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PubMed1988

Clinical and angiographic follow-up after coronary recanalization during acute myocardial infarction.

Coronary angiography followed by percutaneous transluminal coronary angioplasty and/or intracoronary streptokinase infusion was performed in 50 patients 288 +/- 162 min after the onset of symptoms of acute myocardial infarction. Subocclusion of the infarct-related vessel was found in 5 patients, all of whom had angioplasty of the residual stenosis. Recanalization was achieved in 37 patients (success rate 82%). There was no procedure-related death. One patient died 4 days after the intervention. Control coronary angiography 5 +/- 2 months after the procedure in 35 of 42 patients with recanalization documented recurrence of stenosis or reocclusion in 8 (23%). Comparison of preintervention and control angiograms in 33 patients showed an increase in left ventricular ejection fraction from 55 +/- 8 to 61 +/- 13%, p less than 0.001, in patients with collaterals to the infarct-related vessel and/or recanalization within 180 min after the onset of pain, and from 55 +/- 9 to 59 +/- 8%, nonsignificant, in patients with recanalization later than 180 min and without collaterals. At follow-up 7 +/- 4 months after the procedure, 1 patient had died and 36 (86%) were asymptomatic. Good long-term results can be achieved at a reasonable risk by coronary angioplasty with or without thrombolysis in evolving myocardial infarction. Left ventricular function is better preserved in patients with collaterals and/or early recanalization.

Angiography↗
PubMed2003

Spontaneous recanalization of internal carotid artery occlusion.

BACKGROUND AND PURPOSE: Spontaneous recanalization of an acutely occluded internal carotid artery (ICA) is an important phenomenon, the natural history and incidence of which have been incompletely studied. Although conventional catheter arteriography remains the gold standard for distinguishing total arterial occlusion from hairline residual lumen, CT angiography (CTA) is able to make this distinction noninvasively and more sensitively than either unenhanced MR angiography or ultrasound. The purpose of this report is to raise awareness of spontaneous recanalization and to demonstrate the possible use of CTA in following up cases of ICA occlusion. METHODS: We describe here 2 cases of acute cervical ICA occlusion seen on CTAs done at our institution. RESULTS: Follow-up CTAs in both cases showed spontaneous recanalization of the ICA requiring ipsilateral carotid endarterectomy within 1 month of the initial presentation. CONCLUSIONS: CTA, an accurate, rapid, and less invasive modality than conventional catheter arteriography, can be used to serially monitor anticoagulated patients with new-onset ICA occlusion for potential spontaneous vascular recanalization. The ability to conveniently assess ICA patency not only may influence management of individual patients but also could help us better establish the true incidence of spontaneous carotid recanalization in future studies.

Aged↗
PubMed2003

Beta radiation and inhibition of recanalization after coil embolization of canine arteries and experimental aneurysms: how should radiation be delivered?

BACKGROUND AND PURPOSE: Beta radiation prevents recanalization after coil embolization. We sought to determine the effects of varying coil caliber, length, activity of 32P per centimeter of coil or per volume, and spatial distribution of coils on recanalization. METHODS: We studied the angiographic evolution of 81 canine maxillary, cervical, and vertebral arteries implanted with a variety of nonradioactive (n=29 arteries) or radioactive (n=52) devices. We compared 1- or 2-caliber 0.015 or 0.010 coils ion-implanted or not with 3 different activity levels (0.05 to 0.08, 0.06 to 0.12, 0.18 to 0.32 microCi/cm) of 32P and totaling 4, 8, and 16 cm in length for the same arterial volume. We also compared inhibition of recanalization by beta radiation delivered by stents, after coil occlusion proximal to or within the stent, with that delivered by coils placed within nonradioactive stents. We finally studied the angiographic evolution of canine lateral wall carotid aneurysms treated with 1 or 2 stents of various activity levels positioned inside the parent artery across the neck. Animals were killed at 4 and 12 weeks for macroscopic photography and pathological examination. RESULTS: All arteries (29 of 29) occluded with nonradioactive devices were recanalized, while 49 of 52 arteries (94%) implanted with 32P devices were occluded at 4 weeks. All aneurysms treated with stents, radioactive or not, demonstrated residual filling of the sac or of channels leading to the aneurysms at follow-up angiography at 4 weeks. CONCLUSIONS: The recanalization process found in the canine arterial occlusion model is minimally affected by coil caliber, number, and length or packing density. Beta radiation reliably inhibits this process, but thrombosis is an essential condition for the efficacy of a radioactive coil strategy.

