulation, one for failure of anticoagulation.

Conclusions: VTE was rare after removal of IVC filters, but was most likely to occur in patients who had VTE at the time of filter placement.
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http://dx.doi.org/10.1016/j.jvir.2007.11.016DOI Listing
April 2008

Neuroapplication of Amplatzer vascular plug: a novel device for parent artery occlusion.

Neuroradiology 2008 Feb 29;50(2):179-83. Epub 2007 Nov 29.

Radiology Department, Hacettepe University Hospital, Sihhiye, Ankara, Turkey.

Extracranial internal carotid aneurysms are rare, but the complications associated with the traditional surgical reconstruction methods are relatively high. Endovascular treatment has replaced surgery for treatment of a variety of vascular problems. We describe here the treatment of a recurrent extracranial internal carotid artery aneurysm using a detachable balloon combined with the Amplatzer vascular plug.
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http://dx.doi.org/10.1007/s00234-007-0307-0DOI Listing
February 2008

Endovascular treatment of basilar and ICA termination aneurysms: effects of the use of HydroCoils on treatment stability in a subgroup of patients prone to a higher recurrence rate.

Neuroradiology 2007 Dec 2;49(12):1015-21. Epub 2007 Oct 2.

Interventional Neuroradiology Unit, Radiology Department, Hacettepe University Hospital, Sihhiye, 06100 Ankara, Turkey.

Purpose: The aim of this study was to evaluate the stability of occlusion of terminal bifurcation aneurysms after embolization with hydrogel-coated coils.

Methods: Of 35 bifurcation aneurysms, 34 were treated with hydrogel-coated coils in combination with platinum coils, and 1 was treated with hydrogel-coated coils only. Aneurysms were located at the basilar tip in 17 patients, and the internal carotid artery (ICA) bifurcation in 18 patients. The patient population consisted of 20 women and 15 men with ages ranging from 21 to 65 years. The aneurysm was found in 16 patients on presentation for subarachnoid hemorrhage, and in 19 patients the finding was incidental. Of the 35 aneurysms, 25 were small, 9 were large and 1 was giant. The giant aneurysm was located at the basilar tip and showed partial thrombosis. All except two basilar tip aneurysms were treated with balloon assistance. The remaining two basilar tip aneurysms were embolized with the assistance of an aneurysmal neck bridge device.

Results: The mean percentage occluded aneurysm volume for all devices was in the range 34-100%. Follow-up angiograms were obtained at 1 year in 6 patients, 2 years in 11 patients, and 3 years in 18 patients. Angiograms obtained immediately after embolization demonstrated a Raymond class 1 occlusion in 29 patients (82.9%) and a Raymond class 2 occlusion in 6 patients (17.1%). In four of these six patients follow-up angiograms demonstrated regrowth with resultant Raymond class 3 occlusion. In the other two patients, Raymond class 2 occlusion remained stable on follow-up angiograms. In patients who had a Raymond class 1 occlusion on the angiogram obtained immediately after embolization, no regrowth was seen on the follow-up angiograms. The overall recanalization rate was 11.4% (three large, one giant) at 6 months. Retreatment was not considered in three of these patients and they were to be followed; the other patient was retreated.

Conclusion: Our initial procedural data demonstrate that higher volumetric occlusion was achieved with hydrogel-coated coils and the long-term follow-up results showed a favorably low recanalization rates among the terminal bifurcation aneurysms.
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http://dx.doi.org/10.1007/s00234-007-0290-5DOI Listing
December 2007

Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms.

J Neurosurg 2007 Jul;107(1):49-55

Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.

Object: Stent-assisted embolization is an alternative endovascular treatment method for wide-necked intracranial aneurysms. Currently available stents have the limitations of poor radial force, difficult delivery systems, and lack of full retrievability. The authors report on their preliminary experience with the use of a new, fully retrievable, self-expanding neurovascular stent, which has a high radial force and easy delivery system, combined with coil or Onyx embolization for the treatment of wide-necked aneurysms, including 6-month follow-up data.

Methods: Fifteen patients with 18 wide-necked intracranial aneurysms were treated using the SOLO stent system and detachable platinum coils. Aneurysms were located at the posterior communicating artery (seven lesions), midbasilar artery (one lesion), internal carotid artery (ICA) bifurcation (one lesion), ICA-ophthalmic artery segment (eight lesions), and posterior cerebral artery (one lesion). Eleven aneurysms were small, six were large, and one was giant. Only one of these aneurysms was in the acute stage of subarachnoid hemorrhage; balloon remodeling alone failed to keep the coils in the aneurysm sac.

