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PubMedDate not supplied

Salpingitis isthmica nodosa: technical success and outcome of fluoroscopic transcervical fallopian tube recanalization.

PURPOSE: To evaluate the technical success and outcome of fallopian tube recanalization (FTR) in salpingitis isthmica nodosa (SIN). METHODS: SIN is a well-recognized pathological condition affecting the proximal fallopian tube and is associated with infertility and ectopic pregnancy. We reviewed the presentations, films, and case records of all patients attending for FTR for infertility from 1990 to 1994. Technical success and total, intrauterine, and ectopic pregnancy rates at follow-up were determined. RESULTS: SIN was observed in 22 of 349 (6%) patients. FTR was attempted in 34 tubes in these 22 patients. Technical success was achieved in 23 of 34 (68%) tubes affected by SIN. In 5 of the 11 failed recanalizations, failure was due to distal obstruction. At least one tube was patent on selective postprocedural salpingography in 17 of 22 (77%) patients. There were no recorded perforations or complications. At follow-up (mean 14 months), total, intrauterine, and ectopic pregnancy rates were 23%, 18%, and 4.5%, respectively. CONCLUSION: FTR in SIN is technically successful and, compared with previously reported results in unselected infertility patients, is associated with only a slightly less favorable intrauterine pregnancy rate and a comparable ectopic pregnancy rate. The findings of SIN at FTR should not discourage attempted fluoroscopic transcervical recanalization.

Adult↗
PubMed1998

The concept of protective stent placement after successful recanalization of chronic total coronary occlusions: a matched pair analysis in 100 patients.

OBJECTIVE: Interim results of successful balloon angioplasty for total coronary occlusions (TCO) are disappointing due to the high rate of restenosis and reocclusion. Adjunctive stenting has been suggested to improve patency rate after recanalization of total coronary occlusions (TCO); however, this concept of protective stenting has not been substantiated in a case control study. METHODS: To test the efficacy of protective stenting of TCO, 100 patients were subjected to a matched pair analysis (block design) comparing conventional PTCA with protective stenting (Palmaz-Schatz stents) after successful recanalization of TCO followed by a standard antithrombotic regimen. Matching parameters included age (+/- 3.5 years), sex, cardiovascular risk factor, and lesion anatomy. Coronary angiography and QCA were performed before pair assignment, after the intervention, and at a mean follow-up of 5 +/- 1.5 months. RESULTS: There were no deaths or myocardial infarctions related to the intervention in the entire study cohort; bleeding at the puncture site was observed in two patients in both groups. Binary reocclusion and restenosis (> or = 50%) rates were observed in 8% and 0% in stented patients versus 30% and 22% in the group with no protective stenting, respectively (p < 0.01). Target lesion reintervention was necessary in 8% after protective stenting as compared to 58% after PTCA alone (p < 0.001). At 6 months follow-up, 62% of stented patients were free of any symptoms versus 23% with PTCA (p < 0.01). CONCLUSIONS: Protective stenting improves the immediate and follow-up angiographic and clinical results of PTCA in chronic total coronary occlusions. Stenting of successfully recanalized total coronary occlusions should be a routine procedure.

Aged↗
PubMed2006

Spontaneous arterial recanalization with magnetic resonance angiography evidence: report of a case.

A 27-year-old man was admitted to our hospital for investigation of severe claudication in his right foot. Based on the findings of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), we diagnosed anatomic popliteal artery entrapment syndrome, which was causing a short popliteal artery occlusion. Moreover, a long posterior tibial artery occlusion and a peroneal artery lesion had developed as distal thromboembolic complications of the entrapment. Thus, we planned to perform in situ vein bypass graft for the popliteal occlusion and start thrombolytic treatment for the posterior tibial and peroneal lesions. While contemplating the operation, the patient showed a gradual clinical improvement over the next 2 months. A second MRA showed total arterial recanalization of the right posterior tibial and peroneal arteries, although the popliteal artery was still occluded. Spontaneous lower limb arterial recanalization is a rare phenomenon. To our knowledge, this is the first case of spontaneous arterial recanalization after a distal thromboembolic event caused by popliteal entrapment syndrome.