Aneurysm↗
PubMed2003

Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator.

BACKGROUND AND PURPOSE: Although early recanalization is a powerful predictor of stroke outcome after thrombolysis, some stroke patients remain disabled despite tissue plasminogen activator (tPA)-induced recanalization. Therefore, we sought to investigate whether the predictive accuracy of early recanalization on stroke outcome is improved when combined with clinical and radiological information. METHODS: We evaluated 177 patients with nonlacunar strokes in the middle cerebral artery (MCA) treated with intravenous tPA who were followed up during 3 months. Transcranial Doppler monitoring of recanalization was conducted during the first hours after tPA administration. The relative contribution of clinical, transcranial Doppler, and radiological information on stroke outcome was evaluated. We used logistic regression to derive a predictive model for good outcome (modified Rankin Scale score < or =2) after thrombolysis. RESULTS: Median National Institutes of Health Stroke Scale (NIHSS) score before tPA was 16. At 3 months, 87 patients (49.2%) became functionally independent (modified Rankin Scale score < or =2). In a logistic regression model, degree of recanalization within 300 minutes (P<0.001), proximal MCA occlusion (P<0.001), baseline NIHSS score (P=0.0013), systolic blood pressure (P=0.0116), and early ischemic changes on CT (P=0.0253) independently predicted outcome at 3 months. A 5-item score was developed on the basis of the factors significantly associated with stroke outcome in the logistic regression (total score range, 0 to 7). The likelihood of good outcome at 3 months was 0.82 (95% CI, 0.72 to 0.92) in patients who scored 0 to 2, 0.51 (95% CI, 0.36 to 0.66) in those who scored 3 to 4, and 0.15 (95% CI, 0.05 to 0.25) in those who scored 5 to 7 points. CONCLUSIONS: The combination of clinical, radiological, and hemodynamic information predicts with a high accuracy long-term stroke outcome during or shortly after intravenous tPA administration.

Academic Medical Centers↗
PubMed2004

Mechanical thrombolysis in acute ischemic stroke with endovascular photoacoustic recanalization.

BACKGROUND AND PURPOSE: We present the results of endovascular photoacoustic recanalization (EPAR) treatment for acute ischemic stroke from the Safety and Performance Study at 6 centers in Europe and North America. The objectives of mechanical thrombolysis are rapid vessel recanalization and minimal use of chemical thrombolysis. METHODS: This study was a prospective, nonrandomized study. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score were recorded before treatment. The presence of recanalization was assessed by angiography. To measure outcome, follow-up examinations were performed at 24 hours, 7 days, and 30 days after stroke onset. RESULTS: Thirty-four patients (median NIHSS 19) were enrolled. Ten patients had internal carotid artery occlusion, 12 patients had middle cerebral artery occlusion, 11 patients had vertebrobasilar occlusion, and 1 patient had posterior cerebral artery occlusion. The overall recanalization rate was 41.1% (14/34). Complete EPAR treatment was possible in 18 patients (median NIHSS 18), with vessel recanalization in 11 patients (61.1%) after EPAR. The average lasing time was 9.65 minutes. Incomplete EPAR treatment (16/34, median NIHSS 19) was defined as intention to treat with EPAR and that the EPAR microcatheter entered the patient. Additional treatment with intraarterial application of rTPA occurred in 13 patients. An adverse event associated with use of the device occurred in 1 patient. Symptomatic hemorrhages occurred in 2 patients (5.9%). The mortality rate was 38.2%. CONCLUSIONS: This study demonstrates the safety and technical feasibility of EPAR. This new technique may provide another treatment option in the therapeutic armamentarium for patients with acute ischemic stroke.

Adult↗
PubMed2006

Safety and effectiveness of radioactive coil embolization of aneurysms: effects of radiation on recanalization, clot organization, neointima formation, and surrounding nerves in experimental models.