Results: Only one stent required retrieving and repositioning after it had been fully deployed, and retrieval was easy and successful. No thromboembolic complication, dissection/rupture, or vasospasm occured during stent placement. Follow-up angiograms obtained at 6 months posttreatment in the 18 aneurysms demonstrated that all stents were patent with no evidence of intimal hyperplasia or stenosis. In all cases but one, 100% lesion occlusion was observed at the 6-month control angiography examination. Only one aneurysm had recanalized.

Conclusions: The fully retrievable self-expandible SOLO stent is a feasible, secure, and effective system with a high radial force and ease of delivery in treating wide-necked intracranial aneurysms in combination with coil embolization.
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http://dx.doi.org/10.3171/JNS-07/07/0049DOI Listing
July 2007

The safety and efficacy of the Angio-Seal closure device in diagnostic and interventional neuroangiography setting: a single-center experience with 1,443 closures.

Neuroradiology 2007 Sep 27;49(9):739-46. Epub 2007 Jun 27.

Radiology Department, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey.

Introduction: We evaluated the safety and efficacy of the Angio-Seal closure device used to close arterial puncture sites in patients who had undergone diagnostic cerebral angiography and neurointerventional procedures.

Methods: A total of 1,443 Angio-Seal devices were placed in 1,099 patients in the Interventional Neuroradiology Unit between May 2005 and August 2006. Of these, 670 were interventional and 745 were diagnostic cerebral angiographic procedures. In 28 patients bilateral puncture of the femoral arteries was performed for endovascular treatment. In 167 patients 286 repeat diagnostic procedures were performed and 30 interventional procedures were followed by re-closure with an Angio-Seal device at the time of repeat puncture.

Results: The procedural success rate for antegrade closures was 99.7% for all procedures. The device failed in 5 of 745 diagnostic procedures (0.7%). Major complication occurred in one patient only (0.13%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 1.4% (10 of 698 closures) and the minor complication rate was 2.4% (17 of 698 closures). However, in the subgroup of patients with cerebral aneurysms who received heparin in combination with antiplatelet agents after the procedure, the major complication rate was 5.3%, but in the carotid/vertebral stenting group it was 0.8%.

Conclusion: Our experience in a relatively large series of patients shows that the use of the Angio-Seal STS vascular closure device is safe and effective in patients undergoing cerebral diagnostic angiography and neurointerventional procedures with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and/or antiplatelet medication.
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http://dx.doi.org/10.1007/s00234-007-0249-6DOI Listing
September 2007

Existence of cotton granuloma after removal of a parasagittal meningioma: clinical and radiological evaluation -a case report-.

Kobe J Med Sci 2007 ;53(1-2):43-7

Department of Neurosurgery, School of Medicine, Hacettepe University, Ankara, Turkey.

Hemostatic agents, routinely used in neurosurgery to achieve intraoperative hemostasis may cause foreign body reaction. These may produce clinically symptomatic and radiologically apparent mass lesions. It should be kept in mind that retained cotton or rayon materials may mimic the appearance of a tumor or an abscess on MRI scan, especially at sides of previous craniotomies. Here we report a case of intracranial foreign body granuloma which occurred due to remained cottonoid after removal of a parasagittal meningioma. This entity was also documented by MR imaging technics included diffusion weighted, flair and ADC mapping.
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October 2007

Safety of inferior vena cava filter retrieval in anticoagulated patients.

Chest 2007 Jul 15;132(1):31-6. Epub 2007 May 15.

Dotter Interventional Institute, Oregon Health and Science University, L-605, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA.

Purposes: To evaluate the safety of inferior vena cava (IVC) filter retrieval in therapeutically anticoagulated patients in comparison to prophylactically or not therapeutically anticoagulated patients with respect to retrieval-related hemorrhagic complications.

Materials And Methods: This was a retrospective study of 115 consecutive attempted IVC filter retrievals in 110 patients. Filter retrievals were stratified as performed in patients who were therapeutically anticoagulated (group 1), prophylactically anticoagulated (group 2), or not therapeutically anticoagulated (group 3). The collected data included anticoagulant and antiplatelet medications (type, form and duration of administration, dosage) at the time of retrieval. Phone interviews and chart review was performed for the international normalized ratio (INR), activated partial thromboplastin time, platelet count, infusion of blood products, and retrieval-related hemorrhagic complications.

