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PubMed2004

Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke.

BACKGROUND AND PURPOSE: Early reocclusion of recanalized arteries has been observed after thrombolysis for acute coronary occlusion and has been attributed to platelet activation after exposure to thrombolytic agents. We conducted a retrospective study to determine the rate of reocclusion during intra-arterial thrombolysis for acute ischemic stroke and the effect of reocclusion on functional outcome. METHODS: Patients treated for acute ischemic stroke at our center between September 2000 and May 2002 received a maximum total dose of 4 U of reteplase intra-arterially in 1-U increments via superselective catheterization. Pharmacologic thrombolysis was supplemented by mechanical thrombolysis with balloon angioplasty or snare manipulation at the occlusion site. Angiography was performed after each unit of reteplase or mechanical maneuver, and the images were interpreted by a blinded reviewer. Reocclusion was defined as partial or complete initial recanalization with occlusion recurring at the same site as documented by angiography during the endovascular treatment. Reocclusions were treated by further pharmacologic and/or mechanical thrombolysis according to the discretion of the treating physician. Clinical evaluations were performed before and 24 hr, 7 to 10 days, and 1 to 3 months after treatment. RESULTS: Forty-six consecutive patients underwent intra-arterial thrombolysis. Reocclusion was observed in eight (17%). Among these patients, initial sites of occlusion were in the following arteries: intracranial internal carotid artery (n = 2), M1 segment of the middle cerebral artery (n = 3), M1 and M2 segments of the middle cerebral artery (n = 2), and basilar artery (n = 1). The mean initial National Institutes of Health Scale score for these eight patients was 23.3 +/- 6.2; mean time from symptom onset to treatment was 4.4 +/- 1.2 hr. The reocclusions were treated by using additional doses of reteplase alone (n = 1), reteplase with snare maneuver and/or angioplasty (n = 5), reteplase with angioplasty or snare and then stent placement (n = 1), and angioplasty with stent placement (n = 1). The reocclusions resolved in six of eight patients after further treatment. Six patients died and two survived but were severely disabled at 1 month (modified Rankin Scale scores of 4 and 5, respectively). Independent functional outcome scores (modified Rankin Scale scores of 0-2) were significantly lower among patients with angiographically shown reocclusion than in those without (0 of 8 versus 17 of 38, P =.02). CONCLUSION: Reocclusion occurs relatively frequently during intra-arterial thrombolysis for ischemic stroke and seems to be associated with poor clinical outcomes.

Acute Disease↗
PubMed1992

G4120, an Arg-Gly-Asp containing pentapeptide, enhances arterial eversion graft recanalization with recombinant tissue-type plasminogen activator in dogs.

The effects of G4120, a cyclic Arg-Gly-Asp (RGD) containing peptide which inhibits fibrinogen binding to the platelet receptor GPIIb/IIIa, on thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) were investigated in a combined arterial and venous thrombosis model in heparinized dogs. The arterial thrombus model consisted of a 3 cm everted (inside-out) carotid arterial segment inserted into a transsected femoral artery which occludes within 30 min with platelet-rich material and which is resistant to recanalization with 0.5 mg/kg rt-PA. The venous thrombus was a 125I-fibrin labeled whole blood clot produced in the contralateral femoral vein. In 5 dogs given an intravenous bolus of 0.05 mg/kg G4120 followed by a continuous infusion of 0.05 mg/kg per hour for 3 h (group I), arterial occlusion persisted throughout a 4 h observation period and was still present at 24 h in all dogs; the extent of venous clot lysis after 120 min was 27 +/- 7%. In 5 dogs given the same infusion of G4120 in combination with 0.5 mg/kg rt-PA over 60 min, recanalization of the arterial graft occurred in all dogs, within 13 +/- 2 min and persisted throughout the observation period of 4 h (p = 0.01 versus G4120 or rt-PA alone); at 24 h, however, all grafts were occluded. Venous clot lysis in this group was 75 +/- 8% (p = 0.002 versus G4120 alone and p = NS versus rt-PA alone). Pathologic analysis revealed platelet-rich or mixed thrombus with platelet-rich and erythrocyte-rich zones.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed2004

Transcatheter embolization of recanalized coronary artery fistula with Nit-Occlud device.

