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Recanalization
Kinds of Recanalization Selected AbstractsCoronary Recanalization Due to Presumed Thrombosis Following Surgical Ligation of a Large Right Coronary Artery to Right Ventricle FistulaCONGENITAL HEART DISEASE, Issue 4 2008John T. Fahey MD ABSTRACT We report angiographic findings in an infant with congestive heart failure due to a large right coronary artery to right ventricular fistula who underwent surgical ligation. Repeat catheterization 2 years later unexpectedly showed extensive thrombosis of the right coronary artery with multiple recanalized channels supplying the right coronary distribution. Review of the literature showed that this may not be an uncommon finding. [source] Thrombotic occlusion of the common carotid artery (CCA) in acute ischemic stroke treated with intravenous tissue plasminogen activator (TPA)EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2007V. K. Sharma Although common carotid artery (CCA) occlusions are rare, acute clinical presentations vary from mild to devastating strokes primarily due to tandem occlusions in the intracranial arteries. Three patients with acute CCA occlusions were treated with systemic tissue plasminogen activator (TPA). Blood pressures were kept at the upper limits allowed with TPA therapy with fluid balance and the ,head-down' position. Recanalization occurred in intracranial vessels only. Marked early neurological improvement occurred in two of three patients. CCA occlusions should not be considered contra-indication to systemic thrombolysis. [source] Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary OcclusionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002FEDERICO PISCIONE M.D. Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source] Association of Pretreatment ASPECTS Scores with tPA-Induced Arterial Recanalization in Acute Middle Cerebral Artery OcclusionJOURNAL OF NEUROIMAGING, Issue 1 2008Georgios Tsivgoulis MD ABSTRACT BACKGROUND AND PURPOSE The Alberta Stroke Program Early CT-Score (ASPECTS) assesses early ischemic changes within the middle cerebral artery (MCA) and predicts poor outcome and increased risk for thrombolysis-related symptomatic ICH. We evaluated the potential relationship between pretreatment ASPECTS and tPA-induced recanalization in patients with MCA occlusions. SUBJECTS & METHODS Consecutive patients with acute ischemic stroke due to MCA occlusion were treated with standard IV-tPA and assessed with transcranial Doppler (TCD) for arterial recanalization. Early recanalization was determined with previously validated Thrombolysis in Brain Ischemia (TIBI) flow-grading system at 120 minutes after tPA-bolus. All pretreatment CT-scans were prospectively scored by trained investigators blinded to TCD findings. Functional outcome at 3 months was evaluated using the modified Rankin Scale (mRS). RESULTS IV-tPA was administered in 192 patients (mean age 68 ± 14 years, median NIHSS-score 17). Patients with complete recanalization (n= 51) had higher median pretreatment ASPECTS (10, interquartile range 2) than patients with incomplete or absent recanalization (n= 141; median ASPECTS 9, interquartile range 3, P= .034 Mann-Whitney U-test). An ASPECTS ,6 was documented in 4% and 17% of patients with present and absent recanalization, respectively (P= .019). Pretreatment ASPECTS was associated with complete recanalization (OR per 1-point increase: 1.54; 95% CI 1.06,2.22, P= .023) after adjustment for baseline characteristics, risk factors, NIHSS-score, pretreatment TIBI grades and site of arterial occlusion on baseline TCD. Complete recanalization (OR: 33.97, 95% CI 5.95,185.99, P < .001) and higher ASPECTS (OR per 1-point increase: 1.91; 95% CI 1.17,3.14, P= .010) were independent predictors of good functional outcome (mRS 0,2). CONCLUSIONS Higher pretreatment ASPECT-scores are associated with a greater chance of complete recanalization and favorable long-term outcome in tPA-treated patients with acute MCA occlusion. [source] MRI Assessment Followed by Successful Mechanical Recanalization of a Complete Tandem (Internal Carotid/Middle Cerebral Artery) Occlusion and Reversal of a 10-Hour Fixed DeficitJOURNAL OF NEUROIMAGING, Issue 1 2008Catalina C. Ionita MD ABSTRACT BACKGROUND Mechanical clot extraction up to 8 hours after stroke onset is an alternative strategy for opening large vessels, especially for patients ineligible for intravenous thrombolysis. Safety beyond this therapeutic window is untested. METHODS An 81-year-old woman presented 8 hours after she developed left-sided weakness and dysarthria with a National Institutes of Health Stroke Scale (NIHSS) score fluctuating between 6 and 13. Neuroimaging revealed a large perfusion deficit with no diffusion abnormalities. An emergent cerebral angiogram revealed a complete internal carotid artery terminus occlusion. RESULTS Successful mechanical thrombectomy was performed without complication and resulted in almost complete reversal of the patient's deficit to an NIHSS score of 1, 10 hours after stroke onset. CONCLUSION Patients with large hypoperfused areas and minimal diffusion abnormalities on the MRI may benefit from mechanical thrombectomy