BACKGROUND AND PURPOSE: Recanalization after coil embolization can be prevented by radiation emitted from 32P coils. We wanted to determine the upper limits of 32P activities that could be implanted onto coils with respect to the potential injury to nearby nerves, delay in organization of the clot, and effects on neointima formation and recanalization. METHODS: We studied the effects of various 32P activities on recanalization and organization of thrombus after coil occlusion of canine arteries and on neointima formation at the neck of canine carotid bifurcation aneurysms. We also tested potential injury to nerves in the vicinity of radioactive or nonradioactive coils in 3 models: the brachial plexus (near proximal vertebral arteries) and the lingual nerve in a lingual artery bifurcation aneurysm model, both models being treated by radioactive or standard coil occlusion. Finally, we wrapped lingual nerves with nonradioactive or high-activity coils and studied their effects on lingual nerves and tongues. Results were assessed with a pathological scoring system and compared with Mann-Whitney and Kruskal-Wallis tests. RESULTS: No deleterious effect of radiation on nerves could be detected. Neointima formation was not hampered, scores of aneurysms treated with 32P-coils being significantly better when compared with treatments with standard coils (P=0.002). Arteries treated with high-activity coils (>3.39 microCi) showed absent recanalization but delayed organization of the clot at 3 months compared with low-activity or nonradioactive coils (P<0.05). CONCLUSIONS: beta-Radiation can prevent recanalization after coil occlusion. We could not demonstrate any deleterious effects of radioactivity on nervous structure or on neointima formation. Delayed organization of thrombus provides a rational basis to establish an upper limit for 32P activities to be implanted onto coils.

Animals↗
PubMed2000

Transcranial doppler ultrasound criteria for recanalization after thrombolysis for middle cerebral artery stroke.

BACKGROUND AND PURPOSE: Transcranial Doppler (TCD) can demonstrate arterial occlusion and subsequent recanalization in acute ischemic stroke patients treated with intravenous tissue plasminogen activator (tPA). Limited data exist to assess the accuracy of recanalization by TCD criteria. METHODS: In patients with acute middle cerebral artery (MCA) occlusion treated with intravenous tPA, we compared posttreatment TCD with angiography (digital subtraction or magnetic resonance). On TCD, complete occlusion was defined by absent or minimal signals, partial occlusion by blunted or dampened signals, and recanalization by normal or stenotic signals. Angiography was evaluated with the Thrombolysis In Myocardial Ischemia (TIMI) grading scale. RESULTS: Twenty-five patients were studied (age 61+/-18 years, 16 men and 9 women). TCD was performed at 12+/-16 hours and angiography at 41+/-57 hours after stroke onset, with 52% of studies performed within 3 hours of each other. Recanalization on TCD had the following accuracy parameters compared with angiography: sensitivity 91%, specificity 93%, positive predictive value (PPV) 91%, and negative predictive value (NPV) 93%. To predict partial occlusion (TIMI grade II), TCD had sensitivity of 100%, specificity of 76%, PPV of 44%, and NPV of 100%. TCD predicted the presence of complete occlusion on angiography (TIMI grade 0 or I) with sensitivity of 50%, specificity of 100%, PPV of 100%, and NPV of 75%. TCD flow signals correlated with angiographic patency (chi(2)=24.2, P<0.001). CONCLUSIONS: Complete MCA recanalization on TCD accurately predicts angiographic findings. Although a return to normal flow dynamics on TCD was associated with complete angiographic resumption of flow, partial signal improvement on TCD corresponded with persistent occlusion on angiography.

Adult↗
PubMedDate not supplied

Relationship between ophthalmic artery blood flow and recanalization of occluded carotid artery. Ultrasonic Doppler study.

Ophthalmic artery blood flow in 5 patients with internal carotid artery occlusion of sudden onset was monitored by an ultrasonic Doppler flowmeter to investigate the possible relationship to spontaneous recanalization of the occluded artery. The occluded internal carotid arteries of 2 patients were confirmed angiographically to recanalize and the reversed flow of their ophthalmic arteries changed to physiological flow after the recanalization. The ophthalmic artery blood flow remained reversed in 2 patients whose occluded internal carotid arteries did not recanalize on the follow up angiograms. In the other patient, whose ophthalmic artery blood flow was not detected by the ultrasonic Doppler flowmeter in the acute stage, physiological flow through the ophthalmic artery was detected later. The occluded internal carotid artery did not recanalize and this physiological ophthalmic artery blood flow was filled through the circle of Willis.

Acute Disease↗
PubMed2002

Diameter of occluded superficial femoral arteries limits percutaneous recanalization: preliminary results.