Congenital coronary artery fistula is a rare anomaly with varying symptomatology that may be addressed with surgical or interventional closure. Recanalization after complete occlusion of a coronary artery fistula has only been reported after surgical but not after interventional closure. We present a case of coronary artery fistula recanalization after angiographically documented complete transcatheter occlusion with Gianturco coils. The fistula was successfully managed by transcatheter implantation of a Nit-Occlud system, originally designed for interventional closure of patent ductus arteriosus.

Arterio-Arterial Fistula↗
PubMed2004

Subintimal recanalization is safe and effective in treating chronic critical limb ischemia in selected patients.

Subintimal recanalization is a percutaneous technique that allows revascularization in patients with limb-threatening ischemia. It was first described by Bolia (Cardiovasc Intervent Radiol 13;357-63:1990) but has not gained widespread use in the United States. Twenty-five patients with 32 threatened limbs were referred from a single surgeon's practice over a 23-month period. All patients were either high-risk surgical patients, due to severe medical comorbidities, or not surgical candidates due to poor target vessels, lack of appropriate conduit, or failed previous surgical revascularizations. The average age of patients was 69. There were 15 men and 10 women treated. Subintimal recanalization was immediately successful in 30 limbs. One peri-procedural death occurred, although this patient underwent a surgical bypass graft procedure in the same hospitalization. Three significant complications occurred (myocardial infarction, ventricular arrhythmia, and gastrointestinal hemorrhage). Primary patency is 83 per cent. Secondary patency is 90 per cent. Limb salvage rate is 88 per cent. Mean follow-up period is 10 months. Eight patients died in the follow-up period due to unrelated causes.

Aged↗
PubMed2003

Chronic dialysis fistula thrombosis treatment by means of endovascular recanalization with surgical exclusion of developed collateral circulation.

Fistula thrombosis is the most common and dangerous complication resulting in vascular access insufficiency. The most "tricky" lesion of dialysis fistula is chronic thrombosis which occurs when only a short section of efferent vein becomes clotted and collateral circulation enabling further, limited in time functioning of dialysis fistula is created. In 7 chronic thrombosis patients subjected to treatment by means of endovascular recanalization, developed collateral vessels were surgically ligated to obtain single-canal blood flow. The recanalization procedure involved making a puncture, inserting a guide wire and performing balloon angioplasty. Simultaneously, 2 or 3 collateral veins were incised and ligated. The result obtained in all the 7 cases was considered successful as all fistulas remained a 100% patent 6 months after the procedure.

Angioplasty, Balloon↗
PubMed2004

Recanalization by mechanical embolus disruption during intra-arterial thrombolysis in the carotid territory.

BACKGROUND AND PURPOSE: Mechanical disruption of a clot with a microcatheter and a guidewire has not been detailed in conjunction with intra-arterial thrombolysis in patients with acute ischemic stroke. The purpose of this study was to evaluate the efficacy of mechanical disruption of an embolus in the carotid artery distribution. METHODS: We analyzed clinical and radiologic findings and functional outcomes 3 months after thrombolysis with mechanical disruption. Outcomes were classified as good for modified Rankin scale (mRS) scores of 0-2, moderate for mRS scores of 3, and poor for death and mRS scores of 4 or 5. RESULTS: Twenty-three consecutive patients with severe hemispheric symptoms were treated with several methods of mechanical embolus disruption during the intra-arterial administration of urokinase. Twelve patients had occlusions of the proximal middle cerebral artery (MCA), and 11 had occlusions of the distal internal carotid artery (ICA). Recanalization was observed in all patients with MCA occlusions and in 10 (91%) with ICA occlusions. Outcomes were good in nine patients (75%) with MCA occlusions and in four (36.4%) with ICA occlusions. Early management of vessel perforation, caused by a microguidewire tip in two patients, resulted in early hemostasis. Neither patient had a major deficit attributable to the complication. CONCLUSION: A high incidence of recanalization and clinical improvement can be observed in patients with occlusions of not only the proximal MCA but also the distal ICA. This method might be an effective additional option to intra-arterial thrombolysis for acute distal ICA and proximal MCA occlusions.

