[Giant intracranial aneurysms. Therapeutic approaches].
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Biomedical subjects
Publications and source records attributed to J Duquesnel.
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Recently several publications have insisted on the ability of E.I.C.B. in reversing ocular manifestations due to chronic ophthalmic ischemia, when surgical carotid desobstruction is considered impossible or hazardous. Revascularization with E.I.C.B. can also be useful--on emergency --in case of "in evolution" ophthalmic ischemia, due to low pressure perfusion in the carotid-ophthalmic territory, to save vision. The authors report the case of a patient, presenting an optico-pyramidal syndrome "in evolution", secondary to occlusion of the left carotid artery associated with stenotic lesions in the ophthalmic artery, reversed by E.I.C.B. performed on emergency. Left visual acuity and diastolic retinian arterial pressure --respectively inferior to 1/10 and unmeasurable, before operation--raised up to 6/10 and 18 mmHg within the first twelve post-operative days and reached 8/10 and 38 mmHg after eleven weeks. This case report aims at pointing out the capacity of E.I.C.B. performed on emergency in reversing ophthalmic ischemia--"in evolution"--before constitution of irreversible lesions.
A retrospective study of 200 patients with various neurological diseases who had been investigated by Seldinger's technique cerebral or medullar angiography (STA) was undertaken with the view of evaluating the effective contribution of this technique to diagnosis and treatment. On the whole, STA gave positive results in 106 cases, doubtful results in 15 cases and negative, yet often useful, results in 79 cases. It proved more helpful in establishing the cause (120/200 cases) than the location (117/200 cases) of the lesions and contributed to the therapeutic decision in only 36 patients, latrogenic complications included 1 death from locked-in syndrome, 10 neurological disorders and 4 local reactions. However, the diagnostic and therapeutic value of Seldinger's technique angiography cannot be properly assessed owing to uncertainties surrounding each criterium of judgement.
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