Faculty of Medicine

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    CONTINUOUS INTRAVENOUS NIMODIPINE APPLICATION FOR PREVENTION OF VASOSPASM BEFORE ENDOVASCULAR TREATMENT OF RUPTURED CEREBRAL ANEURISMS
    (Macedonian Association of Anatomists and Morphologists, 2022)
    Bushinoska, Jasna
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    Effect of intra-arterial Nimodipine on subarachnoid hemorrhage injured brain
    (Macedonian Association of Anatomists and Morphologists, 2022-08-31)
    Bushinoska, Jasna
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    Subarachnoid hemorrhage is a pathological condition of the brain, caused by rupture of intracerebral aneurism or arteriovenous malformation, with high morbidity and mortality rate. SAH may conceive permanent brain damage with persistent disability. Vasospasm isthe most characteristic pathological state of the vasculature, whose development coincides with onset of bleeding with asymptomatic presentation. The critical extend as a risk factor presentswith symptom presentation and indication of brain damage development. Early vasospasm treatment is a priority in prevention of brain ischemia and disability. Existing methods of vasospasm treatment are conservative, endovascular and combined, with simultaneous intraarterial vasodilator application.The aimof this study wasto determine whether intraarterial application of Calcium-blocker Nimodipine will generate immediate vasodilation, facilitating endovascular aneurism treatment, resulting in longterm resolution of the condition.Fifteen patients with SAH receivedendovascular treatment in the first 48 hours of hemorrhage onset, with consequent intraarterialNimodipine application if vasospasm was detected. All patients had ruptured aneurism of anterior circulation. Vessel diameter was measured before and after Nimodipine application. The occurrence and degree of vasodilation, as a difference between both diameters,were considered a confirmation of drug effectiveness.Complete spasm relief occurred in 10patients, residual vasospasm persisted in 4 patients, no VS relief occurred in 1 patient.IntraarterialNimodipine application during endovascular brain aneurism treatment effectively relievesvasospasm. Early coiling reduces complication risks and development of postischemic brain damage.
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    CHALLENGES IN ENDOVASCULAR TREATMENT OF WIDE NECK ANEURYSMS
    (2019-10-24)
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    Caparovski, Aleksandar
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    Background: An aneurysm is an abnormal focal dilatation of an artery. Most of the unruptured aneurysms are asymptomatic and discovered incidentally or some of them symptomatic with mass effect or nerve palsy, but rupture of aneurysm results in a potentially life-threatening subarachnoid haemorrhage. Aneurysms with wide necks are defined by neck diameters greater than 4 mm or dome-to neck ratios less than 2 and are the most difficult to treat with the endovascular method. Aim: This study aimed to analyse the decision and type of endovascular treatment of intracranial aneurysms with a wide neck. Methods: The study population included 56 patients with 67 aneurysms referred to the University Clinic of Radiology in Skopje, the Republic of Macedonia for endovascular treatment during the period from 2017 to 2019. This study included 29 females and 18 males, ranging in age from 25 to 74 years. Results: From total 56 treated aneurysms 19 were ruptured and 37 unruptured. Six patients were with multiple aneurysms. In these study complex aneurysms were treated with combined technique, 9 with balloon-assisted coiling, 28 with stent-assisted coiling, 6 stents, 3 with flow diverter assisted coiling, 13 FD and 3 with partial coil filling, 5 with coiling and neck remodeling without assistance device. Conclusion: Aneurysms with wide neck remain a challenge for endovascular treatment. But the development of new techniques and materials in the treatment of aneurysms makes endovascular treatment of intracranial aneurysms safe and feasible.
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    Spinal epidural hematoma after lumbar catheter insertion in a patient who underwent TEVAR for an aneurysm of the descending aorta
    (SciTechnol, 2020-01-29)
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    Bushinoska, Jasna
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    Asani, Elmedina
    We present a case of spinal epidural hematoma after Lumbar catheter insertion in a patient who underwent TEVAR for an aneurysm of the descending aorta. Spinal epidural hematoma (SEH) is a relatively rare entity and has been reported to occur in patients who receive anti-coagulant therapy, have bleeding disorders, or after traumatic needle insertion. In our case, the epidural hematoma occurred 4 hours after catheter insertion, in a patient who received anticoagulant and antiplatelet medication. In these cases, early detection of symptoms and rapid diagnosis are an imperative. Our patient’s diagnosis was done 5 hours after symptom development and it consisted of thoracolumbar MRI that showed a spinal hyper-acute epidural hematoma extending from T9-T10 to L4-L5 and the affected segments of the spinal cord and conus medullar showed edema, most significantly at L1-L2 levels. A neurosurgical consult was done immediately after obtaining the results and within six hours after neurosurgical symptoms occurred, the patient underwent spinal decompression, the hematoma was evacuated and the patient regained motor function in her legs. During her stay at the cardiac ICU, the doctors administrated to our patient antiplatelet medication alongside low-molecular-weight heparin (LMWH)–inj. Clexane 40 I.U., against our recommendations. Due to this, our patient developed re-bleeding and we had to perform a second surgery, to do a more extensive spinal decompression and to evacuate the hematoma. Neurologic rehabilitation after the second surgery was difficult, but with extensive physical therapy, we have managed to achieve some improvement, with motor response 2\5 on the left leg and 3\5 on the right leg. Although anticoagulants and\or antiplatelet medication are a must in endovascular procedures and are considered safe to use during epidural analgesia, special attention and care to epidural hematoma should be given, especially in cases when an epidural catheter placement is needed.