Browsing by Author "Oran, I"
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Item Endovascular treatment of intracranial infectious aneurysmsEsenkaya, A; Duzgun, F; Cinar, C; Bozkaya, H; Eraslan, C; Ozgiray, E; Oran, IIntracranial infectious aneurysm (IIA) accounts for less than 5 % of all intracranial aneurysms. The aim of this study was to evaluate the role of endovascular treatment for IIA. During a 14-year period, 15 patients (age range, 2-68 years; mean, 42.8 years) with 17 aneurysms were diagnosed with IIA and treated via an endovascular route at our institution. The IIA diagnosis was based on clinical and laboratory findings of infection, echocardiography results, and digital subtraction angiography that were collected retrospectively. All patients were clinically and radiologically followed. The modified Rankin scale was used to evaluate clinical outcome. Among 15 patients, 12 presented with ruptured aneurysms (7 intraparenchymal hematoma, 4 subarachnoid hemorrhage, 1 subdural hematoma), 2 with cerebral infarcts, and 1 with pansinusitis and epidural abscess. All but one aneurysm were distally located in intracranial circulation, 14 were in anterior, and the remaining 3 were in posterior circulation. The final diagnosis was based on aneurysm morphology, location, and clinical laboratory findings. Endovascular treatment was scheduled initially for all IIAs; 13 of 17 IIAs underwent endovascular parent vessel occlusion, 3 underwent spontaneous parent vessel occlusion while waiting for intervention, and the remaining patient was treated by intrasaccular coil occlusion. There were no instances of perioperative neurological complications. Late clinical and radiological outcomes included absence of endovascular treatment related to mortality and aneurysm recurrence. Endovascular treatment may be performed safely at the time of diagnosis for at least symptomatic IIAs under the protective effect of antibiotic treatment.Item Aggregometry Response to Half-dose Prasugrel in Flow-diverting Stent ImplantationOran, I; Cinar, C; Gok, M; Duzgun, FPurpose The aim of this study was to determine whether half-dose loading (30/mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10/mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation. Methods Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented. Results A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). The 6-month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate. Conclusion Half-dose (30/mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm.Item Symptomatic Spinal Migration of Subarachnoid Hemorrhage due to Ruptured Intradural Vertebral Artery AneurysmOvali, GY; Adam, G; Çinar, C; Bozkaya, H; Çalli, C; Kitis, Ö; Oran, IA 55-year-old patient was admitted to the hospital with severe acute back pain. Thoracolumbar magnetic resonance (MR) imaging showed hemorrhage in subarachnoidal-subdural space. On cranial MR imaging and MR angiography, an aneurysm was suspected in the V4 segment of the right vertebral artery. Angiography showed a fusiform dissecting aneurysm in the V4 segment of right vertebral artery. The final diagnosis was ruptured V4 segment aneurysm with subsequent symptomatic migration of hemorrhage into the spinal subarachnoidal-subdural space. The patient was treated endovascularly by coil occlusion of both the aneurysm and vertebral artery. This rare cause and possible mechanisms for spinal migration of intracranial hemorrhage after aneurysmal rupture is discussed.Item Fibromuscular dysplasia-related renal artery stenosis associated with aneurysm: Successive endovascular therapySerter, S; Oran, I; Parildar, M; Memis, AFibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease. FMD of the renal arteries is one of the leading causes of curable hypertension. The simultaneous occurrence of FMD and renal artery aneurysm has been described previously. In this case, we present a fibrodysplastic lesion and an aneurysm in a renal artery treated with a percutanous transluminal angioplasty and coil embolization.Item The Role of Thrombocyte Activation on Early Brain Injury in Experimental Subarachnoid Hemorrhage ModelKocaman, Ü; Demirçivi Özer, F; Oran, I; Mete, M; Burak Atci, I; Turhan, T; Demirtas, EAim: Thrombocyte activation is one of the mechanisms blamed for emerging of early brain injury(EBI) soon after subarachnoid hemorrhage(SAH). It is wondered by researching to what extend neuron injury is prevented by making thrombocyte inhibition in SAH model. It shows that the role of trombocyte activation on EBI. Material and Method: 21 rabbits weighting 3-5 kg are divided in 3 groups 7 each. After ether anesthesia, 0.2 cc arterial blood taking from group 1 and 2 was injected into cysterna magna and created SAH. After SAH, at regular intervals antithrombocyte drug (tirofiban) was given to group 2 intraperitoneally; no treatment was carried on group 1. 