beyond an 8-hour window. [source] Residual Flow Signals Predict Complete Recanalization in Stroke Patients Treated With TPAJOURNAL OF NEUROIMAGING, Issue 1 2003Lise A. Labiche MD ABSTRACT Background. Residual blood flow around thrombus prior to treatment predicts success of coronary thrombolysis. The authors aimed to correlate the presence of residual flow signals in the middle cerebral artery (MCA) with completeness of recanalization after intravenous tissue plasminogen activator (TPA). Methods. The authors studied consecutive patients treated with intravenous TPA therapy who had a proximal MCA occlusion on pretreatment transcranial Doppler (TCD). Patients were continuously monitored for 2 hours after TPA bolus. Absent residual flow signals correspond to the thrombolysis in brain ischemia (TIBI) 0 grade, and the presence of residual flow signals was determined as TIBI 1-3 flow grades. Complete recanalization was defined as flow improvement to TIBI grades 4-5. Results. Seventy-five patients with a proximal MCA occlusion had median pre-bolus NIHSS 16 (85% with ,10 points). TPA bolus was given at 141 ± 56 minutes (median 120 minutes). Complete recanalization was observed in 25 (33%), partial in 23 (31%), and no early recanalization was seen in 27 (36%) patients within 2 hours after TPA bolus. Only 19% with absent residual flow signals (TIBI grade 0, n= 26) on pretreatment TCD had complete early recanalization. If pretreatment TCD showed the presence of any residual flow (TIBI 1-3, n= 49), 41% had complete recanalization within 2 hours of TPA bolus (P = .03). Conclusions. Patients with detectable residual flow signals before IV TPA bolus are twice as likely to have early complete recanalization. Those with no detectable residual flow signals have less than 20% chance for complete early recanalization with intravenous TPA and may be candidates for intra-arterial therapies. [source] Recanalization of the Collecting Lymphatics in Rabbit Hind LegMICROCIRCULATION, Issue 5 2006FUMITAKA IKOMI ABSTRACT Objective: This study was designed to examine whether mature collecting lymphatics can regenerate in the adult tissue or not. Materials and Methods: The X-ray lymphograms were used to detect network of the collecting lymphatics in rabbit hind leg. Regeneration of the lymphatics was observed after surgical removal of the popliteal lymph node or a part of the popliteal afferent lymphatic. Structure and mechanical properties of the lymphatics were also examined by light and electron microscopes and in vitro functional experiments. Results: One week after removal of the lymph node, only an afferent lymphatic and a deposit of the contrast medium at the popliteal region were observed. Four weeks after the removal, the connection of the afferent and efferent lymphatics at the popliteal region, and collateral lymphatics were present in the leg. Further, 4 weeks after 1-mm excisions of a part of the lymphatic, recanalization was observed between the central and peripheral cut ends of the lymphatic but not after 3- and 10-mm excisions. Endothelial cells and smooth muscle cells could be observed by electron microscope, and contractile proteins, and alpha-smooth muscle actin SM1 and SM2 were immunofluorescently detected in both intact and the regenerated lymphatic walls. In both lymphatics, norepinephrine and acetylcholine induced dose-dependent constriction and dilation of the vessels, respectively. Conclusion: The present study demonstrated that mature collecting lymphatics are able to regenerate in the adult tissues. [source] Laser Recanalization of the Subclavian VeinPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006CHARLES A. HENRIKSON We report the use of a long wire and introducer as a rail for the laser recanalization of a chronically occluded subclavian vein following extraction of a fractured permanent pacing lead. This allowed new pacing leads to be placed through the previously occluded vessel. [source] Restored Atrial Excitability After Late Recanalization in a Patient with Atrial Standstill and Acute Myocardial InfarctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2002TAKA-AKI KOSHIMIZU KOSHIMIZU, T-A., et al.: Restored Atrial Excitability After Late Recanalization in a Patient with Atrial Standstill and Acute Myocardial Infarction. Atrial standstill is electrophysiologically characterized by the loss of spontaneous excitation in atrial muscle and the inability to cause action potential firing upon electrical stimulation. Clinical diagnosis of transient standstill of the right atrium was made in a patient with acute occlusion of the right coronary artery and acute renal failure. Percutaneous coronary intervention, performed 5 days after the onset, restored the coronary blood flow and resulted in full recovery of electrical activity and regular sinus rhythm. [source] Anticoagulants in pediatric cerebral sinovenous thrombosis: A safety and outcome studyANNALS OF NEUROLOGY, Issue 5 2010Mahendranath D. Moharir MBBS Objective Clinical trials are lacking in pediatric cerebral sinovenous thrombosis (CSVT). Neonates and children increasingly receive anticoagulant therapy (ACT) based on adult studies. Safety data for ACT in pediatric CSVT