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Diagnosis and Treatment of Vascular Malformations
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Diagnosis and Treatment of Vascular Malformations

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 12407

Special Issue Editors

Dr. Clifford Raabe Weiss

E-Mail Website
Guest Editor
The Johns Hopkins Hospital, Baltimore, MD 21287, USA
Interests: vascular anomaly; venous malformation; lymphatic malformation; arteriovenous malformation; novel embolics; patient outcomes
Dr. Brian Holly

E-Mail Website
Guest Editor
The Johns Hopkins Hospital, Baltimore, MD 21287 USA
Interests: vascular anomaly; venous malformation; lymphatic malformation; arteriovenous malformation; novel embolics; patient outcomes

Special Issue Information

Dear Colleagues,

This Special Issue will focus on the diagnosis and treatment of vascular malformations. These are a relatively rare group of disorders involving the arterial, venous, and lymphatic systems. Evaluation at a center familiar with these disorders is often key to the patient receiving the proper diagnosis and treatment. This issue will discuss appropriate work-up, including pertinent diagnostic imaging, as well as treatment options. Vascular malformations are challenging to treat and often require a multidisciplinary approach, including diagnostic radiology, interventional radiology, dermatology, medical genetics, and surgical subspecialties. There is no one-size-fits-all approach to treating these very complex and challenging conditions, but in this issue, we hope to lay the foundation for different approaches and techniques to manage these patients.

Dr. Clifford Raabe Weiss
Dr. Brian Holly
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ISSVA Classification
  • diagnostic imaging
  • sclerosis
  • embolotherapy
  • multidisciplinary
  • genetics

Published Papers (4 papers)

