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PubMed1999

Recanalization and rupture of a giant vertebral artery aneurysm after hunterian ligation: case report.

OBJECTIVE AND IMPORTANCE: Recanalization and subsequent rupture of giant aneurysms of the posterior circulation after Hunterian ligation is an extremely rare event that has been noted to occur with basilar apex, basilar trunk, and vertebrobasilar junction aneurysms. We report the case of a giant, previously unruptured right vertebral artery aneurysm, which recanalized from the contralateral vertebral artery and subsequently ruptured after previously performed angiography showed complete thrombosis of the aneurysm. CLINICAL PRESENTATION: A 72-year-old woman presented with headaches, ataxia, and lower extremity weakness. A giant 3-cm right vertebral artery aneurysm was found during the patient evaluation. INTERVENTION: Because of the size of the aneurysm and the absence of a discrete neck, Hunterian ligation was performed. After treatment, angiograms showed no filling of the aneurysm from either the right or left vertebral artery. Nine days later, after the patient developed lethargy and nausea, repeat angiography showed that a small portion of the aneurysmal base had recanalized. The next day, the patient had a massive subarachnoid hemorrhage and subsequently died. CONCLUSION: We think that this is a previously undescribed complication associated with direct arterial ligation of giant vertebral artery aneurysms. Patients with aneurysms treated using Hunterian ligation need to be followed up closely. Even aneurysms that have minimal recanalization are at risk for subarachnoid hemorrhage.

Aged↗
PubMedDate not supplied

Patient age and patency rate after recanalization of occluded peripheral arteries.

OBJECTIVES: Due to an increase in the percentage of older people in industrialized countries there is an increasing demand for medical care for the elderly. With advancing age, a series of structural, architectural and compositional modifications take place in the vasculature. Therefore, we analyzed the influence of patient age on the reocclusion rate of recanalized peripheral arteries. PATIENTS AND METHODS: 471 patients (mean age +/- SD: 62 +/- 12 years, range: 28-90 years) successfully treated by interventional recanalization were followed up (mean +/- SD: 18 +/- 17 months, range:6-48 months). Reocclusion of the recanalized arterial segment could be proven in 175 patients (37%), whereas octogenarians had the highest patency rate i.e. 68%. Univariate analysis, multivariate logistic regression analysis, and ROC analysis were performed. RESULTS: The univariate analysis showed a significant relation between reocclusion and PAOD stage, hyperlipoproteinemia, and total cholesterol level and erythrocyte sedimentation rate (ESR), respectively. Excluding age-related risk factors, the multivariate logistic regression analysis with backward selection reached a significant level for PAOD stage with p = 0.0012 and an odds ratio of 1.63, and for ESR with a p = 0.0013 and an odds ratio of only 1.02. Age did not reach a significant level with a p value of 0.13 and an odds ratio of 0.98. In the ROC analysis, prognostic relevance could be shown for the combination of PAOD stage and ESR adjusted for age and hyperlipidemia, and for PAOD stage and ESR value as a single prognostic factor, but not for patient age. CONCLUSION: Thus, despite proven and hypothetical differences in the vascular biology of older people compared to younger people, age is not related to middle term patency rates after interventional recanalization of peripheral arterial occlusions.

Adult↗
PubMed2006

Local heat shock priming promotes recanalization of thromboembolized microvasculature by upregulation of plasminogen activators.

OBJECTIVE: Thromboembolization and subsequent microvascular perfusion failure is implicated in the pathology of a variety of diseases, including transient ischemic attack (TIA), stroke, and myocardial infarction, and also for the complications after interventional and microsurgical procedures in coronary heart disease and peripheral arterial occlusive disease. In vitro heat shock priming has been suggested to induce plasminogen activators, which are the major upregulators of the fibrinolytic system. Herein, we determined whether local heat shock priming endogenously upregulates plasminogen activators also in vivo, and whether this promotes recanalization of thromboembolized microvasculature. METHODS AND RESULTS: To induce thromboembolization, a suspension of preformed microthrombi (maximum diameter: 40 microm) was injected via the femoral artery into the left hindlimbs of anesthetized rats. Local heat shock priming (42.5 degrees C, 30 minutes) was performed 24 hours before embolization and resulted in a significant increase of endothelium-derived plasminogen activator expression. The study of the microcirculation by intravital microscopy revealed in all tissues analyzed (muscle, periosteum, subcutis, and skin) that heat shock priming significantly (P<0.05) accelerates recanalization of the thromboembolized microvasculature when compared with nonprimed and sham-primed controls. Importantly, the addition of plasminogen activator inhibitor-1 to the microthrombi suspension completely blunted the heat shock-induced acceleration of microvascular recanalization. CONCLUSIONS: Heat shock induces endogenous hyperfibrinolysis by upregulation of plasminogen activators that promote recanalization of thromboembolized microvasculature.

