Carlo Reale | "Tor Vergata" University of Rome (original) (raw)

Papers by Carlo Reale

Research paper thumbnail of Carotid Artery Stenting: risultati dopo otto anni di esperienza

Research paper thumbnail of Costi diretti non sanitari, perdite di produttività e costo efficacia delle diverse ipotesi di trattamento delle lesioni ischemiche periferiche superficiali nel paziente diabetico

Research paper thumbnail of Use of Covered Stents in Treatment of Large Neck Internal Carotid Artery Pseudoaneurysms

PURPOSE To demonstrate the safety and efficacy of endovascular treatment, using covered stents, o... more PURPOSE To demonstrate the safety and efficacy of endovascular treatment, using covered stents, of large neck internal carotid artery pseudoaneurysms,. METHOD AND MATERIALS Between 1999-2003 we treated 6 patients with large neck pseudoaneurysms. 4 pseudoaneurysms post-traumatic and 2 spontaneous; 4 patients were symptomatic. The diameter of the pseudoaneurysms varied between 10-45 mm, with a wide neck between 8 and 25 mm. In all patients a 6Fr guiding catheter was positioned into the ICA. 4 Symbiot ePTFE covered stents, 1 JOSTENT and 1 Advanta were deployed, using the monorail technique. During every procedure 1000 IU of Heparin were administred. Post procedurally all patients receveid antiaggregant therapy. RESULTS Post procedural DSA demonstrated in all patients complete exclusion of aneurysms without complications. CT and ECD, performed at 3, 9, 24, 36 months, confirmed the exclusion of the aneurysms and the patency of ICA in 5 cases. In 1 case the controls revealed a rupture of ...

Research paper thumbnail of Direct Non Sanitary Costs, Productivity Losses and the Cost-Effectiveness of Alternative Treatments of Superficial Foot Lesions in Diabetic Patients

The aim of the study is to compare, in a study period of 12 months, the clinical outcome, express... more The aim of the study is to compare, in a study period of 12 months, the clinical outcome, expressed by the number of wound healings, the costs and the cost-effectiveness of two alternative treatments of superficial foot lesions in diabetic patients: wound dressing and Percutaneous Transluminal Angioplasty (PTA). Being distal revascularisation, to our opinion, the best therapeutic approach to cure ischemic superficial foot lesions, we propose PTA to all the patients with the required foot ulcer carachteristics (Texas stage C grade 1) presented ad Policlinico Universitario of Rome-Tor Vergata - between February 2004 and June 2005. Of the 32 consecutive diabetic patients (mean age 74 - 11 yrs) included in the sample 16 were treated with PTA (group 1)and 16, those who refused PTA, were treated with wound management (group 2). The outcome and costs were recorded for a 12 month period starting with the enrolment of patients in the sample. The cost-effectiveness ratio was calculated by rec...

Research paper thumbnail of PTFE-covered Stent Increases TIPS Patency and Clinical Outcome in Patients with Budd-Chiari Syndrome

PURPOSE To compare patency, rate of re-intervention and clinical outcome of TIPS using uncovered ... more PURPOSE To compare patency, rate of re-intervention and clinical outcome of TIPS using uncovered and ePTFE-covered (VIATORR; W.L. Gore and Associates) stents in patients with Budd-Chiari Syndrome. METHOD AND MATERIALS From January 1994 to November 2003 thirteen patients (mean age: 35.7 yrs, range: 17-65yrs) affected by Budd-Chiari Syndrome underwent TIPS. In the first 6 patients TIPS was performed using uncovered Wallstents (group A). After April 2001, TIPS was carried out in 7 patients (group B) using an ePTFE-covered VIATORR stent-graft. Follow-up was performed with US at 7, 30 days and 3 months and subsequently every 3 months after the procedure. Liver function was evaluated every 3 months. RESULTS All group A shunts underwent occlusion with a mean primary patency of 4.46 months ± 3.40. The 6 and 12-month primary patency rates in this group were 16.7% and 0% respectively. During a 22.7-month ± 10.53 mean follow-up an overall of 12 revisions with Wallstent and 24 balloon dilatatio...

Research paper thumbnail of Carotid artery stenting: findings based on 8 years’ experience

La radiologia medica, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-r... more Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates. In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure. Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses>80% were treated with a repeated endovascular procedure. A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.

Research paper thumbnail of Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

European Radiology, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highr... more Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a follow-up of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.

