Tantalum powder is included in the composition of Non-Adhesive Gel-like Embolic Materials (NAGLEMs) for X-ray opacity. The duration of X-ray opacity during embolization is primarily associated with the particle size, which differs in the most used NAGLEMs—ONYX (Medtronic) and SQUID (Balt). NAGLEMs are widely used for the embolization of branches of the middle meningeal artery (MMA) in patients with chronic subdural hematomas (CSDHs). Considering the size (5–15 microns) of the target dural vessels, we assumed that not only the viscosity of NAGLEMs, but also the size and shape of tantalum granules may be important for the penetration of these gel-like embolic agents and determine their behavior. A notable discrepancy in size was observed. The medium-sized granules in the SQUID 18 sample (0.443 ± 0.086 microns, M ± SD) were found to be approximately ten times smaller than the tantalum granules in the ONYX 18 sample (5.2 ± 0.33 microns, M ± SD).Tantalum granules in SQUID 18 have a regular spherical shape; in ONYX 18 they have an irregular angular shape. When comparing the behavior of gel-like embolic agents of the same viscosity during MMA embolization in patients with CSDHs (an average age of 62.2 ± 14.3 years) in the group where SQUID 18 (n = 8) was used, the gel-like embolic agent in dural vessels demonstrated significantly greater penetration ability compared with the group where ONYX 18 (n = 8) was used. Accordingly, not only the viscosity of NAGLEMs, but also the size and shape of tantalum granules can have a significant effect on the penetration ability of gel compositions.

   Background: The pathogenesis of slow/no-reflow phenomena is a critical socio-medical problem due to high mortality and work disability rates in patients with ST-segment elevation myocardial infarction (STEMI). Slow/no-reflow phenomena are multifactorial involving 4 key elements: 1) distal embolization of the coronary bed of the infarct-related coronary artery; 2) ischemic damage to the myocardium; 3) reperfusion injury of the heart muscle; 4) individual (genetic) susceptibility of the microcirculation to injury.   Objective: To analyze the outcomes of percutaneous coronary interventions (PCI) in patients with STEMI and TIMI 0 blood flow of an infarct-related coronary artery based on the strategy to restore antegrade blood flow (balloon predilation or dilation of an infarctrelated artery).   Materials and methods: We analyzed treatment outcomes of 209 patients with STEMI and TIMI 0 blood flow. The patients were grouped based on the PCI strategy: group 1 included 147 patients who underwent balloon angioplasty to restore antegrade blood flow, and group 2 included 62 patients who underwent dilation of an infarct-related coronary artery.   Results: Our study found that direct stenting in STEMI patients was associated with statistically significantly lower risk of slow/noreflow phenomena (P = 0.001, Pearson’s χ²) and, as a result, better functional outcomes of treatment (chronic heart failure grade classified according to Strazhesko-Vasilenko and by left ventricular ejection fraction) that were also statistically significant (P = 0.001, Pearson’s χ²).   Conclusions: Our study demonstrated that the risk of slow/no-reflow phenomena in patients with TIMI 0 blood flow of an infarctrelated coronary artery was statistically significantly lower (P = .001, Pearson’s χ²) in the group of patients who underwent dilation of an infarct-related coronary artery to restore antegrade blood flow. Functional outcomes (chronic heart failure grade and overall survival) were also better in this group of patients (P = .001, Pearson’s Chi-square). Moreover, dilation of an infarct-related coronary artery was associated with preserved left ventricular ejection fraction compared with the group of patients who underwent balloon angioplasty to restore antegrade blood flow (P < 0.001, Pearson’s χ²).

The choice of surgical treatment for patients with severe subarachnoid hemorrhage due to cerebral aneurysm (CA) rupture remains one of the key challenges in vascular neurosurgery. The widespread introduction of endovascular technology into clinical practice allowed to slightly change the paradigm of surgical treatment of ruptured cerebral aneurysms, making it possible to rapidly and practically atraumatically exclude aneurysms regardless of the initial severity in patients. However, the availability of endovascular (EV) interventions and the high cost of the procedure are limiting factors.STUDY OBJECTIVE: to evaluate the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) of high severity (IV and V according to WFNS) depending on the method of aneurysm exclusion from the blood flow.MATERIALS AND METHODS: From 2010 to 2020, a prospective study including two patient groups was performed: Group 1 comprised 100 patients with SAH of aneurysmal etiology who underwent endovascular occlusion of the ruptured aneurysm cavity, and Group 2 included 35 patients who underwent microsurgical clipping. All the patients were evaluated according to the accepted clinical and instrumental scales, and investigations were performed accordg to the standards of medical care.OUTCOMES AND DISCUSSION: The patients enrolled in both study groups were comparable in terms of baseline severity. Immediate treatment outcomes were better in the endovascular group. Our study demonstrated the applicability of this statement in patients with severe aSAH. However, the effect of aneurysm exclusion procedure on patient survival during treatment has not been established. The risk of intraoperative complications in both endovascular and microsurgical groups is low, and the radicality degree of aneurysm exclusion is significantly higher in the microsurgical clipping group.CONCLUSIONS: The EV and MC remain complementary treatment modalities for the ruptured cerebral aneurysms. When choosing the treatment method, if both procedures are available, intravascular interventions should be given priority in patients with severe aSAH, especially in the presence of sub- or decompensated somatic pathology (long history of diabetes mellitus and arterial hypertension).