| 1. |
- Borota, Ljubisa, et al.
(författare)
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Combined percutaneous and transarterial devascularisation of juvenile nasopharyngeal angiofibroma with protection of internal carotid artery : A modification of the technique
- 2015
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Ingår i: Interventional Neuroradiology. - : SAGE Publications. - 1591-0199 .- 2385-2011. ; 21:3, s. 390-396
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Tidskriftsartikel (refereegranskat)abstract
- Juvenile nasal angiofibroma (JNA) is a hypervascularised, benign, but locally aggressive tumour that grows in the posterior, upper part of the nasal cavity and invades surrounding anatomical structures. The treatment of choice is surgical removal, but complete resection of the tumour can be hampered because of profuse perioperative bleeding. Preoperative embolisation of the tumour has been proposed as an effective method for prevention of perioperative bleeding, thereby shortening of the time of the operation. In this report of five cases, we describe successful preoperative devascularisation of the tumour by applying a modified method of direct intratumoural injection of the liquid embolic agent Onyx combined with protection of the internal carotid artery. The control of bleeding during the embolisation and occlusion of the maxillary or sphenopalatine artery was achieved by using a bi-luminal balloon catheter. Such use of the dual-lumen catheter in treatment of JNA has not been reported so far in the medical literature.
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| 2. |
- Borota, Ljubisa, et al.
(författare)
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Dual lumen balloon catheter - An effective substitute for two single lumen catheters in treatment of vascular targets with challenging anatomy
- 2018
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Ingår i: Journal of clinical neuroscience. - : Elsevier BV. - 0967-5868 .- 1532-2653. ; 51, s. 91-99
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe our experience in the treatment of various pathological conditions of the cranial and spinal blood vessels and hypervascularized lesions using dual lumen balloon catheters. Twenty-five patients were treated with endovascular techniques: two with vasospasm of cerebral blood vessels caused by subarachnoid hemorrhage, one with a hypervascularized metastasis in the vertebral body, two with spinal dural fistula, four with cerebral dural fistula, three with cerebral arteriovenous malformations, and 13 with aneurysms. The dual lumen balloon catheters were used for remodeling of the coil mesh, injection of various liquid embolic agents, particles and nimodipine, for the prevention of reflux and deployment of coils and stents. The diameter of catheterized blood vessels varied from 0.7 mm to 4 mm. Two complications occurred: perforation of an aneurysm in one case and gluing of the tip of balloon catheter by embolic material in another case. All other interventions were uneventful, and therapeutic goals were achieved in all cases except in the case with gluing of the tip of balloon catheter. The balloons effectively prevented reflux regardless of the type of the embolic material and diameter of blood vessel. The results of our study show that dual lumen balloon catheters allow complex interventions in the narrow cerebral and spinal blood vessels where the safe use of two single lumen catheters is either limited or impossible.
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| 3. |
- Borota, Ljubisa, et al.
(författare)
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Endovascular treatment of type 1 and type 4 non-saccular aneurysms of cerebral arteries : a single-Centre experience
- 2021
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Ingår i: Interventional Neuroradiology. - : Sage Publications. - 1591-0199 .- 2385-2011. ; 27:3, s. 372-387
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: The aim of this study was to evaluate our results regarding treatment options, complications, and outcomes in patients with non-saccular aneurysms of cerebral arteries belonging to type 1 and type 4 according to Mizutani's classification.METHODS: A total of 26 aneurysms in 26 patients were treated between 2014 and 2019. There were 13 males (mean age 42.77 ± 11.73 years) and 13 females (mean age 50.84 ± 9.37 years). In 23 cases the onset was haemorrhagic and in three cases non-haemorrhagic. A combination of conventional stents and coils was used in 10 cases, conventional stents and flow diverters in three cases, flow diverters and coils in five cases, and flow diverters only were used in eight cases. Radiological results of treatment were assessed after eight months and clinical after one year.RESULTS: In 24 patients, aneurysms were occluded at the end of the follow-up period. An iatrogenic dissection and two haemorrhagic complications were registered. In three cases, parent arteries were occluded due to re-growth of the aneurysm, which caused middle cerebral artery infarction in one case. A favourable clinical outcome was registered in 19, patients, and non-favourable in five. Two patients died in the early postoperative period due to extensive damage to the brain parenchyma caused by initial bleeding.CONCLUSION: Our results indicate that treatment of type 1 and type 4 non-saccular aneurysms with various combination of stents and flow diverters, with or without coils, is promising, although very challenging and technically demanding.
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| 4. |
- Borota, Ljubisa, et al.