Animals↗
PubMed1990

In vivo thrombin inhibition enhances and sustains arterial recanalization with recombinant tissue-type plasminogen activator.

The effects of heparin and the synthetic competitive thrombin inhibitor (2R,4R)-4-methyl-1-[N2-(3-methyl-1,2,3,4-tetrahydro-8-quinolinesulfon yl)-L-arginyl]-2-piperidinecarboxylic acid monohydrate (Argatroban) on thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) was studied in groups of six or seven rabbits with arterial thrombosis. The model consisted of a whole-blood clot produced in a 1-cm isolated femoral arterial segment with superimposed endothelial damage and distal high-grade stenosis. rt-PA was injected as an intravenous bolus of 0.45 mg/kg body wt at 15-minute intervals until recanalization, or up to a maximum of four boluses. In seven rabbits given an intravenous injection of 17 mg/kg aspirin, rt-PA induced transient reflow in only one animal. In seven rabbits that received intravenous heparin (200 units/kg over 60 minutes), rt-PA administration produced reflow in five animals, which was persistent in two rabbits. Combined administration of aspirin and heparin in seven rabbits was associated with similar rt-PA-induced recanalization. rt-PA administration in six rabbits given intravenous Argatroban (100 micrograms/kg/min for 60 minutes) caused recanalization in five, with persistent patency in three. In six rabbits given aspirin and Argatroban, rt-PA caused recanalization in all, with persistent patency in five animals. Reflow occurred significantly more rapidly with Argatroban (14 +/- 7 minutes) than with heparin (35 +/- 11 minutes), reflow was obtained with fewer boluses of rt-PA in combination with Argatroban (median value of one bolus) than with heparin (median value, three boluses), and reocclusion after reflow was less frequent with Argatroban (0 of 11 versus 5 of 10 rabbits). Furthermore, the degree of thrombolysis determined by pathological analysis was significantly more extensive with Argatroban than with heparin, and patency persisted during a 3-hour observation period, despite elimination of Argatroban from the circulation. Thus, Argatroban, relative to heparin, enhances and sustains thrombolysis with rt-PA. It may offer promise as an adjunctive agent for thrombolytic therapy of arterial thrombosis.

Animals↗
PubMed1996

Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome.

BACKGROUND AND PURPOSE: Thrombolysis may reduce mortality after acute basilar artery (BA) occlusion. We intended to find variables affecting recanalization and clinical outcome in patients with BA occlusion undergoing thrombolytic therapy. METHODS: We analyzed in retrospect the clinical and angiographic data of a consecutive series of 51 patients treated with intra-arterial urokinase (n = 44; 0.3 to 1.5 mIU) or intravenous or intra-arterial recombinant tissue plasminogen activator (n = 7; 22 to 100 mg). We identified effective variables by multiple logistic regression analyses and univariate tests. RESULTS: Sites of occlusion were the caudal (n = 23), middle (n = 18), and distal (n = 10) segments of the BA. The pathogenesis was embolism in 35 and local atherothrombosis in 16 patients. Collateral circulation was good in 32 patients and poor or absent in 19 patients. Recanalization was achieved in 26 of 51 (51%) patients and was associated with occlusions of embolic etiology (P = .0025). Mortality was 46% (12/26) in the recanalization group and 92% (23/25) in the nonrecanalization group (P = .0004). Other independent variables affecting mortality were length of BA obstruction (P = .0011), age (P = .0008), and collateral state (P = .0454). After follow-up (median, 32 months), 10 of the 16 survivors were only minimally impaired, with a Barthel Index score of 95 or greater; 5 patients were moderately and 1 severely disabled. CONCLUSIONS: Recanalization of acute BA occlusion reduces mortality significantly. Length of BA obstruction and state of the collaterals are additional independent variables affecting survival. Young patients with monosegmental embolic occlusion of the BA seem to have the best chance to considerably profit from thrombolysis.

Adolescent↗
PubMedDate not supplied

Sanguineous cerebrospinal fluid in recanalized cerebral infarction.