Research paper thumbnail of Encouraging and Positive Trend Towards Treatment of Acute Ischemic Stroke Performed by Vascular Interventional Radiologist

CardioVascular and Interventional Radiology, 2014

We read with great interest the paper from Fjetland et al. [1]. We agree with the authors that an... more We read with great interest the paper from Fjetland et al. [1]. We agree with the authors that an interventional radiologist may perform endovascular stroke treatment, actually limited in most worldwide reality to the work of fellowship-trained interventional neuroradiologists. In our experience, between August 2009 and March 2013, 94 patients (64.1 ± 12.6 years old) underwent emergency cerebral angiography for acute ischemic stroke in our interventional radiology cathlab. Time from stroke onset-to-arterial puncture was 233.5 ± 68.0 min and from stroke onset to recanalization was 322.0 ± 85.2 min. A successful recanalization (TICI 2b/3) recanalization was obtained in 81 patients (86 %). Our technical success, as in previous experiences by other nonneurointerventional groups [1–4], are superior to that obtained with intra-arterial thrombolysis (successful recanalization rate ranging from 56 to 60 % [5, 6]) and comparable to that obtained with mechanical thrombectomy (successful recanalization rate ranging from 68 to 100 % [7–10] ) in previous studies performed by interventional neuroradiologists. At 3-month follow-up, 52 % of patients had an mRS B 2 and 23 % died, confirming good clinical results considering the baseline neurological symptoms. These clinical results are comparable with those of major clinical trials that reported a good symptoms recovery from 36 to 88 % of patients [7–10]. Despite treatment improvement developed in the past decade, stroke remains the fourth-leading cause of death [11] and the most important cause of disability in western countries [12]. Even if medical therapy is the only approved treatment described in stroke treatment guidelines [13], narrow time windows and the reduced efficacy in case of large artery occlusions limits the percentage of patients who could benefit of this approach [14]. Recently, some randomized trials [15–17], comparing the medical treatment with endovascular therapy, failed to show any outcomes improvement with endovascular approaches. This issue may be due to the prolonged time between stroke symptoms and endovascular treatment in these trials. The delay of endovascular therapy should be minimized in the future in order to improve these results. Involvement of peripherally trained interventional radiologist, as described by Fjetland et al. [1], may be a safe and effective approach to obtain a fast and efficacious stroke treatment, particularly in that area where there is a lack of dedicated neurointerventional center. Other divisions of interventional specialist started endovascular stroke treatment, driven by the need to ensure adequate treatment for stroke patients in areas without dedicated neuroradiology stroke team. DeVries et al. [4], a group of interventional cardiologists, described 26 patients undergoing endovascular stroke therapy. Successful artery recanalization was achieved in 23 (88 %) of the 26 patients. The authors have emphasized that the pool of physicians with carotid stent experience may reasonably augment the national shortage of neuroradiologists. For the authors, any operator with experience in carotid stenting is experienced in cerebral angiography, comfortable with R. Gandini C. Del Giudice (&) F. Chegai D. Konda E. Pampana M. Stefanini A. Spinelli S. Fabiano C. A. Reale G. Simonetti Department of Imaging Diagnostic, Molecular Imaging, Interventional Radiology and Radiation Therapy, IRCCS Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy e-mail: costantino.delgiudice@gmail.com

Research paper thumbnail of The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

CardioVascular and Interventional Radiology, 2007

The purpose of this study was to describe the efficacy of planned combined subintimal arterial fl... more The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

Research paper thumbnail of Management of Biliary Neoplastic Obstruction with Two Different Metallic Stents Implanted in One Session

CardioVascular and Interventional Radiology, 2004

The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultra... more The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultraflex) and associated rate of complications was studied in 87 patients with jaundice secondary to malignant biliary obstruction, with bilirubin level less than 15 mg/dl and Bismuth type 1 or 2 strictures. The study group, composed of 40 men and 47 women with a mean age of 59.4 years (range 37-81 years), was treated with a "one-step" percutaneous transhepatic implantation of self-expanding stents. The cause of the obstruction was pancreatic carcinoma in 38 patients (44%), lymph node metastasis in 20 patients (23%), gallbladder carcinoma in 13 patients (15%), cholangiocarcinoma in 12 patients (14%) and ampullary carcinoma in four patients (5%). A significant reduction in jaundice was obtained in all but one patient, with a drop of total serum bilirubin level from a mean of 13.7 mg/dl to 4.3 mg/dl within the first 4 days. The mean postprocedural hospitalization period was 5.4 days in the Wallstent group and 6.4 days in the Ultraflex group. Mean survival rate was 7.8 months (Wallstent group) and 7.1 months (Ultraflex group). The use of both stents did not reveal any significant difference in parameters tested. The implantation of these self-expandable stents in one session, in selected patients, is clinically effective, devoid of important complications and cost-effective due to the reduction in hospitalization.

