AMEDS Centrum has treated over 500 MS patients with chronic cerebro-spinal venous insufficiency (CCSVI) using venous angioplasty. Their patients saw improvements in quality of life measures like a 35% reduction in fatigue levels and a 13% improvement in physical health scores. The majority of patients reported an improved ability to perform daily activities and increased mobility and energy levels following the procedure.
Magnetic resonance venography & venous ultrasosnography for diagnosisng deep ...Prof. Shad Salim Akhtar
Method of detecting thrombosis in deep leg veins. Use of magnetic resonance venography in comparison to venous ultrasonography. A comparative blinded trial.
Stereotactic radiosurgery in arterio venous malformationsumesh V
Stereotactic radiosurgery (SRS) is an effective treatment for arteriovenous malformations (AVMs). SRS precisely delivers high doses of radiation to the AVM nidus, resulting in progressive occlusion of vessels within 1-3 years. Obliteration rates after SRS range from 35-92%, with higher rates for smaller AVMs receiving higher radiation doses. Careful targeting of the AVM nidus using fusion of imaging modalities is important for treatment planning. Long-term follow up with MRI is needed to monitor for obliteration and potential radiation-related effects.
1. Arteriovenous malformations (AVMs) are abnormalities in blood vessels that allow arteries to connect directly to veins without an intervening capillary bed. This disrupts normal blood flow and can cause dangerous bleeding, especially if located in the brain.
2. Diagnosis of AVMs involves various imaging techniques like CT, MRI, and cerebral angiography. Angiography provides the most detailed information but is an invasive procedure. Treatment options include endovascular embolization, microsurgery, and stereotactic radiosurgery (SRS).
3. SRS uses focused radiation to damage the AVM and cause it to close off over time. It is often used for smaller AV
This study examined the prevalence and severity of coronary artery disease (CAD) in symptomatic patients without known CAD who had a coronary artery calcium score (CACs) of zero on computed tomography angiography (CCTA). The study found that 13% of patients with a CACs of zero had non-obstructive CAD, 3.5% had obstructive CAD, and 1.4% had severe obstructive CAD. While a CACs of zero decreases the likelihood of CAD, it does not exclude it. Patients with a CACs of zero but obstructive CAD on CCTA did not have increased mortality, likely due to most cases involving single vessel disease. Among patients without calcification, the presence of greater than 50
An AVM is an abnormal connection between arteries and veins that allows blood to bypass the capillary bed. AVMs can occur anywhere but are mostly found in the brain and spine. They may be asymptomatic or cause symptoms depending on their location and size. Diagnosis involves imaging tests like CT, MRI, MRA, and DSA. Treatment options include surgery, stereotactic radiosurgery, and endovascular embolization depending on the size, location, and risk profile of the AVM. Complete surgical removal remains the gold standard treatment for lower risk AVMs to eliminate the risk of hemorrhage.
This document discusses various myths and facts regarding the protocol-based management of brain arteriovenous malformations (AVMs). It presents a multi-step decision algorithm that considers patient-related factors, AVM morphology, and the capabilities of different treatment modalities. While embolization and radiosurgery are often considered minimally invasive, the document notes important considerations regarding complications and the potential benefits of a slower occlusion. It also addresses myths around certain treatment approaches and highlights the need to carefully evaluate each patient's individual risks and AVM characteristics when determining treatment.
percutaneous therapies for mitral regurgitationRavi Kanth
This document discusses mitral regurgitation (MR) and percutaneous approaches to mitral valve repair. It provides background on the anatomy of the mitral valve and the types of MR. Surgical repair or replacement is the standard treatment for MR but percutaneous options are being developed to provide less invasive alternatives for high-risk patients. The MitraClip procedure has been used successfully in humans and involves deploying a clip to grasp and oppose the mitral valve leaflets, reducing regurgitation. Indications, outcomes, limitations, and components of the MitraClip system are described.
Magnetic resonance venography & venous ultrasosnography for diagnosisng deep ...Prof. Shad Salim Akhtar
Method of detecting thrombosis in deep leg veins. Use of magnetic resonance venography in comparison to venous ultrasonography. A comparative blinded trial.
Stereotactic radiosurgery in arterio venous malformationsumesh V
Stereotactic radiosurgery (SRS) is an effective treatment for arteriovenous malformations (AVMs). SRS precisely delivers high doses of radiation to the AVM nidus, resulting in progressive occlusion of vessels within 1-3 years. Obliteration rates after SRS range from 35-92%, with higher rates for smaller AVMs receiving higher radiation doses. Careful targeting of the AVM nidus using fusion of imaging modalities is important for treatment planning. Long-term follow up with MRI is needed to monitor for obliteration and potential radiation-related effects.
1. Arteriovenous malformations (AVMs) are abnormalities in blood vessels that allow arteries to connect directly to veins without an intervening capillary bed. This disrupts normal blood flow and can cause dangerous bleeding, especially if located in the brain.
2. Diagnosis of AVMs involves various imaging techniques like CT, MRI, and cerebral angiography. Angiography provides the most detailed information but is an invasive procedure. Treatment options include endovascular embolization, microsurgery, and stereotactic radiosurgery (SRS).
