Publications by authors named "Vania Anagnostakou"

30 Publications

  • Page 1 of 1

Novel Oxygen Carrier Slows Infarct Growth in Large Vessel Occlusion Dog Model Based on Magnetic Resonance Imaging Analysis.

Stroke 2022 04 21;53(4):1363-1372. Epub 2022 Mar 21.

New England Center for Stroke Research, Department of Radiology (M.S., R.M.K., V.A., Z.V., A.K., J.K., C.R., M.J.G.), University of Massachusetts Medical School, Worcester.

Background: Tissue hypoxia plays a critical role in the events leading to cell death in ischemic stroke. Despite promising results in preclinical and small clinical pilot studies, inhaled oxygen supplementation has not translated to improved outcomes in large clinical trials. Moreover, clinical observations suggest that indiscriminate oxygen supplementation can adversely affect outcome, highlighting the need to develop novel approaches to selectively deliver oxygen to affected regions. This study tested the hypothesis that intravenous delivery of a novel oxygen carrier (Omniox-Ischemic Stroke [OMX-IS]), which selectively releases oxygen into severely ischemic tissue, could delay infarct progression in an established canine thromboembolic large vessel occlusion stroke model that replicates key dynamics of human infarct evolution.

Methods: After endovascular placement of an autologous clot into the middle cerebral artery, animals received OMX-IS treatment or placebo 45 to 60 minutes after stroke onset. Perfusion-weighted magnetic resonance imaging was performed to define infarct progression dynamics to stratify animals into fast versus slow stroke evolvers. Serial diffusion-weighted magnetic resonance imaging was performed for up to 5 hours to quantify infarct evolution. Histology was performed postmortem to confirm final infarct size.

Results: In fast evolvers, OMX-IS therapy substantially slowed infarct progression (by ≈1 hour, <0.0001) and reduced the final normalized infarct volume as compared to controls (0.99 versus 0.88, control versus OMX-IS drug, <0.0001). Among slow evolvers, OMX-IS treatment delayed infarct progression by approximately 45 minutes; however, this did not reach statistical significance (=0.09). The final normalized infarct volume also did not show a significant difference (0.93 versus 0.95, OMX-IS drug versus control, =0.34). Postmortem histologically determined infarct volumes showed excellent concordance with the magnetic resonance imaging defined ischemic lesion volume (bias: 1.33% [95% CI, -15% to 18%).

Conclusions: Intravenous delivery of a novel oxygen carrier is a promising approach to delay infarct progression after ischemic stroke, especially in treating patients with large vessel occlusion stroke who cannot undergo definitive reperfusion therapy within a timely fashion.
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http://dx.doi.org/10.1161/STROKEAHA.121.036896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960363PMC
April 2022

Transvascular in vivo microscopy of the subarachnoid space.

J Neurointerv Surg 2022 May 3;14(5). Epub 2022 Feb 3.

New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA

Background: The micro-architectonics of the subarachnoid space (SAS) remain partially understood and largely ignored, likely the result of the inability to image these structures in vivo. We explored transvascular imaging with high-frequency optical coherence tomography (HF-OCT) to interrogate the SAS.

Methods: In vivo HF-OCT was performed in 10 dogs in both the posterior and anterior cerebral circulations. The conduit vessels used were the basilar, anterior spinal, and middle and anterior cerebral arteries through which the perivascular SAS was imaged. The HF-OCT imaging probe was introduced via a microcatheter and images were acquired using a contrast injection (3.5 mL/s) for blood clearance. Segmentation and three-dimensional rendering of HF-OCT images were performed to study the different configurations and porosity of the subarachnoid trabeculae (SAT) as a function of location.

Results: Of 13 acquisitions, three were excluded due to suboptimal image quality. Analysis of 15 locations from seven animals was performed showing six distinct configurations of arachnoid structures in the posterior circulation and middle cerebral artery, ranging from minimal presence of SAT to dense networks and membranes. Different locations showed predilection for specific arachnoid morphologies. At the basilar bifurcation, a thick, fenestrated membrane had a unique morphology. SAT average thickness was 100 µm and did not vary significantly based on location. Similarly, the porosity of the SAT averaged 91% and showed low variability.

