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At least 1,171 records · Page 65Linked to original sources
PubMed1995

[A case of recanalized basilar artery following basilar artery occlusion due to spontaneous dissection].

An 85-year-old man who did not have any previous history of heart disease was admitted to our hospital with the chief complaints of disturbance of consciousness, tetraparesis, and bilateral Babinski signs. On admission, intravenous digital subtraction angiography (DSA) showed bilatral vertebral arteries without filling the basilar artery. On the second hospital day, MRI showed a septum in the basilar artery, and no infarctions were noted in the brain stem. He gradually improved with heparin therapy. On the tenth hospital day, intravenous DSA disclosed filling of the basilar artery. On the sixteenth hospital day, conventional cerebral angiography revealed filling of the basilar artery from the left vertebral artery, and string sign and linear shadow (intimal flap) was noted in the basilar artery. He was diagnosed to have the basilar artery dissection. The patient became ambulatory and was discharged independently. This is very rare case of the basilar artery dissection with a good prognosis.

Aged↗
PubMedDate not supplied

Ankle-arm index, angiography, and duplex ultrasonography after recanalization of occlusions in femoropopliteal arteries: comparison of long-term results.

PURPOSE: Comparison of the relative values of the ankle-arm index (AAI) at rest and after exercise, angiography, and duplex ultrasonography for the follow-up of percutaneous transluminal angioplasty (PTA) in patients with peripheral vascular disease. METHODS: Thirty-two patients were prospectively followed after technically and clinically successful PTA of a femoropopliteal occlusion. The patency of the femoropopliteal artery was assessed for 1 year using AAI measurements at rest and after exercise; duplex ultrasonography at 4, 12, 24, 36, and 52 weeks; and angiography at 3 and 12 months after PTA. RESULTS: Patency was highly dependent on the measurement technique. The cumulative patency after 1 year determined with the AAI at rest and during exercise, by angiography, and by duplex ultrasonography was 74%, 19%, 31%, and 32%, respectively. Seventy-five percent of the restenoses occurred at the site of the treated occlusion. CONCLUSION: Duplex ultrasonography is most suitable for this assessment, as it causes no patient discomfort and the specificity is better than AAI after exercise because vascular disease in other, proximal segments does not interfere with the results.

Aged↗
PubMed1996

[Percutaneous intentional extraluminal recanalization of the femoropopliteal artery. Initial experiences and results].

Between July 1994 and April 1995, 14 patients with a chronic occlusion of the femoropopliteal artery were treated by percutaneous intentional extraluminal recanalisation (PIER). It concerned 11 males and 3 females with a mean age of 65 years (50-76 years). Twelve patients were smokers, two patients had diabetes mellitus. Ten patients had severe claudication, four patients suffered from rest pain, three of the latter had ulcerations. In all patients, recanalisation and balloon dilatation could be established. However, angiographic result was unsatisfactory in one case. There were no complications. Clinical follow-up varied from 2 weeks to 9 months. Two patients needed a surgical femoropopliteal bypass respectively 4 and 7 months after recanalisation because of claudication recurrence. A third patient had two percutaneous redilatations of a restenosis. The remaining 11 patients became free of complaints. PIER seems to be a feasible treatment for patients with chronic femoropopliteal occlusions with a very good technical success, low complication rate and promising initial clinical outcome. Follow-up studies have to prove its superiority over the established revascularisation techniques.

Aged↗
PubMed1996

[Management of iatrogenic hemorrhage after mechanical vascular recanalization].

Nine patients with hemorrhage due to revascularization procedures underwent successful embolization (5), surgery (2), covered stent implantation (1), or long-lasting ballon dilatation (1). Bleeding was the result of Fogarty thrombectomy (3), ring stripper revascularization (1), balloon dilatation (3), or perforation of the artery with the guide wire (1). In all cases, bleeding was stopped successfully without sequelae for the patients. In spite of the preceeding hemorrhage, local fibrinolysis with 1,000,000 units of urokinase was performed on the same day in 3 patients without any complications being observed.