3. SRS uses focused radiation to damage the AVM and cause it to close off over time. It is often used for smaller AV
This study examined the prevalence and severity of coronary artery disease (CAD) in symptomatic patients without known CAD who had a coronary artery calcium score (CACs) of zero on computed tomography angiography (CCTA). The study found that 13% of patients with a CACs of zero had non-obstructive CAD, 3.5% had obstructive CAD, and 1.4% had severe obstructive CAD. While a CACs of zero decreases the likelihood of CAD, it does not exclude it. Patients with a CACs of zero but obstructive CAD on CCTA did not have increased mortality, likely due to most cases involving single vessel disease. Among patients without calcification, the presence of greater than 50
An AVM is an abnormal connection between arteries and veins that allows blood to bypass the capillary bed. AVMs can occur anywhere but are mostly found in the brain and spine. They may be asymptomatic or cause symptoms depending on their location and size. Diagnosis involves imaging tests like CT, MRI, MRA, and DSA. Treatment options include surgery, stereotactic radiosurgery, and endovascular embolization depending on the size, location, and risk profile of the AVM. Complete surgical removal remains the gold standard treatment for lower risk AVMs to eliminate the risk of hemorrhage.
This document discusses various myths and facts regarding the protocol-based management of brain arteriovenous malformations (AVMs). It presents a multi-step decision algorithm that considers patient-related factors, AVM morphology, and the capabilities of different treatment modalities. While embolization and radiosurgery are often considered minimally invasive, the document notes important considerations regarding complications and the potential benefits of a slower occlusion. It also addresses myths around certain treatment approaches and highlights the need to carefully evaluate each patient's individual risks and AVM characteristics when determining treatment.
percutaneous therapies for mitral regurgitationRavi Kanth
This document discusses mitral regurgitation (MR) and percutaneous approaches to mitral valve repair. It provides background on the anatomy of the mitral valve and the types of MR. Surgical repair or replacement is the standard treatment for MR but percutaneous options are being developed to provide less invasive alternatives for high-risk patients. The MitraClip procedure has been used successfully in humans and involves deploying a clip to grasp and oppose the mitral valve leaflets, reducing regurgitation. Indications, outcomes, limitations, and components of the MitraClip system are described.
Perfusion and dynamic contrast enhanced mrifahad shafi
This document discusses dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) techniques for measuring tissue perfusion. It describes how DCE-MRI analyzes the passage of gadolinium contrast agents through tissue over time to provide quantitative measurements of microvascular properties like permeability and blood flow. The document outlines the principles, image acquisition, and qualitative, semi-quantitative, and quantitative analysis methods for DCE-MRI. It also discusses applications for evaluating brain tumors and other disorders.
This document discusses intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing coronary artery disease and optimizing percutaneous coronary interventions. It provides an overview of the basic principles, equipment, and clinical applications of IVUS and OCT. IVUS and OCT produce high-resolution cross-sectional images of coronary arteries, allowing for more accurate evaluation of vessel size, plaque morphology, and stent results compared to angiography alone. Both modalities can help answer questions that arise during interventional cardiology procedures. Patients with complex coronary disease may especially benefit from an approach that incorporates intravascular imaging.
This document summarizes the current status of surgical and transcatheter mitral valve repair. It notes that mitral valve repair surgery has low risks and good outcomes when appropriate procedures are used. However, around 50% of symptomatic patients with severe mitral regurgitation are denied surgery. New transcatheter techniques are being developed as alternatives to surgery, including the MitraClip edge-to-edge repair device, annuloplasty devices, and future prospects for transcatheter mitral valve replacement. Early experiences with MitraClip show it reduces mitral regurgitation in many patients but long-term outcomes need further study. An individualized approach is needed to determine the best repair option based on a patient's anatomy,
The Barrow Ruptured Aneurysm Trial (BRAT) aimed to include all eligible patients with ruptured brain aneurysms to compare microsurgical clipping versus endovascular coiling. At 3-year follow-up, 35.8% of patients assigned to clipping and 30% assigned to coiling had poor outcomes, though this difference was no longer significant. Patients who crossed over from coiling to clipping had worse outcomes than those who remained in the coiled group. For posterior circulation aneurysms, outcomes were significantly better with coiling than clipping. While coiling reduces retreatment needs, clipping provides better aneurysm occlusion and protection from rebleeding long-term. Both treatments remain important options.
SWI , high susceptibility for blood products, iron depositions, and calcifications
makes susceptibility-weighted imaging an important additional sequence for the diagnostic
workup of pediatric brain pathologic abnormalities. Compared with conventional MRI
sequences, susceptibility-weighted imaging may show lesions in better detail or with higher
sensitivity
new technologies for Mitral regurgitationdrmaisano
This document discusses potential treatments for mitral regurgitation beyond the MitraClip procedure. It notes that while the MitraClip is effective for selected patients, other options are needed to treat a wider range of patients. These include open heart surgery, combining approaches synergistically, and new technologies such as annuloplasty, neochordae implantation, and mitral valve replacement. Several new transcatheter techniques are discussed such as devices to implant neochordae or reshape the coronary sinus. The document emphasizes tailoring the treatment approach to each individual patient based on their anatomy, comorbidities, and goals of care.
This document describes a study that compared outcomes of intravascular ultrasound (IVUS)-guided drug-eluting stent implantation versus angiography-guided implantation in all patients (all-comers) undergoing percutaneous coronary intervention. The study found that IVUS guidance resulted in a significantly lower rate of the primary endpoint, target vessel failure, at 12-month follow-up compared to angiography guidance. Patients who had an IVUS-defined optimal procedure also had lower rates of the primary endpoint than those with a suboptimal procedure.
