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Percutaneous Treatment (percutaneou + treatment)
Selected AbstractsCryoballoon Pulmonary Vein Isolation Guided by Transesophageal Echocardiography: Novel Aspects on an Emerging Ablation TechniqueJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009CLAUDIA HERRERA SIKLÓDY M.D. Background: Pulmonary vein (PV) isolation using a balloon-mounted cryoablation system is a new technology for the percutaneous treatment of atrial fibrillation (AF). Transesophageal echocardiography (TEE) allows real-time visualization of cryoballoon positioning and successful vein occlusion via color Doppler. We hypothesized that PV mechanical occlusion monitored with TEE could predict effective electrical isolation. Methods: We studied 124 PVs in 30 patients. Under continuous TEE assessment, a cryoballoon was placed in the antrum of each PV aiming for complete PV occlusion as documented by color Doppler. At the end of the procedure, PV electrical isolation was evaluated using a circumferential mapping catheter. Results: Of the 124 PVs studied, 123 (99.2%) could be visualized by TEE: the antrum was completely visualized in 80 of them (64.5%), partially in 36 (29.0%), and only disappearance of proximal flow could be observed in the remaining 7 PVs (5.7%). Vein occlusion could be achieved in 111 of the 123 (90.2%) visualized PVs. Postinterventional mapping demonstrated electrical isolation in 109 of 111 occluded PVs (positive predictive value 98.2%) and only in 1 of 12 nonoccluded PVs (negative predictive value 91.7%, P < 0.001). After a mean follow-up of 7.4 ± 3.7 months, 73.3% of patients remained in sinus rhythm without antiarrhythmic drugs. Conclusion: Color Doppler documented PV occlusion during cryoballoon ablation can predict effective electrical isolation. [source] Primary hydatid cysts of psoas muscleANZ JOURNAL OF SURGERY, Issue 6 2002Marcovalerio Melis Background:, Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in muscle is not common, accounting for 2,3% of all sites; even rarer is the development of multiple cysts. Methods: The patient presented with a painless abdominal mass which gradually increased in size to a diameter of approximately 16 cm. Organ imaging scan revealed multiple hydatid cysts within the right psoas muscle. Because of the proximity of the lesions to the iliac vessels, ureter and nerves to the lower limb, percutaneous drainage and alcoholization under local anaesthesia were performed with the aim of reducing the size of the cysts and sterilizing them prior to definitive surgery. This procedure was not effective. Two weeks after percutaneous treatment the patient underwent surgery. Results:, At operation the cysts were localized and successfully removed under ultrasound guidance. Postoperative stay was uneventful. Two years after surgery the patient has no evidence of recurrent hydatid disease. Conclusions:, Ultrasonography is the preferred method for detecting muscular hydatid cyst and for guiding the surgeon during resection. [source] Venous rupture during percutaneous treatment of hemodialysis fistulas and grafts,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2009John A. Bittl MD Abstract Objectives: The aim of this study was to analyze the risk and consequences of venous rupture during angioplasty of malfunctioning hemodialysis grafts and fistulas. Background: Venous stenoses in the outflow limb of hemodialysis accesses often require ultra-high balloon pressure for optimal dilatation. Methods: Baseline characteristics and outcomes were analyzed for a consecutive series of patients treated between 1999 and 2008. Results: Venous rupture or perforation occurred in 11 of 1242 (0.9%) procedures. No patient with a rupture or perforation died or required emergency or urgent surgical repair. Two of 11 patients (18.2%) required transfusions, 8 of 11 patients (72.7%) required stenting, and 6 of 8 (75.0%) who needed stenting received covered stents to achieve hemostasis. Rupture led to access thrombosis within 30 days in 9 of 11 cases (82%). Multivariable logistical regression analysis suggested that using a balloon catheter more than 2 mm larger than the diameter of the hemodialysis access or using peripheral cutting balloons increased the risk of rupture or perforation. Conclusions: Rupture or perforation is a rare complication of treatment of malfunctioning hemodialysis grafts and fistulas. The complication may be managed with nonsurgical methods and might be avoided by optimal balloon selection and sizing. © 2009 Wiley-Liss, Inc. [source] Late thrombosis following treatment of in-stent restenosis with drug-eluting stents after discontinuation of antiplatelet therapyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2005Richard E. Waters MD Abstract Drug-eluting stent usage has become commonplace for the percutaneous treatment of de novo coronary lesions, but the safety and efficacy profile for their evolving usage in restenotic lesions is largely unknown. We report three cases of angiographically confirmed drug-eluting stent thrombosis following treatment of restenotic lesions that occurred late (193, 237, and 535 days) and shortly after interruption of antiplatelet therapy. All three patients suffered ST elevation myocardial infarction, and there was one death. Further studies are necessary to better define the associated risk and ideal duration of antiplatelet therapy necessary in this cohort of patients with restenotic lesions. © 2005 Wiley-Liss, Inc. [source] Current status of rotational atherectomyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2004Erdal Cavusoglu MD Abstract Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era. Catheter Cardiovasc Interv 2004;62:485,498. © 2004 Wiley-Liss, Inc. [source] Orbital venous malformation: percutaneous treatment using an electrolytically detachable fibred coilACTA OPHTHALMOLOGICA, Issue 2 2009Sara Diolaiuti Abstract. Purpose:, To report the efficacy of percutaneous treatment of an orbital venous malformation with an electrolytically detachable fibred coil. Methods:, We report an instance of radiography-guided percutaneous treatment with an electrolytically detachable fibred coil in a 16-year-old boy with acute, spontaneous, painless proptosis on the left side, which progressed with time. Results:, Magnetic resonance imaging, angiography and orbitophlebography revealed a low-flow, intraorbital venous malformation. Percutaneous puncture and drainage were followed by a short remission. Following an acute recurrence, a single detachable fibred coil was deployed via a percutaneous approach under angiographic guidance. No radiological or clinical recurrences were observed over 4 years. Conclusions:, Embolization of a deep orbital venous malformation with detachable fibred coils via a percutaneous approach can be highly effective, and may be considered before proceeding with open surgery. 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