Adult↗
PubMed2004

Spontaneous recanalization of acute internal carotid artery occlusion.

Little is known about the natural course of internal carotid artery occlusion and its possible recanalization. We present here a case of spontaneous recanalization of an acutely occluded internal carotid artery, angiographically reported, which later allowed the patient to benefit from surgical treatment. These and other similar cases raise the possibility of a more frequent recanalization of this artery than previously considered. We suggest routine follow-up of these patients to detect this eventuality, which could influence clinical outcome and secondary prophylaxis strategies.

Arterial Occlusive Diseases↗
PubMed2007

Does supervised exercise after deep venous thrombosis improve recanalization of occluded vein segments? A randomized study.

OBJECTIVES: The aim of the present study was to evaluate weather early supervised exercise improves recanalization of acute deep vein thrombosis (DVT) and reduces symptoms. PATIENTS AND METHODS: From September 2001 to March 2004, of 381 patients, 72 eligible patients were included and with a mean age 54 +/- 14 years, 39 (52%) men with deep vein thrombosis (DVT) proven with phlebography were randomized to: an exercise group (n = 36) receiving routine anticoagulation, class II compression stockings and additionally supervised exercise and a control group (n = 36) receiving the same therapy but no exercise. Patients were followed-up during six months. Phlebography was scored initially and at six-months. RESULTS: There were at inclusion no differences between the two groups regarding age, body weight, body mass index (BMI), calf circumference of the affected leg, and overall quality of life estimated by visual analog scale (VAS)-scale. In both groups there were significant reductions regarding calf circumference in the affected leg compared to the inclusion time, both at one-month (P = 0.0012) and six month (P = 0.0002) follow-up. The degree of recanalization of the affected venous segments was high and did not differ between groups. There were no recurrent DVT or pulmonary emboli or other treatment complications in any individual during the six-month follow-up period. CONCLUSIONS: Early exercise did not acutely exacerbate the risk of complications in patients with DVT. No benefits of early exercise were seen regarding the degree of recanalization of the thrombi, or faster resolution of pain or swelling. Nevertheless, our study shows that early exercise/ambulation is safe in combination with anticoagulation and compression stockings for the majority of patients with DVT.

Adult↗
PubMed1981

Percutaneous transluminal coronary recanalization: procedure, results, and acute complications.

Percutaneous transluminal coronary recanalization, a new therapeutic procedure used in acute myocardial infarction, offers significant reduction in mortality, as well as more effective limitation of the zone of infarction than has been possible with other pharmacologic treatment employed in the past. The risk of coronary angiography during acute myocardial infarction was surprisingly low, as was the risk of hemorrhagic complications following the intracoronary administration of relatively low doses of thrombolytic substances such as streptokinase. Mechanical recanalization was possible in about one fifth of patients and successful in approximately half of all such attempts, but complications occurred in a small percentage of attempts at this step. Coronary artery spasm was excluded as a possible cause of occlusion in almost all cases. Selective intracoronary infusion of streptokinase produced the highest degree of myocardial reperfusion, and best results were achieved when therapy was initiated shortly after thrombotic occlusion occurred. Residual stenosis of more than 75% luminal diameter narrowing was present in approximately three fourths of cases after complete thrombolysis, and the majority of patients remained appropriate candidates for coronary bypass surgery or for percutaneous transluminal coronary angioplasty (Grüntzig procedure). Although complete analysis of the efficacy of selective recanalization was difficult because it was not possible to establish a suitable control group for purposes of comparison, the mortality of less than 1% in the present group of 232 patients within the first 6 hours following myocardial reperfusion provides an encouraging result.

Angioplasty, Balloon↗
PubMed1995

Endogenous tissue plasminogen activator and platelet reactivity as risk factors for reocclusion after recanalization of chronic total coronary occlusions.

