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Biomedical subjects

M H Wholey

Publications and source records attributed to M H Wholey.

At least 37 records · Page 2Linked to original sources
PubMed1998

Comparison of thrombolytic therapy of lower-extremity acute, subacute, and chronic arterial occlusions.

Our purpose was to study the effectiveness of thrombolytic therapy in treating acute, subacute, and chronic arterial occlusions in a multicenter retrospective study. Intraarterial urokinase infusion was performed in 235 patients for occluded native arteries. There were 70 (30%) with acute and 26 (5%) with subacute occlusions, and 141 (59%) with chronic symptoms for longer than 3 mo. Complete thrombolysis was achieved in 60 (86%) of the acute, 20 (77%) of the subacute, and 106 (75%) of the chronic occlusions. Adjunctive interventional procedures were performed as needed. Long-term follow-up revealed a primary patency of 87%, 85%, and 76% for the acute, subacute, and chronic occlusion groups, respectively. We conclude that the rate of complete thrombolysis of chronic occlusions proved slightly more efficient for acute and virtually the same for subacute occlusions. Long-term follow-up demonstrated a higher failure rate with chronic than with acute occlusions, probably due to worsened peripheral vascular runoff.

Acute Disease↗
PubMed1998

Use of coronary artery stents in the treatment of internal carotid artery stenosis at the base of the skull.

The management of high-grade stenosis involving the petrosal segment of the internal carotid artery has been limited to angioplasty alone in the past. However, if angioplasty fails or has less than optimum results, then endovascular stent placement should be considered. We present the first two known cases in which the Multi-Link coronary stent was used for the treatment of internal carotid disease in the petrosal segment. The first patient had symptomatic stenosis that failed angioplasty after seven months and the second patient had a symptomatic lesion that dissected upon angioplasty. The flexibility and low profile characteristics of the stent allowed it to be safely deployed with balloon expansion. No complications occurred and the patients tolerated the procedure. Patients were carefully monitored and no new neurologic events in six months of follow up occurred. These cases reveal the good clinical results of stent placement for surgically-inaccessible lesions of the internal carotid artery in the skull base.

Aged↗
PubMed1998

Initial clinical experience with colonic stent placement.

BACKGROUND: The purpose of this study is to review initial experience with a colonic stent as an alternative to colostomy in patients with colonic obstruction. METHODS: Ten patients diagnosed with acute colonic obstructions from both benign and malignant causes underwent stent placement. Self-expandable metallic stents were deployed using fluoroscopic guidance. Patients were followed up clinically until removal of the stent or death. RESULTS: Nine of the 10 patients who underwent colonic stent placement achieved clinical decompression within 6 hours. Six patients underwent standard mechanical bowel preparation and elective resection of obstructing lesions. The other 4 patients received stent placement for palliative purposes. Complications included 4 cases of migration and 1 death. Migrated stents in the rectum were easily retrieved and replaced using fluoroscopic techniques. There were no perforations. CONCLUSION: Placement of self-expandable metallic stents for acute colonic obstructions may allow patients to undergo elective surgical resection avoiding possible colostomy.

Acute Disease↗
PubMed1998

Cervical carotid artery stent placement.

This article reviews the clinical application and early results of cervical carotid artery stent placement. Patient preparation, techniques in stent delivery and post care treatment performed at Pittsburgh Vascular Institute are discussed. Experiences of a multicentre study obtained from an international survey is revealed. A total of 3129 carotid stent procedures have been performed worldwide to date, with a technical success rate of 98.8%. Complications during placement or within a 30-day period of placement included 74 (2.4%) transient ischemic insults, 78 (2.49%) minor strokes, 43 (1.37%) major strokes and 30 (0.96%) procedure-related deaths. Restenosis rates at 6 months was 2.3%. Post-procedure neurologic sequelae occurred in 14 (0.79%) of cases. Carotid artery stent placement is growing as an alternative for endarterectomy, especially for patients with high surgical risk. The periprocedural risks for death and minor and major stroke are generally acceptable at this early stage of development.

Angiography↗
PubMed1997

Endovascular stents for carotid artery occlusive disease.

