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At least 289 records · Page 16Linked to original sources
PubMed1991

[Recanalization of chronically obstructed coronary vessels using ROTACS (low-speed rotational angioplasty. Early and long-term results in 152 patients following unsuccessful conventional angioplasty].

Total coronary artery occlusion is the main limiting factor of non-surgical recanalization procedures. With conventional methods, recanalization of total occlusions older than 6 months has a low success rate. Low-speed rotational angioplasty (ROTACS, Osypka, Medtronic) was employed in 152 patients with chronic coronary occlusions in whom conventional guide wire techniques failed. The average success rate was 60% and, although not correlated to site of occlusion, revealed a clear correlation to the duration of the occlusion: 93% (1-3 months), 74% (4-6 months), 52% (6-12 months) and 8% (greater than 12 months). Emergency surgery was needed in 2 patients in whom an attempt was made to recanalize an occluded LAD branch. In both cases, the occlusion was located in the immediate vicinity of the main trunk of the left coronary artery. Thereafter, this anatomical situation was considered a contraindication and no further complications occurred in the subsequent 120 patients. Among the 152 patients, no deaths, no myocardial infarction and no perforation of the vessel wall occurred. Long-term results were monitored by angiography in 95% of successfully treatment patients; good results were documented in 72%.

Angioplasty, Balloon↗
PubMed1990

[ST segment as an arterial recanalization indicator after thrombolytic therapy in myocardial infarction].

PURPOSE: To evaluate the importance of the segment ST in the identification of coronary recanalization in patients submitted to intravenous thrombolysis during acute myocardial infarction (MI). PATIENTS AND METHODS: Seventy four patients with MI, 62 male with mean age of 52.6 +/- 10 years. All patients had angiographically demonstrated occlusion of the infarct-related artery (IRA) before the thrombolytic treatment with intravenous "in bolus" infusion of 50 mg, 60 mg and 70 mg of rt-PA. The recanalization of the IRA was assessed 90 minutes later. The real status of the IRA in the angiograms was compared with the ST segment changes between the ECGs obtained before and after the thrombolytic therapy. RESULTS: Fifty six (75.6%) patients presented a significant reduction in the ST segment elevation (groups I and II). Of these, 47 possessed an opened IRA. From the 18 patients who did not show ST segment decrement (group III), 13 had an occluded IRA, and 5 an opened one. The method presented sensitivity of 90.3% and a specificity of 59.1%, positive predictive value of 83.9% and negative predictive value of 72.2%. CONCLUSIONS: The ST segment is an important marker of coronary recanalization or not following intravenous thrombolytic therapy.

Adult↗
PubMed1990

Percutaneous recanalization of chronic total coronary occlusions: experience with the direct argon laser assisted angioplasty system (LASTAC).

The present study reports initial experience with the argon laser LASTAC system in patients with chronic coronary artery occlusion not amenable to recanalization with conventional systems. The LASTAC system conducts focused argon laser light through an optical fiber of 200 microns which is inserted through a multiple-lumen balloon catheter. The balloon serves the purpose of coaxially positioning the optical fiber. The balloon catheter is advanced by means of a guidewire to about 2 mm proximal to the occlusive lesion. After advancing the optical fiber, in three times 10 to 20 Joules are applied. Thereafter, the optical fiber is withdrawn, the balloon deflated, the catheter system repositioned and the sequence repeated. The integrity of the system with respect to temperature increase, energy loss and contact with tissue is monitored with lens fluorescence. In 29 patients with angina pectoris and documented ischemia, 30 complete occlusions were treated. In 18 (60%), there was successful recanalization with conventional balloon dilation thereafter. The total success rate for the right coronary artery was 55%, for the circumflex artery 71% and for the left anterior descending artery 67%. With regard to complications, in one patient there was nontransmural myocardial infarction, in seven there were asymptomatic dissections, one patient required defibrillation. The value of the LASTAC system for recanalization of chronically occluded coronary arteries has not yet been fully delineated. However, the success rate of 60% in previously treatment-refractory patients as well as the fact that no perforations were incurred, is encouraging. Further assessment will require analysis of long-term results as well as comparison of other methods.

Adult↗
PubMed1990

[Endoscopic laser recanalization in the chemo- and radiotherapy of stenosing cancer of the esophagus].