A prospective study was performed to investigate the role of the endogenous fibrinolytic system and platelet function for the occurrence of reocclusion after successful recanalization of chronic coronary occlusions. At control coronary angiography 8 +/- 2 weeks after recanalization, reocclusion was found in 10 (21%) of 47 patients. After correction for angiographic and clinical confounding factors, endogenous concentrations of tissue plasminogen activator (TPA) were lower in patients with reocclusion than in patients without. In contrast, plasma levels of plasminogen activator inhibitor-1 and alpha 2-antiplasmin were similar in the two groups. The mean platelet volume was significantly higher in patients with reocclusion than in patients without. In addition, agonist-induced platelet aggregation in platelet-rich plasma was enhanced in the patients with reocclusion. Decreased endogenous plasma TPA concentrations and enhanced platelet reactivity may contribute to the occurrence of reocclusion after primarily successful coronary artery recanalization.

Aged↗
PubMed1987

Prediction of infarct coronary artery recanalization after intravenous thrombolytic therapy.

Clinical assessment of patients with evolving acute myocardial infarction may suggest recanalization of the infarct coronary artery if chest pain, electrocardiographic ST-segment elevation and reperfusion arrhythmia are diminished. These 3 criteria, however, have not been correlated with immediate coronary angiography. Determination of which patients will achieve myocardial reperfusion after intravenous fibrinolytic therapy would allow for appropriate triage; those in whom it fails may be considered for mechanical or surgical recanalization. Fifty-six patients were studied: 28 received intravenous streptokinase and 28 intravenous recombinant tissue-type plasminogen activator. None of these clinical criteria, considered separately, was predictive of infarct artery recanalization status. Using the presence or absence of all 3 criteria, the specificity and predictive value increased to 100%. However, only 9% of patients in the series had all 3 criteria present (all had a patent infarct artery) and 34% had no criteria present (all had an occluded vessel). Noninvasive clinical markers are simple and practical, but only concordance of all 3 major criteria, when present, accurately predicts results of thrombolytic therapy.

Aged↗
PubMed1994

Feasibility of recanalization of human coronary arteries using high-intensity ultrasound.

To investigate the feasibility of ultrasonic recanalization of obstructed human coronary arteries in vitro, high-intensity ultrasound was applied to 16 coronary arteries obtained at autopsy, using a prototype instrument enabling insonification through a catheter tip. It was a 119 cm long, 0.95 mm thick wire in an 8Fr catheter connected to an external ultrasonic transformer and power generator. A 5 MHz phased-array 2-dimensional echocardiography instrument was used to determine minimal luminal diameter and percent diameter narrowing before and after ultrasound application. The ultrasonic energy was delivered at 21.5 kHz and with a 52 +/- 19 micrometer average amplitude of tip displacement. The mean percent luminal diameter narrowing, flow rate and mean pressure gradient before ultrasound exposure were 74 +/- 11%, 97 +/- 61 ml/min, and 92 +/- 18 mm Hg, respectively. After recanalization, the mean percent luminal diameter narrowing decreased to 45 +/- 17% (p < 0.001), the mean flow rate increased to 84 +/- 92 ml/min (p < 0.001), and the mean pressure gradient was reduced to 45 +/- 24 mm Hg (p < 0.001). Of the debris particles, 95% had a diameter < 9 microns (range 5 to 12). Arterial perforation occurred in 5 of 16 arteries (31%) and all 5 occurred due to stiff wire manipulation and without ultrasound application. Mechanical fracture of the wire occurred in 8 cases (50%). No signs of thermal injury were found on histology. Thus, ultrasonic recanalization of human coronary arteries in vitro is feasible. It may reduce obstruction and improve blood flow. Debris sizes are sufficiently small to minimize the hazard of peripheral embolization.

Adult↗
PubMed1995

Delayed recanalization of a cerebral arteriovenous malformation following angiographic obliteration with polyvinyl alcohol embolization.