Conclusion: We have demonstrated the feasibility to image the structures of the SAS with transvascular HF-OCT. Future studies are planned to further map the SAT to increase our understanding of their function and possible impact on neurovascular pathologies.
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http://dx.doi.org/10.1136/neurintsurg-2021-018544DOI Listing
May 2022

Preclinical modeling of mechanical thrombectomy.

J Biomech 2022 01 8;130:110894. Epub 2021 Dec 8.

New England Center for Stroke Research, Department of Radiology University of Massachusetts 55 Lake Avenue North, SA 107-R, Worcester, MA 01655, United States. Electronic address:

Mechanical thrombectomy to treat large vessel occlusions (LVO) causing a stroke is one of the most effective treatments in medicine, with a number needed to treat to improve clinical outcomes as low as 2.6. As the name implies, it is a mechanical solution to a blocked artery and modeling these mechanics preclinically for device design, regulatory clearance and high-fidelity physician training made clinical applications possible. In vitro simulation of LVO is extensively used to characterize device performance in representative vascular anatomies with physiologically accurate hemodynamics. Embolus analogues, validated against clots extracted from patients, provide a realistic simulated use experience. In vitro experimentation produces quantitative results such as particle analysis of distal emboli generated during the procedure, as well as pressure and flow throughout the experiment. Animal modeling, used mostly for regulatory review, allows estimation of device safety. Other than one recent development, nearly all animal modeling does not incorporate the desired target organ, the brain, but rather is performed in the extracranial circulation. Computational modeling of the procedure remains at the earliest stages but represents an enormous opportunity to rapidly characterize and iterate new thrombectomy concepts as well as optimize procedure workflow. No preclinical model is a perfect surrogate; however, models available can answer important questions during device development and have to date been successful in delivering efficacious and safe devices producing excellent clinical outcomes. This review reflects on the developments of preclinical modeling of mechanical thrombectomy with particular focus on clinical translation, as well as articulate existing gaps requiring additional research.
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http://dx.doi.org/10.1016/j.jbiomech.2021.110894DOI Listing
January 2022

Optical Coherence Tomography for Neurovascular Disorders.

Neuroscience 2021 10 12;474:134-144. Epub 2021 Jun 12.

University of Massachusetts Medical School, Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States. Electronic address:

Diagnosis of cerebrovascular disease includes vascular neuroimaging techniques such as computed tomography (CT) angiography, magnetic resonance (MR) angiography (with or without use of contrast agents) and catheter digital subtraction angiography (DSA). These techniques provide mostly information about the vessel lumen. Vessel wall imaging with MR seeks to characterize cerebrovascular pathology, but with resolution that is often insufficient for small lesions. Intravascular imaging techniques such as ultrasound and optical coherence tomography (OCT), used for over a decade in the peripheral circulation, is not amendable to routine deployment in the intracranial circulation due to vessel caliber and tortuosity. However, advances in OCT technology including the probe profile, stiffness and unique distal rotation solution, holds the promise for eventual translation of OCT into the clinical arena. As such, it is apropos to review this technology and present the rationale for utilization of OCT in the cerebrovasculature.
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http://dx.doi.org/10.1016/j.neuroscience.2021.06.008DOI Listing
October 2021

Quantitative Characterization of Recanalization and Distal Emboli with a Novel Thrombectomy Device.

Cardiovasc Intervent Radiol 2021 Feb 11;44(2):318-324. Epub 2020 Nov 11.

Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA, 01655, USA.

Purpose: The first-pass effect during mechanical thrombectomy improves clinical outcomes regardless of first-line treatment approach, but current success rates for complete clot capture with one attempt are still less than 40%. We hypothesize that the ThrombX retriever (ThrombX Medical Inc.) can better engage challenging clot models during retrieval throughout tortuous vasculature in comparison with a standard stent retriever without increasing distal emboli.

Materials And Methods: Thrombectomy testing with the new retriever as compared to the Solitaire stent retriever was simulated in a vascular replica with hard and soft clot analogs to create a challenging occlusive burden. Parameters included analysis of distal emboli generated per clot type, along with the degree of recanalization (complete, partial or none) by retrieval device verified by angiography.

