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PubMed1998

Plasma soluble P-selectin in acute myocardial infarction: effects of coronary recanalization therapy.

P-selectin is translocated from platelets and endothelial cells to initiate the first step in a sequence of events leading to the adherence of leukocytes, possibly inducing reperfusion injury and the no-reflow phenomenon in acute myocardial infarction (AMI). This study was undertaken to investigate plasma P-selectin in AMI patients undergoing coronary recanalization therapy. A total of 40 patients were studied: 20 patients with AMI who underwent coronary recanalization by direct percutaneous transluminal coronary angioplasty (PTCA), 10 patients with AMI who underwent thrombolytic therapy by tissue-type plasminogen activator (TPA), and 10 patients with stable angina pectoris who underwent elective PTCA. Blood samples were obtained from systemic arteries before and immediately after PTCA or thrombolytic therapy. Plasma-soluble P-selectin was measured by enzyme immunoassay. Plasma P-selectin was significantly higher in AMI than in stable angina pectoris (176.6 +/- 12.9 ng/mL vs 91.4 +/- 9.5 ng/mL, p<0.001). Plasma P-selectin did not change significantly as a result of elective PTCA in patients with stable angina (from 91.4 +/- 9.5 ng/mL to 87.9 +/- 7.9 ng/mL). Plasma P-selectin was decreased by direct PTCA in all of the 20 patients with AMI (from 176.2 +/- 17.7 ng/mL to 141.7 +/- 12.6 ng/mL; p<0.001, paired t-test), whereas it was increased by thrombolysis using TPA in nine of the 10 AMI patients (from 177.4 +/- 17.2 ng/mL to 248.8 +/- 17.3 ng/mL, p<0.005). Increased P-selectin activity in AMI appeared to be attenuated by direct PTCA, but augmented by thrombolysis, possibly due to direct stimulatory effects of TPA on P-selectin expression. This may lead to less favorable results in salvaging the ischemic myocardium by thrombolytic than mechanical coronary recanalization therapy in AMI.

Angina Pectoris↗
PubMed2003

Thrombosis and recanalization of symptomatic nongiant saccular aneurysm.

Complete thrombosis followed by recanalization of giant aneurysms is an infrequent process that has been exceptionally mentioned in relation to nongiant saccular aneurysms. A 25-year-old male presented with a right temporal hematoma and associated subarachnoid hemorrhage. Cerebral angiography revealed a small blister-like dilatation at the right middle cerebral artery bifurcation. The cerebral hematoma was surgically removed and a large thrombosed aneurysm was discovered and was wrapped. Follow-up angiography revealed complete recanalization of the aneurysm with preservation of all the arterial branches and the aneurysm was then completely occluded with detachable coils. This case provides insight into the well-known but poorly understood dynamic process of thrombosis and recanalization of cerebral aneurysms. The possible role of a cerebral hematoma in the pathogenesis of this process is discussed.

Adult↗
PubMed1985

Emergency aorto-coronary bypass surgery after percutaneous transluminal coronary recanalization--its indication and results.

Percutaneous transluminal coronary recanalization (PTCR) was carried out in 201 patients with acute myocardial infarction. Fifteen patients required emergency aorto-coronary bypass grafting (ACBG) subsequent to PTCR; in one immediately following unsuccessful thrombolysis and the remaining 14 patients within 10 days after initial successful recanalization because of reinfarction. One patient died of multiorgan failure postoperatively. Excluding one patient, all patients had left main trunk disease (LMTD) and/or 3 vessel disease (3VD), with residual stenosis at the site of recanalization of greater than 99% with filling delay. Nonsurviving without surgery and medically managed patients on whom repeated angiography was carried out also analysed, in an effort to establish angiographic indications for supplementary surgical revascularization. Patients having extensive coronary artery disease such as LMTD and/or 3VD, emergency ACBG should be performed immediately following PTCR, if the remaining causative stenosis is greater than 99% with filing delay.

Aged↗
PubMed1995

Effect of the initial bolus volume of recombinant tissue-type plasminogen activator on coronary recanalization and infarct size in Japanese acute myocardial infarction patients. Kumamoto University Myocardial Infarction Study (KUMIS) Group.