BACKGROUND: The efficacy of embolization of cerebral arteriovenous malformations (AVMs) is presently being evaluated. Embolization of single pedicle AVMs may produce complete angiographic obliteration and has been suggested as the sole therapy for treating these lesions. METHODS: A 17-year-old female presented with a left intraventricular and intraparenchymal cerebral hemorrhage resulting from a 1 cm left posterior choroidal AVM. She subsequently underwent polyvinyl alcohol (PVA) embolization of the AVM with complete angiographic obliteration. RESULTS: At 9 months follow-up, no evidence of recanalization of the AVM nidus was seen. Two years later, recanalization of the nidus was seen; and the patient received radiosurgical treatment. The natural history of previously embolized AVMs is reviewed and the mechanisms for recanalization are discussed. CONCLUSION: We recommend that patients with angiographic obliteration of AVMs receive further treatment, preferably resection, or be followed with serial angiography.

Adolescent↗
PubMed1987

Outcome of primary coronary recanalization and arrhythmia profile in survivors of acute myocardial infarction.

The purpose of this study was to assess the arrhythmia profile in survivors of acute myocardial infarction in whom recanalization of the infarct-related vessel was attempted. 127 patients with acute myocardial infarction were randomized to intravenous and intracoronary thrombolysis with or without transluminal coronary angioplasty. 84 of them, aged 54 +/- 9 years, had angiographic control, 24-hour Holter electrocardiographic monitoring and programmed electrical stimulation 4 weeks after infarction. The study protocol of programmed electrical stimulation included single and double extrastimuli at 2 driving cycle lengths. The end point was the induction of ventricular tachycardia with 10 and more beats. During infarction 28 patients had occlusion of the left anterior descending, 12 of the circumflex and 44 of the right coronary artery. Holter monitoring revealed both frequent (greater than 100 ventricular premature complexes per 24 hours) and repetitive (Lown IVA, IVB) ventricular arrhythmias in 23 patients (27%). Inducible ventricular tachycardia (greater than 6 beats) was found in 25 patients (30%), which was sustained in 4 patients. According to the angiographic results two groups of patients could be identified: group A consisted of 64 patients who showed primary recanalization of the infarct-related vessel with persistent patency at control. Group B consisted of 20 patients who showed late reopening (n = 5) or a closed infarct-related vessel (n = 15) due to late reocclusion in 9 of them. Frequent ventricular premature contractions occurred in 18 group A and in 5 group B patients (n.s.). Repetitive ventricular premature contractions were found in 21 group A and in 2 group B patients (P less than 0.05). Inducible ventricular tachycardia was observed in 17 patients of group A (27%) and in 8 patients of group B (40%) (n.s.). The incidence of spontaneous and stimulus-induced ventricular arrhythmias was not influenced by the type of recanalization procedure. Furthermore no relation to the time interval between onset of preinfarct angina and angiographically demonstrated reperfusion of the infarct-related vessel was found. The patients in the two groups did not differ with respect to left ventricular ejection fraction, number of abnormal contracting wall segments or site of infarction. It is concluded that reperfusion infarction does not differ from infarction due to permanent occlusion with respect to inducible ventricular tachycardia but may favor repetitive ectopic activity.

Angioplasty, Balloon↗
PubMed1990

Experimental ultrasonic angioplasty: disruption of atherosclerotic plaques and thrombi in vitro and arterial recanalization in vivo.