Results: Group 1 included 65 attempted filter retrievals in 61 therapeutically anticoagulated patients by measured INR or dosing when receiving low-molecular-weight heparin (LMWH). Four retrievals were not successful. In patients receiving oral anticoagulation, the median INR was 2.35 (range, 2 to 8). Group 2 comprised 23 successful filter retrievals in 22 patients receiving a prophylactic dose of LMWH. Group 3 included 27 attempted filter retrievals in 27 patients not receiving therapeutic anticoagulation. Six retrievals were not successful. Five patients were receiving oral anticoagulation with a subtherapeutic INR (median, 1.49; range, 1.16 to 1.69). No anticoagulation medication was administered in 22 patients. In none of the groups were hemorrhagic complications related to the retrieval procedures identified.

Conclusions: These results suggest that retrieval of vena cava filters in anticoagulated patients is safe. Interruption or reversal of anticoagulation for the retrieval of vena cava filters is not indicated.
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http://dx.doi.org/10.1378/chest.06-2897DOI Listing
July 2007

Exclusion of atherosclerotic plaque from the circulation using stent-grafts: alternative to carotid stenting with a protection device?

Cardiovasc Intervent Radiol 2007 Sep-Oct;30(5):854-60

Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.

Purpose: To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts.

Methods: Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47-83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1-42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination.

Results: The technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts.

Conclusions: Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs.
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http://dx.doi.org/10.1007/s00270-007-9010-0DOI Listing
January 2008

An unusual complication of carotid stenting: spontaneous rectus sheath hematoma and its endovascular management.

Diagn Interv Radiol 2007 Mar;13(1):46-8

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Carotid stenting has recently emerged as a potential alternative to surgical treatment. We report a case of a spontaneous rectus sheath hematoma in a patient who underwent anticoagulation therapy following carotid stenting. Computed tomography findings were consistent with active bleeding within the hematoma, and this was confirmed with selective angiography via right deep circumflex iliac artery injection. Transcatheter embolization of the right deep circumflex iliac artery with n-butyl 2-cyanoacrylate was successfully performed. To the best of our knowledge, spontaneous anterior abdominal wall hemorrhaging following carotid stenting has not been previously reported in the English language literature.
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March 2007

Transjugular liver biopsy via the left internal jugular vein.

J Vasc Interv Radiol 2007 Feb;18(2):237-41

Oregon Health and Science University, Dotter Interventional Institute, Portland, Ore., USA.

Purpose: To retrospectively review the indications and outcomes of transjugular liver biopsy (TJLB) with the left internal jugular vein (IJV) approach.

Materials And Methods: A retrospective review of all TJLBs performed at one institution was performed. From August 1995 to October 2004, 293 liver biopsies were performed. Nineteen of the 293 procedures (6.5%) were performed from the left IJV in 17 patients. There were 11 men and six women aged 36-59 years (mean, 49.3 years). All patients were suspected of having diffuse hepatic parenchymal disease and had contraindications to conventional percutaneous liver biopsy. The stiff metal biopsy cannula was advanced across the mediastinum and through the heart over a stiff guide wire. Biopsy was performed from the right hepatic vein in 15 procedures, the middle hepatic vein in two, and the intrahepatic IVC in two.

Results: The indications for using the left IJV approach were nonusable right IJV in 12 procedures, difficult previous catheterization of the hepatic veins from the right IJV due to distorted hepatic anatomy in six procedures, and the operator's predilection for this approach in one procedure (the patient had previously undergone liver transplantation). All biopsies were successful, with diagnostic tissue obtained in 100% of cases. Two patients had chest pain during the procedure associated with placement of the rigid cannula through the mediastinal veins. One patient had a vaso-vagal episode that necessitated the use of intravenous atropine but subsequently underwent successful biopsy. All episodes of chest pain resolved after the cannula was removed. There were no recorded hemorrhagic or cardiac complications.

Conclusion: TJLB can be safely and repeatedly performed from the left IJV when the right IJV is not available or the hepatic anatomy prevents catheterization of the hepatic veins from the right IJV.
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http://dx.doi.org/10.1016/j.jvir.2006.12.730DOI Listing
February 2007

Intrasaccular combination of metallic coils and onyx liquid embolic agent for the endovascular treatment of cerebral aneurysms.