Coronary recanalization rate and infarct size were compared between 2 different methods of intravenously administering recombinant tissue-type plasminogen activator (rt-PA) 41.4 mg; 1) an initial bolus dose of 30% followed by infusion of the remainder over 60 min (30% group), and an initial bolus dose of 10% followed by infusion of the remainder over 60 min (10% group). Thirty min after beginning rt-PA infusion, the coronary recanalization rate was higher in the 30% group than in the 10% group (82.9% (34/41) vs 53.7% (22/41), p < 0.01). The peak creatine kinase and peak creatine kinase-MB levels were lower in the 30% group than in the 10% group. We conclude that a higher initial bolus dose of rt-PA gives a higher rate of recanalization of the infarct-related artery at the very early phase, and probably leads to a smaller infarct size.

Aged↗
PubMed2005

Ruptured vertebral artery dissecting aneurysm followed by spontaneous acute occlusion and early recanalization: case report.

A 47-year-old man presented with a ruptured vertebral artery dissecting aneurysm manifesting as subarachnoid hemorrhage followed by acute occlusion and early recanalization of the affected artery. Cerebral angiography 2 hours after the onset of the symptom showed pearl-and-string sign in the right vertebral artery. Serial angiography showed that the affected artery was occluded at 12 hours but was recanalized on the 4th day. The dissecting aneurysm was resected with side-to-side anastomosis between the bilateral posterior inferior cerebellar arteries. Postoperative cerebral angiography demonstrated disappearance of the lesion and patency of the right posterior inferior cerebellar artery via the anastomosis. Histological examination of the lesion showed hematoma between the media and adventitia, disrupting the internal elastica and intima. Acute occlusion and early recanalization of the affected artery may occur in ruptured vertebral artery dissecting aneurysms. Serial neurological and neuroradiological examinations are essential to decide the timing and method of treatment.

Acute Disease↗
PubMed2006

Progression of middle cerebral artery susceptibility sign on T2*-weighted images: its effect on recanalization and clinical outcome after thrombolysis.

OBJECTIVE: The middle cerebral artery (MCA) "susceptibility sign" on T2*-weighted imaging has been reported to indicate acute thrombotic occlusion. We evaluated the serial progression of this susceptibility sign on follow-up MRI and its effect on recanalization and clinical outcome after intraarterial thrombolysis. MATERIALS AND METHODS: Thirty-three acute ischemic stroke patients who were treated with intraarterial thrombolysis and underwent MRI within 6 hours of symptom onset were enrolled in this study. All study participants had either M1 or M2 occlusion on digital subtraction angiography before thrombolysis and underwent follow-up MRI 2-3 days after thrombolysis. Recanalization status was evaluated using the thrombolysis in myocardial infarction (TIMI) flow grade on digital subtraction angiography immediately after thrombolysis. The serial progression of the susceptibility sign on follow-up T2*-weighted imaging was compared with the MR angiographic findings. Baseline clinical parameters and clinical outcome were also reviewed. RESULTS: A positive MCA susceptibility sign on the initial T2*-weighted imaging was detected in 16 (48%) of the 33 patients. The mean TIMI grade was higher in the patients with a positive sign on imaging than in those without the sign (2.3 vs 1.0, respectively; p < 0.005). In the risk factor analysis, a history of atrial fibrillation was significantly higher in the patients with the MCA susceptibility sign than in those with negative findings for the sign (13/16 [81%] vs 4/17 [24%], respectively). In 14 of the 16 patients with the positive sign, the sign disappeared on follow-up MRI, and that finding (i.e., disappearance of the sign) was well correlated with complete recanalization on follow-up MR angiography in 12 patients. Multivariate logistic regression analysis showed that this sign was not associated with a favorable functional outcome 30 days after thrombolytic treatment. CONCLUSION: The MCA susceptibility sign can be indicative of acute thromboembolic occlusion and can be used to predict the immediate effectiveness of intraarterial thrombolysis. However, the appearance of this sign was not associated with a favorable clinical outcome after thrombolysis in our small series study.

Adult↗
PubMed1999

Recanalization of thrombosed superficial femoral arteries with a hydraulic thrombectomy catheter in a canine model.