To investigate the use of high energy ultrasound as an alternative energy for angioplasty, an experimental ultrasonic angioplasty device was developed. The device was studied in two bioassay systems: an in vitro system for the disruption of atherosclerotic plaques and thrombi and an in vivo system for the recanalization of occluded canine femoral arteries. In vitro, sonication efficiently reduced the size of the plaques. Atheromatous plaques (n = 11) disrupted at a rate of 21 +/- 8 s/cm2; complicated plaques (n = 14) disrupted at a rate of 132 +/- 45 s/cm2 (p less than 0.001). Histologic examination revealed that the disruption of the plaques took place without concurrent damage to the media or adventitia. Ninety percent of the disrupted plaque debris had a diameter of less than 20 microns and was composed primarily of cholesterol monohydrate crystals. Solid thrombus (n = 5) weight was reduced from 1.6 +/- 0.2 to 0.4 +/- 0.1 g (p less than 0.0001) after 20 s of sonication. In vivo, sonication resulted in recanalization in all seven arteries tested in seven dogs. The obstruction was reduced from 93 +/- 11% to 18 +/- 7% (p less than 0.001). On histologic examination, the arterial wall injury index was found to be 1.56 +/- 0.42 in the test arteries compared with 1.37 +/- 0.47 in the control arteries (p = NS). The disruption of atherosclerotic plaques and thrombi, together with the efficient recanalization of the occluded arteries, demonstrates the potential of ultrasound angioplasty as a catheter-based technique for angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed2004

Comparison of rapidity of coronary recanalization in men with tenecteplase versus alteplase in acute myocardial infarction.

To determine whether tenecteplase (TNK-t-PA), a bioengineered variant of tissue-type plasminogen activator (t-PA) designed to accelerate thrombolysis, exhibits favorable properties compared with those of alteplase, 266 men were studied </=6 hours after the onset of symptoms and signs of acute myocardial infarction. The primary end point was the rapidity of recanalization as judged from analysis of serial changes in the concentrations in blood of isoforms of creatine kinase-MM in serially obtained blood samples. Additional end points included enzymatically estimated infarct size and mortality. Patients were treated quite promptly after the onset of symptoms. The interval from the onset of chest pain to recanalization seen with TNK-t-PA was 208 +/- 10 (SE) minutes compared with 237 +/- 9 minutes seen with alteplase (p = 0.04). Thirty-day mortality was low with the use of the 2 agents (2%). TNK-t-PA appears to induce recanalization more rapidly than alteplase, and thrombolysis initiated early after the onset of symptoms is associated with remarkably low mortality.

Adult↗
PubMed2005

Outflow protection filters during percutaneous recanalization of lower extremities' arterial occlusions: a pilot study.

PURPOSE: Filter devices are already employed for the protection of carotid, coronary and renal distal vascular bed during endovascular procedures. This is a pilot study investigating their feasibility, safety and distal emboli protection capability during recanalization of lower extremities' acute and subacute occlusions. MATERIALS AND METHODS: Study population included 16 patients, 11 with a subacute arterial occlusion and 5 with an acute episode. The Trap filter (Microvena, USA) and its successor the Spider filter (EV3, USA) were utilized. Subacute occlusions were dealt with standard angioplasty and stenting procedures, while acute ones were managed primarily with Angiojet rheolytic thrombectomy. Outflow arterial tree was checked angiographically in-between consequent procedural steps. Embolic material collected after filter recovery was analyzed histopathologically. Patients' follow-up was scheduled at 1 month. RESULTS: Seventeen filter baskets were applied in the recanalization of 16 target lesions in total. Mean length of the occluded segments was 6.1 (range: 2-15 cm; S.D. = 3.7 cm). Mean in situ time of the filters was 38.75 min (range: 20-60 min; S.D. = 12.71 min). Technical success rate of deployment and utilization of the filtration devices was 100% (17/17). Procedural success rate of the recanalization was 100% (16/16) without any clinical or angiographic evidence of periprocedural distal embolization. Macroscopic particulate debris was extracted from all the filters (17/17) containing fresh thrombus, calcification minerals, cholesterol and fibrin. Mean diameter of the largest particle per specimen was 1702.80 (range: 373.20-4680.00 microm; S.D. = 1155.12 microm). No adverse clinical events occurred at 1-month follow-up with 100% limb salvage (16/16). CONCLUSION: The application of outflow protection filters is safe, feasible and efficacious in hindering distal embolization complications and safeguarding the distal capillary bed. Nevertheless, this is a pilot study in a limited group. Further studies have to be contacted in order to provide evidence for a more general use of these devices.