Aged↗
PubMed2005

Tissue at risk is overestimated in perfusion-weighted imaging: MR imaging in acute stroke patients without vessel recanalization.

BACKGROUND AND PURPOSE: The volume of decreased cerebral blood flow (CBF) in acute stroke perfusion-weighted imaging frequently overestimates final infarct volume. We hypothesized that surviving tissue exists even in patients without recanalization and tried to determine perfusion thresholds from initial MR imaging. METHODS: Stroke MR imaging including MR angiography was carried out at days 0, 1, and 7 after stroke onset in 19 patients without recanalization at least until day 1. The following lesions were defined: L0 = diffusion restriction at day 0; LG1 = lesion growth until day 1; LG7 = lesion growth until day 7; ST7 = initially hypoperfused, but surviving tissue. These lesions were transferred on initial MR imaging within 4.7 hours and perfusion values at day 0 were determined. RESULTS: Median lesion volume L0 at day 0 was 18.2 mL and increased to 39.4 and 43.8 mL at days 1 and 7. Volume of decreased rCBF not progressing to infarction was 148.5 mL (ST7). Mean ST7 perfusion values were different from L0 and LG1, but only mean relative cerebral blood volume (rCBV) was different from LG7, discriminating survival against death of tissue. A threshold value of 0.82 CBV for death versus survival was determined with a sensitivity of 0.56 and specificity of 0.95. Carotid T occlusions showed the greatest potential of lesion growth. CONCLUSION: Even when vessel occlusion persists, hypoperfused tissue on MR imaging does not necessarily progress toward infarction. The most conclusive inferences can be drawn from CBV images. The site of arterial occlusion also determines progression to infarction.

Adult↗
PubMed1992

[Proximal tubal recanalization by endoluminal laser probe. I. Anatomic results in the female rat].

To evaluate the cicatrization of the uterine horn after the recanalization by endoluminal laser probe, 50 white female rats of Wistar's race have been separated into two groups. The group 1 (nb = 10) had for aim to validated the procedure of obstruction. In group 2 (nb = 40), we performed the recanalization six weeks after the obstruction. Histologic samples were obtained 48 hours, 3 weeks and 6 weeks after treatment. In group 1, we found a complete obstruction in 70% of the cases, and a tight stenosis in 30% of the cases. In group 2, at 48 hour's control after the treatment by laser, we found a drill hole with a blackened look without parietal sequel in 80% of the cases. At 6 week's control, we found a normal lumen with a regeneration of the epithelioma in 85% of the cases. For energy deposition under 30 Joules, we found good results in 95% of the cases. Above 30 Joules, we always found bad results (5 cases on 5).

Animals↗
PubMed1992

[Proximal tubular recanalization by endoluminal laser. II. Functional results in the female rabbit].

To evaluate the function of the fallopian tube after a recanalization by endoluminal laser probe, 34 mature female New Zealand white rabbits have been separated into two groups. The group 1 (nb = 12) had for aim to validate the procedure of obstruction. In group 2 (nb = 22), we performed the recanalization six weeks after the obstruction. The female rabbits underwent a fertilization six weeks after the laser treatment. The results have been appreciated by the ratio nidation/ovulation. In group 1, we valided the procedure of obstruction. In group 2 twelve rabbits on thirteen have been fecundated in the treated tube.

Animals↗
PubMedDate not supplied

Endovascular recanalization of internal carotid artery occlusion in acute ischemic stroke.