Adult↗
PubMed1997

[Large arterial thrombosis. Rapid recanalization with a new thrombocyte inhibitor].

A 56-year-old male cigarette smoker, without other risk factors for arterial disease and no history of heart disease or thrombotic events, was admitted as an emergency case because of chest pain shortly after a fall. He had a right coronary artery occlusion, which was managed with angioplasty and stenting. A large thrombotic occlusion in the distal aorta probably occurred simultaneously with the coronary occlusion, became symptomatically manifest and was diagnosed when the chest pain subsided after stenting. This thrombus was successfully treated with the new platelet inhibitor abciximab.

Abciximab↗
PubMedDate not supplied

Metallic stents for low invasive recanalization of the portal veins with cancerous invasion--first case report.

BACKGROUND/AIMS: Portal venous stenosis caused by cancer invasion has been difficult to treat and patients do not have any treatment options. On the other hand, protal venous stents have been applied to patients with variceal haemorrhaging associated with portal vein thrombosis. However, there have not been any reports concerning portal venous stents for malignant portal stenosis. The aim of this report was to apply metallic stent for malignant portal stenosis to reduce portal hypertension and restore portal venous blood flow, which in turn leads to the recovery of liver function. METHODOLOGY: Two patients with portal hypertension caused by malignant portal stenosis were treated by metallic stent implantation. In one case, the stent was applied intraoperatively via the ileal vein and in the other case, it was applied postoperatively via transhepatic portal cannulation. RESULTS: In the first case, portal pressure monitored before and after placement of the stent was 350 mmH2O and 200 mmH2O, respectively. Liver function tests showed normalization after stent placement. In the second case, over 3000 ml of ascites, which were drained through the drainage catheter every day, could be reduced remarkably, and one week later, the catheter could be withdrawn. Portal pressure before and after embedding the stent was 410 and 275 mmH2O, respectively. Both patients were discharged from the hospital and their recovery was uneventfully. CONCLUSION: Both cases had an uneventful postoperative course, with normalization of liver function and cessation of ascites on the next postoperative day in case 2. Thus, portal venous stent should be considered a viable option for the treatment of malignant portal stenosis.

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PubMed1998

Percutaneous recanalization of iliac artery occlusions with the Strecker stent.

Within a 3-year period a total of 16 iliac artery occlusions in 16 patients were treated with percutaneous angioplasty and stenting with the Strecker stent without adjunctive thrombolytic therapy. The length of the occlusions varied from 0.5 to 8 cm (mean 4.1 cm). The average stent diameter was 7.6 mm and the average length was 6.1 cm. Reocclusion occurred in 3 patients (two after one month and one after 11 months). One case of dissection and two cases of distal embolization to the external iliac artery were diagnosed during the procedure by an angiogram and were successfully treated by stenting. Two cases of small groin hematoma were treated conservatively.

Acute Disease↗
PubMed2001

Speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy: sonographic classification and short-term improvement.