PURPOSE: To explore if the diameter of an occluded superficial femoral artery (SFA) can predict the technical success of percutaneous recanalization. METHODS: Two hundred patients (151 men; mean age 57 +/- 16 years) suffering from peripheral arterial occlusive disease were evaluated with duplex ultrasonography to measure arterial diameters and percent diameter reduction. Seventy-nine (39.5%) patients had segmental or complete SFA occlusions that ranged in age from 2 to 26 months (median 11). The majority of occlusions (45, 57.0%) were < or =10 cm long (range 10-35). Percutaneous recanalization was performed in 71 patients using either conventional angioplasty or local low-dose thrombolysis with rtPA. RESULTS: Diameters of 79 unilaterally occluded SFAs at the level of occlusion were 4.5 +/- 1.4 mm versus 5.7 +/- 1.3 mm for the patent contralateral artery (p=0.055). None of the 121 patent SFAs had diameters < or =3.5 mm, but 12 (15%) of the 79 occluded SFAs did, and none of these could be recanalized. The sensitivity of the 3.5-mm cut point to predict recanalization failure was 44% (specificity 100%). CONCLUSIONS; Our data suggest that occluded SFAs with a diameter reduction to < or =3.5 mm are not suitable for percutaneous recanalization, as the original arterial lumen cannot be reconstructed.

Angioplasty, Balloon↗
PubMed2005

Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA.

OBJECTIVE: To determine whether pretreatment markers of coagulation and fibrinolysis are related to recanalization and functional outcome. METHODS: The authors included patients treated with IV rt-PA with occlusion on baseline transcranial Doppler (Thrombolysis in Brain Ischemia [TIBI] criteria) in whom recanalization within 6 hours was monitored. At baseline, the authors recorded data about demographics, vascular risk factors, the NIH Stroke Scale (NIHSS) score, early CT signs, etiology, blood glucose, and time to rt-PA. The authors also measured plasmatic markers of coagulation (fibrinogen, prothrombin fragments 1 + 2, Factor XIII, Factor VII) and fibrinolysis (alpha2-antiplasmin, Plasminogen Activator Inhibitor, Functional Thrombin Activatable Fibrinolysis Inhibitor [fTAFI]). A favorable outcome was defined as a modified Rankin score < 2 at 3 months. RESULTS: The authors studied 63 patients with a mean age of 67.3 +/- 12.5 years. The median NIHSS score was 16. Patients who recanalized had lower concentrations of alpha2-antiplasmin (87.5 +/- 18% vs 96.5 +/- 12.5%, p = 0.023) and fTAFI (91.7 +/- 26.7% vs 104.4 +/- 21%, p = 0.039). A multivariant logistic regression analysis showed that the level of alpha2-antiplasmin was the only predictive variable of recanalization (OR 0.95, 95% CI 0.91, 0.99, p = 0.038), while the NIHSS score was the only predictive variable of functional outcome (OR 0.81, 95% CI 0.72, 0.92, p = 0.001). CONCLUSION: Baseline levels of alpha2-antiplasmin were predictive of recanalization but were not related to the long-term outcome in patients treated with rt-PA within the first 3 hours.

Aged↗
PubMed1999

[Therapeutic ultrasound for the recanalization of peripheral vascular occlusions].

Since the development of percutaneous transluminal angioplasty several techniques such as laser or atherectomy devices have been developed for recanalization of peripheral arterial occlusions. In a first clinical study we investigated if also the application of intravascular ultrasound can be useful for recanalization of occluded peripheral arteries. We applied an ultrasound angioplasty device (ACOLYSIS, ANGIOSONICS, USA) in a percutaneous approach in 8 patients with peripheral arterial occlusions (7 femoro-popliteal segments, 1 external iliac artery-occlusion). All patients suffered from severe leg ischemia due to subacute thrombotic occlusions. The ultrasound transmitter was introduced and advanced under fluoroscopic guidance to the site of the lesion. After activation the ultrasound transmitter was slowly advanced into the occlusion easily creating a channel within the occlusive material. Depending on the length of the occlusion (5-16 cm) treatment times ranged from 120-480 s. To further reduce the mass of the occlusive material an aspiration thrombectomy was performed in all cases leading to a complete recanalization in 6 cases. In 2 cases a remaining stenosis was successfully dilated. Intra-vascular ultrasonic devices can be useful for recanalization of occluded peripheral arteries. With the use of high-energy ultrasound a selective injury of the occlusive material can be induced without damaging the surrounding arterial wall. This selectivity is based on the differences in elasticity between the atherosclerotic plaque and the media layers. Especially if thrombolytic therapy of longer peripheral arterial occlusions fails or is contraindicated ultrasound angioplasty may be a new approach for recanalization.