BACKGROUND: Endovascular therapy (ET) of internal carotid artery (ICA) stenosis is equivalent to carotid endarterectomy for stroke prevention; however, patients with ICA occlusion and acute symptoms are traditionally not candidates for ET. We report our experience in endovascular recanalization of acute stroke patients with ICA occlusion. PATIENTS AND TECHNIQUES: We reviewed our registry for acute stroke patients treated with ET who had (1) ICA occlusion by digital subtraction angiography (thrombolysis in myocardial ischemia=0) with location of type II (above ophthalmic artery involving M1 or A1 but not both) or type III (proximal to the ophthalmic artery but distal to the bifurcation); (2) acute stroke symptoms from the index lesion presenting 3 hours after onset of symptoms; (3) minimal ischemic changes on brain CT scan (less than one third of the MCA territory); (4) attempted ET. Neuroradiologists reviewed angiograms for thrombolysis in cerebral infarction. A blinded vascular neurologist reviewed post-procedural brain imaging for Alberta Stroke Program Early CT (ASPECT) scoring. Outcome scales were assessed. RESULTS: We identified 14 patients, 10 of whom were men (mean age, 58 +/- 14 years; median age, 54 years; age range, 40-74 years). There were 8 left ICA occlusions, 3 type II; and 6 right ICA occlusions, one type II. Median baseline National Institutes of Health Stroke Scale score was 17 (range, 11-25; mean, 18 +/- 4.9). Mean time to ET was 389 +/- 103 minutes (median, 306 minutes; range, 197-1290 minutes). Immediate recanalization occurred in 64%. Decrease in expected stroke volume by brain imaging occurred in 50% with mean ASPECT score of 4 +/- 2.9 (median, 3; range, 0-8; 21% > or = 8). Two hemorrhages occurred, one symptomatic; 3 patients died. Good outcome was achieved in 64% of cases. CONCLUSION: Endovascular therapy of carotid occlusion in hyperacute stroke patients is feasible and may help to reduce stroke volume and increase good outcome in some patients.

Adult↗
PubMed2006

Intravascular ultrasound-guided recanalization of a coronary chronic total occlusion located in a stent implanted subintimally: a case report.

Successful percutaneous recanalization of coronary chronic total occlusion (CTO) results in improved survival, as well as enhanced left ventricular function, reduction of angina, and improved exercise tolerance. The procedural success rate has increased over time, but CTO recanalization does still fail in about 20% of cases. Different strategies and specific devices for CTOs have been developed with various degrees of success. We report the case of CTO after a first unsuccessful treatment attempt during which subintimal wire positioning without reentry into the distal lumen, and stent implantation were done. At the second revascularization, intravascular ultrasound guidance allowed reentry of the distal true lumen through the stent, restoring normal flow.

Angioplasty, Balloon, Coronary↗
PubMed1991

[The effects of delayed transluminal balloon coronary angioplasty in myocardial infarct patients with early thrombolytic recanalization of the coronary artery: the results of dynamic quantitative angiography].

As many as 71 patients with the developing large-focal myocardial infarction (MI) were entered into the study. The purpose was to examine the dynamics of the status of the coronary arteries and left ventricular function in MI patients with early recanalization of the infarct-related artery (IRA) as a result of thrombolytic therapy (TLT) and delayed transluminal coronary angioplasty (TCA). Coronary arteriography and left ventriculography were provided 3 times to all the patients: within the first 4 hours of the disease (in combination with TLT), on days 4-6 of the disease (in combination with TCA of the IRA), and after 6 months of observation. It is concluded that the combined use in MI patients of coronary thrombolysis within the first 4 hours of the disease and delayed TCA (on days 4-6 of the disease) ensure steady recovery of IRA patency, with an insignificant residual stenosis of the artery. At the same time the patients demonstrated improvement of local contractility of the deranged compartment of the left ventricle by the 6th month of observation. Restenosis of the recanalized IRA that occurs during 6 months of observation after the interventions performed does not affect the recovery of left ventricular function.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Recanalization of an iliac artery occlusion from the contralateral side using "low-speed rotational angioplasty"].

This paper demonstrates the applicability of "low-speed rotational angioplasty" in antegrade direction for recanalization of the common iliac artery. After recanalization, a 4-mm PTCA balloon was used to dilate in antegrade direction using a PTCA exchange wire. After 5 weeks the femoral artery could be punctured and a residual stenosis dilated in retrograde direction.

Angioplasty, Balloon↗
PubMed1991

[Evaluation of clinical criteria of coronary artery recanalization in acute myocardial infarction].