(författare)
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Expanded range of indications for Neuroform Atlas stent in the treatment of very small, wide-necked cerebral aneurysms
- 2023
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Ingår i: Journal of clinical neuroscience. - : Elsevier. - 0967-5868 .- 1532-2653. ; 114, s. 38-47
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate the range of indications for using the Neuroform Atlas stent. Between 2016 and 2020, we treated 20 females and 5 males for aneurysms with a diameter of less than 3 mm and an aspect ratio less than 1.5. The diameter of the parent arteries varied from 1.1 mm to 4.5 mm. There were 13 ruptured and 12 unruptured aneurysms. Double stent-assisted coiling was performed in 14 cases, and single stent-assisted coiling was performed in 11 cases. After deployment, the morphology of the Neuroform Atlas stents was analyzed in tapered or Y-shaped silicone tubes that simulated parent arteries. Radiological results were assessed 7 months and 2 years after the intervention using the Raymond-Roy scale. Clinical outcome was assessed 1 year after the intervention using the modified Rankin score. There were three fatal outcomes. One aneurysm was recoiled. The rate of class I aneurysm occlusion was registered in 21 patients at the last follow-up. At the end of the clinical follow-up period, a favorable outcome (modified Rankin scale 0 -1) was registered in nine patients with ruptured aneurysms. An analysis of the morphology of the stents deployed in the silicone tubes provided an explanation for the stability of the coil mass in the treated aneurysms. Our results suggest that the range of indications for use of the Neuroform Atlas stent can be expanded beyond the present range with regard to the diameter of the parent vessels and size of the aneurysms.
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| 5. |
- Borota, Ljubisa, et al.
(författare)
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Neuroform Atlas stent in treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries : a single-centre experience
- 2019
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Ingår i: Interventional Neuroradiology. - : SAGE Publications. - 1591-0199 .- 2385-2011. ; 25:4, s. 390-396
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: To present our experience in the treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent.MATERIALS AND METHODS: Between January 2017 and February 2018 we treated iatrogenic dissections of three internal carotid arteries and three vertebral arteries. These iatrogenic dissections occurred during the endovascular treatment of ruptured and unruptured intracranial aneurysms. The indication for stenting was haemodynamically significant, flow-limiting dissection with threatening flow arrest. In all six cases, the dissections were treated by placement of Neuroform Atlas stents in the dissected segments of internal carotid or vertebral arteries. Deployment of the stent was followed by the usual dual antiplatelet regimen.RESULTS: Single or multiple Neuroform Atlas stents were deployed without any technical difficulties, and blood flow was restored immediately after placement of the stents in all six cases. Midterm follow-up (6-8 months) showed complete reconstruction of the shape and lumen of all treated arteries, with negligible intimal hyperplasia.CONCLUSION: Our results indicate that a favourable outcome can be achieved by treating iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent.
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| 6. |
- Borota, Ljubisa, et al.
(författare)
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Spot fluoroscopy : a novel innovative approach to reduce radiation dose in neurointerventional procedures
- 2017
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 58:5, s. 600-608
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Increased interest in radiation dose reduction in neurointerventional procedures has led to the development of a method called "spot fluoroscopy" (SF), which enables the operator to collimate a rectangular or square region of interest anywhere within the general field of view. This has potential advantages over conventional collimation, which is limited to symmetric collimation centered over the field of view.PURPOSE: To evaluate the effect of SF on the radiation dose.MATERIAL AND METHODS: Thirty-five patients with intracranial aneurysms were treated with endovascular coiling. SF was used in 16 patients and conventional fluoroscopy in 19. The following parameters were analyzed: the total fluoroscopic time, the total air kerma, the total fluoroscopic dose-area product, and the fluoroscopic dose-area product rate. Statistical differences were determined using the Welch's t-test.RESULTS: The use of SF led to a reduction of 50% of the total fluoroscopic dose-area product (CF = 106.21 Gycm(2), SD = 99.06 Gycm(2) versus SF = 51.80 Gycm(2), SD = 21.03 Gycm(2), p = 0.003884) and significant reduction of the total fluoroscopic dose-area product rate (CF = 1.42 Gycm(2)/min, SD = 0.57 Gycm(2)/s versus SF = 0.83 Gycm(2)/min, SD = 0.37 Gycm(2)/min, p = 0.00106). The use of SF did not lead to an increase in fluoroscopy time or an increase in total fluoroscopic cumulative air kerma, regardless of collimation.CONCLUSION: The SF function is a new and promising tool for reduction of the radiation dose during neurointerventional procedures.
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| 7. |
- Carvalho, Ricardo, 1985-, et al.
(författare)
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Household Bioenergy Transitions with Alternative Biomass Feedstocks and Technologies: An Integrated System to Mitigate Environmental Risks in Western Kenya
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In Kenya, over 50% of the total primary energy consumption is from traditional solid-fuel cooking, being this a major cause of deforestation and household air pollution (HAP). Western Kenya has an agricultural biofuel feedstock of over 1.9 million Mt, which could be processed to supply cookstoves with crop-residue pellets and improved wood fallows. The sociotechnical viability of two novel bioenergy value chains were analysed using the Long-Range Energy Alternatives Planning system. Three scenarios of transition to efficient cookstoves and decentralized biofuel and electricity production systems were tested. In the “Optimal scenario”, the current feedstock in the Kisumu and Siaya counties could satisfy over 80% of the cooking energy demand by 2030. Here, the net greenhouse gas emissions from charcoal production and HAP could be reduced by 87% to 12.6 thousand Mt CO2e. Further work should integrate socioeconomic indicators reflecting additional local/regional stakeholders´ collaboration channels (cost-effective) to support the bioenergy transitions.
