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Background: Middle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH). Objective: To examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients. Methods: A single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics. Results: A total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures. Conclusion: This study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs. [ABSTRACT FROM AUTHOR]

BackgroundMiddle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH).ObjectiveTo examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients.MethodsA single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics.ResultsA total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3 mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures.ConclusionThis study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs.

Abstract Background The present study attempted to demonstrate how the configuration of hydrogel-coated coils is influenced by different temperature exposures. Thirty detachable hydrogel-coated coils were evaluated in an in vitro water immersion test under five different temperature ranges (22.6 °C, 37 °C, 40–50 °C, 50–60 °C, and 60–70 °C). The configuration changes were classified (configuration I, configuration II, and configuration III) according to the curling that occurred during 30 min of immersion. Configuration stability of five Hydrogel-coated coils was also evaluated in a two-step temperature immersion test. Results All hydrogel-coated coils showed some configuration changes during water immersion. However, a logarithmic transformation of the time and temperature data showed a significant (p

Objective: To summarize and discuss the application of Willis covered stents (WCSs) and double stent-assisted coils in the treatment of blood blister-like aneurysms (BBAs).Materials and Methods: Thirty-two patients with BBAs treated from January 2015 to October 2020 were included in the study. Among them, 18 were treated using WCSs and 14 using double stents-assisted coils. The indications for treatment, perioperative findings, and postoperative follow-up results were collected and analyzed.Results: All 32 patients had successful stent deployments. Complete aneurysm occlusion was achieved in all 18 patients treated with WCSs immediately. WCS-related adverse events included 2 cases of mild vasospasm and 4 aggressive procedure-related vasospasms during WCS deployment, a case of dissection after WCS deployment, and 1 death due to ipsilateral temporal lobe rebleeding at the sixth day after WCS deployment. In patients treated with double stent-assisted coils, there were 3 cases of neck remnants, 1 acute occlusion of the ipsilateral MCA branch, and 4 mild procedure-related intraoperative vasospasms. The mean follow-up period was 4.2±1.6 months (range 3–6 months). Follow-up imaging data were available for 25 patients (78.1%). In the first postoperative angiographic follow-up, all BBAs were completely occluded. Mild asymptomatic stent stenosis was observed in 3 patients treated with WCSs. Follow-up examination at 6 months after the employment of WCSs showed that the modified Rankin score (mRs) was 0 in 6 patients, 1 in 5 patients, 2 in 3 patients, 3 in 1 patient, 4 in 2 patients, and 6 in 1 patient. After treatment with double stents-assisted coils, the mRs was 0 in 4 patients, 1 in 5 patients, 2 in 3 patients, and 4 in 2 patients.Conclusions: WCSs and double stent-assisted coils for the treatment of BBAs are both safe and efficient. WCSs provide a higher rate of immediate occlusion; however, there was no significant difference in the long term.

Objective: To summarize and discuss the application of Willis covered stents (WCSs) and double stent-assisted coils in the treatment of blood blister-like aneurysms (BBAs). Materials and Methods: Thirty-two patients with BBAs treated from January 2015 to October 2020 were included in the study. Among them, 18 were treated using WCSs and 14 using double stents-assisted coils. The indications for treatment, perioperative findings, and postoperative follow-up results were collected and analyzed. Results: All 32 patients had successful stent deployments. Complete aneurysm occlusion was achieved in all 18 patients treated with WCSs immediately. WCS-related adverse events included 2 cases of mild vasospasm and 4 aggressive procedure-related vasospasms during WCS deployment, a case of dissection after WCS deployment, and 1 death due to ipsilateral temporal lobe rebleeding at the sixth day after WCS deployment. In patients treated with double stent-assisted coils, there were 3 cases of neck remnants, 1 acute occlusion of the ipsilateral MCA branch, and 4 mild procedure-related intraoperative vasospasms. The mean follow-up period was 4.2±1.6 months (range 3–6 months). Follow-up imaging data were available for 25 patients (78.1%). In the first postoperative angiographic follow-up, all BBAs were completely occluded. Mild asymptomatic stent stenosis was observed in 3 patients treated with WCSs. Follow-up examination at 6 months after the employment of WCSs showed that the modified Rankin score (mRs) was 0 in 6 patients, 1 in 5 patients, 2 in 3 patients, 3 in 1 patient, 4 in 2 patients, and 6 in 1 patient. After treatment with double stents-assisted coils, the mRs was 0 in 4 patients, 1 in 5 patients, 2 in 3 patients, and 4 in 2 patients. Conclusions: WCSs and double stent-assisted coils for the treatment of BBAs are both safe and efficient. WCSs provide a higher rate of immediate occlusion; however, there was no significant difference in the long term. [ABSTRACT FROM AUTHOR]