Results: The ThrombX device exhibited significantly higher rates of first-pass efficacy (90%) during hard clot retrieval in comparison with the control device (20%) (p < 0.009), while use of both techniques during soft clot retrieval resulted in equivalent recanalization. The soft clot model generated higher numbers of large emboli (>200 μm) across both device groups (p = 0.0147), and no significant differences in numbers of distal emboli were noted between the ThrombX and Solitaire techniques.

Conclusions: Irrespective of clot composition, use of the ThrombX retriever demonstrated high rates of complete recanalization at first pass in comparison with a state-of-the-art stent retriever and proved to be superior in the hard clot model. Preliminary data suggest that risk of distal embolization associated with the ThrombX system is comparable to that of the control device.
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http://dx.doi.org/10.1007/s00270-020-02683-3DOI Listing
February 2021

Efficacy of beveled tip aspiration catheter in mechanical thrombectomy for acute ischemic stroke.

J Neurointerv Surg 2021 Sep 6;13(9):823-826. Epub 2020 Oct 6.

Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA.

Background: Direct aspiration thrombectomy techniques use large bore aspiration catheters for mechanical thrombectomy. Several aspiration catheters are now available. We report a bench top exploration of a novel beveled tip catheter and our experience in treating large vessel occlusions (LVOs) using next-generation aspiration catheters.

Methods: A retrospective analysis from a prospectively maintained database comparing the bevel shaped tip aspiration catheter versus non-beveled tip catheters was performed. Patient demographics, periprocedural metrics, and discharge and 90-day modified Rankin Scale (mRS) scores were collected. Patients were divided into two groups based on which aspiration catheter was used.

Results: Our data showed no significant difference in age, gender, IV tissue plasminogen activator administration, admission NIH Stroke Scale score, baseline mRS, or LVO location between the beveled tip and flat tip groups. With the beveled tip, Thrombolysis in Cerebral Infarction (TICI) 2C or better recanalization was more frequent overall (93.2% vs 74.2%, p=0.017), stent retriever usage was lower (9.1% vs 29%, p=0.024), and patients had lower mRS on discharge (median 3 vs 4, p<0.001) and at 90 days (median 2 vs 4, p=0.008).

Conclusion: Patients who underwent mechanical thrombectomy with the beveled tip catheter had a higher proportion of TICI 2C or better and had a significantly lower mRS score on discharge and at 90 days.
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http://dx.doi.org/10.1136/neurintsurg-2020-016695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372385PMC
September 2021

High-resolution image-guided WEB aneurysm embolization by high-frequency optical coherence tomography.

J Neurointerv Surg 2021 Jul 28;13(7):669-673. Epub 2020 Sep 28.

Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

Background: High-frequency optical coherence tomography (HF-OCT) is an intra-vascular imaging technique capable of assessing device-vessel interactions at spatial resolution approaching 10 µm. We tested the hypothesis that adequately deployed Woven EndoBridge (WEB) devices as visualized by HF-OCT lead to higher aneurysm occlusion rates.

Methods: In a leporine model, elastase-induced aneurysms (n=24) were treated with the WEB device. HF-OCT and digital subtraction angiography (DSA) were performed following WEB deployment and repeated at 4, 8, and 12 weeks. Protrusion (0-present, 1-absent) and malapposition (0-malapposed, 1-neck apposition >50%) were binary coded. A device was considered 'adequately deployed' by HF-OCT and DSA if apposed and non-protruding. Aneurysm healing on DSA was reported using the 4-point WEB occlusion score: A or B grades were considered positive outcome. Neointimal coverage was quantified on HF-OCT images at 12 weeks and compared with scanning electron microscopy (SEM).

Results: Adequate deployment on HF-OCT correlated with positive outcome (P=0.007), but no statistically significant relationship was found between good outcome and adequate deployment on DSA (P=0.289). Absence of protrusion on HF-OCT correlated with a positive outcome (P=0.006); however, malapposition alone had no significant relationship (P=0.19). HF-OCT showed a strong correlation with SEM for the assessment of areas of neointimal tissue (R²=0.96; P<0.001). More neointimal coverage of 78%±32% was found on 'adequate deployment' cases versus 31%±24% for the 'inadequate deployment' cases (P=0.001).