Clinical features of recanalization of infarct-related coronary artery during thrombolytic therapy or emergency PTCA and their correlation with immediate coronary angiography were analysed in 23 patients with acute myocardial infarction (AMI) to evaluate the predictive value of clinical criteria of reperfusion. The coronary angiography was performed before treatment and every 15 to 30 minutes during intravenous (rt-PA) or intracoronary (UK or SK) thrombolysis. Reperfusion was achieved in 16 cases by thrombolysis and in 4 cases by PTCA. The results revealed that in patients with reperfusion chest pain was relieved rapidly at least 70% in a period of 30 minutes, the ST segments fell by 50% or more from their elevated levels during a period of 30 minutes. Transient "paradoxical" increase of ST segment elevation followed by rapid falling was observed in 4 patients. This phenomenon was considered as a reliable marker of reperfusion. The changes in cardiac rhythm and conduction were noticed in 90% of the patients with reperfusion, among them accelerated idioventricular rhythm and disappearance of new-onset AVB and intraventricular conduction defects were useful bedside evidences of reperfusion, and transient significant sinus bradycardia or AVB with or without transient hypotension were useful markers of reperfusion in inferior myocardial infarction. When these clinical criteria were separately used as predictor of infarct-related coronary artery recanalization, the specificity was about 70% to 80%. Using the presence of all 3 criteria, the specificity and predictive value increased to 100% and the sensitivity was 70.6%. The time interval between onset of symptoms and peak CK and CK-MB were significantly shorter in patients with reperfusion than in those without persistent reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Recanalization of arterial occlusions by laser].

Recanalization of arterial occlusions by laser light application has attracted much interest in recent years. Extensive investigations have been carried out to evaluate the optimal delivery system, in order to minimalize the rate of perforation. Systems based upon conversion of laser energy to thermal energy has been tried out. The laser probe as well as the sapphire tip create a channel through the occlusion by thermal ablation. A guide wire is thereafter passed through the narrow channel in order to perform an ordinary balloon dilatation. Other lasers are currently being investigated. Both the lasers themselves and the required disposable equipment, are relatively expensive. Laser recanalization of arterial occlusions is still being investigated. The clinical benefit in the therapy of arterial disease remains to be seen.

Angioplasty, Laser↗
PubMed1991

[Fallopian tube recanalization with a catheter system--experience in the use of a balloon catheter].

Fallopian tube obstruction is one of the most difficult problems in the treatment of infertility. This report gives the results of a pilot study on the transcervical recanalization of the occlusive fallopian tube. Selective catheterization of the uterine cornu was applied through a balloon catheter, which was wedged at the internal uterine os. In 16 occlusive fallopian tubes of 11 cases, the catheterization procedure was attempted and accomplished with a 87.5% success rate. Recanalization was successful in 75.0% of the affected tubes. Subsequent pregnancy was confirmed in three cases. This convenient technique is safe and effective and it will be accepted as the first choice in the diagnosis and treatment of fallopian tube obstruction.

Adult↗
PubMed1991

[Radiologically-guided vascular prosthesis after laser recanalization of occlusive lesions of the blood vessels of the lower limbs].

The article deals with the first clinical experience in radiologically-guided prosthetics after laser recanalization of occluded vessels of the lower limbs in 20 patients. The method was introduced into clinical practice after applying separately the methods of radiologically-guided endovascular prosthetics and laser recanalization with subsequent dilatation and experimental substantiation on dogs with artificially created chronic occlusions of the femoral artery. The first results are promising, although the true place of the method in sparing treatment of vessels will be ascertained after rich clinical experience is accumulated and the late-term results studied.

Adult↗
PubMed1990

[Femoropopliteal laser recanalization--a multicenter study].

Laser-assisted angioplasty was performed in four different hospital centers, following the same treatment protocol and using an Nd-YAG laser with a sapphire-probe catheter. The initial recanalization rate of 259 femoro-popliteal occlusions with a mean length of 7.5 cm was 84%. Dissections or perforations were observed in 10%. An emergency surgical intervention was required in 1.1%. The long-term patency rate of the successfully recanalized arteries was 74% after 2 years. The cumulative cure rate of all 259 patients was 62%.

Adult↗