0.2 cc SF was injected into cysterna magna in group 3. Decapitation was done in 72nd hour and then ischemic brain map was done at hippocampus level. The amount of ischemic neuron was scored and statistically analyzed. Results: SAH was detected in all rabbits of group 1 and 2. There are meaningful difference between the group 1 and group 3 of scoring ischemic neuron of hippocampus's CA-3 and CA-4 areas. Whereas in group 2, which is a ischemic neuron treatment group, there is a decline in each area, this decline has reached to a statistical means only in CA-4 area. Conclusion: There can be neuronal loss due to EBI even in the area which is free from blood in experimental SAH. Decreasing the injury of neuron with an antithrombocyte medicine shows that thrombocyte activation plays a great role in pathogenesis of EBI.Item Edaravone Leads To Increased Internal Luminal Vascular Circumference Following Subarachnoid Hemorrhage in An Animal Model of VasospasmMete, M; Özer, FD; Duransoy, YK; Kocaman, Ü; Oran, I; Demirtas, E; Selçuki, MPurpose: Cerebral vasospasm is the leading cause of morbidity and mortality following subarachnoid hemorrhage. Although a number of factors have been examined in clinical and experimental studies, the agent(s) responsible for developing and diminishing vasospasm remain poorly understood. Here, the role of edaravone, an antioxidant agent, was evaluated for its ability to diminish vasospasm in an animal model of subarachnoid hemorrhage. Materials and Methods: A rat basilar artery subarachnoid hemorrhage model was used. Rats were divided into three groups: sham (n=7; Group 1), subarachnoid hemorrhage (n=7 Group 2), and subarachnoid hemorrhage plus edaravone (4 mg/kg intraperitoneally, n=7; Group 3). At the end of the seventh day, the rats were sacrificed, their brains were removed, and sections were taken from the basilar artery. These were examined using a light microscope, comparing the internal luminal circumference of the basilar artery of each group. Results: The circumference was largest in Group 1, followed by Group 3 and then Group 2. That of Group 3 was 2% higher than that of Group 2, but this difference was not statistically significant. Conclusion: This animal model for vasospasm suggests that edaravone helps enlarge internal luminal circumference following vasospasm caused by subarachnoid hemorrhage. It may do this by blocking lipid peroxidation and thereby reducing the effects of oxyhemoglobin and reactive oxygen species.Item Ruptured dissecting aneurysms arising from non-vertebral arteries of the posterior circulation: endovascular treatment perspectiveOran, I; Çinar, C; Yagci, B; Tarhan, S; Kiroglu, Y; Serter, SPURPOSE Most intracranial dissecting aneurysms involve the posterior circulation, and the intradural segment of the vertebral artery is affected in majority of these. The aim of this report is to summarize the results of endovascular treatment in patients with ruptured dissecting aneurysms of the non-vertebral posterior circulation. MATERIALS AND METHODS During the past six years, the medical records of 23 patients with subarachnoid hemorrhage related to dissecting aneurysm arising from non-vertebral arteries of the posterior circulation were reviewed retrospectively. RESULTS The locations of the aneurysms were as follows: seven in the posterior cerebral artery, five in the superior cerebellar artery, six in the basilar artery trunk, and five in the posterior inferior cerebellar artery. Two basilar artery aneurysms were treated in the chronic stage with stent-assisted coil embolization. In the remaining patients, the aneurysm was coiled with or without parent vessel occlusion in the acute stage. One patient re-bled and died 20 days after initial treatment. At follow-up, recanalization had occurred in two patients, whose aneurysms were re-embolized successfully. Overall, three patients had permanent neurological sequelae, two had transient neurological sequelae, and one patient died. CONCLUSION Embolization with or without parent artery occlusion is feasible with an acceptable morbidity and mortality rate in the treatment of dissecting aneurysms confined to non-vertebral arteries of the posterior circulation.Item The short-and long-term effectiveness of transcatheter arterial embolization in patients with intractable hematuriaKorkmaz, M; Sanal, B; Aras, B; Bozkaya, H; Çinar, C; Güneyli, S; Gök, M; Adam, G; Düzgün, F; Oran, IPurpose: Selective transarterial embolization (TAE) of the internal iliac artery is a well-known alternative technique to control intractable bladder hemorrhage (IBH). We explored the shortand long-term effectiveness of, and clinical outcomes after, TAE in patients with IBH. Materials and methods: In this retrospective study, we reviewed the hospital records of 18 IBH patients non-responsive to conservative medications who underwent TAE between January 2003 and May 2014. The early-and long-term effectiveness of TAE was investigated in the context of hematuria control, complications, mortality, requirement for blood transfusions, and hematocrit level. Results: Sixteen of the 18 patients underwent endovascular treatment; the technical success rate was 88%. TAE allowed complete remission in 16 patients (100% clinical success). On follow-up, mean hematocrit (P = 0.003) and hemoglobin (P = 0.005) levels significantly improved. Thirteen of the 16 patients (81%) required no further emergency admission after TAE during a mean follow-up period of 18.1 months (range, 3-105 months). Conclusion: TAE is a feasible, effective, and safe technique in both the short-and long-term for the treatment of IBH. (C) 2015 Editions francaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.Item Idiopathic thoracic spinal epidural lipomatosis causing spinal cord compressionKorkmaz, M; Gök, M; Bozkaya, H; Güneyli, S; Düzgün, F; Oran, IItem Progressive spinal epidural hemangioma in pregnancyKorkmaz, M; Gök, M; Çinar, C; Güneyli, S; Düzgün, F; Oran, I