OBJECTIVE: This experiment was conducted to evaluate efficacy and safety of the Oasis thrombectomy catheter on arterial thrombosis in dogs. MATERIALS AND METHODS: Thrombosis was induced in 18 femoral arteries of nine mongrel dogs. Recanalization of the thrombosed femoral artery was performed using a thrombectomy catheter 7-10 days after thrombus induction. Pre- and postprocedural arterial status was documented by angiography. After mechanical thrombectomy, the animals were sacrificed and the femoral arteries were harvested and examined macro- and microscopically. Additionally, in vitro fragmentation was carried out to determine particle size and distribution from the recovered effluent. RESULTS: Subacute thrombosis was successfully created in 15 femoral arteries. Full recanalization was achieved in 80% (12/15) of the thrombosed femoral arteries without any residual thrombus. No significant downstream embolization was documented angiographically. Endothelial denudation was observed in all the treated arteries along with occasional disruption of the internal elastic lamina. No medial injury was seen. Ninety-eight percent of thrombus was liquefied, defined as particles smaller than 15 microm, by the catheter. Particles larger than 400 microm represented 0.27% of the original clot weight. CONCLUSION: Occluded femoral arteries with 7- to 10-day-old thrombus can be efficiently recanalized with the Oasis catheter in dogs without any significant complication. This thrombectomy catheter appears to be highly effective and safe and requires no sophisticated equipment. Blood loss was our major concern regarding use of this catheter but can be minimized by strictly controlling activation time and restricting the inflow into the vascular segment being treated.

Animals↗
PubMed1989

Recanalization of spinal arteriovenous malformations following embolization.

Recently, therapeutic embolization has been advocated as the treatment of choice for arteriovenous malformations (AVM's) of the spine. However, no study has established lasting benefit from this procedure or determined the incidence of recanalization, as occurs with cerebral AVM's. In this study, six patients were followed periodically after complete obliteration of their AVM's by particulate embolization was shown by immediate arteriography. The study group included three men (aged 59 to 72 years) with spinal dural arteriovenous (AV) fistulas and three women (aged 27 to 38 years) with intramedullary glomus-type spinal cord AVM's. The patients were treated by embolization with 100- to 1000-microns diameter polyvinyl alcohol particles. Clinical improvement, most commonly manifesting as increased lower-extremity strength, occurred in all patients after embolization. However, recurrent symptoms, including weakness, numbness, and urinary incontinence, occurred within 2 and 8 months in two of the three patients with dural AV fistulas and within 2 months in two of the three patients with glomus AVM's, prompting radiological reevaluation. Spinal arteriography revealed recanalization of the AV fistulas and spinal AVM's in five patients. Magnetic resonance (MR) imaging demonstrated a signal-void area caused by intramedullary AVM's. This area disappeared after embolic occlusion, but recurred after delayed recanalization, indicating restored flow through the AVM. Embolization provides only temporary treatment for many spinal AVM's. After embolic occlusion, delayed reassessment with arteriography and/or MR imaging is indicated, particularly if the symptoms persist or recur. Surgical excision of spinal AVM's provides the only therapeutic means to eliminate flow through the AVM permanently in most patients, and should be considered the treatment of choice when feasible.

Aged↗
PubMed2005

Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. Case report.

A symptomatic internal carotid artery (ICA) occlusion with hemodynamic compromise was treated at its chronic stage by using an endovascular technique. An embolic protection system was used during the recanalization procedure to prevent stroke by reversing the flow from the distal ICA to the common carotid artery. The totally occluded ICA was completely recanalized through percutaneous transluminal angioplasty and stent placement. The patient's symptom (transient ischemic attack) disappeared completely after treatment with no new neurological deficit. Single-photon emission computerized tomography findings confirmed improvement of the hemodynamic compromise, and no new high-intensity spots appeared on diffusion-weighted magnetic resonance imaging after treatment. This case shows that endovascular recanalization by using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise and refractoriness to antiplatelet therapy, even in the chronic stage of the illness.

Aged↗
PubMed2005

Blood pressure in the artery distal to an intraarterial embolus during thrombolytic therapy for occlusion of a major artery: a predictor of cerebral infarction following good recanalization.