are scant and urgently needed. The objective was to assess the safety and outcome of ACT in pediatric CSVT. Methods In a single-center prospective study, neonates and children with CSVT received ACT (standard/low molecular weight heparin, warfarin) by standardized protocol. A study neuroradiologist (M.S.) assessed all initial and follow-up neuroimaging for intracranial hemorrhage (ICH), thrombus propagation, and recanalization. Clinical outcome was assessed with the Pediatric Stroke Outcome Measure. Results Among 162 pediatric patients, 85 received ACT at diagnosis, including 29/83 (35%) neonates and 56/79 (71%) children. Major hemorrhage occurred in 6% (6/99) of treated patients, including 14% (3/21 neonates, 2/15 children) with and 2% (0/17 neonates, 1/46 children) without pretreatment ICH. ACT-associated bleeds were all nonfatal, and clinical outcome was favorable in 50%, similar to the remaining patients (53%). Early follow-up imaging demonstrated thrombus propagation in 11/57 neonates (10/35 [28%] without and 1/22 [4%] with ACT [p = 0.037]) and 10/63 children (7/19 [37%] without and 3/44 [7%] with ACT [p = 0.006]). Propagation was associated with new venous infarcts in 10% neonates and 40% children and worse clinical outcome in children (p = 0.053). Recanalization occurred earlier and more completely in neonates (p = 0.002). Clinical outcome was unfavorable in 47%. Interpretation In pediatric CSVT, ACT appears safe. Nontreatment with ACT is associated with thrombus propagation, observed in ¼ of untreated neonates and over , of children. Anticoagulants merit strong consideration in pediatric CSVT. ANN NEUROL 2010;67:590,599 [source] Mechanical embolectomy for large vessel ischemic strokes: A cardiologist's experience,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2010Dr. Mark Abelson FCP (Cardiology) Abstract Introduction: Large vessel acute ischemic stroke has a poor outcome. Intravenous (IV) thrombolysis is often contra-indicated and if given, usually ineffective. Mechanical embolectomy is an option in these patients and may be performed by an interventional cardiologist experienced in carotid interventions. Method: Consecutive stroke patients were assessed by the stroke physician and, if eligible, referred for possible mechanical embolectomy using the Merci retriever. All procedures were done by a single cardiologist. Patient information, procedural characteristics and clinical outcomes at 90 days were collected by retrospective chart review. Results: A total of 22 patients were referred for emergency cerebral angiography with 17 undergoing mechanical embolectomy. The mean National Institute of Health Stroke Scale (NIHSS) score was 20.1 and the mean stroke duration was 284 min. Recanalization was successful in 15 (88%) patients. Ten patients (59%) had a good outcome (modified Rankin Score ,2 at 90 days) and four died (mortality 23%). Three patients had significant intra-cerebral hemorrhage. There were no other major adverse events. Conclusions: For patients with large vessel occlusion strokes where IV thrombolysis was either contra-indicated or had failed, mechanical embolectomy performed by an interventional cardiologist had a high recanalization rate with an acceptable clinical outcome and safety profile. © 2010 Wiley-Liss, Inc. [source] High-frequency vibration for the recanalization of guidewire refractory chronic total coronary occlusions,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2008Klaus Tiroch MD Abstract Background: Recanalization of coronary chronic total occlusions (CTOs) remains a clinical challenge, particularly when standard guidewire attempts fail. Objectives: We sought to determine the safety and efficacy of a novel method that used high-frequency (20 kHz) vibration to fragment occlusive fibrous tissue and facilitate guidewire crossing into the distal vessel. Methods: A total of 125 patients with CTO, who failed at attempts of conventional guidewire recanalization after more than 5 min of fluoroscopy time, were enrolled in the study. The primary efficacy endpoint was the advancement of the CROSSERÔ catheter through the occlusion and attainment of coronary guidewire positioning in the distal coronary lumen. The primary safety endpoint was the occurrence of death, myocardial infarction, clinical perforation, or target vessel revascularization within the first 30 days. Results: The average fluoroscopy time while delivering the CROSSER catheter was 12.4 min. CROSSER-assisted guidewire recanalization was achieved in 76 (60.8%) procedures and a final diameter stenosis <50% was obtained in 68 (54.4%) of cases. Major adverse events occurred in 11 (8.8%) patients, lower than the predefined objective performance criteria. Angina frequency and quality of life were improved in patients with successful guidewire recanalization. Conclusions: We conclude that high-frequency vibration using the CROSSER catheter is a safe and effective therapy for patients with CTO, which are refractory to standard guidewire recanalization. © 2008 Wiley-Liss, Inc. [source] Evaluation of the Efficacy of Polidocanol in the Form of Foam Compared With Liquid Form in Sclerotherapy of the Greater Saphenous Vein: Initial ResultsDERMATOLOGIC