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| 8. |
- Carvalho, Ricardo L., et al.
(författare)
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Bioenergy strategies to address deforestation and household air pollution in western Kenya
- 2019
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Ingår i: European Biomass Conference and Exhibition Proceedings. - : ETA-Florence Renewable Energies. ; , s. 1536-1542
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Konferensbidrag (refereegranskat)abstract
- Over 640 million people in Africa are expected to rely on solid-fuels for cooking by 2040. In Western Kenya, cooking inefficiently persists as a major cause of burden disease due to household air pollution. The Long-Range Energy Alternatives Planning (LEAP) system and the Life-Cycle Assessment tool Simapro 8.5 were applied for analyzing biomass strategies for the region. The calculation of the residential energy consumption and emissions was based on scientific reviews and original data from experimental studies. The research shows the effect of four biomass strategies on the reduction of wood fuel use and short-lived climate pollutant emissions. A Business As Usual scenario (BAU) considered the trends in energy use until 2035. Transition scenarios to Improved Cookstoves (ICS), Pellet-fired Gasifier Stoves (PGS) and Biogas Stoves (BGS) considered the transition to wood-logs, biomass pellets and biogas, respectively. An Integrated (INT) scenario evaluated a mix of the ICS, PGS and BGS. The study shows that, energy use will increase by 8% (BGS), 20% (INT), 26% (PGS), 42% (ICS) and 56% (BAU). The BGS has the lowest impact on global warming, particle formation, terrestrial acidification, fossil resource scarcity, water consumption, as well as on eutrophication followed by the PGS and INT.
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| 9. |
- Carvalho, Ricardo Luís, et al.
(författare)
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Environmental Sustainability of Bioenergy Strategies in Western Kenya to Address Household Air Pollution
- 2020
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Ingår i: Energies. - : MDPI. - 1996-1073. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Over 640 million people in Africa are expected to rely on solid-fuels for cooking by 2040. In Western Kenya, cooking inefficiently persists as a major cause of burden of disease due to household air pollution. Efficient biomass cooking is a local-based renewable energy solution to address this issue. The Life-Cycle Assessment tool Simapro 8.5 is applied for analyzing the environmental impact of four biomass cooking strategies for the Kisumu County, with analysis based on a previous energy modelling study, and literature and background data from the Ecoinvent and Agrifootprint databases applied to the region. A Business-As-Usual scenario (BAU) considers the trends in energy use until 2035. Transition scenarios to Improved Cookstoves (ICS), Pellet-fired Gasifier Stoves (PGS) and Biogas Stoves (BGS) consider the transition to wood-logs, biomass pellets and biogas, respectively. An Integrated (INT) scenario evaluates a mix of the ICS, PGS and BGS. In the BGS, the available biomass waste is sufficient to be upcycled and fulfill cooking demands by 2035. This scenario has the lowest impact on all impact categories analyzed followed by the PGS and INT. Further work should address a detailed socio-economic analysis of the analyzed scenarios.
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| 10. |
- Carvalho, Ricardo L., et al.
(författare)
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Household air pollution mitigation with integrated biomass/cookstove strategies in Western Kenya
- 2019
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Ingår i: Energy Policy. - : Elsevier. - 0301-4215 .- 1873-6777. ; 131, s. 168-186
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Tidskriftsartikel (refereegranskat)abstract
- Traditional cooking is today's largest global environmental health risk. Over 640 million people in Africa are expected to rely on biomass for cooking by 2040. In Kenya, cooking inefficiently with wood and charcoal persists as a cause of deforestation and household air pollution. This research analyses the effects of four biomass cookstove strategies on reducing air pollutant emissions in Kisumu County between 2015 and 2035 using the Long-Range Energy Alternatives Planning system. The Business as Usual scenario (BAU) was developed considering the historical trends in household energy use. Energy transition scenarios to Improved Cookstoves (ICS), Pellet Gasifier Stoves (PGS) and Biogas Stoves (BGS) were applied to examine the impact of these systems on energy savings and air pollution mitigation. An integrated scenario (INT) was evaluated as a mix of the ICS, PGS and BGS. The highest energy savings, in relation to the BAU, are achieved in the BGS (30.9%), followed by the INT (23.5%), PGS (19.4%) and ICS (9.2%). The BGS offers the highest reduction in the GHG (37.6%), CH4 (94.3%), NMVOCs (85.0%), CO (97.4%), PM2.5 (64.7%) and BC (48.4%) emissions, and the PGS the highest reduction in the N2O (83.0%) and NOx (90.7%) emissions, in relation to the BAU.
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