Research paper thumbnail of Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate—Outcome in 244 Patients

Radiology, 2008

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen paramet... more To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. Materials and Methods: The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. Results: Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months Ϯ 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P Ͻ .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months Ϯ 7.77). Conclusion: TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Research paper thumbnail of Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

CardioVascular and Interventional Radiology, 2004

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, r... more Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

Research paper thumbnail of SFA Subintimal Angioplasty: Experience in 148 Patients

PURPOSE To evaluate indications, feasibility and results of subintimal angioplasty of long femora... more PURPOSE To evaluate indications, feasibility and results of subintimal angioplasty of long femoral-popliteal occlusions in patients with severe claudicatio and/or critical limbs ischaemia. METHOD AND MATERIALS We treated 148 patients (91 males, 57 female; mean age: 71.3 yrs) with long femoral-popliteal occlusion (> 10 cm). Seventy-five patients were symptomatic for claudicatio, 22 patients had rest pain and 51 patients presented with gangrene. We have studied all patients with Angio-MR and Doppler-US before the treatment. Always recanalization of the superficial femoral artery was performed. Contemporary recanalization of limb arteries was carried out in 64 patients. In 139 cases recanalization was obtained by antegrade femoral approach, in 3 case by retrograde trans-popliteal approach and in 6 by combined femoral-popliteal approach. Follow-up was performed by physical examination, Doppler US 1, 3 and 6 months after the procedure and subsequently after every 6 months. RESULTS Tec...

Research paper thumbnail of Carotid artery stenting: findings based on 8 years’ experience

La radiologia medica, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-r... more Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates. In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure. Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses>80% were treated with a repeated endovascular procedure. A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.

Research paper thumbnail of Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate—Outcome in 244 Patients 1

Radiology, 2008

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen paramet... more To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77). TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Research paper thumbnail of Management of Biliary Neoplastic Obstruction with Two Different Metallic Stents Implanted in One Session

CardioVascular and Interventional Radiology, 2005

The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultra... more The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultraflex) and associated rate of complications was studied in 87 patients with jaundice secondary to malignant biliary obstruction, with bilirubin level less than 15 mg/dl and Bismuth type 1 or 2 strictures. The study group, composed of 40 men and 47 women with a mean age of 59.4 years (range 37-81 years), was treated with a "one-step" percutaneous transhepatic implantation of self-expanding stents. The cause of the obstruction was pancreatic carcinoma in 38 patients (44%), lymph node metastasis in 20 patients (23%), gallbladder carcinoma in 13 patients (15%), cholangiocarcinoma in 12 patients (14%) and ampullary carcinoma in four patients (5%). A significant reduction in jaundice was obtained in all but one patient, with a drop of total serum bilirubin level from a mean of 13.7 mg/dl to 4.3 mg/dl within the first 4 days. The mean postprocedural hospitalization period was 5.4 days in the Wallstent group and 6.4 days in the Ultraflex group. Mean survival rate was 7.8 months (Wallstent group) and 7.1 months (Ultraflex group). The use of both stents did not reveal any significant difference in parameters tested. The implantation of these self-expandable stents in one session, in selected patients, is clinically effective, devoid of important complications and cost-effective due to the reduction in hospitalization.

Research paper thumbnail of The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

CardioVascular and Interventional Radiology, 2007

The purpose of this study was to describe the efficacy of planned combined subintimal arterial fl... more The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

Research paper thumbnail of Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

CardioVascular and Interventional Radiology, 2004

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, r... more Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

Research paper thumbnail of Terlipressin versus Norepinephrine to Counteract Anesthesia-induced Hypotension in Patients Treated with Renin-Angiotensin System Inhibitors: Effects on Systemic and Regional Hemodynamics

Anesthesiology, 2005

Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypoten... more Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia.