SURGERY, Issue 12 2003Claudine Hamel-Desnos MD Background. Foamed sclerosing agents have been used with enthusiasm by phlebologists for more than 5 decades. Any type of varicose veins can and has been treated with this technique. Numerous publications have stressed the advantages of foamed sclerosing agents on the basis of empiric and experimental criteria and have described various individual techniques to prepare foams. Until now, however, no comparative study for the treatment of large varicose veins with foam or liquid exists. Objective. The purpose of this first randomized, prospective, multicenter trial was to study the elimination of reflux, the rate of recanalization, and possible side effects of foam sclerotherapy (FS) compared with conventional liquid sclerotherapy for the greater saphenous vein (GSV). Methods. Eighty-eight patients were randomized into two groups: One group was treated with sclerosing foam (45 patients) and the other with sclerosing liquid (43 cases). Sclerotherapy was performed with direct puncture of the vessel under duplex guidance. The reference sclerosing agent was polidocanol in a 3% solution. The foam was prepared using the Double Syringe System (DSS) method. Only one injection of 2.0 or 2.5 mL liquid or foam was allowed, depending on the diameter of the GSV. Results were assessed according to the protocol. Results. Follow-up after 3 weeks showed 84% elimination of reflux in the GSV with DSS foam versus 40% with liquid sclerosant (P < 0.01). At 6 months, six recanalizations were found in the liquid group versus two in the foam group. After 1 year, no additional recanalization was observed with either foam or liquid. Longer term studies are underway. Side effects did not differ between both groups. Conclusion. The efficacy of sclerosing foam (DSS) compared with sclerosing liquid in therapy of the GSV is superior, a finding that had already gained empirical recognition but for which there has not been any clinical evidence to date. [source] Real-time monitoring of recanalization after intravenous thrombolysis for acute ischemic strokeEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2006R. Delgado-Mederos No abstract is available for this article. [source] Complete hypopharyngeal obstruction by mucosal adhesions: A complication of intensive chemoradiation for advanced head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2006Elizabeth J. Franzmann MD Abstract Background. Severe swallowing dysfunction is the dominant long-term complication observed in patients treated for head and neck squamous cell carcinoma (HNSCC) with treatment protocols using intensive concurrent chemotherapy with radiation therapy (chemo/XRT). We identified a subset of these patients, who were seen with complete obstruction of the hypopharynx distal to the site of the primary cancer, and in whom we postulate that the obstruction was caused by separable mucosal adhesions rather than obliteration by a mature fibrous stricture. Methods. Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction between 1992 and 2001. The diagnosis was confirmed by barium swallow imaging and/or endoscopy before referral in all patients. Patients underwent recanalization by passing a Jesberg esophagoscope under general anesthesia, followed by serial dilations and intensive swallowing therapy. Patient charts were reviewed retrospectively after institutional review board approval. Results. All seven patients were successfully recanalized. No patient had a perforation or other significant complication related to the recanalization procedure or subsequent dilations. Five of the seven patients showed improvement in swallowing at some point after the initial procedure, but just two patients recovered sufficiently to have their gastrostomy tube removed permanently. Conclusions. We conclude that complete hypopharyngeal obstruction secondary to mucosal adhesions is one cause of gastrostomy tube dependence in patients who have been treated with chemo/XRT for HNSCC. It is a difficult problem to treat, but most patients can recover useful swallowing function without undergoing laryngectomy or major surgical reconstruction. The postulated pathophysiology has implications for prevention as well as treatment. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Aiming at minimal invasiveness as a therapeutic strategy for Budd-Chiari syndrome,HEPATOLOGY, Issue 5 2006Aurélie Plessier The 1-year spontaneous mortality rate in patients with Budd-Chiari syndrome (BCS) approaches 70%. No prospective assessment of indications and impact on survival of current therapeutic procedures has been performed. We evaluated a therapeutic strategy uniformly applied during the last 8 years in a single referral center. Fifty-one consecutive patients first received anticoagulation and were treated for associated diseases. Symptomatic patients were considered for hepatic vein recanalization; then for transjugular intrahepatic portosystemic shunt (TIPS), and finally for liver transplantation. The absence of a complete response led to the next procedure. Assessment was according to the strategy, whether procedures were technically applicable and successful. At entry, median (range) Child-Pugh score and Clichy prognostic index were 8 (5,12), and 5.4 (3.1,7.7), respectively. A complete response was achieved on medical therapy alone in 9 patients; after recanalization in 6, TIPS in 20, liver transplantation in 9, and retransplantation in 1. Of the 41 patients considered for recanalization, the procedure was not feasible in 27 and technically unsuccessful in 3. Of the 34 patients considered for TIPS, the procedure was considered not feasible in 9 and technically unsuccessful in 4. At 1 year of follow-up, a complete response to TIPS was achieved in 84%. One- and 5-year survival from starting anticoagulation were 96% (95% CI, 90,100) and 89% (95% CI, 79,100), respectively. In conclusion, excellent survival can be achieved in BCS patients when therapeutic procedures are introduced by order of increasing invasiveness, based on the response to previous therapy rather than on the severity of the patient's condition. (HEPATOLOGY 2006;44:1308,1316.) [source] Endovenous laser therapy , application studies and latest investigationsJOURNAL OF BIOPHOTONICS, Issue 5-6 2010Ronald Sroka Abstract Endovenous laser therapy (ELT) was introduced in clinical practice as a therapy for incompetent veins about ten years ago. One characteristic of ELT is the broad spectrum of different treatment protocols by means of a variety of laser systems as well as manifold application forms and dosimetry concepts are under investigations. Clinical results with effective, relatively pain-free occlusion of incompetent varicosis veins have been observed, as well as undesired side effects such as ecchymosis, phlebitis and recanalization. In recent years systematic experimental investigations and the analysis of clinical results have increased the understanding of the interrelation between the clinical and physical aspects, followed to a continuous optimization of ELT. The use of IR wavelengths and radial irradiation concepts, together with continuous moving of the optical fiber seem to reduce possible side effects. This way ELT treatment becomes a more standardized effective method for the treatment of varicose veins. In future controlled randomized studies are required to compare optimized ELT treatment with other endoluminal modalities as well as conventional surgery. (© 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Left Ventricular Reconstruction for Ischemic CardiomyopathyJOURNAL OF CARDIAC SURGERY, Issue 3 2002Vincent Dor M.D. The technique is conducted under a totally arrested heart; coronary revascularization is accomplished first. The mitral valve is checked by TEE and repaired if necessary. Endocardectomy and cryotherapy are used in case of ventricular tachycardia. At the limit between scarred and normal tissue, a continuous suture is tied on a balloon inflated at the theoretical diastolic volume of the patient, and a patch is fixed inside the ventricle. Autologous tissue can be also used. The experience of the author is more than 1000 cases since 1984. The global hospital mortality of the whole series is 7.3%, and 13% in patients with very poor ejection fraction (<30%). In the series of the last 3 years, these mortality rates are 4.8% and 7.9%, respectively. Both geometry and performances of the LV are improved, and the mean increase of ejection fraction is between 10 and 15 points. Three causes can explain delayed impairment; continuum in remodeling, lack in diastolic capacity, or absence of mitral repair. After an infarct, with or without successful coronary recanalization, that leaves a large asynergic scarred ventricle (50% of LV circumference), LVR is recommended to avoid or prevent permanent congestive heart failure with global dilatation. In end-stage ischemic cardiomyopathy with congestive heart failure, and poor response to full medical therapy, LVR, with acceptable risk, could slow down the remodeling and avoid or delay heart transplantation. [source] Serial compression B-scan and Doppler sonography for the screening of deep venous thrombosis in patients with spinal cord injuriesJOURNAL OF CLINICAL ULTRASOUND, Issue 1 2010Alfried Germing MD Abstract Purpose To evaluate the usefulness of serial compression B-scan and Doppler sonography (US) in screening for deep venous thrombosis (DVT) of the lower extremities in patients with spinal cord injuries. Method Patients with paraplegia and tetraplegia due to spinal cord injuries were screened by a serial compression B-scan and Doppler US protocol for DVT of the bilateral lower extremities within the first 36 hours after admission, at day 7 and at day 21. In patients with DVT, a follow-up US examination was performed 3 weeks after diagnosis to assess thrombi distribution. Results Between January 2007 and March 2008, a total of 115 patients (75 males, 40 females), aged 19 to 85 years, were included. The first US examination documented a DVT in 44 cases (38.3%). After an initial negative scan, sonography after 7 days and 21 days showed DVT in 6 patients and 2 patients, respectively. Cumulative rate of DVT after the first 3 weeks was 45.2% (n=52). Follow-up US after 3 weeks in patients with DVT documented a complete recanalization in 19 patients (36.5%), no change in 12 patients (23.1%), and residual thrombi with partial recanalization in 21 patients (40.4%). Conclusion Our study supports the use of serial compression B-scan and Doppler US as a screening tool for DVT of the lower extremities in patients with spinal cord injuries early after injury. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source] Extracranial and intracranial vertebral artery dissection: Long-term clinical and duplex sonographic follow-upJOURNAL OF CLINICAL ULTRASOUND, Issue 8 2008Tiemo Wessels MD Abstract Purpose. To determine the value of color Doppler sonography (CDUS) in the diagnosis and follow-up of patients with extracranial and intracranial vertebral artery (VA) dissection. Method. Thirty-three patients aged 42 ± 12 years with 40 VADS confirmed via digital subtraction angiography (DSA) (n = 37) and magnetic resonance angiography (MRA) (n = 3) were included in the study. All patients were investigated with extracranial CDUS and transcranial CDUS (TCCDUS) over a mean ± SD follow-up period of 42 ± 24 months and occurrence of new ischemic symptoms was assessed. Sonographic results were compared with initial and follow-up angiographic results. Results. At presentation, 24/33 (73%) patients had suffered an ischemic stroke, 5/33 (15%) had a transient ischemic attack (TIA), and 4/33 (12%) were asymptomatic. Two patients had a recurrent vertebrobasilar TIA; there was no recurrent stroke. The initial DSA findings consisted of 14 stenoses, 20 tapered occlusions, and 6 pseudoaneurysms. During follow-up, 63% of the vessels recanalized. Sonographic findings were consistent with angiographic findings in 80% at the initial examination and in 86% during follow-up. The main reason for discordant results was the failure of CDUS to detect pseudoaneurysms. No recurrence occurred in the vertebral arteries (VA), but 1 patient had an asymptomatic carotid artery dissection during follow-up. Conclusion. Recurrent TIA or stroke after VAD appears to be extremely rare, independent of recanalization or persistent occlusion of the affected artery. CDUS and TCCDUS provide reliable follow-up of VAD in all patients presenting with stenosis or occlusion, but do not allow for detection of pseudoaneurysms of the VA. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] The Challenges of Chronic Total Coronary Occlusions: An Old Problem in a New PerspectiveJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2004DAVID E. KANDZARI M.D. In spite of the remarkable technological innovation and improved outcomes with percutaneous coronary revascularization, chronic coronary artery total occlusions remain a familiar source of procedural frustration and clinical uncertainty. However, considering the recent development of catheter-based technologies specific for chronic total occlusion (CTO) recanalization and the potential for drug-eluting stents to reduce restenosis and reocclusion, this challenging lesion subset is now recognized as the last formidable barrier to percutaneous revascularization success. Further, consistent observations from more recent clinical trials support successful CTO revascularization to avoid subsequent adverse cardiac events and improve long-term overall survival. This review of total coronary occlusions provides an overview of CTO pathophysiology, describes the procedural and clinical outcomes associated with CTO revascularization, and presents future directions for clinical investigation. [source] Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary OcclusionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002FEDERICO PISCIONE M.D. Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source] Acute Myocardial Infarction in a Discrete Coronary Artery Aneurysm Without ObstructionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2000YUJI YOSHITOMI M.D. We report an unusual case of acute myocardial infarction attributable to obstruction of a discrete coronary aneurysm in a 54-year-old man. Although coronary angioplasty and thrombolysis were unsuccessful, serial arteriography showed spontaneous recanalization, and no spasm was induced by ergonovine. We discuss its mechanism. [source] Role of neuroimaging in promoting long-term recovery from ischemic strokeJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2010Rüdiger J. Seitz MD Abstract Human ischemic stroke is an acute disorder followed by a recovery period which may be of varying duration and mechanism. Imaging has created a means to explore the stroke process in vivo, particularly its underlying pathophysiology and recovery mechanisms. Evidence from multicenter studies has shown that, in the acute phase, arterial recanalization and reperfusion of ischemic brain tissue are the most important determinants of recovery. This is followed by functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks that continue with different dynamics for weeks to months. Proof-of-principle studies have revealed that the behavioral gains induced by rehabilitation are paralleled by changes in functional representations. This is supported by data from neuroimaging and electrophysiological studies early after stroke which have shown that dedicated training can induce changes in cerebral functional