Conclusion: HF-OCT visualizes features that can determine adequate device deployment to prognosticate early aneurysm occlusion following WEB implantation and can be used to longitudinally monitor aneurysm healing progression.
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http://dx.doi.org/10.1136/neurintsurg-2020-016447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205185PMC
July 2021

Biomechanics and hemodynamics of stent-retrievers.

J Cereb Blood Flow Metab 2020 12 19;40(12):2350-2365. Epub 2020 May 19.

New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA.

In 2015, multiple randomized clinical trials showed an unparalleled treatment benefit of stent-retriever thrombectomy as compared to standard medical therapy for the treatment of a large artery occlusion causing acute ischemic stroke. A short time later, the HERMES collaborators presented the patient-level pooled analysis of five randomized clinical trials, establishing class 1, level of evidence A for stent-retriever thrombectomy, in combination with intravenous thrombolysis when indicated to treat ischemic stroke. In the years following, evidence continues to mount for expanded use of this therapy for a broader category of patients. The enabling technology that changed the tide to support endovascular treatment of acute ischemic stroke is the stent-retriever. This review summarizes the history of intra-arterial treatment of stroke, introduces the biomechanics of embolus extraction with stent-retrievers, describes technical aspects of the intervention, provides a description of hemodynamic implications of stent-retriever embolectomy, and proposes future directions for a more comprehensive, multi-modal endovascular approach for the treatment of acute ischemic stroke.
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http://dx.doi.org/10.1177/0271678X20916002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820689PMC
December 2020

Haptoglobin administration into the subarachnoid space prevents hemoglobin-induced cerebral vasospasm.

J Clin Invest 2019 12;129(12):5219-5235

Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.

Delayed ischemic neurological deficit (DIND) is a major driver of adverse outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH), defining an unmet need for therapeutic development. Cell-free hemoglobin that is released from erythrocytes into the cerebrospinal fluid (CSF) is suggested to cause vasoconstriction and neuronal toxicity, and correlates with the occurrence of DIND. Cell-free hemoglobin in the CSF of patients with aSAH disrupted dilatory NO signaling ex vivo in cerebral arteries, which shifted vascular tone balance from dilation to constriction. We found that selective removal of hemoglobin from patient CSF with a haptoglobin-affinity column or its sequestration in a soluble hemoglobin-haptoglobin complex was sufficient to restore physiological vascular responses. In a sheep model, administration of haptoglobin into the CSF inhibited hemoglobin-induced cerebral vasospasm and preserved vascular NO signaling. We identified 2 pathways of hemoglobin delocalization from CSF into the brain parenchyma and into the NO-sensitive compartment of small cerebral arteries. Both pathways were critical for hemoglobin toxicity and were interrupted by the large hemoglobin-haptoglobin complex that inhibited spatial requirements for hemoglobin reactions with NO in tissues. Collectively, our data show that compartmentalization of hemoglobin by haptoglobin provides a novel framework for innovation aimed at reducing hemoglobin-driven neurological damage after subarachnoid bleeding.
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http://dx.doi.org/10.1172/JCI130630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877320PMC
December 2019

Safety and efficacy of balloon angioplasty in symptomatic intracranial stenosis: A systematic review and meta-analysis.

J Neuroradiol 2020 Feb 9;47(1):27-32. Epub 2019 Mar 9.

Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, 8091 Switzerland.

Background And Purpose: Endovascular treatment is offered for symptomatic intracranial stenosis (ICS) when medical therapy fails. The purpose of this meta-analysis is to evaluate the risks and effectiveness of balloon angioplasty (BA) alone.

Materials And Methods: Systematic review and meta-analysis of all available articles on BA for symptomatic ICS was conducted. Data was analyzed separately for > 70% (Group 1) and > 50% (Group 2) stenosis. The results of the Group 1 were compared with those of SAMMPRIS study to the extent possible.