Vascular malformations are difficult to treat and patients are affected psychologically and physically. The aim of the presentation is to discuss various treatment modalities available for management of venous malformations of Hand.
Intracoronary Imaging – when to use, how to use and how to interpret the imagesEuro CTO Club
This document discusses the use of intravascular ultrasound (IVUS) in chronic total occlusion (CTO) percutaneous coronary interventions (PCI). IVUS can aid in CTO PCI in several ways, including guiding wiring of ostial lesions, sizing balloons for reverse controlled antegrade and retrograde subintimal tracking techniques, guiding re-entry maneuvers, assessing distal vessels, optimizing stent placement, and managing complications. Studies show IVUS guidance may improve outcomes after CTO PCI compared to angiography alone. IVUS provides valuable information on stent expansion and placement that can influence long-term results. While useful, IVUS requires contrast administration and cannot be used for real-time guidance in some techniques like controlled antegrade
Percutaneous Transcatheter Mitral Valve ReplacementShadab Ahmad
Symptomatic mitral regurgitation (MR) conveys significant morbidity and mortality. However, many patients with severe MR are not treated with surgery due to advanced age, left ventricular (LV) dysfunction, or other comorbidities. This unmet clinical need has driven the development of safer, catheter-based treatments for mitral valve disease.
Transcatheter mitral valve repair can be safe and effective in patients with suitable anatomy.
Spinal Tumors: approach and managementAmit Agrawal
The spinal cord consists of
Central canal surrounded by an H-shaped gray matter region containing neurons
Outer myelinated nerve tracts, termed white matter, surround the central gray matter
Central canal is lined with ependymal cells
Astrocytes support gray matter neurons and white matter axons
Meningiomas are the most common benign brain tumors, arising from the meninges. They occur most often in the 7th decade of life and are more common in women. Risk factors include genetic conditions like NF2 and prior radiation exposure. Common locations include the parasagittal/falcine region, convexity, sphenoid ridge, and posterior fossa. Imaging with CT and MRI is used to characterize the tumor. Surgery is the primary treatment when possible, with the goal of Simpson Grade I resection. Radiation therapy can be used for inoperable or residual tumors. Prognosis is generally good for Grade I meningiomas but poorer for higher grades.
The COFIDIS study aims to prove the superiority of the radial approach compared to the femoral approach for coronary interventions in patients with fistulas for dialysis in terms of vascular and bleeding complications. The study is a prospective, multicenter, randomized trial that will enroll 784 patients undergoing planned coronary interventions who will be randomized 1:1 to either radial or femoral access. The primary endpoint is the total in-hospital vascular and bleeding complications. Secondary endpoints include major and minor bleeding, vascular complications, radial occlusion rates, and outcomes at 6 months. The results of this study could demonstrate that the radial approach reduces complications in dialysis patients undergoing coronary procedures.
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
This document discusses subarachnoid hemorrhage (SAH), providing information on epidemiology, clinical presentation, causes, imaging techniques, and complications. It can be summarized as follows:
SAH most commonly results from a ruptured intracranial aneurysm (80% of cases), with imaging playing a key role in confirming the presence of SAH, identifying its cause, and detecting complications. CT and CT angiography are the initial imaging modalities, allowing diagnosis of SAH in 95% of cases as well as characterization of aneurysms. MR angiography and cerebral angiography provide alternatives for evaluating SAH of unknown origin or atypical presentations. Managing SAH requires a multidisciplinary approach including emergency
Usefulness of Non-Enhanced 3-Dementional CT with Partial Maximum Intensity Pr...science journals
Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs).
How to learn the catheter skill techniquesdrmaisano
The document discusses the need for cross-training of surgeons and interventional cardiologists in percutaneous heart valve treatment. It states that the procedure requires skills independent of one's base discipline, and that specific training is required. Those undergoing the procedural training should be experienced interventionalists or surgeons. The document then outlines various pathways for acquiring the necessary skills through simulation, proctoring, visiting other centers, and industry-supported opportunities.
Perfusion and dynamic contrast enhanced mrifahad shafi
This document discusses dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) techniques for measuring tissue perfusion. It describes how DCE-MRI analyzes the passage of gadolinium contrast agents through tissue over time to provide quantitative measurements of microvascular properties like permeability and blood flow. The document outlines the principles, image acquisition, and qualitative, semi-quantitative, and quantitative analysis methods for DCE-MRI. It also discusses applications for evaluating brain tumors and other disorders.
This document discusses intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing coronary artery disease and optimizing percutaneous coronary interventions. It provides an overview of the basic principles, equipment, and clinical applications of IVUS and OCT. IVUS and OCT produce high-resolution cross-sectional images of coronary arteries, allowing for more accurate evaluation of vessel size, plaque morphology, and stent results compared to angiography alone. Both modalities can help answer questions that arise during interventional cardiology procedures. Patients with complex coronary disease may especially benefit from an approach that incorporates intravascular imaging.