Research paper thumbnail of Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

European Radiology, 2009

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highr... more Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a follow-up of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.

Research paper thumbnail of Carotid Artery Stenting: risultati dopo otto anni di esperienza

Research paper thumbnail of Costi diretti non sanitari, perdite di produttività e costo efficacia delle diverse ipotesi di trattamento delle lesioni ischemiche periferiche superficiali nel paziente diabetico

Research paper thumbnail of Use of Covered Stents in Treatment of Large Neck Internal Carotid Artery Pseudoaneurysms

PURPOSE To demonstrate the safety and efficacy of endovascular treatment, using covered stents, o... more PURPOSE To demonstrate the safety and efficacy of endovascular treatment, using covered stents, of large neck internal carotid artery pseudoaneurysms,. METHOD AND MATERIALS Between 1999-2003 we treated 6 patients with large neck pseudoaneurysms. 4 pseudoaneurysms post-traumatic and 2 spontaneous; 4 patients were symptomatic. The diameter of the pseudoaneurysms varied between 10-45 mm, with a wide neck between 8 and 25 mm. In all patients a 6Fr guiding catheter was positioned into the ICA. 4 Symbiot ePTFE covered stents, 1 JOSTENT and 1 Advanta were deployed, using the monorail technique. During every procedure 1000 IU of Heparin were administred. Post procedurally all patients receveid antiaggregant therapy. RESULTS Post procedural DSA demonstrated in all patients complete exclusion of aneurysms without complications. CT and ECD, performed at 3, 9, 24, 36 months, confirmed the exclusion of the aneurysms and the patency of ICA in 5 cases. In 1 case the controls revealed a rupture of ...

Research paper thumbnail of Direct Non Sanitary Costs, Productivity Losses and the Cost-Effectiveness of Alternative Treatments of Superficial Foot Lesions in Diabetic Patients

The aim of the study is to compare, in a study period of 12 months, the clinical outcome, express... more The aim of the study is to compare, in a study period of 12 months, the clinical outcome, expressed by the number of wound healings, the costs and the cost-effectiveness of two alternative treatments of superficial foot lesions in diabetic patients: wound dressing and Percutaneous Transluminal Angioplasty (PTA). Being distal revascularisation, to our opinion, the best therapeutic approach to cure ischemic superficial foot lesions, we propose PTA to all the patients with the required foot ulcer carachteristics (Texas stage C grade 1) presented ad Policlinico Universitario of Rome-Tor Vergata - between February 2004 and June 2005. Of the 32 consecutive diabetic patients (mean age 74 - 11 yrs) included in the sample 16 were treated with PTA (group 1)and 16, those who refused PTA, were treated with wound management (group 2). The outcome and costs were recorded for a 12 month period starting with the enrolment of patients in the sample. The cost-effectiveness ratio was calculated by rec...

Research paper thumbnail of PTFE-covered Stent Increases TIPS Patency and Clinical Outcome in Patients with Budd-Chiari Syndrome

PURPOSE To compare patency, rate of re-intervention and clinical outcome of TIPS using uncovered ... more PURPOSE To compare patency, rate of re-intervention and clinical outcome of TIPS using uncovered and ePTFE-covered (VIATORR; W.L. Gore and Associates) stents in patients with Budd-Chiari Syndrome. METHOD AND MATERIALS From January 1994 to November 2003 thirteen patients (mean age: 35.7 yrs, range: 17-65yrs) affected by Budd-Chiari Syndrome underwent TIPS. In the first 6 patients TIPS was performed using uncovered Wallstents (group A). After April 2001, TIPS was carried out in 7 patients (group B) using an ePTFE-covered VIATORR stent-graft. Follow-up was performed with US at 7, 30 days and 3 months and subsequently every 3 months after the procedure. Liver function was evaluated every 3 months. RESULTS All group A shunts underwent occlusion with a mean primary patency of 4.46 months ± 3.40. The 6 and 12-month primary patency rates in this group were 16.7% and 0% respectively. During a 22.7-month ± 10.53 mean follow-up an overall of 12 revisions with Wallstent and 24 balloon dilatatio...

Research paper thumbnail of Carotid artery stenting: findings based on 8 years’ experience

La radiologia medica, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-r... more Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates. In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure. Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses>80% were treated with a repeated endovascular procedure. A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.

Research paper thumbnail of Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

European Radiology, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highr... more Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a follow-up of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.