The authors analyze the results of endoscopic laser recanalization in 11 patients with stenosing esophageal carcinoma, whose mean age is 61 years. The tumor was located in the upper thoracic portion of the esophagus in 3 patients, in the middle thoracic portion in 6, and in the lower thoracic portion in 2 patients. The diagnosis of carcinoma was morphologically verified. The length of the esophagus involvement was estimated by x-ray data and varied from 5 to 12 cm and longer. Endophytic form predominated--it was diagnosed in 5 patients. The technique of endoscopic laser recanalization by means of Raduga-1 unit with neodymium alumo-yttrium garnet laser as the source of irradiation is described. The method was specified with consideration for the type of tumor growth. The patients were kept on parenteral nutrition during the treatment session. Three-five days after endoscopic laser destruction long-distance open-field gamma-beam therapy was administered to 10 patients and polychemotherapy to 9 of these. After laser destruction dilatation of the stenosed portion of the esophagus from 0.2-0.6 to 1.0-2.0 cm was recorded in 10 patients. Complete regression of the tumor resultant from laser destruction and chemoradiotherapy was achieved in 5 patients, partial regression in the rest 5. The patients were followed up for 5-12 months. No recurrences were recorded in patients with complete regression of the tumor; the process progressed in 3 cases with partial regression. Studies on improvement of recanalization technique, specification of indications for and contraindications against this treatment modality are in progress.

Aged↗
PubMed1989

Effects of thrombolytic agents on coronary recanalization and patency, cardiac enzyme release, left ventricular function, and mortality in patients with acute myocardial infarction.

Morbidity and long-term mortality following acute myocardial infarction are directly related to the extent of left ventricular dysfunction. None of the numerous interventions that have been explored in the prevention of myocardial necrosis appears to surpass the benefit provided by rapid restoration of blood flow in the infarct-related coronary artery and attendant reperfusion of the ischemic zone. Although intracoronary administration of thrombolytic drugs results in rapid recanalization (72% with streptokinase or urokinase, 65% with APSAC), this route of administration is not practical and probably not necessary. Indeed, with intravenous administration of thrombolytics, the recanalization rate determined 90 min after the start of 1.5 million U of streptokinase is 43%, after 30 U of APSAC is 56%, after 1 to 2 million U of urokinase is 53%, and after rt-PA is 69%. Coronary patency can be achieved by intravenous therapy, with rates at 90 min of 56% for SK, 77% for APSAC, 71% for prourokinase, and 75% for rt-PA. There is sufficient evidence at present to conclude that the early administration of a thrombolytic agent will reduce infarct size and promote improved ventricular function. The benefits afforded by early recanalization on ejection fraction are clear and unmistakable. When compared to placebo treatment, the hospital mortality reduction in patients treated within 6 h after onset of symptoms is 47% after intracoronary SK. 43% after intravenous SK, 48% after intravenous APSAC, and 51% after intravenous rt-PA. However, the results of direct comparison of these different thrombolytic agents on the left ventricular function and mortality in a large number of patients are crucially important and eagerly anticipated.

Coronary Disease↗
PubMed1989

[Percutaneous transluminal coronary angioplasty for treatment of acute myocardial infarction: comparison with percutaneous transluminal coronary recanalization].

Percutaneous transluminal coronary angioplasty (PTCA) was evaluated as a means of reperfusion of the infarct-related coronary artery, and the results were compared with those of percutaneous transluminal coronary recanalization (PTCR). There were no difference in sex, age, infarct location and time from the onset to start of treatment between 135 patients with evolving acute myocardial infarction treated with PTCA (PTCA group) and 113 patients treated with PTCR alone (PTCR group). Fifty-nine patients in the PTCA group underwent PTCA following PTCR; the remaining 76 patients were without prior PTCR. Successful PTCA, defined as a 20% or more reduction in percent luminal stenosis diameter, was achieved in 123 (90%) of the 135 patients in the PTCA group. The reperfusion rate was 93% in the PTCA group and 77% in the PTCR group (p less than 0.01). Residual stenosis immediately after the treatment was 30 +/- 13% in the PTCA group and 70 +/- 16% in the PTCR group (p less than 0.01). In the PTCA group, three cases developed serious complications which were associated with angioplasty: coronary perforation, side branch occlusion resulting in cardiogenic shock and exacerbation of cardiogenic shock. The latter two patients died, however, there was no difference in hospital mortality rate: 6% in the PTCA group versus 11% in the PTCR group. At follow-up angiography performed four weeks after admission, reocclusion of the successfully recanalized arteries was observed in 3% of the PTCA group and in 14% of the PTCR group (p less than 0.01). Regional wall motion was evaluated by left ventriculography using a wall motion score system which consisted of six grades; from normal counted as 0, to dyskinesis counted as 5. There was no difference in the wall motion score between the successful PTCA group and the successful PTCR group (2.6 +/- 1.4 versus 2.8 +/- 1.4), but the scores of both groups were better than those of the non-recanalized group (3.4 +/- 1.0: p less than 0.01). In conclusion, PTCA and PTCR have the same effect on hospital mortality rate and regional wall motion, but PTCA has a higher reperfusion rate and a lower reocclusion rate than does PTCR. Although PTCA has a potential disadvantage inducing serious complications, it appears to be a useful treatment for acute myocardial infarction.