This document summarizes the current status of surgical and transcatheter mitral valve repair. It notes that mitral valve repair surgery has low risks and good outcomes when appropriate procedures are used. However, around 50% of symptomatic patients with severe mitral regurgitation are denied surgery. New transcatheter techniques are being developed as alternatives to surgery, including the MitraClip edge-to-edge repair device, annuloplasty devices, and future prospects for transcatheter mitral valve replacement. Early experiences with MitraClip show it reduces mitral regurgitation in many patients but long-term outcomes need further study. An individualized approach is needed to determine the best repair option based on a patient's anatomy,
The Barrow Ruptured Aneurysm Trial (BRAT) aimed to include all eligible patients with ruptured brain aneurysms to compare microsurgical clipping versus endovascular coiling. At 3-year follow-up, 35.8% of patients assigned to clipping and 30% assigned to coiling had poor outcomes, though this difference was no longer significant. Patients who crossed over from coiling to clipping had worse outcomes than those who remained in the coiled group. For posterior circulation aneurysms, outcomes were significantly better with coiling than clipping. While coiling reduces retreatment needs, clipping provides better aneurysm occlusion and protection from rebleeding long-term. Both treatments remain important options.
SWI , high susceptibility for blood products, iron depositions, and calcifications
makes susceptibility-weighted imaging an important additional sequence for the diagnostic
workup of pediatric brain pathologic abnormalities. Compared with conventional MRI
sequences, susceptibility-weighted imaging may show lesions in better detail or with higher
sensitivity
new technologies for Mitral regurgitationdrmaisano
This document discusses potential treatments for mitral regurgitation beyond the MitraClip procedure. It notes that while the MitraClip is effective for selected patients, other options are needed to treat a wider range of patients. These include open heart surgery, combining approaches synergistically, and new technologies such as annuloplasty, neochordae implantation, and mitral valve replacement. Several new transcatheter techniques are discussed such as devices to implant neochordae or reshape the coronary sinus. The document emphasizes tailoring the treatment approach to each individual patient based on their anatomy, comorbidities, and goals of care.
This document describes a study that compared outcomes of intravascular ultrasound (IVUS)-guided drug-eluting stent implantation versus angiography-guided implantation in all patients (all-comers) undergoing percutaneous coronary intervention. The study found that IVUS guidance resulted in a significantly lower rate of the primary endpoint, target vessel failure, at 12-month follow-up compared to angiography guidance. Patients who had an IVUS-defined optimal procedure also had lower rates of the primary endpoint than those with a suboptimal procedure.
Vascular malformations are difficult to treat and patients are affected psychologically and physically. The aim of the presentation is to discuss various treatment modalities available for management of venous malformations of Hand.
Intracoronary Imaging – when to use, how to use and how to interpret the imagesEuro CTO Club
This document discusses the use of intravascular ultrasound (IVUS) in chronic total occlusion (CTO) percutaneous coronary interventions (PCI). IVUS can aid in CTO PCI in several ways, including guiding wiring of ostial lesions, sizing balloons for reverse controlled antegrade and retrograde subintimal tracking techniques, guiding re-entry maneuvers, assessing distal vessels, optimizing stent placement, and managing complications. Studies show IVUS guidance may improve outcomes after CTO PCI compared to angiography alone. IVUS provides valuable information on stent expansion and placement that can influence long-term results. While useful, IVUS requires contrast administration and cannot be used for real-time guidance in some techniques like controlled antegrade
Percutaneous Transcatheter Mitral Valve ReplacementShadab Ahmad
Symptomatic mitral regurgitation (MR) conveys significant morbidity and mortality. However, many patients with severe MR are not treated with surgery due to advanced age, left ventricular (LV) dysfunction, or other comorbidities. This unmet clinical need has driven the development of safer, catheter-based treatments for mitral valve disease.
Transcatheter mitral valve repair can be safe and effective in patients with suitable anatomy.
Spinal Tumors: approach and managementAmit Agrawal
The spinal cord consists of
Central canal surrounded by an H-shaped gray matter region containing neurons
Outer myelinated nerve tracts, termed white matter, surround the central gray matter
Central canal is lined with ependymal cells
Astrocytes support gray matter neurons and white matter axons
Meningiomas are the most common benign brain tumors, arising from the meninges. They occur most often in the 7th decade of life and are more common in women. Risk factors include genetic conditions like NF2 and prior radiation exposure. Common locations include the parasagittal/falcine region, convexity, sphenoid ridge, and posterior fossa. Imaging with CT and MRI is used to characterize the tumor. Surgery is the primary treatment when possible, with the goal of Simpson Grade I resection. Radiation therapy can be used for inoperable or residual tumors. Prognosis is generally good for Grade I meningiomas but poorer for higher grades.
The COFIDIS study aims to prove the superiority of the radial approach compared to the femoral approach for coronary interventions in patients with fistulas for dialysis in terms of vascular and bleeding complications. The study is a prospective, multicenter, randomized trial that will enroll 784 patients undergoing planned coronary interventions who will be randomized 1:1 to either radial or femoral access. The primary endpoint is the total in-hospital vascular and bleeding complications. Secondary endpoints include major and minor bleeding, vascular complications, radial occlusion rates, and outcomes at 6 months. The results of this study could demonstrate that the radial approach reduces complications in dialysis patients undergoing coronary procedures.
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
This document discusses subarachnoid hemorrhage (SAH), providing information on epidemiology, clinical presentation, causes, imaging techniques, and complications. It can be summarized as follows:
SAH most commonly results from a ruptured intracranial aneurysm (80% of cases), with imaging playing a key role in confirming the presence of SAH, identifying its cause, and detecting complications. CT and CT angiography are the initial imaging modalities, allowing diagnosis of SAH in 95% of cases as well as characterization of aneurysms. MR angiography and cerebral angiography provide alternatives for evaluating SAH of unknown origin or atypical presentations. Managing SAH requires a multidisciplinary approach including emergency
Usefulness of Non-Enhanced 3-Dementional CT with Partial Maximum Intensity Pr...science journals
Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs).