representations. Accordingly, there is clear evidence that neuroimaging has a significant potential for monitoring the hemodynamic, functional, and structural factors determining recovery from stroke. New imaging methods may provide relevant biomarkers for treatment decisions and therapeutic monitoring. By combining neuroimaging with electrophysiological measures, opportunities exist to develop neuroscience-based strategies in rehabilitation. J. Magn. Reson. Imaging 2010;32:756,772. © 2010 Wiley-Liss, Inc. [source] Novel intra-arterial strategies in the treatment of acute ischaemic strokeJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2008PP Ng Summary Acute ischaemic stroke is among the leading causes of death and disability in developed societies. I.v. and intra-arterial thrombolysis, and mechanical thrombectomy carried out within the appropriate time window can result in superior clinical outcomes compared with traditional therapy consisting of anticoagulation and/or aspirin. In cases where thrombolysis and/or thrombectomy have not been proven effective or have failed to result in rapid clinical and/or angiographic improvement, novel intra-arterial strategies may be applied by experienced interventional neuroradiologists to achieve recanalization of recalcitrant vessel occlusions with good clinical outcomes. [source] Association of Pretreatment ASPECTS Scores with tPA-Induced Arterial Recanalization in Acute Middle Cerebral Artery OcclusionJOURNAL OF NEUROIMAGING, Issue 1 2008Georgios Tsivgoulis MD ABSTRACT BACKGROUND AND PURPOSE The Alberta Stroke Program Early CT-Score (ASPECTS) assesses early ischemic changes within the middle cerebral artery (MCA) and predicts poor outcome and increased risk for thrombolysis-related symptomatic ICH. We evaluated the potential relationship between pretreatment ASPECTS and tPA-induced recanalization in patients with MCA occlusions. SUBJECTS & METHODS Consecutive patients with acute ischemic stroke due to MCA occlusion were treated with standard IV-tPA and assessed with transcranial Doppler (TCD) for arterial recanalization. Early recanalization was determined with previously validated Thrombolysis in Brain Ischemia (TIBI) flow-grading system at 120 minutes after tPA-bolus. All pretreatment CT-scans were prospectively scored by trained investigators blinded to TCD findings. Functional outcome at 3 months was evaluated using the modified Rankin Scale (mRS). RESULTS IV-tPA was administered in 192 patients (mean age 68 ± 14 years, median NIHSS-score 17). Patients with complete recanalization (n= 51) had higher median pretreatment ASPECTS (10, interquartile range 2) than patients with incomplete or absent recanalization (n= 141; median ASPECTS 9, interquartile range 3, P= .034 Mann-Whitney U-test). An ASPECTS ,6 was documented in 4% and 17% of patients with present and absent recanalization, respectively (P= .019). Pretreatment ASPECTS was associated with complete recanalization (OR per 1-point increase: 1.54; 95% CI 1.06,2.22, P= .023) after adjustment for baseline characteristics, risk factors, NIHSS-score, pretreatment TIBI grades and site of arterial occlusion on baseline TCD. Complete recanalization (OR: 33.97, 95% CI 5.95,185.99, P < .001) and higher ASPECTS (OR per 1-point increase: 1.91; 95% CI 1.17,3.14, P= .010) were independent predictors of good functional outcome (mRS 0,2). CONCLUSIONS Higher pretreatment ASPECT-scores are associated with a greater chance of complete recanalization and favorable long-term outcome in tPA-treated patients with acute MCA occlusion. [source] Bilateral Internal Carotid Artery Dissection Mimicking Inflammatory Demyelinating DiseaseJOURNAL OF NEUROIMAGING, Issue 4 2003C. Lie MD ABSTRACT Background and Purpose. Internal carotid artery (ICA) dissection (ICAD) may be extremely difficult to diagnose only on the basis of historical information and clinical signs, and even standard brain imaging (computed tomography [CT], T2-weighted magnetic resonance imaging [MRI]) may not be sufficient to delineate the underlying pathology clearly, as shown in this case. Methods. The clinical presentation and parenchymal lesion pattern on CT were suggestive of inflammatory demyelinating disease, and additional multiparametric MRI was per-formed. Results. Diffusion-weighted MRI, magnetic resonance angiography, and perfusion-weighted MRI revealed acute ischemic lesions, bilateral ICA obstruction, and bilateral hypoperfusion in the middle cerebral artery territories. Bilateral ICAD was confirmed by Doppler and duplex ultrasound, and anticoagulation therapy was initiated. A follow-up examination showed recanalization of the obstructed ICAs and the normalization of cerebral perfusion. Conclusion. This case illustrates the importance of demonstrating the pathology and the value of multiparametric MRI techniques for the diagnosis and monitoring of ICAD and its hemodynamic consequences. [source] Residual Flow Signals Predict Complete Recanalization in Stroke Patients Treated With TPAJOURNAL OF NEUROIMAGING, Issue 1 2003Lise A. Labiche MD ABSTRACT Background. Residual blood flow around thrombus prior to treatment predicts success of coronary thrombolysis. The authors aimed to correlate the