OBJECT: The aim in this study was the investigation of back pressure in arteries distal to the occlusion site during intraarterial thrombolysis as well as the usefulness of back pressure measurement in combination with diffusion-weighted (DW) magnetic resonance (MR) imaging to predict the occurrence of ischemic lesions following good recanalization. METHODS: . Twenty-five consecutive patients with severe hemiparesis caused by embolism of the internal carotid artery (10 patients) and the proximal middle cerebral artery (15 patients) were treated using intraarterial thrombolysis. Systolic back pressure, measured through a microcatheter in the artery just distal to the emboli, ranged from 22 to 78 mm Hg. According to an angiographic inclusion criterion for good recanalization--that is, recanalization of the M2 or more distal arteries at the end of thrombolysis--21 of 25 patients underwent evaluation in this study. In 14 patients volumes of low-density areas on computerized tomography (CT) scans obtained 2 months postthrombolysis were smaller in comparison with volumes of hyperintense areas on DW MR images acquired before treatment, whereas these low-density areas were larger in seven patients. Compared with those on initial DW MR images, the volume of abnormalities on CT scans obtained 2 months posttreatment were significantly reduced in patients with a systolic back pressure greater than 30 mm Hg (16 patients) than in those with a back pressure of 30 mm Hg or less (five patients) (p < 0.05). Systolic back pressures greater than 30 mm Hg were associated with significantly better modified Rankin Scale scores than those 30 mm Hg or less (p < 0.05). CONCLUSIONS: Back pressure measurement in combination with DW MR imaging can be used to predict the occurrence of infarction as demonstrated on CT scans following thrombolysis.

Aged↗
PubMed2000

[A case of cardiogenic cerebral embolism with successful recanalization: apparent diffusion coefficient analysis for prediction of reversible cerebral ischemia].

A 54-year-old woman complaining of left hemiplegia was transferred to our hospital. Computed tomography on admission demonstrated normal. Electrocardiogram showed atrial fibrillation. Cerebral blood flow (CBF) was decreased in both the cortex and the perforator territory of the right middle cerebral artery (MCA), whereas the apparent diffusion coefficient (ADC) in the cortex was normal. Digital subtraction angiography (DSA) revealed an occlusion of the right MCA (M 1 proximal) with collateral flow from the right anterior cerebral artery (ACA) to the territory of the right MCA. After intra-arterial injection of tissue-plasminogen activator (t-PA), DSA showed partial recanalization, and the symptoms of the patient improved considerably. Five days after that, the patient deteriorated again and showed disturbance of consciousness and left hemiplegia. In this episode, both CBF and ADC in the cortex of the right MCA were decreased. DSA revealed an occlusion of the right internal carotid artery (ICA) and collateral flow from the right ACA to the territory of the right MCA disappeared. After intra-arterial injection of t-PA, DSA showed partial recanalization with collateral flow from the right ACA, and the symptoms of the patient improved. DSA 5 weeks after onset showed complete recanalization of both the right MCA and the ICA. The patient was diagnosed as both mitral and aortic stenosis and regurgitation (MSR + ASR) and underwent an operation for both mitral and aortic value replacement. She was discharged with no neurological deficit 4 months after onset. ADC analysis is especially useful for the prediction of reversible ischemic damage and the prevention of hemorrhagic transformation and fatal edema in acute ischemic stroke.

Angiography, Digital Subtraction↗
PubMed2000

[Percutaneous recanalization of occluded renal arteries].