How to learn the catheter skill techniquesdrmaisano
The document discusses the need for cross-training of surgeons and interventional cardiologists in percutaneous heart valve treatment. It states that the procedure requires skills independent of one's base discipline, and that specific training is required. Those undergoing the procedural training should be experienced interventionalists or surgeons. The document then outlines various pathways for acquiring the necessary skills through simulation, proctoring, visiting other centers, and industry-supported opportunities.
Intravascular ultrasound (IVUS) allows for a 360-degree tomographic view of the vessel wall from inside and more accurate assessment of venous pathologies than venography. IVUS is used in diagnosing and treating Chronic Cerebrospinal Venous Insufficiency by precisely locating narrowings for angioplasty procedures. The azygos and jugular veins are routinely assessed during IVUS while renal and iliac veins can be examined if the lumen allows; angioplasty of detected lesions may then be done. IVUS can optimize angioplasty results by providing more accurate information on lesions than venography.
1. The document discusses Chronic Cerebrospinal Venous Insufficiency (CCSVI), a condition linked to multiple sclerosis (MS) where veins draining the brain and spinal cord are narrowed or blocked.
2. It provides details on diagnosing and treating CCSVI using procedures like Doppler ultrasound, MRI, venography, and venous angioplasty to widen blocked veins.
3. While the relationship between CCSVI and MS is still being studied, the document reports that over 600 MS patients treated for CCSVI experienced reduced fatigue, improved quality of life, psychological state, and physical condition based on evaluation scales.
This document discusses sonographic evaluation for diagnosing upper extremity deep venous thrombosis (UEDVT). It provides an overview of the risk factors and complications of UEDVT. Color Doppler sonography is outlined as the preferred noninvasive screening technique, with sensitivity of 78-100% and specificity of 82-100% for diagnosing UEDVT. The normal venous anatomy of the upper extremity is described and techniques for performing the sonographic examination are explained. Examples of sonographic appearances of acute and chronic UEDVT are illustrated and described.
1. The document discusses cerebral venous thrombosis (CVT), providing statistics on incidence and demographics.
2. It describes the most commonly thrombosed venous structures as being the superior sagittal sinus, lateral sinus, and straight sinus.
3. Imaging findings of CVT include direct visualization of clot, absence of flow voids, empty delta sign on contrast-enhanced CT or MR, and venous infarction patterns like bilateral parasagittal lesions.
Trans-Cranial Doppler (TCD) is a non-invasive ultrasound technique used to evaluate cerebral blood flow velocities. There are two main types of TCD devices - non-duplex devices which identify arteries "blindly" based on Doppler shift and duplex devices which combine Doppler with B-mode imaging to directly visualize arteries. TCD allows evaluation of intracranial steno-occlusive disease, vasospasm, aneurysms, and other conditions. It can detect elevated velocities indicative of stenosis but has limitations including operator dependence and inability to image distal arteries. TCD is useful for monitoring conditions like sickle cell disease where elevated velocities increase stroke risk.
This study investigated the use of susceptibility vessel sign (SVS) on susceptibility weighted imaging (SWI) MRI to detect thrombus in patients with acute ischemic stroke. The study found that SVS was present in 62.8% of patients with confirmed vessel occlusion on MR angiography. SVS detection was correlated with risk factors like cardiac disease and territories of occlusion like the MCA. A moderate correlation was also found between thrombus length seen with SVS and NIH stroke scale scores. However, the study was limited by its small sample size and retrospective design. In conclusion, SVS on SWI can help identify thrombus location and burden in acute stroke.
1. Magnetic resonance angiography (MRA) is a non-invasive imaging technique that uses magnetic resonance imaging to visualize blood vessels and evaluate vascular anatomy and blood flow without using ionizing radiation or iodinated contrast material.
2. There are different MRA techniques including time-of-flight MRA, phase contrast MRA, and contrast-enhanced MRA. Time-of-flight MRA relies on differences in flowing and stationary blood signal while phase contrast MRA assesses velocity and direction of flow. Contrast-enhanced MRA uses gadolinium contrast to improve vessel depiction.
3. MRA has various clinical applications for evaluating carotid and intracranial arterial stenosis, aneurysms,
Doppler ultrasound is useful for diagnosing the severity of vascular diseases. The study investigated 84 patients between 30-70 years old, including 46 with clinical forms of acute ischemic stroke (AIT) and other non-specific neurological diseases, using Doppler ultrasound and echocardiography to evaluate carotid disease and left ventricular ejection fraction. The results showed most patients had 10-50% carotid stenosis, with highest numbers between ages 40-60. The study concluded that non-invasive investigation of both coronary and carotid disease could help reduce pre- and post-surgical complications for patients with vascular disease by evaluating both disorders in a single session.
