Local recombinant tissue plasminogen activator to clear cerebral artery thrombosis developing soon after surgery.
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Biomedical subjects
Publications and source records attributed to P Courtheoux.
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A case of postnephrectomy arteriovenous fistula of the right renal pedicle is reported here. The diagnosis was confirmed by angiography, and successful treatment was achieved using detachable balloon.
Sixteen patients underwent local fibrinolytic therapy for thrombosis or embolism of the main trunk or intracranial branches of the internal carotid artery. There were eight cases of complete thrombosis of the internal carotid artery, five proximal stenoses of the internal carotid artery with extensive thrombus, one thrombus of the carotid siphon and two middle cerebral artery emboli. Indications for treatment included transient ischemic attacks in 11 cases, cerebral ischemia after carotid arteriography in two cases, and after surgery for atheromatous lesions of the carotid bifurcation in three cases. The fibrinolytic therapy was initiated during carotid surgery in three cases, where extended thrombosis of the internal carotid artery was discovered, which was inaccessible to a Fogarty catheter. The other 13 cases were treated during arteriography procedures. Lysis of the clot was always obtained. One patient died of hematoma of the frontal lobe. All other patients survived and showed neurologic improvement. The neurologic outcome was dependent on the duration and the degree of initial ischemia. Fibrinolytic therapy appears to be beneficial therapy for certain cases of cerebral ischemia.
The authors reported a case of cervical paraganglioma. Patient had a coma suggesting secretary activity of the lesion or cerebral venous thrombosis. Angiography showed an hypervascular lesion characterized by venous reflux into the contro-lateral sinus. After neurological stabilization by tumor embolization, the tumor was surgically removed.
Percutaneous transluminal angioplasty of the carotid artery was performed in four patients with recurrent stenosis following endarterectomy. Balloon catheter dilatation was successful in 3 of the 4 lesions. Post dilatation angiography demonstrated an increase in luminal diameter: there were no neurological complications with the procedure. PTA appears to be an effective method of treating recurrent stenosis following carotid endarterectomy.
A case of bilateral spontaneous carotid-cavernous fistulas producing increased intraocular pressure is reported. The fistulas lay between the meningeal branches of the internal carotid artery (ICA) and the cavernous sinus, but the ICA itself was not involved. Successful treatment was accomplished by the introduction of steel coils and a sclerotic liquid into the cavernous sinus via the distal superior ophthalmic vein.
A case of bilateral spontaneous carotid-cavernous fistula with increased intra-ocular pressure is reported. Two new methods have been performed with success on this patient during successive interventions realised by two teams (maxillo-facial surgeons and neuroradiologists). Coils and sclerotic liquid are introduced by the distal superior ophthalmic vein.
A study of 130 patients having presented either a transient ischemic attack or a completed stroke, or admitted for an asymptomatic carotid stenosis, allowed the following investigations: CT-scan, doppler, angiography, measurement of the regional cerebral blood flow (rCBF) by the study of 133Xe clearance (Novocerebrograph (R)), and measurement of the regional cerebral blood volume (rCBV) made by gamma emission tomography after autotransfusion of 99m Tc-labeled erythrocytes with an Elscint Apex 415 ECT (R) camera. Our aim was to look in which case a rCBF and/or a rCBV interhemispheric asymmetry was observed, by comparing the previous hemodynamic parameters with clinical, CT-scan and angiographic data. Although a rCBF and/or a rCBV asymmetry appeared more often among patients presenting with infarction than among those of the asymptomatic category, this does not seem specific for any clinical grade. The same statement applies to the comparison between hemodynamic parameters and CT data. The arterial lesions were classified in 4 groups: no stenosis (12 cases), uni or bilateral moderate carotid stenosis (40 cases), unilateral severe carotid stenosis or occlusion (65 cases), bilateral carotid severe stenosis or occlusion (13 cases). We observed a rCBF asymmetry among some patients in the 4 groups, although this was more frequent among the two latter groups. Nevertheless no case of a rCBV asymmetry was observed in the 2 first groups. Such an asymmetry was present in 31 percent of the patients belonging to the two latter groups. In patients of the third group the asymmetry was always due to a relative increase of rCBV beyond the carotid lesion.(ABSTRACT TRUNCATED AT 250 WORDS)
A 2 year-old child admitted for Haemophilus meningitis was immediately treated by adequate antibiotic treatment. Three days later multiple hypertonic strokes and periodic respiration occurred; a resuscitation was necessary. CAT scan showed an acute hydrocephalus with non visible 4th ventricle and low-density areas in both cerebellar hemispheres allowing the diagnosis of cerebellar infarction. External drainage of CSF was rapidly performed and maintained for 11 days with success. The child was secondarily discharged with temporary cortical blindness and persistent moderate static cerebellar signs. The etiology of the cerebellar infarction was likely to be an arterial thrombosis in the vertebro-basilar area, probably secondary to cerebral arteritis related to Haemophilus.
Forty-six patients with defective erection of venous origin were treated by embolization of deep dorsal vein at the Santorini plexus level. Embolization was by insertion of disposable balloons after surgical approach to deep dorsal vein of penis. Follow up showed that 57% of patients had recovered satisfactory, normal sexual activity and 15% a fairly satisfactory sexual activity.
A case report concerning a left primary maxillary meningioma is presented. Clinical, conventional radiographic and CT signs are presented. The diagnosis was made after histologic examination of the specimen. The pathogenesis is discussed.
Twenty-one patients with hepatic metastases were treated by chemoembolization over a 2-year period, the technique consisting of selective injection of a mixture of Spongel powder and Adriamycin plus 5-FU into the hepatic artery. Indications and results are discussed as a function of clinical, biologic and radiologic criteria.
The authors report 25 cases of pre-operative embolisation of tumours of bone or muscle. The aim of this technique is to improve surgical safety by diminishing hemorrhage at operation and to preserve vessels in the region of the tumour especially if secondary intra-arterial chemotherapy is required.
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Impotence can be caused by leakage of venous blood from the penis during erection. Of 135 patients studied with erectile dysfunction, 40 had venous leakage, and these patients were classified into three groups according to findings on cavernosograms. Thirty-one patients were treated with implantation of balloons and coils. Twenty-six of these patients now have normal sexual function. The authors believe this technique is simple, safe, and effective for the treatment of impotence caused by venous leakage.
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Eight cases of isolated, mature and active arteriovenous malformations of scalp were explored and treated with embolization, alone or combined with surgery. A programme of exploration and the therapeutic approach as a function of angiographic findings are discussed, the latter being the basis for pathologic and hemodynamic features allowing classification of these malformations into two distinct groups.