Results: A total of 25 studies comprising 674 patients were included. The cumulative incidence of periprocedural (within 30 days) stroke and death were 16.3% (Group 1), 7.6% (Group 2) and 11.5% (all studies). Incidence rates of ischemic stroke in the qualifying artery territory during follow-up (per 100 patient-years) were 2.0, 2.4 and 2.3, any stroke and death during follow-up were 4.4, 7.4 and 6.9, restenosis rates were 4.9, 11.5 and 8.9 respectively. While comparison of cumulative incidences of periprocedural ischemic stroke between Group 1 (13.0%) and the medical arm from SAMMPRIS study(4.4%) showed a significant difference (P = 0.008), there was no significant difference between the Group 1 and the stenting arm from SAMMPRIS study(10.7%) in the same variable.

Conclusion: Balloon angioplasty for stenosis of more than 70% is likely to have similar outcome comparable to the stenting arm in the SAMMPRIS study, however it presents lower rates of late ischemic events and restenosis. These data may help deciding on the endovascular method of choice in case of medical therapy failure.
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http://dx.doi.org/10.1016/j.neurad.2019.02.007DOI Listing
February 2020

Ivy Sign in Moyamoya Disease.

Eurasian J Med 2016 Feb;48(1):58-61

Department of Radiology, Division of Neuroradiology, Cerrahpaşa School of Medicine, University of İstanbul, İstanbul, Turkey.

Moyamoya disease is an idiopathic disease characterized by the progressive stenosis and collateral development of the distal internal carotid arteries. In this disease, several collateral vascular structures develop following stenosis and occlusion. The ivy sign is a characteristic Magnetic rezonance imaging (MRI) finding frequently encountered in patients with moyamoya. It can be observed both in post contrast T1-weighted images and Fluid attenuated inversion recovery (FLAIR) images. While this sign manifests in the form of contrasting on the cortical surfaces due to the formation of leptomeningeal collateral development and increased numbers of pial vascular webs on post contrast images, in FLAIR images it originates from the slow arterial flow in the leptomeningeal collateral vascular structures. In this case, we presented the Digital subtraction angiography (DSA) signs of moyamoya disease and "ivy sign" in MRI and its development mechanism in a 16 years old female patient.
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http://dx.doi.org/10.5152/eurasianjmed.2015.14142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792498PMC
February 2016

Geometrical characteristics after Y-stenting of the basilar bifurcation.

Diagn Interv Radiol 2015 Nov-Dec;21(6):483-7

Department of Radiology, GATA Haydarpaşa Training and Research Hospital, İstanbul, Turkey.

Purpose: We aimed to investigate the angular changes after Y-stenting of the basilar bifurcation aneurysms.

Methods: A total of 19 patients (age range, 27-80 years; mean age, 52.5 years) underwent Y-stent coiling for basilar bifurcation aneurysm. Three vascular angles (α, β1, β2) were measured in the anteroposterior plane. β1 and β2 represented the angles between the basilar artery and the proximal P1 segments of the right and left posterior cerebral arteries, respectively. α represented the complementary angle between the β1 and β2 angles. Angles were measured before and after stent deployment. Diameters of the basilar artery and P2 segment of the posterior cerebral artery were measured at both sides. Correlation between vascular diameter and angular change of the basilar bifurcation was investigated.

Results: Statistically significant α, β1, and β2 angle changes were found after stent deployment (P < 0.001). There was no statistically significant relationship between the diameter of the basilar artery and the α, β1, β2 angle changes (P > 0.05). There was no statistically significant relationship between the diameter of the posterior cerebral artery and the β angle change (P > 0.05). We found a statistically significant inverse correlation between pre-stent β angle and post-stent angle change (right side, P = 0.008; left side, P < 0.001).

Conclusion: Y-stenting narrows the effective neck and straightens the vascular bifurcation angle. Most of the angular remodeling occurs on the side that had a more acute angle before stent deployment.
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http://dx.doi.org/10.5152/dir.2015.14523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622396PMC
December 2016

Teaching NeuroImages: A rare cause of trigeminal neuralgia: dysplastic venous aneurysm of dural arteriovenous fistula.

Neurology 2015 Apr;84(17):e128-9

From the Department of Radiology (M.S.), GATA Haydarpasa Training Hospital, Uskudar, Istanbul, Turkey; the Department of Radiology (V.A.), Evangelismos General Hospital, Athens, Greece; and the Department of Radiology (N.K., C.I., O.K.), Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Turkey.