Aged↗
PubMed1983

Intra-coronary thrombolysis with streptokinase or lys-plasminogen/urokinase in acute myocardial infarction: effects on recanalization and blood fibrinolysis.

Forty-two patients with total occlusion of a coronary vessel were treated with intracoronary fibrinolytic agents. Four therapeutic protocols were compared: group I received streptokinase (SK) as a continuous infusion; group II and III received SK as a bolus at different doses and group IV received lysplasminogen (Pg) plus urokinase (UK); maximal doses were 350,000 IU of SK and 250,000 IU of UK plus 75 microK of Pg. Thrombolysis was assessed by coronary angiography. Coagulation studies were performed prior to, 15 min and 6 hr after the end of the thrombolytic treatment. Recanalization was achieved in 27 of the 31 SK-treated patients (87%) and in 7 of the 11 Pg-UK-treated patients (63.6%). The recanalization frequency was the same in the three SK-treated groups, even though when SK was administered as a bolus, the dose was significantly less than when administered on a continuous infusion. Although systemic fibrinolysis occurred in all 4 groups of patients, this effect was less pronounced in the UK-treated patients than in the three SK-treated groups. This study also shows that recanalization can be achieved with a dose of SK lower than the anti-SK antibody level. Haemorrhagic side effects were minimal in all patients studied. Severe defibrination is usually considered a risk of haemorrhage. These preliminary results suggest that bolus injection of SK or the use of UK plus lys-Pg can reduce the level of defibrination and thus the haemorrhagic risk.

Adult↗
PubMedDate not supplied

[Spontaneous recanalization of tubes after surgical sterilization].

The authors present their 13 cases of sterilization in which a spontaneous recanalization of tubes occurred. Out of these 13 cases, 11 underwent sterilization after the operative Madlener method, while in the remaining 2 cases a laparoscopic method by thermocoagulation was applied. Recanalization in most cases (7) developed 15 or more months after operative sterilization. An adequate passage of tubes was verified in 12 cases through pregnancy, while only in one case HSG was applied, showing a spontaneous recanalization of the right tube.

Adult↗
PubMed1994

[Physiopathology of recanalization].

Clinical benefit from coronary recanalization in acute myocardial infarction is linked to the restoration of optimal reperfusion. Experimental and clinical data demonstrate that the positive effect of coronary recanalization in terms of myocardial salvage, functional improvement and reduction in mortality depends on the ability to obtain early and complete reperfusion. Phenomena like no reflow, intermittent coronary patency, coronary reocclusion, reperfusion damage, residual coronary stenosis may reduce the benefit of recanalization.

Coronary Thrombosis↗
PubMed1995

Unexpected pregnancies after tubal recanalization failure with selective catheterization.

OBJECTIVE: To evaluate selective salpingography sensitivity. DESIGN: Retrospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa, Italy. PATIENTS: One hundred seventeen patients previously submitted to selective salpingography because of unilateral or bilateral proximal tubal injection failure. RESULTS: Seven pregnancies, one of which was ectopic, were obtained in 17 patients who had only recanalized tubes available for conception; 15 pregnancies were obtained in 39 patients who had one tube recanalized and one already patent; 3 tubal pregnancies were obtained in 12 patients who had only one tube already patent; 4 pregnancies, one of which was ectopic, were obtained in 19 patients who had neither patent nor recanalized tubes. CONCLUSIONS: Selective salpingography can give false-positive results; therefore, it is possible to obtain a pregnancy even after selective salpingography failure.

Abortion, Spontaneous↗
PubMed1993

[Endovascular surgery: recanalization technics and stent(s)].