Research paper thumbnail of Encouraging and Positive Trend Towards Treatment of Acute Ischemic Stroke Performed by Vascular Interventional Radiologist

CardioVascular and Interventional Radiology, 2014

We read with great interest the paper from Fjetland et al. [1]. We agree with the authors that an... more We read with great interest the paper from Fjetland et al. [1]. We agree with the authors that an interventional radiologist may perform endovascular stroke treatment, actually limited in most worldwide reality to the work of fellowship-trained interventional neuroradiologists. In our experience, between August 2009 and March 2013, 94 patients (64.1 ± 12.6 years old) underwent emergency cerebral angiography for acute ischemic stroke in our interventional radiology cathlab. Time from stroke onset-to-arterial puncture was 233.5 ± 68.0 min and from stroke onset to recanalization was 322.0 ± 85.2 min. A successful recanalization (TICI 2b/3) recanalization was obtained in 81 patients (86 %). Our technical success, as in previous experiences by other nonneurointerventional groups [1–4], are superior to that obtained with intra-arterial thrombolysis (successful recanalization rate ranging from 56 to 60 % [5, 6]) and comparable to that obtained with mechanical thrombectomy (successful recanalization rate ranging from 68 to 100 % [7–10] ) in previous studies performed by interventional neuroradiologists. At 3-month follow-up, 52 % of patients had an mRS B 2 and 23 % died, confirming good clinical results considering the baseline neurological symptoms. These clinical results are comparable with those of major clinical trials that reported a good symptoms recovery from 36 to 88 % of patients [7–10]. Despite treatment improvement developed in the past decade, stroke remains the fourth-leading cause of death [11] and the most important cause of disability in western countries [12]. Even if medical therapy is the only approved treatment described in stroke treatment guidelines [13], narrow time windows and the reduced efficacy in case of large artery occlusions limits the percentage of patients who could benefit of this approach [14]. Recently, some randomized trials [15–17], comparing the medical treatment with endovascular therapy, failed to show any outcomes improvement with endovascular approaches. This issue may be due to the prolonged time between stroke symptoms and endovascular treatment in these trials. The delay of endovascular therapy should be minimized in the future in order to improve these results. Involvement of peripherally trained interventional radiologist, as described by Fjetland et al. [1], may be a safe and effective approach to obtain a fast and efficacious stroke treatment, particularly in that area where there is a lack of dedicated neurointerventional center. Other divisions of interventional specialist started endovascular stroke treatment, driven by the need to ensure adequate treatment for stroke patients in areas without dedicated neuroradiology stroke team. DeVries et al. [4], a group of interventional cardiologists, described 26 patients undergoing endovascular stroke therapy. Successful artery recanalization was achieved in 23 (88 %) of the 26 patients. The authors have emphasized that the pool of physicians with carotid stent experience may reasonably augment the national shortage of neuroradiologists. For the authors, any operator with experience in carotid stenting is experienced in cerebral angiography, comfortable with R. Gandini C. Del Giudice (&) F. Chegai D. Konda E. Pampana M. Stefanini A. Spinelli S. Fabiano C. A. Reale G. Simonetti Department of Imaging Diagnostic, Molecular Imaging, Interventional Radiology and Radiation Therapy, IRCCS Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy e-mail: costantino.delgiudice@gmail.com

Research paper thumbnail of The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

CardioVascular and Interventional Radiology, 2007

The purpose of this study was to describe the efficacy of planned combined subintimal arterial fl... more The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

Research paper thumbnail of Management of Biliary Neoplastic Obstruction with Two Different Metallic Stents Implanted in One Session

CardioVascular and Interventional Radiology, 2004

The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultra... more The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultraflex) and associated rate of complications was studied in 87 patients with jaundice secondary to malignant biliary obstruction, with bilirubin level less than 15 mg/dl and Bismuth type 1 or 2 strictures. The study group, composed of 40 men and 47 women with a mean age of 59.4 years (range 37-81 years), was treated with a "one-step" percutaneous transhepatic implantation of self-expanding stents. The cause of the obstruction was pancreatic carcinoma in 38 patients (44%), lymph node metastasis in 20 patients (23%), gallbladder carcinoma in 13 patients (15%), cholangiocarcinoma in 12 patients (14%) and ampullary carcinoma in four patients (5%). A significant reduction in jaundice was obtained in all but one patient, with a drop of total serum bilirubin level from a mean of 13.7 mg/dl to 4.3 mg/dl within the first 4 days. The mean postprocedural hospitalization period was 5.4 days in the Wallstent group and 6.4 days in the Ultraflex group. Mean survival rate was 7.8 months (Wallstent group) and 7.1 months (Ultraflex group). The use of both stents did not reveal any significant difference in parameters tested. The implantation of these self-expandable stents in one session, in selected patients, is clinically effective, devoid of important complications and cost-effective due to the reduction in hospitalization.