To clarify the causal relationship between spontaneous recanalization of the occluded cerebral artery and development of hemorrhagic infarction, 15 patients with internal carotid or middle cerebral arterial axis occlusion were submitted to consecutive lumbar punctures and follow-up cerebral angiography. Consequently, six of seven recanalized patients had sanguineous cerebrospinal fluid (CSF) on the second or third day after ictus, while only one of eight non-recanalized patients had bloody CSF. It was strongly suggested that recanalization might have an initimate relationship with the development of hemorrhagic infarction.

Adult↗
PubMed2002

Cerebral blood flow restoration and reperfusion injury after ultraviolet laser-facilitated middle cerebral artery recanalization in rat thrombotic stroke.

BACKGROUND AND PURPOSE: A reversible model of focal thrombotic stroke was developed in the rat and examined for histological evidence of reperfusion injury after clinically relevant times of recanalization. METHODS: The distal middle cerebral artery of 28 male Sprague-Dawley rats was occluded by 562-nm laser-driven photothrombosis for 0.5, 2, and 3 hours or permanently (each n=7) and was recanalized by 355-nm UV laser irradiation. Occlusive material was examined by transmission electron microscopy. Cortical cerebral blood flow was monitored by laser-Doppler flowmetry. Brain infarcts were examined histologically at 3 days. RESULTS: After occlusion, cortical cerebral blood flow was reduced to 33+/-4% of baseline for all groups and was restored to 82+/-9%, 75+/-3%, and 93+/-7% of baseline for the 0.5-, 2-, and 3-hour groups, respectively, following recanalization after 29+/-8, 38+/-20, and 70+/-33 minutes of UV laser irradiation. The thrombotic occlusion contained compactly aggregated platelets but no fibrin, with length (1.2 to 1.8 mm) proportional to the ischemic period. During recanalization, microchannels containing erythrocytes and scattered leukocytes and bordered by intact disaggregated platelets infiltrated the thrombus. Infarct volumes (mm3) at 3 days were 12+/-3 for the permanent case and 8+/-4, 24+/-3, and 30+/-9 for the 0.5-, 2-, and 3-hour cases, respectively, thus demonstrating reperfusion injury histologically in the latter 2 groups. No hemorrhage was seen. CONCLUSIONS: UV laser-facilitated dissolution of a conventionally refractory platelet thrombus provides a novel and effective method for restoring blood flow without hemorrhagic complications during thrombotic stroke. This was the first observation of histologically confirmed reperfusion injury in such a model.

Angioplasty, Laser↗
PubMed1992

Laser recanalization of thrombosed arteries using thermal and/or modified optical probes; angiographic and angioscopic study.

The degree of residual stenosis by fresh thrombus after laser recanalization was compared by use of angiography and angioscopy. Fifteen NZW rabbits were used. Occlusive fresh thrombus in rabbit aorta was produced by mechanical deendothelialization and external constrictions simulating clinical situations. Argon laser angioplasty using microlens-tipped optical fiber and/or 2 mm hot-tip probe was done to recanalize thrombosed aorta in 10 animals. Two-mm hybrid probe was used in 5. Percent area stenosis (% AST) was derived by use of the mean radius method obtained by angiography of stenotic segments in two orthogonal views and/or from angioscopy. All 15 totally occluded vessels with fresh thrombus were recanalized. Four minor perforations occurred. Following argon laser angioplasty with the microlens optical fiber, percent stenosis was reduced to 53% in diameter by angiography and 66 in % AST by angioscopy, and to 48% and 55 respectively following hot-tip probe. After laser angioplasty with the hybrid probe, residual stenosis by fresh thrombus was 37% in diameter on angiography and 63 in % AST on angioscopy. Mean percent AST was 62% with angiography and 52% with angioscopy, and there was no correlation between them (r = -0.028). Angioscopy provided cross-sectional topographic views of thrombosed lumen and showed charring and shrinkage of thrombus following laser angioplasty. This study suggests that (1) continuous-wave laser angioplasty using modified optical fibers can recanalize thrombotic vascular occlusion, (2) laser angioplasty by hot-tip probe could evacuate fresh thrombus more than microlens fiber on angioscopy, and (3) angiographic % AST did not correlate with angioscopic % AST.

Angiography↗
PubMed2001

Diffusion-perfusion MRI characterization of post-recanalization hyperperfusion in humans.