This document discusses the use of multi-modal CT scanning in evaluating patients with cerebrovascular disease. It begins by introducing ischemic stroke as a leading cause of disability and mortality. It then discusses how CT has evolved as a non-invasive imaging tool to evaluate carotid artery pathology and intracranial vessels. In particular, it describes the use of CT angiography (CTA) to assess vessel lumen and plaque characteristics, and CT perfusion (CTP) to provide information on brain vascular physiology and identify ischemic penumbra. The document provides details on CT protocols for CTA and CTP, and discusses how findings from these techniques can predict stroke risk and guide treatment decisions. It focuses on how CTA allows evaluation of
Neurosurgical management of ischemic strokeDrkedirDekebi
This document summarizes neurosurgical management of cerebrovascular accidents (CVAs) and spontaneous intracerebral hemorrhage (sICH). It discusses the pathophysiology and clinical presentation of ischemic stroke and transient ischemic attacks. Imaging techniques for evaluation including CT, CTA, MRI, and MRA are outlined. Endovascular and surgical revascularization options for acute ischemic stroke are described, including limitations of intravenous thrombolysis. The document also reviews evaluation and management of atherosclerotic carotid artery stenosis, indicating criteria for medical management, carotid endarterectomy, and carotid angioplasty/stenting.
The document provides information about brain metastasis including:
- Brain metastasis are cancer cells that have spread to the brain from primary tumors elsewhere in the body. Lung cancer, breast cancer, melanoma, and renal cancer are common sources.
- Symptoms depend on the location of metastases and can include headaches, nausea, focal weakness, seizures, and alterations in consciousness. Diagnosis is typically made through MRI or CT imaging.
- Treatment involves steroids, anticonvulsants, surgery to remove solitary metastases, stereotactic radiosurgery for a small number of lesions, whole brain radiation, and occasionally chemotherapy. The prognosis is generally poor with a median survival of 4-5 months.
Arteriovenous Malformations are one of the toughest cerebral pathologies to manage with high post op mortality and morbidity. this powerpoint contains classification, grading and managment of various severity of AVMs
The study investigated the relationship between dilated Virchow-Robin spaces (VRS) seen on MRI and cerebral microvascular disease in elderly patients with dementia. 75 patients with Alzheimer's disease, ischemic vascular dementia, or frontotemporal dementia underwent MRI and were compared to 35 healthy volunteers. VRS scores were significantly higher in patients with vascular dementia compared to those with Alzheimer's disease, frontotemporal dementia, or healthy volunteers. VRS scores accounted for 29% of the variance in a regression model, more than periventricular hyperintensities, suggesting dilated VRS are a sensitive indicator of cerebral microvascular disease.
The document describes the anatomy of the carotid arteries and their branches, evaluation and imaging of carotid artery disease, and treatment strategies including lifestyle modifications to reduce risk factors, carotid endarterectomy to remove plaques from significantly stenotic arteries, and outcomes data from clinical trials on endarterectomy for symptomatic and asymptomatic carotid stenosis. Imaging modalities like carotid duplex ultrasound, CTA, and MRA are described for evaluating the degree of carotid stenosis. The benefits of carotid endarterectomy are greater for symptomatic high-grade stenosis while more moderate for asymptomatic disease.
Percutaneous Valve implantation or Operation in aortic stenosisdrucsamal
1) This document describes the case of an 80-year-old male patient with severe aortic stenosis, mitral valve disease, and reduced left ventricular function who is being evaluated for treatment.
2) Echocardiography revealed severe aortic stenosis, mild aortic regurgitation, moderate-severe mitral regurgitation, and severe tricuspid regurgitation with a reduced ejection fraction of 30%.
3) Due to his age and comorbidities, the patient is at high surgical risk. Transcatheter aortic valve implantation (TAVI) may be a safer alternative to surgical aortic valve replacement (AVR) plus mitral valve surgery.
Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserv...Premier Publishers
Fraction flow reserve (FFR) is considered the gold standard for assessing intermediate coronary lesions. Retrospective data analyses showed variable relationship between intravascular ultrasound (IVUS) parameters and FFR results. This study aimed to determine the optimal minimum lumen area (MLA) by IVUS that correlates with FFR and to assess the correlation between two modalities in assessing intermediate coronary lesions. Methods: Fifty eight intermediate coronary lesions mainly located in proximal and mid segments of large main coronary vessels with RVD (3-4mm) were analyzed using both IVUS and FFR to assess the significance of coronary stenting and to determine the optimal IVUS-MLA that correlates with FFR value < 0.8. Results: IVUS-MLA ranged from 2.5 to 4.2 mm2 had a highly significant positive correlation with FFR value < 0.8 (p < 0.0001). Using the ROC curve analysis, IVUS-MLA < 3.9 mm2 (84.2% sensitivity, 80% specificity, area under curve (AUC) = 0.68) was the best threshold value for identifying FFR <0.8>< 0.8 in coronary vessels with RVD (3-4mm). Different MLA cutoffs should be used for different vessel diameters.
1. Arteriovenous malformations (AVMs) are abnormalities of blood vessels in the brain that directly connect arteries and veins without an intervening capillary bed.
2. The document discusses the epidemiology, presentation, diagnosis, grading scales, and management of cerebral AVMs.
3. Treatment options include microsurgery, radiosurgery, and endovascular embolization, with the approach depending on factors like the AVM size, location, and vascular anatomy. Small, non-eloquent Spetzler-Martin Grade 1 or 2 lesions are generally best treated with microsurgery.