Research paper thumbnail of Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate—Outcome in 244 Patients

Radiology, 2008

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen paramet... more To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. Materials and Methods: The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. Results: Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months Ϯ 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P Ͻ .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months Ϯ 7.77). Conclusion: TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Research paper thumbnail of Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

CardioVascular and Interventional Radiology, 2004

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, r... more Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

Research paper thumbnail of SFA Subintimal Angioplasty: Experience in 148 Patients

PURPOSE To evaluate indications, feasibility and results of subintimal angioplasty of long femora... more PURPOSE To evaluate indications, feasibility and results of subintimal angioplasty of long femoral-popliteal occlusions in patients with severe claudicatio and/or critical limbs ischaemia. METHOD AND MATERIALS We treated 148 patients (91 males, 57 female; mean age: 71.3 yrs) with long femoral-popliteal occlusion (> 10 cm). Seventy-five patients were symptomatic for claudicatio, 22 patients had rest pain and 51 patients presented with gangrene. We have studied all patients with Angio-MR and Doppler-US before the treatment. Always recanalization of the superficial femoral artery was performed. Contemporary recanalization of limb arteries was carried out in 64 patients. In 139 cases recanalization was obtained by antegrade femoral approach, in 3 case by retrograde trans-popliteal approach and in 6 by combined femoral-popliteal approach. Follow-up was performed by physical examination, Doppler US 1, 3 and 6 months after the procedure and subsequently after every 6 months. RESULTS Tec...

Research paper thumbnail of Carotid artery stenting: findings based on 8 years’ experience

La radiologia medica, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-r... more Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates. In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure. Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses>80% were treated with a repeated endovascular procedure. A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.

Research paper thumbnail of Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate—Outcome in 244 Patients 1

Radiology, 2008

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen paramet... more To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77). TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Research paper thumbnail of Management of Biliary Neoplastic Obstruction with Two Different Metallic Stents Implanted in One Session

CardioVascular and Interventional Radiology, 2005

The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultra... more The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultraflex) and associated rate of complications was studied in 87 patients with jaundice secondary to malignant biliary obstruction, with bilirubin level less than 15 mg/dl and Bismuth type 1 or 2 strictures. The study group, composed of 40 men and 47 women with a mean age of 59.4 years (range 37-81 years), was treated with a "one-step" percutaneous transhepatic implantation of self-expanding stents. The cause of the obstruction was pancreatic carcinoma in 38 patients (44%), lymph node metastasis in 20 patients (23%), gallbladder carcinoma in 13 patients (15%), cholangiocarcinoma in 12 patients (14%) and ampullary carcinoma in four patients (5%). A significant reduction in jaundice was obtained in all but one patient, with a drop of total serum bilirubin level from a mean of 13.7 mg/dl to 4.3 mg/dl within the first 4 days. The mean postprocedural hospitalization period was 5.4 days in the Wallstent group and 6.4 days in the Ultraflex group. Mean survival rate was 7.8 months (Wallstent group) and 7.1 months (Ultraflex group). The use of both stents did not reveal any significant difference in parameters tested. The implantation of these self-expandable stents in one session, in selected patients, is clinically effective, devoid of important complications and cost-effective due to the reduction in hospitalization.

Research paper thumbnail of The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

CardioVascular and Interventional Radiology, 2007

The purpose of this study was to describe the efficacy of planned combined subintimal arterial fl... more The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

Research paper thumbnail of Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

CardioVascular and Interventional Radiology, 2004

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, r... more Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

Research paper thumbnail of Terlipressin versus Norepinephrine to Counteract Anesthesia-induced Hypotension in Patients Treated with Renin-Angiotensin System Inhibitors: Effects on Systemic and Regional Hemodynamics

Anesthesiology, 2005

Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypoten... more Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia.

Research paper thumbnail of Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

European Radiology, 2009

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highr... more Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a follow-up of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.