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Research

30 pages, 11380 KiB  
Article
Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms
by Karol Wiśniewski, Bartłomiej Tomasik, Zbigniew Tyfa, Piotr Reorowicz, Ernest J. Bobeff, Ludomir Stefańczyk, Bartłomiej J. Posmyk, Krzysztof Jóźwik and Dariusz J. Jaskólski
J. Clin. Med. 2021, 10(7), 1348; https://doi.org/10.3390/jcm10071348 - 24 Mar 2021
Cited by 9 | Viewed by 2289
Abstract
Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. [...] Read more.
Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Vascular Malformations)
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12 pages, 2728 KiB  
Article
3D Printing of Rapid, Low-Cost and Patient-Specific Models of Brain Vasculature for Use in Preoperative Planning in Clipping of Intracranial Aneurysms
by Maciej Błaszczyk, Redwan Jabbar, Bartosz Szmyd and Maciej Radek
J. Clin. Med. 2021, 10(6), 1201; https://doi.org/10.3390/jcm10061201 - 13 Mar 2021
Cited by 23 | Viewed by 4394
Abstract
We developed a practical and cost-effective method of production of a 3D-printed model of the arterial Circle of Willis of patients treated because of an intracranial aneurysm. We present and explain the steps necessary to produce a 3D model from medical image data, [...] Read more.
We developed a practical and cost-effective method of production of a 3D-printed model of the arterial Circle of Willis of patients treated because of an intracranial aneurysm. We present and explain the steps necessary to produce a 3D model from medical image data, and express the significant value such models have in patient-specific pre-operative planning as well as education. A Digital Imaging and Communications in Medicine (DICOM) viewer is used to create 3D visualization from a patient’s Computed Tomography Angiography (CTA) images. After generating the reconstruction, we manually remove the anatomical components that we wish to exclude from the print by utilizing tools provided with the imaging software. We then export this 3D reconstructions file into a Standard Triangulation Language (STL) file which is then run through a “Slicer” software to generate a G-code file for the printer. After the print is complete, the supports created during the printing process are removed manually. The 3D-printed models we created were of good accuracy and scale. The median production time used for the models described in this manuscript was 4.4 h (range: 3.9–4.5 h). Models were evaluated by neurosurgical teams at local hospital for quality and practicality for use in urgent and non-urgent care. We hope we have provided readers adequate insight into the equipment and software they would require to quickly produce their own accurate and cost-effective 3D models from CT angiography images. It has become quite clear to us that the cost-benefit ratio in the production of such a simplified model is worthwhile. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Vascular Malformations)
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11 pages, 963 KiB  
Article
High-Resolution Vessel Wall Magnetic Resonance Imaging of Small Unruptured Intracranial Aneurysms
by Łukasz Zwarzany, Ernest Tyburski and Wojciech Poncyljusz
J. Clin. Med. 2021, 10(2), 225; https://doi.org/10.3390/jcm10020225 - 10 Jan 2021
Cited by 12 | Viewed by 2782
Abstract
Background: We decided to investigate whether aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR VW-MRI) coexists with the conventional risk factors for aneurysm rupture. Methods: We performed HR VW-MRI in 46 patients with 64 unruptured small intracranial [...] Read more.
Background: We decided to investigate whether aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR VW-MRI) coexists with the conventional risk factors for aneurysm rupture. Methods: We performed HR VW-MRI in 46 patients with 64 unruptured small intracranial aneurysms. Patient demographics and clinical characteristics were recorded. The PHASES score was calculated for each aneurysm. Results: Of the 64 aneurysms, 15 (23.4%) showed wall enhancement on post-contrast HR VW-MRI. Aneurysms with wall enhancement had significantly larger size (p = 0.001), higher dome-to-neck ratio (p = 0.024), and a more irregular shape (p = 0.003) than aneurysms without wall enhancement. The proportion of aneurysms with wall enhancement was significantly higher in older patients (p = 0.011), and those with a history of prior aneurysmal SAH. The mean PHASES score was significantly higher in aneurysms with wall enhancement (p < 0.000). The multivariate logistic regression analysis revealed that aneurysm irregularity and the PHASES score are independently associated with the presence of AWE. Conclusions: Aneurysm wall enhancement on HR VW-MRI coexists with the conventional risk factors for aneurysm rupture. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Vascular Malformations)
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10 pages, 1047 KiB  
Article
Stent-Assisted Coiling of Unruptured MCA Aneurysms Using the LVIS Jr. Device: A Multicenter Registry
by Wojciech Poncyljusz, Łukasz Zwarzany, Bartosz Limanówka, Miłosz Zbroszczyk, Mariusz Banach, Sławomir Bereza and Leszek Sagan
J. Clin. Med. 2020, 9(10), 3168; https://doi.org/10.3390/jcm9103168 - 30 Sep 2020
Cited by 9 | Viewed by 2384
Abstract
Purpose: The low-profile visualized intraluminal support junior (LVIS Jr.) is a new generation low-profile braided stent. Our aim was to evaluate the safety and efficacy of the LVIS Jr. in the stent-assisted coiling of unruptured middle cerebral artery (MCA) aneurysms. This was a [...] Read more.
Purpose: The low-profile visualized intraluminal support junior (LVIS Jr.) is a new generation low-profile braided stent. Our aim was to evaluate the safety and efficacy of the LVIS Jr. in the stent-assisted coiling of unruptured middle cerebral artery (MCA) aneurysms. This was a multicenter retrospective study. Patient demographics, aneurysm characteristics, procedural details, complications, and the results of clinical and imaging follow-up were analyzed. Four centers participated in the study. A total of 162 consecutive patients with 162 unruptured MCA aneurysms were included for the analysis. The mean aneurysm size was 7.6 mm (range 2 to 37 mm) and 97.5% were wide-necked. Immediate postprocedural angiograms showed Raymond-Roy class 1 in 118 (72.8%), class 2 in 23 (14.2%), and class 3 in 21 patients (13%). Periprocedural complications occurred in 14 patients (8.6%). There were no procedure-related deaths. Follow-up imaging at 12–18 months post-procedure showed Raymond–Roy class 1 in 132 (81.5%), class 2 in 17 (10.5%), and class 3 in 13 patients (8%). There were 3 cases of in-stent stenosis (1.9%). All 162 patients had good clinical outcome (mRS score 0–2) at 90 days post-procedure. Stent-assisted coiling of unruptured MCA aneurysms with the LVIS Jr. stent is safe and effective, with high immediate and long-term total occlusion rates. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Vascular Malformations)
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