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http://dx.doi.org/10.1212/WNL.0000000000001530DOI Listing
April 2015

Right ventricular outflow tract obstruction caused by double-chambered right ventricle presenting in adulthood.

Tex Heart Inst J 2014 Aug 1;41(4):425-8. Epub 2014 Aug 1.

Second Departments of Cardiac Surgery (Drs. Anagnostakou, Charitos,and Kokotsakis) and Cardiology (Dr. Rouska), Evangelismos General Hospital, 10376 Athens, Greece; and Department of Surgery and Cancer (Drs. Ashrafian, Athanasiou, and Harling), Imperial College London, London W2 1NY, United Kingdom.

Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old man who presented with long-standing shortness of breath on exertion. Imaging revealed right ventricular outflow tract obstruction caused by a double-chambered right ventricle, and he was referred for surgical correction. This case emphasizes both the detailed perioperative evaluation that is needed when diagnosing adults who present with manifestations of congenital heart disease and a method of successful surgical correction that resulted in symptom resolution.
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http://dx.doi.org/10.14503/THIJ-13-3398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120509PMC
August 2014

An alternative technique of the superselective catheterization of the ophthalmic artery for intra-arterial chemotherapy of the retinoblastoma: retrograde approach through the posterior communicating artery to the ophthalmic artery.

Neuroradiology 2014 Sep 10;56(9):751-4. Epub 2014 Jun 10.

GATA Haydarpasa Training Hospital, Department of Radiology, Uskudar, Istanbul, 34668, Turkey,

Introduction: Superselective intra-arterial chemotherapy (IAC) in retinoblastoma has recently become a popular treatment option. In this study, we purposed to investigate the effectiveness of the technique of "retrograde approach through the posterior communicating artery to the ophthalmic artery (OA)" for IAC.

Methods: A total of 12 unilateral retinoblastomas were treated with IAC in 29 sessions from October 2011 to November 2013. Of the 12 patients, 6 were male and 6 were female, with ages ranging from 12 to 72 months with a median age of 27.6 months. Left-to-right ratio for affected eye was 6/6. In the first 4 patients, we used the ipsilateral internal carotid artery (ICA) to reach the OA of the affected globe (10 sessions). Then, we used the vertebral artery, basilary artery, ipsilateral/contralateral P1 segment of the posterior cerebral artery, and ipsilateral/contralateral posterior communicating artery, respectively, to reach inside the OA at next 15 sessions.

Results: At ipsilateral approach, fluoroscopy total time ranged from 16 to 34 min (mean 21.5 min), and the angle between ophthalmic segment of the ICA and proximal segment of the OA was ranged between 34° and 77° with an average angle of 53.4°. At retrograde approach, fluoroscopy total time ranged from 3 to 12 min (mean 7.5 min), and the angle between ophthalmic segment of the ICA and proximal segment of the OA was ranged between 147° and 178° with an average angle of 148.3°.

Conclusion: Retrograde approach makes the IAC procedure easier in retinoblastoma patients and shortens the fluoroscopy time.
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http://dx.doi.org/10.1007/s00234-014-1388-1DOI Listing
September 2014

Surgical treatment of innominate artery and aortic aneurysm: a case report and review of the literature.

J Cardiothorac Surg 2013 Jun 1;8:141. Epub 2013 Jun 1.

Department of Surgery and Cancer, Imperial College London, London, UK.

Innominate artery (IA) aneurysms represent 3% of all arterial aneurysms. Due to the risk of thromboembolic complications and spontaneous rupture, surgical repair is usually recommended on an early elective basis. We present the case of 81-year-old Caucasian male presenting with atypical anterior chest pain secondary to a large innominate artery aneurysm who underwent successful open surgical repair at our institution. In our experience, open correction via median sternotomy with extension into the right neck provides excellent exposure and facilitates rapid reconstruction with good short and long-term outcomes. Minimally invasive and endovascular approaches provide emerging alternatives to open IA aneurysm repair, however further research is required to better define optimal patient selection criteria and determine the long-term outcomes of these novel therapies.
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http://dx.doi.org/10.1186/1749-8090-8-141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680210PMC
June 2013

Single-stage surgical repair in a complex case of aberrant right subclavian artery aneurysm and common carotid trunk.