BACKGROUND: Animal and human studies have demonstrated that postischemic hyperperfusion may occur both early and late timepoints following acute cerebral ischemia. OBJECTIVE: To use diffusion-perfusion MRI to characterize hyperperfusion in humans following intra-arterial thrombolysis. METHODS: MRI were performed before treatment, several hours following vessel recanalization, and at day 7 in patients successfully recanalized with intra-arterial thrombolytics. RESULTS: Hyperperfusion was visualized in 5 of 12 patients within several hours after recanalization (mean volume, 18 mL; range, 7 to 40 mL), and in 6 of 11 patients at day 7 (mean volume, 28 mL; range, 4 to 45 mL). Within the core region of hyperperfusion, mean cerebral blood flow was 2.1 times greater than in the contralateral homologous region at the early time point, and 3.1 times greater at day 7. Seventy-nine percent of voxels with hyperperfusion at day 7 demonstrated infarction at day 7, whereas only 36% of voxels (within the initial hypoperfusion region) not showing hyperperfusion at day 7 demonstrated infarction at day 7. Mean pretreatment apparent diffusion coefficient (ADC) and perfusion values were more impaired in voxels that subsequently developed hyperperfusion compared with other at-risk voxels (all p values < 0.0001). There were no significant differences in the degree of clinical improvement in patients with regions of hyperperfusion versus those without, although sample size limited power to detect group differences. CONCLUSIONS: Postischemic hyperperfusion, visualized with perfusion MRI in humans following recanalization by intra-arterial thrombolytic therapy, occurred in about 40% of patients within hours and in about 50% of patients at day 7. Hyperperfusion developed mainly in regions that went on to infarction. Compared with other abnormal regions, tissues that developed postischemic hyperperfusion had greater bioenergetic compromise in pretreatment apparent diffusion coefficient values and greater impairment in pretreatment blood flow measures.

Adult↗
PubMed2004

Covered stents to treat partial recanalization of onyx-occluded giant intracavernous carotid aneurysm.

PURPOSE: To present the application of a covered stent for the management of a left internal carotid artery (ICA) aneurysm that had recanalized following embolization with Onyx. CASE REPORT: A 54-year-old man had a giant intracavernous aneurysm of the left ICA successfully occluded with Onyx. Recurrence of symptoms 5 months later prompted control angiography, which showed partial recanalization of the aneurysm. The aneurysm neck was successfully sealed by placing 2 polytetrafluoroethylene-covered stents across it. Control angiography performed at 12 months after stent placement showed no stenosis or signs of recanalization of the aneurysm. CONCLUSIONS: Recanalization of giant intracavernous carotid aneurysms post-Onyx treatment may be safely treated with placement of covered stents across the aneurysm neck.

Angioplasty, Balloon↗
PubMed2004

Use of the Parodi Anti-Emboli System and transient subclavian steal for cerebral protection during emergent vertebral artery recanalization.

PURPOSE: To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent vertebral artery recanalization. CASE REPORT: A 56-year-old chimney sweep was referred with recurrent episodes of vertigo and gait ataxia. Left vertebral artery (LVA) flow was barely detectable on duplex Doppler, and brain computed tomography revealed a small infarct in the posterior inferior cerebellar artery territory. Angiography showed subtotal ostial stenosis of the LVA with poor distal flow and possible thrombus. Due to a high risk of distal embolization with percutaneous treatment, anticoagulation was initiated, and the lesion was to be re-evaluated in 2 to 3 weeks. However, 2 days later, the patient developed severe, aggravating headache, gait and left-limb ataxia, horizontal nystagmus, and vomiting. Emergent angiography showed a total ostial LVA occlusion. The PAES was employed to elicit a temporary subclavian steal during percutaneous LVA recanalization, thus protecting the brain from embolization. The ostial LVA was successfully recanalized and stented, with immediate symptom cessation. CONCLUSIONS: The PAES can be successfully applied in the subclavian artery to prevent distal embolization during emergent vertebral artery recanalization. Since a significant proportion of vertebral strokes are embolic, PAES may play a novel role in the treatment of acute cerebellar stroke.

Angioplasty, Balloon↗
PubMed2006

Endovascular recanalization of chronic long-segment occlusions of the inferior vena cava: midterm results.