Endovascular surgery has experimented a great development in the last years owing to the technologic advances in fields as mechanical and Laser recanalization technics, low profile catheters, Stents and diagnostic image. In a review work we discuss the role of this therapeutic modality in the treatment of vascular disease. To the vascular surgeon it becomes essential to be prepared to perform this procedures; to the general practitioner it becomes important to know about endovascular surgery potentialities. We discuss historical and technical aspects as also two important and polemic subjects in endovascular interventions: recanalization technics and stents. The authors personal experience, which is the first in Portugal in the fields of laser recanalization technics and stents placements, has been presented in several meetings and here is illustrated with one of our cases.

Angioplasty, Balloon↗
PubMed1996

[Recanalization of dural sinus occlusion following the disappearance of dural arteriovenous fistula: report of a case].

A 73-year-old female was admitted to our hospital because of disturbed consciousness and left-sided motor weakness. Computed tomographic scans demonstrated a hemorrhagic infarction in the right parietal region. Right carotid angiograms showed both the posterior portion of the superior sagittal sinus (SSS) and the entire left transverse sinus simultaneously occluded. Left carotid angiograms revealed an enlarged occipital artery, which had direct communications to the left sigmoid sinus and the superior petrosal sinus. These findings were consistent with dural arteriovenous fistula (D-AVF). The laboratory examinations yieled normal results. The patient was managed conservatively with glyceol and anticonvulsants for four weeks and eventually recovered with complete resolution of hemiparesis. Follow-up angiography carried out 6 weeks later showed the SSS, partially stenotic, but recanalized with no evidence of venous congestion. The D-AVF still remained opacified, but there was a marked reduction in retrograde flow to the sigmoid sinus. Further repeated angiograms obtained at 10 months after the onset confirmed complete recanalization of the SSS and disappearance of the D-AVF. From the timing of the angiographies, we considered that the sinus occlusion was caused by the high arterial flow to the fistula and its disappearance made recanalization of SSS possible.

Aged↗
PubMed1996

Complete recanalization via fibrinolytic therapy can reduce the number of ischemic territories that progress to infarction.

PURPOSE: To clarify the clinical significance of fibrinolytic therapy for acute ischemic stroke. METHODS: We analyzed findings in 18 patients with occlusion of a major artery in respect to cerebral blood flow thresholds for infarction. Nine of these patients had shown complete recanalization just after the treatment, between 3.5 and 7.25 hours after symptom onset, and the other nine had shown no change. Cerebral blood flow was measured by single-photon emission CT using 99mTC-labeled hemamethylpropyleneamine oxime and assessed semiquantitatively: multiple regions of interest were placed on the section images and two parameters, the R/CL ratio and the R/CE ratio, were calculated (where R represents a mean count of the region of interest in the affected hemisphere, CL on the opposite side, and CE in the cerebellar hemisphere on the affected ischemic side). RESULTS: Reperfusion significantly reduced the development of infarction in the regions of interest with an R/CL ratio between 0.65 and 0.85 or an R/CE ratio between 0.55 and 0.75. No correlation was observed between the development of infarction and the duration of ischemia. The cerebral blood flow threshold in patients without recanalization was higher than that in patients with recanalization. CONCLUSION: Reperfusion achieved by fibrinolytic therapy in the acute stage can save ischemic brain within a limited cerebral blood flow value.

Aged↗
PubMedDate not supplied

Elective coronary stenting after recanalization for chronic total occlusion: clinical and angiographic follow-up results.