Efek varicocelectomy tentang aliran arteri antara laaproskopik dengan mikroandilania
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Similar to 1st medical report on ccsvi treatment ameds centrum (20)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
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5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
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9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
2. Since 2010 AMEDS Centrum has
professionally dealt with the diagnosis
and treatment of chronic cerebro-spinal
venous insufficiency (CCSVI). The statistical AMEDS Centrum
patient has been diagnosed with MS
This venous system pathology, which has 11 years ago. The majority of
only recently been described patients suffered from secondary
by Prof. P. Zamboni, shares a striking progressive MS. Pre-operation, our
similarity with multiple sclerosis (MS). patients were assessed on the 10
Our center has treated more than 500 point Expanded Disability Status
MS patients, from Poland and abroad Scale (EDSS), with the average patient
(a majority of patients have come from score of 5.5 points.
Canada and the Scandinavian
countries), 38% of which have been
men. Average age of our patients was MS type
46 years.
Patients by gender Relapsing-
remitting
24%
37%
Secondary
38% progressive
Female 39%
62% Male Primary
progressive
Chart 1.1.: Chart 1.3.:
Distribution of AMEDS Centrum patients by Distribution of AMEDS Centrum patients by MS type
3. Patients by age
100
90
80 Female Male
70
60
50
40
30
20
10
0
Male
20-30 years
30-40 years Female
40-50 years
50-60 years
>60 years
Chart 1.2.: Distribution of AMEDS Centrum patients by age
4. DIAGNOSIS AND TREATMENT
Ultrasound (Doppler and transcranial)
The basic method used in the diagnosis of patients with chronic cerebro-
spinal venous insufficiency (CCSVI) is a Doppler ultrasound. It is a safe and
completely non-invasive diagnosis of the vascular system. The equipment
we use at AMEDS Centrum is the "MyLabVinco" from the Italian company
Esaote, designed for both extra and intracranial testing. 3D Doppler
technology is used to determine the hemodynamic severity of venous
insufficiency.
Prevalence of changes observed in
The following parameters are assessed during
Doppler ultrasound
diagnosis: 70%
The presence of venous stenosis 60%
Circulatory disorders and reversed blood flow 50% 62%
(reflux) 40%
30%
Flow change in extra-cranial veins dependent on 20%
33%
28%
body position 10%
The presence of valvular disease 0%
Stenosis Reflux Valves
Chart 2.1.
The above chart shows the prevalence of abnormalities that were discovered
in patients who underwent Doppler examination.
5. Magnetic Resonance Imaging (MRI)
MRI of the brain and neck has two main purposes:
The assessment of brain activity in the context of
determining the presence and location of
demyelinating lesions, as well as the possible
presence of other abnormalities.
Evaluation of venous outflow, in particular the
jugular and azygos veins. The analysis includes:
symmetry of venous outflow, width and patency of
the veins, as well as an assessment of any
stenosis or vein modeling caused by adjacent
anatomical structures.
The examination of the venous system is made using modern techniques with the
use of a contrast agent (which allows for optimum picture clarity): Multi-phase MRI
venography as well as a T1-weighted 3D GRE sequence of very high
resolution, which guarantees very high quality images.
The contrast agents used are paramagnetic and result in negligible, mild side
effects (headaches, hot flashes, extremely rare allergic reactions). The MRI contrast
agent we use has been rated by the European Society of Urogenital Radiology as one
of the safest agents available. Moreover, this contrast agent contains a higher
concentrations of paramagnetic media than other contrast agents, and also
improves relaxation times – these traits guarantee an optimal level of contrast
enhancement in MR Venography, which in turn permits a more accurate evaluation
to be performed.
6. DIAGNOSIS AND TREATMENT
VENOGRAPHY
The final step in the diagnostic process is a venography, which produces the most
reliable diagnosis of abnormalities in the venous system. It consists of the
administration of a contrast agent into the vein via a catheter (inserted in either
the femoral or subclavian vein). This allows the most accurate visualization of
vascular lesions. This procedure is invasive and therefore entails a risk of
complications. Venography precedes any intra-vascular operations.
The venography procedure allows for an exact examination and imaging of the
venous system, which provides an excellent method of verifying and confirming
the presence of any abnormalities detected by Doppler or MRV. The below
drawings show the prevalence of stenosis detection using Doppler ultrasound and
venography (IJVR – right internal jugular vein; IJVL – left internal jugular vein; VVR
– right vertebral vein; VVL – left vertebral vein;
AV – azygos vein).
7. VENOUS ANGIOPLASTY
Venous angioplasty, also known as
balloon angioplasty, is the basic
method of treatment applied to
CCSVI patients at AMEDS Centrum. ANGIOPLASTY STENTS
In rare instances, when
necessary, stents are inserted. Left internal 401 32
jugular vein
Venous angioplasty is a procedure
performed for widening the Right 389 15
constricted vein with the use of a internal
special catheter placed in the vein via
percutaneous access (the catheter is jugular vein
introduced in the groin area, into the
femoral vein). Azygos vein 37 7
A balloon is then inserted into the
constricted vein and inflated with
gas.
The risk of complications connected
with the procedure is estimated to be
less than 3%, with the risk of serious
events staying below 1,5%.
8. Treatment results – neurological state
Fatigue Severity Scale (FSS)
6
In two thirds of patients with
multiple sclerosis, chronic fatigue is 5.5
an accompanying symptom of the 5
disease and always a big problem for 35%
the patient. The FSS scale helps in 4.5
assessing fatigue levels. The scale is 4
from
3.5
1 to 7, with higher scores reflecting 5,37
higher fatigue levels (scores above 3 3,67
5.5 signify severe fatigue). 2.5
Our patients have been observed to
2
experience a marked improvement in
the incidence of fatigue (a reduction Pre-op
Chart 3.1.: Fatigue Severity Scale
Post-op
of 35% on the FSS scale!) and a
dramatic increase in strength and
energy.