PURPOSE: To report the midterm results of endovascular recanalization of chronic long-segment (> 5 cm) occlusions of the inferior vena cava (IVC) with stent placement. METHODS: Nine patients (5 men; median age 30 years, range 14-58) with disabling complaints for more than 6 months caused by IVC occlusions were treated by endovascular recanalization. Mean occlusion length was 11 cm (range 6-22); some occlusions extended to the iliac (n = 3) or common femoral (n = 2) veins. All procedures were performed under local anesthesia via a bilateral femoral (n = 7) or popliteal (n = 2) approach. In 3 patients, combined access to the brachial or internal jugular vein was necessary. Patients with acute-on-chronic thrombosis were pretreated with urokinase. After guidewire recanalization, the chronic occlusions were predilated and self-expanding Wallstents were implanted. RESULTS: The initial technical and clinical success was 100%. The venous clinical severity score (pain, venous edema, inflammation, and active ulceration) decreased from a mean 8 +/- 2 to 5 +/- 1 after the procedure. Over a median follow-up of 9 months (mean 21, range 4- 110), 3 patients died. One rethrombosis occurred, and an asymptomatic restenosis was discovered on routine imaging. The primary patency rate was 78%, and the 9-month occlusion-free survival rate was 56%. CONCLUSION: Endovascular recanalization of chronic long-segment occlusions of the IVC is a safe and worthwhile technique to offer patients with debilitating symptoms.

Adolescent↗
PubMed2000

[Perforations in recanalization of arterial occlusions of the femoropopliteal area].

Interventional recanalizations may induce wall perforations. The aim of this study was to evaluate the incidence and the management of this complication in chronic femoropoliteal occlusions. 512 cases undergoing interventional recanalization (PTA or Excimer laser-assisted angioplasty) of femoropopliteal occlusions between 5 and 32 cm in length (mean: 13.8 cm) were included. Perforations were immediately examined by angiography or colour-coded ultrasonography (7.5 MHz). Perforations were observed in 22/512 cases (4.3%). The event was coincident with guide-wire manipulations in 16/512 cases (3.1%), laser catheter advancement without wire guidance in 3/58 cases (5.2%), and balloon dilatation in 3/431 cases (0.7%), while lasering via wire guidance (n = 408) did not induce perforation. Combining treatment with prolonged balloon dilatation (success: 6/8, recurrent bleeding: 4/6), ultrasound-guided compression (UGC; success: 20/20) and regulation of anticoagulation, all active bleedings could be terminated. Due to perforation, 12/512 cases (2.3%) required repeated interventions for successful recanalization. Except hematomas of 15-320 ml volume (ultrasound measurement) and prolonged hospital stays for 24-72 h, no further clinical sequelae resulted. In conclusion, perforations occurring during recanalization of long and chronic femoropopliteal occlusions have to be considered as primary interventional failure. However, with immediate treatment including UGC, the risk of serious clinical sequelae is low.

Aged↗
PubMed2005

[Endoscopic recanalization of the respiratory ways as the stage of radical surgical treatment of tracheal and bronchial stenosis of tumoral origin].

The experience of the laser and electrocoagulational recanalization conduction of the respiratory ways stenosis portions in 118 patients with respiratory organs tumors was summarized. There was established the probability of the recanalization application for tumoral and cicatricial tracheobronchial stenosis. The advantages of various bronchoplastic operations application after performance of endoscopic recanalization of tracheobronchial tree were noted. After performance of endoscopic recanalization of respiratory ways all the patients are alive.

Adolescent↗
PubMed2006

Intra-arterial reteplase compared to urokinase for thrombolytic recanalization in acute ischemic stroke.

BACKGROUND AND PURPOSE: Reteplase (RP) and urokinase (UK) are being used "off-label" to treat acute ischemic stroke. The safety and efficacy of intra-arterial RP or UK in the treatment of acute ischemic stroke, however, has yet to be proved. We aim to evaluate the safety and efficacy of RP compared with UK in acute ischemic stroke patients with large vessel occlusion. METHODS: Retrospective analysis was conducted of cases from a prospectively collected stroke data base on consecutive acute ischemic stroke patients with large vessel occlusion by digital subtraction angiography treated with intra-arterial RP or UK. Thrombolytic dosage, recanalization rate, intracerebral hemorrhage (ICH), mortality, and outcome were determined. RESULTS: Thirty-three patients received RP and 22 received UK (mean doses, 2.5 +/- 1.4 mg and 690,000 +/- 562,000 U, respectively). Vascular occlusions included 9 basilar arteries (BAs), 7 internal carotid arteries (ICAs), and 17 middle cerebral arteries (MCAs) with RP and 9 BAs, 4 ICAs, and 9 MCAs with UK. Median baseline National Institutes of Health Stroke Scales were as follows: 16 (range, 5-25; 81% > or = 10) with RP and 17 (range, 6-38; 85% > or =10) with UK. Mean time from symptom onset to thrombolytic initiation: 333 +/- 230 minutes with RP and 343 +/- 169 minutes with UK. Recanalization rates were as follows: 82% with RP and 64% with UK (P = .13). Symptomatic ICH rates were as follows: 12% with RP and 4.5% with UK (P = .50). The mortality rate was 24% with RP and 27% with UK (P = .8). CONCLUSION: Although limited in statistical power, our study suggests that, although IA thrombolysis with RP shows a trend for higher recanalization rates and hemorrhage rates, IA thrombolysis with RP is not significantly different in recanalization, outcome, mortality, and ICH compared with that of UK or rates reported with IA pro-UK.