J Neurosurg 2006 Nov;105(5):706-12

Department of Radiology, Hacettepe University Hospital, Ankara, Turkey.

Object: The aim of this study was to report on a novel technique in which metallic embolization coils were combined with the Onyx liquid embolic agent in the aneurysm sac to achieve a more durable result after endovascular treatment. This therapeutic procedure was performed in selected cases in which, based on the authors' experiences, either coil embolization or Onyx alone would likely have failed. The authors report long-term clinical and angiographic follow-up results in 20 consecutive intracranial aneurysms treated using this combination for defined indications.

Methods: Twenty aneurysms in 20 patients were treated with a combination of embolic coils and Onyx. Four aneurysms were giant; 13, large; and three, small. This new technique was used when standard Onyx or coil treatment with balloon assistance was determined to involve a higher possibility of recanalization, because either an adjunctive stent insertion could not be performed or the Onyx technique could not be used due to an unsuccessful seal test or intraaneurysm balloon prolapse. In one case, an adjunctive stent was placed before coil placement and Onyx deposition to control the material in the sac of the aneurysm, which had a fusiform neck. All aneurysms were completely occluded after using this technique. No clinical or technical adverse events occurred in any of the cases. Follow-up angiography was performed in all patients: 3-year studies in six patients, 2-year studies in five, and 1-year studies in nine. None of these studies demonstrated aneurysm regrowth or parent artery occlusion.

Conclusions: The combination of the embolic coils and the Onyx liquid embolic agent provides very durable aneurysm occlusion for defined indications.
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http://dx.doi.org/10.3171/jns.2006.105.5.706DOI Listing
November 2006

Effects of blood flow and/or ventilation restriction on radiofrequency coagulation size in the lung: an experimental study in swine.

Cardiovasc Intervent Radiol 2006 Sep-Oct;29(5):838-45

Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon 97201-3098, USA.

The purpose of this study was to investigate how the restriction of blood flow and/or ventilation affects the radiofrequency (RF) ablation coagulation size in lung parenchyma. Thirty-one RF ablations were done in 16 normal lungs of 8 living swine with 2-cm LeVeen needles. Eight RF ablations were performed as a control (group G1), eight with balloon occlusion of the ipsilateral mainstem bronchus (G2), eight with occlusion of the ipsilateral pulmonary artery (G3), and seven with occlusion of both the ipsilateral bronchus and pulmonary artery (G4). Coagulation diameters and volumes of each ablation zone were compared on computed tomography (CT) and gross specimen examinations. Twenty-six coagulation zones were suitable for evaluation: eight in G1, five in G2, seven in G3, and six in G4 groups. In G1, the mean coagulation diameter was 21.5 +/- 3.5 mm on CT and 19.5 +/- 1.78 mm on gross specimen examination. In G2, the mean diameters were 26.5 +/- 5.1 mm and 23.0 +/- 2.7 mm on CT and gross specimen examination, respectively. In G3, the mean diameters were 29.4 +/- 2.2 mm and 27.4 +/- 2.9 mm on CT and gross specimen examination, respectively, and in G4, they were 32.6 +/- 3.33 mm and 28.8 +/- 2.6 mm, respectively. The mean coagulation volumes were 3.39 +/- l.52 cm(3) on CT and 3.01 +/- 0.94 cm(3) on gross examinations in G1, 6.56 +/- 2.47 cm(3) and 5.22 +/- 0.85 cm(3) in G2, 10.93 +/- 2.17 cm(3) and 9.97 +/- 2.91 cm(3) in G3, and 13.81 +/- 3.03 cm(3) and 11.06 +/- 3.27 cm(3) in G4, respectively. The mean coagulation diameters on gross examination and mean coagulation volumes on CT and gross examination with G3 and G4 were significantly larger than those in G1 (p < 0.0001, p < 0.0001, p < 0.0001, respectively) or in G2 (p < 0.05, p < 0.005, p < 0.005, respectively). Pulmonary collapse occurred in one lung in G2 and pulmonary artery thrombus in two lungs of G3 and two lungs of G4. The coagulation size of RF ablation of the lung parenchyma is increased by ventilation and particularly by pulmonary artery blood flow restriction. The value of these restrictions for potential clinical use needs to be explored in experimentally induced lung tumors.
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http://dx.doi.org/10.1007/s00270-005-0217-7DOI Listing
December 2006

Comparison of the endothelialization of small intestinal submucosa, dacron, and expanded polytetrafluoroethylene suspended in the thoracoabdominal aorta in sheep.