Background: The present study attempted to demonstrate how the configuration of hydrogel-coated coils is influenced by different temperature exposures. Thirty detachable hydrogel-coated coils were evaluated in an in vitro water immersion test under five different temperature ranges (22.6 °C, 37 °C, 40–50 °C, 50–60 °C, and 60–70 °C). The configuration changes were classified (configuration I, configuration II, and configuration III) according to the curling that occurred during 30 min of immersion. Configuration stability of five Hydrogel-coated coils was also evaluated in a two-step temperature immersion test. Results: All hydrogel-coated coils showed some configuration changes during water immersion. However, a logarithmic transformation of the time and temperature data showed a significant (p < 0.05) negative linear correlation between time and temperature for all coil configurations (configuration I: R = 0.97, configuration II: R = 0.98, configuration III: R = 0.97). The time needed to reach configuration III (complete coiling) was 160.4 ± 41.9 s at 37.5 °C (range: 100–205 s), 45.7 ± 22.2 s at 47.5 °C (range: 23–70 s), 20.2 ± 7.2 s at 57.5 °C (range: 14–32 s), and 10.3 ± 2.4 s at 67.5 °C (range: 7–13 s). Conclusions: Temperatures above 55 °C induced immediate configurational changes in the hydro-coated coils, achieving complete curling within less than 30 s. Temperatures near 36 °C (normal body temperature) require more time to reach optimal coil curling (configuration III). The optimization of HydroCoil preparation can reduce interventional procedural time and improve clinical results. [ABSTRACT FROM AUTHOR]

Simple Summary: Immune checkpoint inhibitors (ICI) have failed to overcome the high therapy resistance of Metastatic Uveal Melanoma (MUM) in contrast to the dramatic benefits of immunotherapy seen in many other tumor entities. Considering the poor clinical outcome and survival rates of MUM, the urgent need of new therapeutic approaches becomes apparent. This retrospective single-center cohort study of patients with liver-metastatic UM aims to investigate whether the combination of ICI and liver-directed therapies may improve the activity of immunotherapy against this highly malignant cancer. Our results demonstrate a response to MUM resistance to immunotherapy by combining liver-directed therapies and ICI, leading to improvement of overall survival (OS). Uveal Melanoma (UM) is a rare disease; however, it is the most common primary intraocular malignant tumor in adults. Hematogenous metastasis, occurring in up to 50% of cases, mainly to the liver (90%), is associated with poor clinical course and treatment failure. In contrast to dramatic benefits of immunotherapy in many tumor entities, as seen in cutaneous melanoma, immune checkpoint inhibitors (ICI) do not achieve comparable results in Metastatic UM (MUM). The aim of this study was to investigate whether the combination of ICI with liver-directed therapies provides a potential survival benefit for those affected. This retrospective, single-center study, including n = 45 patients with MUM, compared the effect of combining ICI with liver-directed therapy ("Cohort 1") with respect to standard therapies ("Cohort 2") on overall survival (OS). Our results revealed a significant survival difference between Cohort 1 (median OS 22.5 months) and Cohort 2 (median OS 11.4 months), indicating that this combination may enhance the efficacy of immunotherapy and thus provide a survival benefit. There is an urgent need for randomized, prospective trials addressing the combination of liver-directed therapies and various strategies of immunotherapy (such as ICI; IMCgp100; personalized vaccines) in order to establish regimens which finally improve the prognosis of patients with MUM. [ABSTRACT FROM AUTHOR]