Percutaneous transluminal coronary angioplasty (PTCA) for chronic totally occluded coronary arteries is associated with a significant residual stenosis and a high incidence of restenosis. Between March 1995 to February 1997, recanalization of chronic total occlusion (CTO) was attempted in 95 patients, of whom 79 (83.1%) were dilated successfully using balloon angioplasty, rotablation or both. Forty two patients underwent elective stent implantation to evaluate the influence of stenting on immediate results and clinical as well as angiographic outcome on long-term follow-up. There were 39 males and 3 females, with a mean age of 51 +/- 8 years. The majority (69.1%) had multivessel disease. The target vessel was LAD in 25 (58.1%), RCA in 12 (27.9%), LCx-OM in 5 (11.6%) and ramus in 1 (2.3%). After recanalization and adequate predilatation, various types of stents were deployed successfully at the target site in all patients, using high pressure intrastent balloon dilatation. The luminal diameter stenosis reduced to 47 +/- 15 percent after balloon angioplasty and < 10 percent in all, after stent implantation. There were no in-hospital major complications, including subacute stent thrombosis, myocardial infarction, need for emergency bypass graft surgery or death. The follow-up data is available in 36 patients, ranging from 1-22 months (mean: 7.4 +/- 4.7; median: 6). Of these, 32 (88.8%) were free of angina at their last visit, 3 (8.3%) required target lesion revascularization and 2 patients died, one at 3 weeks and the other at 6 months after the procedure. The event-free survival, estimated by the Kaplan-Meier survival curve was 97.3, 82.8 and 77.25 percent at one, 6, and 12 months, respectively after stenting. Out of 29 eligible patients, 20 underwent repeat coronary angiography after 6 months, which revealed restenosis in 5 (25%). In conclusion, our study shows that elective coronary stenting following successful recanalization of chronic total occlusion produces an excellent immediate result and reduces the recurrence of angina, target lesion revascularization and angiographic restenosis on long-term follow-up.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Recanalization of complete coronary occlusions followed by STENT implantation. An angiographic study after 6 months].

The restenosis and reocclusion rate after coronary recanalization by conventional angioplasty are high. The role of stent implantation in this context is unknown. The authors assessed a group of 49 patients who underwent implantation of one or more stent after a recanalization procedure by angiography at 6 months. The restenosis rate assessed by quantitative angiography was 24%; no cases of reocclusion were observed. These angiographic results were accompanied with a significant improvement of the anginal symptoms (p < 0.01). These results suggest that stent implantation following recanalization of a coronary occlusion may be beneficial on the restenosis and reocclusion rates and anginal symptoms. However, they should be confirmed by randomised study. It would also be important to analyse the impact of this procedure on the outcome of left ventricular function.

Aged↗
PubMed1998

Recanalization of chronic peripheral arterial occlusions by alternating intra-arterial rt-PA and PGE1.

BACKGROUND: Recanalization of femoral artery occlusions is difficult and different forms of intra-arterial lysis or mechanical procedures have been described. We investigated the effectiveness of a prolonged intra-arterial lysis with rt-pa in combination with PGE1 followed by angioplasty. PATIENTS AND METHODS: 43 patients (age 60.4 +/- 14.3 years) with peripheral arterial occlusions older than 3 months and longer than 10 cm were treated with intra-arterial rt-pa (3 mg in 3 h) followed by PGE1 (2.1 ml/h for 3 h, concentration: 20 micrograms/50 ml NaCl) in alternating order. Treatment times ranged from 1 to 7 days (2.9 +/- 1.6). Doses of 26.5 +/- 21.9 mg rt-PA and 20.4 +/- 16 micrograms PGE1 were used. If necessary, angioplasty was performed after a wire was passed through the lumen. RESULTS: Recanalization was achieved in 47 out of 85 arterial segments with reocclusion in 9 segments. The arterial perfusion deteriorated once due to peripheral embolism. Other adverse effects included one case of retroperitoneal and one case of intracrural bleeding and one aneurysma spurium. CONCLUSION: In chronic arterial occlusions which do not respond to conventional angioplasty and/or short term fibrinolysis recanalization may be achieved in about 50% by means of prolonged alternating application of rt-pa and PGE1.

Adult↗
PubMed1984

Delayed spontaneous recanalization of the vas deferens.

Eight patients were identified who had undergone successful vasectomy a mean of 4.6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy. Histological examination of the excised portions revealed the presence of spermatozoa in the distal end of one side; but also the presence of a well formed sperm granuloma in continuity with both divided ends of the vas. There does not appear to be any correlation with the suture previously used, nor incidence of infections or injury. Although recanalization is a recognized complication of vasectomy, the majority have occurred within months of the operation. The association of the delayed recanalization with sperm granuloma formation in these cases suggests an aetiological link, it being previously reported that such granuloma can develop up to six years postoperatively.

Adult↗
PubMed1983

The mechanism of spontaneous recanalization of human vasectomized ductus deferens.

The longitudinal and serial histologic sections of spontaneously recanalized ductus deferens and those of the contralateral ductus deferens displayed many tortuous epithelial tubules growing from the mucosal epithelium of distal stumps intruding into the fibrous scar tissue toward proximal stumps. One of the growing gland-like tubules might perform the spontaneous recanalization.

Humans↗