9. Multiple Sclerosis Impact Scale 29 (MSIS-29)
Multiple Sclerosis Impact Scale 29 (MSIS-29) is a proven and reliable scale
for measuring the quality of life in patients with MS.
The patient answers 29 questions (20 regarding physical
state, coordination and mobility and 9 about mental state). After the
score is calculated we obtain a result on a scale of 0-100, where the
higher the score, the worse the state of health of the patient.
AMEDS Centrum patients who have undergone treatment display a
noticeable improvement in mental and physical health – shown below –
with a corresponding reduction of points on the MSIS-29 scale.
68
62
60 66
58
64
56
13% 67
54 61 62
9%
52
60
50 53 61
48 58
Pre-op Post-op Pre-op Post-op
Chart 3.2.: MSIS-29 Psychological compound Chart 3.3.: MSIS-29 Physical compound
10. Treatment results – quality of life
In order to assess the influence that treatment at AMEDS Centrum has on
the quality of life and level of improvement in different aspects of
functioning, we have devised a special survey for our patients.
Within 4-6 months of treatment we asked our patients to answer the
questions found in our survey.
Below are the results of a couple of selected questions:
How would you describe your current Have you noticed any changes in the state
state of health? of your health since treatment?
100%
60% 87%
44% 80%
40%
60%
30%
17% 40%
20%
9% 20%
13%
0%
0%
Very good Good Average Bad
Yes No
11. How would you describe your current
How would you rate your current ability
mobility in comparison to your mobility
to perform day-to-day activities?
before treatment?
60% 55%
40% 36%
32%
40% 36%
24%
20%
20%
8% 9%
0%
0% It has improved It is the same as It is worse than
It has It has It has not It has gotten since treatment - I before the before treatment
significantly improved improved worse am more treatment
improved independent
How would you rate your current problems with severe
fatigue?
80%
64%
60%
40%
31%
20%
5%
0%
It has improved since It is the same as before It is worse than before
treatment treatment treatment
12. We have performed over 500 venous angioplasty to
Summary date at AMEDS Centrum. The positive effects of
treatment of MS patients are noticeable both in the
objective assessment of the patients’ quality of life
as per the MSIS-29 system, as well as in our own
assessment. Based on the scale for measuring
fatigue levels, improvements reach up to 35%.
After 4-6 months, more than half of our patients
report a positive change in mobility and daily
activity.
In addition to the services currently offered, the staff
of AMEDS Centrum plans to conduct clinical trials
into the efficacy and safety of angioplasty in CCSVI
patients. We also actively participate in international
scientific conferences (CCSVI Congress
Glasgow, October 2010, Venous Endovascular Forum
Katowice, March 2011, ISNVD&CNR Congress
Bologna, March 2011) where we present our own
experiences and keep abreast of progress in the
field.
Maciej Zarębiński, MD, PhD Dr. Maciej Zarębiński, AMEDS Centrum Medical Team
Leader, would like to thank all our patients for
placing their trust in us and for sharing (by
answering our survey) their opinions on the
treatment they received at AMEDS Centrum.
13. “The existence of CCSVI, its relation to MS and the legitimacy of
performing balloon angioplasty is the source of much
controversy among – and is dismissed by many – neurologists.
This state of affairs is the result of unfamiliarity with CCSVI, an
attachment to their theory of immuno-inflammatory disease, as
well as a conviction that procedures using stents (which are
rarely used) are dangerous. Reports presented at two
international symposia devoted to CCSVI in Katowice and
Bologna in March, 2011 confirm the association of CCSVI with
MS. As a result of venous re-canalization after angioplasty, it
has been objectively confirmed that the levels of venous oxygen
saturation do improve. The reports emphasized the positive
influence balloon angioplasty has on the quality of life of
Prof. Jerzy Kotowicz patients, on their fatigue levels, on bladder disorders, balance
disorders, vision problems, sensory problems and, to a lesser
Professor Jerzy
Kotowicz, MD, PhD is a degree, mobility issues. Improvement was also noted in
prominent cognitive abilities (memory, concentration, attention).
neurologist, specialist and
authority on multiple At present, results are not yet in regarding the clinical trials
sclerosis. He is the author of
more than 80 scientific conducted on the basis of “good medical practice” and
papers in the Polish and “evidence based medicine” which were begun in the middle of
international medical
literature. Since 2006 he has 2010, and no long-term results of venous angioplasty are
served as chairman of the known. The results of these studies will only become available
Review Committee of the
Polish Clinical in the future and settle the question of this treatment’s
Neurophysiology
Association, he is the vice-
effectiveness. The desire of the patient for treatment is highly
president of the Advisory understandable, though, especially in light of the disease’s
Board to the Polish Multiple
Sclerosis Society. He has
progress and the lack of effectiveness of other treatments
served two terms as the vice- available.“
president of the Polish
Clinical Neurophysiology
Association.
Professor Jerzy Kotowicz, MD, PhD
14. Our common goal is to improve MS Patients’ quality of life
and establish a new quality in MS Rehabilitation.
Address:
ul. Daleka 11
05-825 Grodzisk Mazowiecki, Poland