Acute embolic renal artery occlusion is usually clinically typical. In case of early diagnosis, an in situ thrombolysis may be effective. As thrombosis often progressively completes a severe renal artery stenosis, the classical clinical description of renal infarction (lumbar pain, hematuria) is frequently not present. The kidney parenchyma downstream from the renal arterial occlusion is not always irreparably lost: collateral circulation may preserve nephron viability, which requires a lower perfusion pressure than glomerular filtration. An iodine, isotopic, or MR gadolinium nephrogram may prove this viability. Over the last 10 years, we attempted 21 percutaneous recanalizations of renal artery occlusion. Mean patient age was 62 years (44-85). All were hypertensive. Serum creatinin level of 17 patients was above 130 micromoles/ml. Three patients were previously hemodialysed. We observed 8 failures, without any complication. Thirteen immediate technical successes occurred, but one rethrombosis occurred at Day 1. Immediate complications were seen in 2 patients: 1 acute pulmonary edema, 1 puncture site false aneurysm. The mean follow up of the 12 technical successes was 26 months (18-60). One rethrombosis occurred at 6 months. Hypertension was unchanged in 4 patients and improved in 8. In all patients with renal insufficiency, a significative improvement of serum creatinine level was observed. It was possible to discontinue hemodialysis in the 3 patients previously hemodialysed. One predictive factor of success was recognized: a short delay (shorter than 90 days) between occlusion and recanalization. Percutaneous recanalization must be proposed in case of renal artery occlusion, especially to avoid vascular azotemia and dialysis, even if the kidney fed by the occluded artery is small.

Acute Disease↗
PubMedDate not supplied

Emergency transcatheter balloon recanalization of acutely thrombosed modified Blalock-Taussig shunts.

BACKGROUND: Modified Blalock-Taussig shunts are used to palliate a variety of cyanotic heart diseases associated with reduced pulmonary blood flow. Acute shunt thrombosis in patients with shunt-dependent pulmonary blood flow can result in life-threatening hypoxia. We describe our experience of emergency transcatheter recanalization in 5 severely hypoxic children with acute shunt occlusion. METHODS AND RESULTS: Five patients with ages ranging between 5 and 24 months (median 11 months) and weight ranging from 4 to 8 kg (median 5 kg) presented with severe hypoxia, acidosis and hypotension following acute occlusion of modified Blalock-Taussig shunts placed 11 days to 12 months ago. As severe hypoxia (saturation range 3 5%-5 0%), acidosis and a state of shock in all the patients increased the risk for a redo surgical procedure, they were taken up for emergency transcatheter recanalization within 2-6 hours of hospitalization. This was done by positioning a Judkin's right coronary catheter at the mouth of the thrombosed shunt, crossing the shunt with a guidewire and serial dilatations with coronary and/or peripheral angioplasty balloons to the size of the graft. This technique was immediately successful in 4 of the 5 patients, thereby avoiding a repeat palliative operation. In 2 patients with residual stenosis, stents were used to restore luminal patency. One patient with acute stent thrombosis was managed successfully with local delivery of thrombolysis for 36 hours, which resulted in good luminal patency. At follow-up after 6 and 12 months, the shunts in both the stented patients are patent, with an oxygen saturation of 78% and 80%, respectively. In 2 other patients who had undergone plain balloon angioplasty, the shunts remained patent for 11 days (died of bronchopneumonia and septicemia) and 3 months, respectively. The procedure was unsuccessful in one very sick patient in whom the shunt had a tortuous course. CONCLUSIONS: Transcatheter recanalization of an acutely thrombosed Blalock-Taussig shunt is feasible. It can offer satisfactory short-term palliation in selected patients. Stents may play a role in patients with residual narrowing after dilatation. The procedure can be expeditiously accomplished in an emergency situation in a severely hypoxic child and may be a realistic alternative to surgery or thrombolysis.

Anastomosis, Surgical↗
PubMedDate not supplied

Transcervical fallopian tube recanalization: a safe and effective therapy for patients with proximal tubal obstruction.

Over a 13-month period, 14 patients with proximal tubal obstruction underwent transcervical fallopian tube recanalization under fluoroscopic guidance in an outpatient setting at the hospital of the University of Pennsylvania. Twenty-one of 24 attempted tubal dilations (87.5%) were successful, as demonstrated by tubal opacification and contrast spillage into the peritoneal cavity at the conclusion of the procedure. Four intrauterine pregnancies, and no ectopic pregnancies, have followed the recanalization. One pregnancy ended in an early miscarriage, one patient delivered a healthy term female, and two pregnancies are ongoing at greater than twenty weeks' gestation. Two procedure-related complications occurred: in one patient, the isthmic segment of a fallopian tube was perforated, but healed without incident, and another patient experienced a low-grade fever, which resolved with p.o. antibiotics. We therefore conclude that fallopian tube recanalization is a well-tolerated, safe, and effective procedure for the treatment of proximal tubal occlusion.