J Cardiothorac Surg 2013 Apr 25;8:112. Epub 2013 Apr 25.

Department of Cardiac Surgery, Evangelismos General Hospital Athens, Athens, Greece.

Aberrant right subclavian artery with coexisting common carotid trunk is an extremely rare congenital anomaly affecting <0.1% of the population. We report the case of a 77-year-old Caucasian man presenting with dysphagia and dyspnea secondary to an aberrant right subclavian artery aneurysm and describe our technique for open surgical repair.
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http://dx.doi.org/10.1186/1749-8090-8-112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646667PMC
April 2013

Intimal aortic sarcoma mimicking ruptured thoracoabdominal type IV aneurysm. A rare case report and review of the literature.

J Cardiothorac Surg 2011 Dec 11;6:162. Epub 2011 Dec 11.

1st Cardiac Surgery Department, Evaggelismos Hospital, Athens, Greece.

Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis is made either by embolic events caused by the tumor or by surrounding tissue symptoms such as pain. Herein we report an extremely rare case of a 51-year-old man previously operated for ascending aortic aneurysm, who presented with clinical and radiological findings suggestive of a ruptured thoracoabdominal type IV aneurysm. The patient underwent radical resection of the aorta and surrounding tissue with placement of a composite 4-branched graft. The diagnosis was made by frozen section and regular histopathologic examination of the specimen and the patient received adjuvant chemotherapy. Nine months after surgery the patient is still alive and has no signs of recurrence. We review the literature and discuss the option of postoperative chemotherapy.
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http://dx.doi.org/10.1186/1749-8090-6-162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250943PMC
December 2011

Ectopic hepatocellular carcinomas developed in the chest wall and skull.

Asian Cardiovasc Thorac Ann 2011 Oct;19(5):360-2

Department of Cardiothoracic and Vascular Surgery, Evaggelismos General Hospital, Athens, Greece.

A 68-year-old man presented with a suppurating mass on his skull and a palpable mass on his right upper thoracic wall. Computed tomography revealed a round mass, 70 mm in diameter, invading the right pleural cavity, and a second tumor infiltrating the skull through the left parietal bone. Both masses were resected simultaneously. Histopathology showed that both tumors were hepatocellular carcinomas.
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http://dx.doi.org/10.1177/0218492311419460DOI Listing
October 2011

Papillary fibroelastoma of the aortic valve in a β-thalassemia patient.

Gen Thorac Cardiovasc Surg 2011 Oct 8;59(10):712-4. Epub 2011 Oct 8.

Cardiac Surgery Department, Evaggelismos General Hospital, Athens, Greece.

Papillary fibroelastomas are uncommon benign tumors with frond-like growths usually arising from the heart valves. The identification of their presence is of major clinical importance owing to the fact that although rarely symptomatic they can cause coronary occlusion, stroke, and even sudden cardiac death. We present an asymptomatic 38-year-old woman with homozygous β-thalassemia in whom transthoracic echocardiography incidentally discovered an aortic mass. Two-dimensional echocardiography and magnetic resonance imaging confirmed the diagnosis of papillary fibroelastoma. Valvesparing tumor resection, even in asymptomatic patients, is recommended as the standard therapy procedure.
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http://dx.doi.org/10.1007/s11748-010-0754-0DOI Listing
October 2011

Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium.

J Cardiothorac Surg 2011 Aug 26;6:102. Epub 2011 Aug 26.

1st Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece.

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare cases.
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http://dx.doi.org/10.1186/1749-8090-6-102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170317PMC
August 2011

Effects of interval cycle training with or without strength training on vascular reactivity in heart failure patients.

J Card Fail 2011 Jul 22;17(7):585-91. Epub 2011 Apr 22.

1(st) Critical Care Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, NKUA, Athens, Greece.

Background: Exercise training confers beneficial effects on vascular reactivity in patients with chronic heart failure (CHF). This randomized study compares the effects of interval cycle training combined with strength training versus interval training alone on vascular reactivity in CHF patients.