Aged↗
PubMed2002

[Impact of the effectiveness of myocardial reperfusion after thrombolytic and spontaneous recanalization of infarct related artery on myocardial recovery in the future].

OBJECTIVE: To assess the efficiency of myocardial reperfusion after thrombolytic and spontaneous recanalization of infarct related artery (IRA) by the serial 12 lead ECG data and its impact on subsequent myocardial recovery. MATERIAL AND METHODS: We examined 25 patients with a first Q wave myocardial infarction at hospital and after 1 and 3 years from discharge (13 treated with intravenous thrombolysis, 12 treated conservatively). Four patients treated using thrombolysis and 3 patients treated conservatively were excluded from the analysis due to reocclusion or another myocardial infarction and coronary bypass surgery. The efficiency of myocardial reperfusion was assessed by our original method, based on the intensity of changes in ECG stages. The myocardial recovery was analyzed by quantitative changes in clinical, radiographic, echocardiographic and ECG (the Selvester-Wagner QRS score) data. RESULTS: Clinical and radiographic signs of heart failure decreased in cases of sufficient myocardial reperfusion after thrombolytic and spontaneous recanalization, but increased--in cases of insufficient myocardial reperfusion. Echocardiographic dyssynergic score decreased after 3 years from discharge (79, 67 after 1 and 3 yrs/at discharge (%), respectively, p < 0.00005) in cases of thrombolysis with sufficient myocardial reperfusion but the tendency for increasing (113, 183 after 1 and 3 yrs/at discharge (%), respectively, p = 0.07) was shown in cases of insufficient myocardial reperfusion; although, the QRS score decreased in both subgroups of thrombolysis (89, 36 after 1 and 3 yrs/at discharge (%), respectively, p < 0.01,--with sufficient myocardial reperfusion; 73, 62 after 1 and 3 yrs/at discharge (%), respectively, p < 0.005,--with insufficient myocardial reperfusion). CONCLUSIONS: The QRS score normalization after myocardial infarction predicts myocardial functional recovery only in patients with sufficient myocardial reperfusion. Thrombolysis gives positive impact on subsequent myocardial functional recovery only in cases of sufficient myocardial reperfusion; spontaneous recanalization of IRA may give positive impact on myocardial functional recovery in cases of sufficient myocardial reperfusion. Our method of serial ECG interpretation provides the possibility to detect insufficient myocardial reperfusion after thrombolytic and spontaneous recanalization and then the additional mechanical methods of recanalization should be applied.

Adult↗
PubMed2004

[Analysis of 1006 cases with selective salpingography and fallopian tube recanalization].

OBJECTIVE: To retrospectively analysis of selective salpingography (SSG) and fallopian tube recanalization (FTR) in 1006 infertile women with tube obstruction, to summarize their clinical effect and practical value, to analyze the related factors which can improve treatment effect and pregnancy rate, and give suggestions of their indication and contraindication. METHODS: SSG and FTR using self-made coaxial catheter were carried out in 1006 infertile cases with tube obstruction of various portions and extents confirmed by hysterosalpingography (HSG). The one-year cumulative pregnancy rate and the effective rate by HSG reexamination were calculated, in combination with dynamic observation of preoperative HSG and intraoperative tube imaging. RESULTS: In the complete tubal occlusion group of 601 tubes in 315 cases, the recanalization rate was 87.9% (528/601), among which, 35.4% was only treated by SSG and 64.6% by FTR. Postoperative pregnancy rate and ectopic pregnancy rate were 39.9% and 2.7% respectively, and tubal reocclusion was 1.8% in one-year's follow up. In those failure to recanalization, tubal tuberculosis was in 4 cases, salpingitis isthmica nodosum was in 3 cases, isthmic occlusion was in 9 cases with club-changed terminal, ampullar or fimbrial occlusion was in 6 cases, and tubal fibrosis in 10 cases. In the incomplete tubal occlusion group of 1314 tubes in 691 cases, catheterized hydrotubation was carried out. Fimbrial adhesion diagnosed by HSG was found false positive or negative in 65 cases. The pregnancy rate was 53.6%, 45.7% and 26.8% in the mildly, moderately and severely occluded cases respectively. The ectopic pregnancy rate was 1.4%. The patent rate confirmed by HSG reexamination was 86.9% one year later. Sixteen cases with obvious fimbrial adhesion or enwrapped adnexa in both groups were treated by laparoscopy, with a coincidence rate of 97.1%. CONCLUSIONS: Selective salpingography and fallopian tube recanalization have both effects of diagnosis and treatment on tubal infertility. The techniques are simple, safe, and credible, and worth to be applied clinically. Knowing the shapes of fallopian tube confirmed by preoperative HSG can increase the rates of recanalization.