Adult↗
PubMed1992

[Neodymium--Yag laser in the recanalization of arterial occlusions].

Failure of the guide-wire to recanalize some arterial total occlusion does not preclude balloon angioplasty. Nowadays there are recanalization devices such as the mechanical atherectomy and Lasers. The following report describes the successful use of the Nd: YG Laser in the recanalization of a common iliac artery total occlusion in a patient with claudication, rendering possible balloon angioplasty and a Palmaz Stent implantation, which is the first case performed in our country.

Aged↗
PubMedDate not supplied

32P-oligodeoxynucleotide-coated coils to prevent arterial recanalization after embolization.

BACKGROUND AND PURPOSE: Endovascular treatment of aneurysms with coils, a less invasive alternative to surgery, is too often associated with recurrences. In a canine model, recanalization after coil embolization can be inhibited by in situ beta radiation. METHODS: Radioactive platinum coils were produced by immersion in a (32)P-oligodeoxynucleotide solution. In vitro and in vivo (32)P-oligodeoxynucleotide elution profiles were assessed after incubation or arterial implantation for 14 days or less. Activities within arteries, thrombi, and coils were measured by scintillation counting. Angiographic and pathologic results no more than 12 weeks after standard platinum and radioactive coil embolization of canine maxillary, cervical, and vertebral arteries were compared among 17 animals. RESULTS: Exposure to (32)P-oligodeoxynucleotide solution at 65 degrees C yielded coils with an average activity of 0.3 microCi/cm. Elution profiles in vitro and in vivo showed that 50% of total activities eluted from coils within 24 hours at first, but coil activities then paralleled the natural decay of (32)P. Radioactivity was present in the thrombi and arterial wall throughout the 14-day observation period. Arteries that were embolized with standard coils recanalized at 2 weeks. Implantation of (32)P-oligodeoxynucleotide-coated coils produced total occlusions in 78.6% of arteries throughout the 12-week observation period. Most arteries that were implanted with radioactive coils were filled with fibrous tissue at 3 months. CONCLUSION: Radioactive coils can be produced by using the binding properties of a (32)P-oligodeoxynucleotide to platinum. Use of these coils in an animal model was effective in preventing recanalization. This method could be performed on site to provide coils tailored to each intervention.

Animals↗
PubMedDate not supplied

Peroperative arterial recanalization with Kensey dynamic angioplasty. Histopathologic studies.

The morphology of occluded superficial femoral artery segments and of particles in the effluent fluid after dynamic Kensey catheter angioplasty was analyzed in six patients treated with an intraoperative retrograde technique. The effluent was collected during the procedure and the arteries were extirpated for microscopy after the recanalization attempt. In three patients with easy recanalization, histologic study showed highly cellular, proliferating connective tissue. In three patients with unsuccessful recanalization, mature, cell-poor connective healing tissue obliterated the lumen. The effluent contained particles measuring 14 to 320 microns, the largest of which had the potential to occlude small arteries. The results of this pilot study are to be regarded as preliminary.

Aged↗
PubMed1991

[Transcutaneous transcatheter use of laser recanalization of coronary arteries in patients with ischemic heart disease].

The paper discusses the potential possibility and effectiveness of X-ray endovascular laser recanalization (ELR) of the coronary arteries in order to treat coronary atherosclerosis in patients with coronary heart disease. The intervention was performed in 4 patients (into the anterior interventricular artery in 3 and into the right coronary artery in 1). In 3 of 4 cases, X-ray ELR proved to be successful, in one case the intervention failed due to technological reasons. Recanalization of a completely occluded segment of the coronary artery with a residual stenosis of no more than 40% was observed in two cases. Laser recanalization of profound local coronary stenosis was made in the mid-third of the vessel in one case. It can be stated that X-ray ELR of the coronary artery may extend the scope of X-ray surgical therapeutical tools of the treatment of coronary atherosclerosis. At the same time, accumulation of clinical experience and further improvement of laser and laser catheter engineering are essential in defining the value and possible scope for the application of this method.

Angioplasty, Laser↗