Angiography, Digital Subtraction↗
PubMed2006

Sharp recanalization of a short esophageal occluding stricture in a patient with epidermolysis bullosa.

BACKGROUND: Although esophageal strictures caused by epidermolysis bullosa are often treated with balloon dilations, complete obstruction has few effective therapies except esophagectomy with colonic replacement. OBJECTIVE: Resolution of esophageal obstructive lesion without surgical intervention. DESIGN: Case study. SETTING: Interventional radiology. PATIENT: Epidermolysis bullosa with esophageal stricture. INTERVENTION: Endoscopic- and guidewire-guided sharp recanalization. MAIN OUTCOME MEASUREMENT: Radiologic evidence of stricture resolution. RESULTS: Successful recanalization. LIMITATIONS: Experience of operators (anesthesiologist, endoscopist, interventional radiologist). CONCLUSIONS: Sharp recanalization of a complete stricture in patients with epidermolysis bullosa is feasible in a controlled setting.

Adult↗
PubMed2006

Spontaneous recanalization at subacute phase of stroke may be dramatic: A case report.

Spontaneous recanalization of the occluded cerebral arteries has occasionally occurred in an acute phase of stroke patients. We report a stroke patient with recanalization at 7 days of onset detected by using continuous transcranial Doppler (TCD) monitoring. After the presence of microembolic signals on TCD display, dynamic flow changes of the middle cerebral artery (MCA) occurred, which represented recanalization of the occluded MCA.

Adult↗
PubMed2006

Reconstruction of the middle hepatic vein tributaries using the recipient's recanalized umbilical vein in right-lobe living-donor liver transplantation.

BACKGROUND: Right-lobe grafts without the middle hepatic vein (MHV) can cause severe congestion of the anterior segment in living-donor liver transplantation (LDLT). However, the indications and methods for reconstructing the MHV or its tributaries remain controversial. METHODS: We herein describe two cases of the successful use of the recipient's recanalized umbilical vein as an interposition graft to drain the major MHV tributaries in right-lobe LDLTs. RESULTS: After surgery, both right-lobe grafts are currently functioning well and all of the reconstructed venous tributaries have been confirmed to be patent by doppler ultrasonography. The histopathological features of the recanalized umbilical vein showed an intact intima with thickened media. CONCLUSIONS: The use of the recipient's recanalized umbilical vein is a good option for reconstructing MHV tributaries in right-lobe LDLTs.

Hepatic Veins↗
PubMed1999

Stent or angioplasty after recanalization of chronic coronary occlusions? (The SARECCO Trial).

This study tests whether stent implantation without anticoagulation after catheter recanalization of coronary occlusions can improve outcome compared with balloon angioplasty alone. One hundred ten patients were randomly assigned to angioplasty alone (no stent group) or stent implantation (stent group) after successful recanalization and balloon angioplasty. The type of stent and angioplasty technique utilized were decided by the operator. The acute procedural success in both groups was 100%. The acute minimal lumen diameter (MLD) was 1.85 +/- 0.44 mm in the no stent group versus 2.54 +/- 0.53 mm in the stent group (p <0.01). The diameter stenosis was 21 +/- 13% versus 3 +/- 14% (p <0.01). This was achieved not only by the stent implantation itself but primarily by a larger maximum balloon diameter in the stent group after stent implantation (3.32 +/- 0.55 mm vs 2.86 +/- 0.4 mm, p <0.05). After 4 months, the MLD was 1.15 +/- 0.73 mm in the no stent group versus 1.81 +/- 0.9 mm in the stent group (p <0.01). The diameter stenosis was 56 +/- 29% versus 34 +/- 28% (p <0.01). After 2 years, event-free survival was 26% in the no stent group and 52% in the stent group (p <0.05). Thus, acute and long-term procedural and angiographic success of stent implantation without anticoagulation after recanalization of total coronary occlusions is superior to that of balloon angioplasty alone. This beneficial effect is mainly the result of the larger balloon diameters, which may be used after stent implantation.

Angioplasty, Balloon↗