Methods: Twenty-eight consecutive stable CHF patients (23 males, 53 ± 10 years, 28.4 ± 4.1 kg/m(2), left ventricular ejection fraction of 37 ± 12%) were randomly assigned to 3 times' weekly training sessions for 3 months, consisting of a) 40 minutes of interval cycle training (n = 14), versus b) 20 minutes of similar interval training plus 20 minutes of strength training of the quadriceps, hamstrings, muscles of the shoulder and biceps brachialis (n = 14). The work/recovery ratio of each session was 30/60 seconds. The intensity of interval training was set at 50% of the peak workload achieved at the steep ramp test (consisted of a 25-Watt increase on a cycle ergometer every 10 seconds until exhaustion). All patients underwent maximal, symptom-limited cardiopulmonary exercise testing and ultrasound evaluation of vascular reactivity by flow-mediated vasodilation (FMD) before and after the program.

Results: A significant improvement in FMD was observed in the combined training group (P = 0.002), in contrast to the interval training alone group (P = NS); the improvement was significantly greater in the combined training than in the interval training alone group (P < .05). Peak oxygen uptake increased significantly and similarly in both groups, in the interval training group (P = .03), and in the combined training group (P = .006). No significant correlation was found between FMD improvement and cardiopulmonary exercise parameters.

Conclusions: A combined high-intensity, interval cycle exercise with strength training induces a greater beneficial effect on vascular reactivity rather than interval exercise training alone in CHF patients.
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http://dx.doi.org/10.1016/j.cardfail.2011.02.009DOI Listing
July 2011

Cor triatriatum presenting as heart failure with reduced ejection fraction: a case report.

J Cardiothorac Surg 2011 Jun 14;6:83. Epub 2011 Jun 14.

Cardiac Surgery Department, Evaggelismos General Hospital, Athens, Greece.

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 - year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction.
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http://dx.doi.org/10.1186/1749-8090-6-83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141318PMC
June 2011

Acute aortic syndrome: surgical, endovascular or medical treatment.

Br J Hosp Med (Lond) 2011 May;72(5):252-8

Department of Radiology, Evangelismos General Hospital, Athens, Greece.

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http://dx.doi.org/10.12968/hmed.2011.72.5.252DOI Listing
May 2011

Frozen Elephant Trunk: a technique which can be offered in complex pathology to fix the whole aorta in one setting.

J Cardiothorac Surg 2011 May 8;6:66. Epub 2011 May 8.

Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.

We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer.We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.
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http://dx.doi.org/10.1186/1749-8090-6-66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117693PMC
May 2011

Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis.

J Cardiothorac Surg 2011 Mar 14;6:30. Epub 2011 Mar 14.

1st Cardiac Surgery Department, Evangelismos Hospital, Athens, Greece.

Background: Foramen of Morgagni hernias have traditionally been repaired by laparotomy, laparoscopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases.

Case Presentation: We present the case of a 74 year-old symptomatic male with severe aortic valve stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion.

Conclusions: Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, unless viscera strangulation and necrosis are suspected. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.
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http://dx.doi.org/10.1186/1749-8090-6-30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065407PMC
March 2011

Huge Kommerell's diverticulum associated with type-B aortic dissection.

Eur J Cardiothorac Surg 2011 Sep 23;40(3):771. Epub 2011 Feb 23.

Radiology Department, Evangelismos General Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.ejcts.2011.01.027DOI Listing
September 2011

Right aortic arch with mirror image aplasia of brachiocephalic trunk presented as subclavian steal syndrome.

Eur J Cardiothorac Surg 2011 Oct 11;40(4):1029-30. Epub 2011 Feb 11.

Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.ejcts.2010.12.039DOI Listing
October 2011

Creating arteriovenous fistula using an automatic anastomotic device.

J Vasc Surg 2011 Feb 26;53(2):531-3. Epub 2010 Sep 26.

Second Cardiac Surgery Department, Evaggelismos General Hospital, Athens, Greece.

We describe the use of the Cardica C-Port xA Distal Anastomosis System for performing an automated, arteriovenous fistula in patients on hemodialysis with end stage renal failure.
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http://dx.doi.org/10.1016/j.jvs.2010.08.008DOI Listing
February 2011
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