Acute Disease↗
PubMed2006

New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique.

OBJECTIVES: To demonstrate the safety and feasibility of a new concept for CTO recanalization using a controlled antegrade and retrograde subintimal tracking technique (CART technique). BACKGROUND: A successful percutaneous recanalization of chronic coronary occlusions results in improved survival, as well as enhanced left ventricular function, reduction in angina, and improved exercise tolerance. However, successful recanalization of CTOs is still not optimal, and needs further improvements. METHODS: Ten patients with a CTO underwent the CART procedure. This technique combines the simultaneous use of the antegrade and retrograde approaches. A subintimal dissection is created antegradely and retrogradely, which allows the operator to limit the extension of the subintimal dissection in the CTO portion. A retrograde approach means that the occlusion site is approached in a retrograde fashion through the best collateral channel from any other patent coronary artery. RESULTS: The occlusion site was located in the RCA in 9 patients, and in the LAD in 1 patient. CTO duration varied from 7 to 84 months. Vessel recanalization was achieved in all patients. In all cases, the subintimal dissection was limited to the CTO region. No complications occurred in the collateral channel used for the retrograde approach. There were no in-hospital major adverse cardiac events. CONCLUSIONS: The CART technique is feasible, safe, and has a high success rate.

Aged↗
PubMed1991

[Association of aortocoronary bypass and intraoperative laser recanalization of the coronary arteries in ischemic heart disease. Initial clinical results].

The work discusses the results of intraoperative laser recanalization (LR) of the coronary arteries (CA). It is shown that the method facilitates increase of the degree of myocardial revascularization after a combined operation--aortocoronary shunting and intraoperative CA LR. The intervention was carried out on 10 patients, in 9 of them retrograde CA LR was conducted for recanalization of proximal affection of the CA and one patient underwent retrograde LR of a distally occurring stenosis of the anterior interventricular artery. Among the 10 interventions 7 were successful: in 5 patients the narrowed CA lumen was completely restored without residual stenosis, in 2 patients the stenosis reduced by 50-60% with a residual stenosis of no more than 30-40%. Perforation of the CA wall occurred in 2 cases and was repaired surgically. Still in another case an attempt to perform laser recanalization of the right CA failed because of technical reasons. Reocclusion of the recanalized CA segment was encountered in the late-term period in 2 of 4 patients. The conclusion may be drawn that CA LR is an effective auxiliary method in the formation of an aortocoronary shunt. The presence of diffuse, multiple lesions of the shunted CA and occlusion of the vascular lumen, affection of the distal arterial channel of the CA are the main indications for the use of intraoperative CA LR.

Adult↗
PubMed1989

Laser recanalization, laser assisted balloon angioplasty and laser angioplasty.

The efficacy of laser recanalization (LR), laser assisted balloon angioplasty (LABA) and laser angioplasty (LA) was evaluated. These procedures were performed a total of 55 times upon 49 patients who had occlusive arterial disease of a lower extremity with a history of incapacitating, intermittent claudication, rest pain or loss of tissue, or all three. Patients with lesions through which a guide wire could be passed were eliminated from this study. Two lesions in the common iliac artery, 44 in the superficial femoral artery, seven in the popliteal artery and two in the infrapopliteal artery were studied. Thirty-nine of 55 lesions (71 per cent), including 12 of 12 stenoses and 27 of 43 occlusions (63 per cent), were successfully recanalized. None of the seven total length occlusions were successfully recanalized (p less than 0.001); perforation occurred in four. Bypass procedures were required in six of 13 and two of 25 lesions treated by LR and LABA, respectively (p less than 0.05). All patients with lesions successfully recanalized using LR, LABA and LA were observed for a period of 15 days to six months, with an 82 per cent patency rate (32 of 39). Total length occlusions are not a good indication for treatment with currently available laser techniques. The addition of balloon dilation in LR decreased the requirement for bypass procedures in a significant number of patients.

Angioplasty, Balloon↗