J Vasc Interv Radiol 2006 May;17(5):873-82

Department of Radiology, Royal Perth Hospital, Perth, Australia.

Purpose: This study was undertaken to evaluate and compare endothelialization of small intestinal submucosa (SIS), Dacron, and expanded polytetrafluoroethylene (ePTFE) in high-pressure flow without aortic wall contact and to evaluate the suitability of SIS as a vascular graft material.

Materials And Methods: In 12 adult sheep, three types of membrane leaflets of similar thickness (approximately 200 mum) were suspended within large square stents without contact with the thoracoabdominal aortic wall: SIS (n = 12), Dacron (n = 12), and ePTFE (n = 12). Each animal received one leaflet of each material. Aortograms were obtained before and after percutaneous implantation and when the animal was killed at 8 weeks (n = 6) or 18 weeks (n = 6). Cell coverage and remodeling of SIS, Dacron, and ePTFE membranes were assessed by gross and histologic microscopic examinations.

Results: Thirty-five successfully implanted leaflets were evaluated. SIS showed progressive remodeling. Thirty-three leaflets exhibited thickening as a result of neointimal formation and endothelialization, most likely from circulating endothelial cells. Dacron exhibited the greatest and most progressing degree of neointimal formation and endothelialization, followed by SIS and then ePTFE. With SIS and ePTFE, neointimal formation decreased with time, but endothelialization was stable. Uneven neointimal formation and endothelialization on the outer surfaces and distal leaflet positions were seen.

Conclusions: SIS showed progressive remodeling with moderate and regressive neointimal formation and moderate stable endothelialization. Further study of its durability and incorporation into the aortic wall needs to be performed to evaluate its suitability as a cover for aortic endografts.
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http://dx.doi.org/10.1097/01.RVI.0000217938.20787.BBDOI Listing
May 2006

Unusual systemic artery to pulmonary artery malformation without evidence of systemic disease, trauma or surgery.

Cardiovasc Intervent Radiol 2006 Sep-Oct;29(5):897-901

Dotter Interventional Institute, Oregon Health and Sciences University, L342, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.

Connections between the systemic and pulmonary arterial systems are rare conditions that can be due to either congenital or acquired diseases such as anomalous systemic arterial supply to normal lung, pulmonary sequestration, and systemic supply to pulmonary arteriovenous malformations. Herein, a unique case of systemic artery to pulmonary arterial malformation and its endovascular treatment in a patient with no history of the usual etiologies is reported.
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http://dx.doi.org/10.1007/s00270-004-0289-9DOI Listing
December 2006

Retrieval of a malpositioned vena cava filter with embolic protection with use of a second filter.

J Vasc Interv Radiol 2005 Apr;16(4):531-4

DSA Peripheric Vascular Imaging Center, Ankara, Turkey.

Proper positioning of inferior vena cava (IVC) filters is necessary for effective protection from pulmonary embolism (PE). This report describes a case of an IVC filter malpositioned partially in the right common iliac vein that resulted in risk of recurrent PE caused by thrombus emanating from the left common iliac vein. A new filter was placed in the IVC above the first device, followed by retrieval of the malpositioned filter through the new filter.
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http://dx.doi.org/10.1097/01.RVI.0000153112.43278.42DOI Listing
April 2005

Granulocytic sarcoma. Cranial and breast involvement.

Clin Imaging 2002 May-Jun;26(3):166-9

Department of Radiology, Medical School, Ankara University, Ibn-i Sina Hospital, 06100 Sihhiye, Turkey.

The term granulocytic sarcoma designates an infrequent solid tumor composed of aggregates of immature granulocytic precursors in extramedullary sites. The lesion generally occurs either during the natural course of acute myelogenous leukemia or after a remission has been achieved; however, it may rarely represent the initial manifestation of the disease. We present radiologic features of cranial and breast involvement of granulocytic sarcoma in a 13-year-old female with acute myelogenous leukemia. The cranial lesion appeared nearly isointense with cortical gray matter on T1- and T2-weighted magnetic resonance (MR) images, and enhanced homogeneously after the injection of gadolinium. MRI showed a well-delineated lobulated mass in the left breast, which had a heterogeneous hyperintense signal and remarkable contrast enhancement.
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http://dx.doi.org/10.1016/s0899-7071(01)00388-6DOI Listing
July 2002