presence of residual flow signals in the middle cerebral artery (MCA) with completeness of recanalization after intravenous tissue plasminogen activator (TPA). Methods. The authors studied consecutive patients treated with intravenous TPA therapy who had a proximal MCA occlusion on pretreatment transcranial Doppler (TCD). Patients were continuously monitored for 2 hours after TPA bolus. Absent residual flow signals correspond to the thrombolysis in brain ischemia (TIBI) 0 grade, and the presence of residual flow signals was determined as TIBI 1-3 flow grades. Complete recanalization was defined as flow improvement to TIBI grades 4-5. Results. Seventy-five patients with a proximal MCA occlusion had median pre-bolus NIHSS 16 (85% with ,10 points). TPA bolus was given at 141 ± 56 minutes (median 120 minutes). Complete recanalization was observed in 25 (33%), partial in 23 (31%), and no early recanalization was seen in 27 (36%) patients within 2 hours after TPA bolus. Only 19% with absent residual flow signals (TIBI grade 0, n= 26) on pretreatment TCD had complete early recanalization. If pretreatment TCD showed the presence of any residual flow (TIBI 1-3, n= 49), 41% had complete recanalization within 2 hours of TPA bolus (P = .03). Conclusions. Patients with detectable residual flow signals before IV TPA bolus are twice as likely to have early complete recanalization. Those with no detectable residual flow signals have less than 20% chance for complete early recanalization with intravenous TPA and may be candidates for intra-arterial therapies. [source] Association of growth factors with arterial recanalization and clinical outcome in patients with ischemic stroke treated with tPAJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 7 2010T. SOBRINO Summary.,Background: Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and granulocyte-colony stimulating factor (G-CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. Objectives: To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. Methods: We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color-coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0,2 at 90 days. GF levels were determined by ELISA. Results: Mean serum levels of VEGF, G-CSF and Ang-1 at baseline were significantly higher in patients with early MCA recanalization (n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G-CSF (OR, 1.02) and Ang-1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) (n = 20) showed higher levels of Ang-1 (P < 0.0001). Ang-1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome (n = 38) had higher levels of G-CSF (P < 0.0001). G-CSF was independently associated with good outcome (OR, 1.12; P = 0.036). Conclusions: These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t-PA, although they might increase the HT. [source] The utility of quantitative calf muscle near-infrared spectroscopy in the follow-up of acute deep vein thrombosisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2006T. YAMAKI Summary.,Background:,To investigate patterns of venous insufficiency and changes in calf muscle deoxygenated hemoglobin (HHb) levels after an acute deep vein thrombosis (DVT). Methods:,A total of 78 limbs with an acute DVT involving 156 anatomic segments were evaluated with duplex scanning and near-infrared spectroscopy (NIRS) at 1, 3, 6 and 12 months. Venous segments were examined whether they were occluded, partially recanalized, and totally recanalized, and the development of venous reflux was noted. The NIRS was used to measure calf muscle HHb levels. Calf venous blood filling index (HHbFI) was calculated on standing, then the calf venous ejection index (HHbEI), and the venous retention index (HHbRI) were obtained after exercise. Results:,The segments investigated were the common femoral vein (CFV; 38 segments), femoral vein (FV; 37), popliteal vein (POPV; 44), and calf veins (CV; 37). At 1 year, thrombi had fully resolved in 67% of the segments, 27% remained partially recanalized, 6% were occluded. The venous occlusion was predominant in the FV (24%) at 1 year. On the contrary, rapid recanalization was obtained in CV than proximal veins at each examination (P < 0.01). Venous reflux was predominant in POPV (55%), followed by FV (19%), and no reflux was found in CV. At 1 year, the HHbFI in POPV reflux patients was significantly higher than those with resolution (0.19 ± 0.14, 0.11 ± 0.05 ,m s, P = 0.009, respectively). Similarly, there was a significant difference in the HHbRI between the two groups (3.08 ± 1.91, 1.42 ± 1.56, P = 0.002, respectively). In patients with FV occlusion, the value of HHbRI was significantly higher than those with complete resolution (2.59 ± 1.50, 1.42 ± 1.56, P = 0.011, respectively). Conclusions:,The lower extremity venous segments show different proportions of occlusion, partial recanalization, and total recanalization. The CV shows more rapid recanalization than proximal veins. The NIRS-derived HHbFI and HHbRI could be promising parameters as the overall venous function in the follow-up of acute DVT. These findings might be very helpful for physician in detecting patients who require much longer follow-up studies. [source] | ||||||||||||||||||||||||||||