BACKGROUND: Arterial recanalization precedes clinical improvement or may lead to hemorrhage or reperfusion injury. Speed of clot lysis was not previously measured in human stroke. METHODS AND RESULTS: Transcranial Doppler (TCD) and the National Institutes of Health Stroke Scale (NIHSS) were used to monitor consecutive patients receiving intravenous tissue plasminogen activator (tPA), before tPA bolus and at 24 hours. Patients with complete or partial recanalization of the middle cerebral or basilar artery on TCD were studied. Recanalization was classified a priori as sudden (abrupt appearance of a normal or stenotic low-resistance signal), stepwise (flow improvement over 1 to 29 minutes), or slow (>/=30 minutes). Recanalization was documented in 43 tPA-treated patients (age 68+/-17 years; NIHSS score 16.8+/-6, median 15 points). tPA bolus was given at a mean of 135+/-61 minutes after symptom onset. Recanalization began at a median of 17 minutes and was completed at 35 minutes after tPA bolus, with mean duration of recanalization of 23+/-16 minutes. Recanalization was sudden in 5, stepwise in 23, and slow in 15 patients. Faster recanalization predicted better short-term improvement (P=0.03). At 24 hours, 80%, 30%, and 13% of patients in these respective recanalization groups had NIHSS scores of 0 to 3. Symptomatic hemorrhage occurred in only 1 patient, who had stepwise recanalization 5.5 hours after stroke onset. Slow or partial recanalization with dampened flow signal was found in 53% of patients with total NIHSS scores >10 points at 24 hours (P=0.01). Complete recanalization (n=25) occurred faster (median 10 minutes) than partial recanalization (n=18; median 30 minutes; P=0.0001). CONCLUSIONS: Rapid arterial recanalization is associated with better short-term improvement, mostly likely because of faster and more complete clot breakup with low resistance of the distal circulatory bed. Slow (>/=30 minutes) flow improvement and dampened flow signal are less favorable prognostic signs. These findings may be evaluated to assist with selection of patients for additional pharmacological or interventional treatment.

Aged↗
PubMed2002

Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator.

BACKGROUND: Arterial reocclusion has not been systematically studied despite the fact that 13% of patients in the National Institute of Neurological Diseases and Stroke rt-PA Trial deteriorated following initial improvement, suggesting that reocclusion might be responsible for poor clinical outcome in some of these patients. METHODS: Consecutive stroke patients treated with IV tissue plasminogen activator (TPA) within 3 hours and an M1 or M2 middle cerebral artery (MCA) occlusion on pre-TPA transcranial Doppler (TCD) were monitored up to 2 hours after TPA bolus. Reocclusion was defined as the Thrombolysis in Brain Ischemia flow decrease by >/=1 grades and no hemorrhage on repeat CT. The NIH Stroke Scale (NIHSS) and modified Rankin Scores (mRS) were obtained by a neurologist independently of TCD. RESULTS: Sixty patients with median prebolus NIHSS score of 16 (range 6 to 28, 90% with >/=10 points) had TPA bolus at 130 +/- 32 minutes (median 120 minutes, 58% within the first 2 hours). Recanalization was complete in 18 (30%), partial in 29 (48%), and none in 13 (22%) patients. Reocclusion occurred in 34% of patients with any initial recanalization (16/47): in 4 of 16 patients with complete recanalization (22%), and in 12 of 29 patients with partial recanalization (41%). Reocclusion was detected in four patients (25%) before TPA bolus, in three (19%) by 30 minutes after bolus, in three (19%) by the end of infusion, and in six (37%) by 60 to 120 minutes. Before reocclusion, those patients had earlier median timing of recanalization: 130 versus 180 minutes after stroke onset compared with those who recanalized without reocclusion (p = 0.01). Median prebolus NIHSS score in the reocclusion group was 13.5 versus 17 (rest, NS), whereas at 2 and 24 hours, their NIHSS scores were higher: 14 versus 9 and 16 versus 6 points (p </= 0.04). Deterioration followed by improvement by >/=4 NIHSS points occurred in 8 of 16 (50%) patients with reocclusion versus 10% (rest) (p < 0.05). In-hospital mortality was 25 versus 3% (p < 0.0001). At 3 months, good outcome (mRS score of 0 to 1) was achieved by 8% of patients with no recanalization, by 33% of patients with reocclusion, and by 50% of patients with stable recanalization (p </= 0.05), and mortality was 42% with no early recanalization, 33% after reocclusion, and 8% in patients with stable recanalization (p </= 0.05). CONCLUSIONS: Early reocclusion occurs in 34% of TPA-treated patients with any initial recanalization, accounting for two-thirds of deteriorations following improvement. Reocclusion occurs more often in patients with earlier and partial recanalization, leading to neurologic deterioration and higher in-hospital mortality. However, patients with reocclusion have better long-term outcomes than patients without any early recanalization.

Adult↗