PURPOSE: To study the feasibility and safety of endovascular stenting of cervical carotid artery stenosis. METHODS: Between April 1994 and May 1997, 108 consecutive patients (58 men; mean age 70.1 years) with > or = 70% carotid stenosis were treated with percutaneous stent implantation under a protocol that featured independent neurological review. Forty-four percent were asymptomatic. Over half the lesions (59%) were in the internal carotid artery; the mean stenosis was 86%. Palmaz stents were implanted without cerebral protection following preliminary balloon dilation; two Wallstents were used in long lesions. RESULTS: Carotid stents were successfully placed in 108 of 114 (95%) lesions. Of the 6 technical failures, 5 were access related and 1 was due to seizures during balloon dilation. Two major (1.8%) and 2 minor (1.8%) strokes occurred (3.7% stroke rate for 108 patients; 3.5% in 114 procedures), all in symptomatic patients, one of whom died. There were 5 (4.4%) transient ischemic attacks and 2 (1.8%) brief seizure episodes during dilation. One patient died of a cardiac event on day 20. The all stroke or death rate was 5.3% based on 114 arteries at risk (5.6% in 108 patients). In the mean 6-month follow-up (range 1 to 36) of 97 eligible patients, 3 (3.1%) died from unrelated causes. There was 1 restenosis (1.0%) from a stent compression, which was successfully redilated. There were no neurological sequelae, cranial palsies, or cases of stent or vessel thrombosis in follow-up. CONCLUSIONS: The use of stents in the treatment of cervical carotid occlusive disease appears feasible, effective in the short term, and without excessive risk of periprocedural stroke.

Adult↗
PubMed1997

Extracranial carotid angioplasty and stenting. Initial results and short-term follow-up.

Carotid percutaneous transluminal angioplasty, with or without stent implantation, is becoming another therapeutic option for carotid revascularization. To evaluate the feasibility and effectiveness of the technique, from October of 1995 to March of 1997, we performed 24 percutaneous transluminal angioplasty procedures in 22 patients with severe extracranial carotid artery stenosis. Three common carotid and 21 internal carotid arteries were treated, and 19 procedures included stent implantation using nonarticulated PALMAZ stents (P154 and P204). Twelve patients were asymptomatic and 10 patients were symptomatic; 2 of the symptomatic patients had complete obstruction of the internal carotid artery that was successfully recanalized. Technical and angiographic success was achieved in 23 of 24 procedures, with the carotid artery obstruction diminishing from 85.6% +/- 8.5% to 5.7% +/- 3.2% (P < 0.001). Average stenosis length was 12.5 +/- 3.1 mm, and mean time of carotid occlusion during balloon inflation was 11.5 +/- 2.5 seconds. Three patients experienced transitory seizures during the procedure prior to dilation, 1 patient had a minor stroke with complete recovery within 72 hours, and 1 patient had a major stroke and died 45 days after the procedure. Clinical follow-up was achieved in all patients (mean, 10.5 +/- 7.2 months) and angiographic follow-up in 16 patients (mean, 6.3 +/- 1.2 months). The results obtained in this initial experience provide adequate support to continue further evaluation of this new therapeutic strategy.

Aged↗
PubMed1992

Subclavian artery angioplasty for treatment of coronary artery steal syndrome.

Three patients underwent percutaneous transluminal angioplasty for treatment of subclavian artery stenosis producing the coronary artery steal syndrome. Technical success and immediate relief of angina were achieved in all three patients. Clinical follow-up ranged from 4 to 16 months. One patient developed clinical evidence of restenosis. Subclavian artery angioplasty may be a safe and efficacious technique for the treatment of the coronary artery steal syndrome.

Aged↗
PubMed1992

Arterial imaging.

Angioscopy, magnetic resonance angiography, computed tomography, and nuclear medicine are assuming an increasingly important role in arterial imaging. This review discusses recent advances in these modalities. Angioscopy has proven valuable in monitoring intraoperative surgical procedures as well as percutaneous interventions. Carotid artery magnetic resonance angiography is gaining increasing acceptance in clinical practice. Magnetic resonance angiography of the peripheral arteries is limited by spatial resolution and signal loss distal to the stenosis. The role of computed tomography in limiting the number of aortograms performed in evaluating aortic laceration remains controversial; however, several recent papers indicate its usefulness in evaluating clinically stable patients with abnormal chest radiographs. Computed tomography of abdominal aortic aneurysms may obviate the need for preoperative aortography in the majority of cases. Nuclear imaging for deep venous thrombosis using 111In-labeled antifibrin monoclonal antibodies was shown highly sensitive in its initial report.

Adult↗
PubMed1991

Intravascular stents in the management of superior vena cava syndrome.

Superior vena cava syndrome can be effectively palliated with the use of intravascular stents. Adjunctive modalities which may be utilized prior to stent placement are thrombolytic therapy and balloon angioplasty. Six patients with an underlying malignancy were treated with these modalities. Complete resolution of symptoms occurred in five patients, and partial resolution occurred in the sixth. Two of the patients who had initial, complete resolution of symptoms had recurrences. One involved rethrombosis of the superior vena cava which occurred twice and required percutaneous thrombectomy, and the second involved restenosis requiring a percutaneous transluminal angioplasty of the SVC just distal to the stent. Both of these patients with second procedures, again, had complete resolution of symptoms. Intravascular stents are a valuable additional treatment of superior vena cava syndrome.

Adult↗