Adult↗
PubMed2005

[Effectiveness of external mechanical recanalization in the treatment of cardiogenic shock in patients with myocardial infarction].

Attempts of mechanical coronary artery recanalization (angioplasty) were undertaken in 52 patients with acute myocardial infarction and cardiogenic shock. In 28 patients (53.9%) recanalization was successful while in 24 it was not (in-hospital mortality 39.3 and 87.5%, respectively, p<0.001). Overall 11 and 21 patients died among those with (n=28) and without (n=24) successful recanalization, respectively. Among patients with successful recanalization survivors compared with nonsurvivors had shorter time from onset of myocardial infarction to recanalization (11.44+/-2.86 vs 16.8+/-3.4 hours, respectively). No serious complications occurred during invasive interventions.

Aged↗
PubMed2004

Percutaneous endovascular recanalization of iliac artery.

BACKGROUND: The method of percutaneous, endovascular recanalization of the iliac artery in patients with occluded common and external iliac arteries was used. MATERIAL/METHODS: In 58 patients (mean age 59 years), percutaneous endovascular recanalization of 40 common and 18 external iliac arteries was performed. In 2 cases the common superficial femoral artery was also occluded. The average length of occlusion was 6.2 cm. The time since the onset of occlusion symptoms was 1 to 12 months. The recanalization was performed by passing with hydrophilic guidewire and catheter through the occlusion,and then performing balloon angioplasty. In case of unsatisfying results, a stent was placed. Intra-arterial thrombolysis was not provisionally applied in any case. RESULTS: 56 arteries were recanalized, 2 intravascular procedures were not successful. 7 cases of complications occurred: 3 of peripheral embolia, 1 occlusion of internal iliac artery, 3 hematomas at the puncture site; none of them required surgical intervention. CONCLUSIONS: Percutaneous endovascular recanalization is an efficient method of treatment in occlusion of iliac arteries.

Adult↗
PubMed1995

[ST segment re-evaluation immediately after successful recanalization in acute myocardial infarction: predictor for poor recovery of left ventricular regional wall motion].

The value of recanalization therapy in restoring risk area after acute coronary occlusion is well documented. However, some cases show poor recovery of left ventricular function regardless of early reperfusion. This study investigated the use of ST segment re-elevation immediately after recanalization in patients with acute myocardial infarction as a predictor of recovery of regional wall motion and risk area. ST segment change and regional wall motion were compared in 16 patients with [ST(+)] and 8 patients without ST segment re-elevation [ST(-)] after successful recanalization within 6 hours from onset. ST segment re-elevation was defined as 0.2 mV or more in at least two contiguous leads immediately after recanalization. Wall motion was measured from single-plane ventriculograms performed in the acute and chronic (3-4 weeks later) phases in the infarct regions by the centerline method. Hypokinesis was defined as more than -2SD/chord(c) below normal and expressed as SD/c for the severity of regional wall motion and chord number(CN) for risk area. Time from symptom onset to recanalization did not differ between the two groups [3.8 +/- 1.2 hours for ST(-), 3.9 +/- 0.9 hours for ST(+), not significant]. In the ST(-) group, regional wall motion improved from -2.92 +/- 0.33 to -1.45 +/- 0.81 SD/c (p = 0.0005) and risk area decreased from 29.8 +/- 16.6 to 9.5 +/- 15.7 CN (p = 0.005) in the acute and chronic phases, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

The combination of laser recanalization and endoluminal intubation in the palliation of malignant dysphagia.

Laser recanalization and endoluminal intubation have been combined to optimize the palliation of malignant dysphagia in 37 patients. Nine patients with an endoluminal tube in situ presented with secondary dysphagia due to tumour overgrowth. Patency of the prosthesis was restored in all patients by laser recanalization with no complications. Twenty-eight patients treated initially by laser recanalization required subsequent intubation. The indications were dysphagia secondary to external compression (n = 3), significant angulation (n = 9), tracheo-oesophageal fistula (n = 3), failure of laser recanalization (n = 8), poor palliation (n = 3) or a combination of these (n = 2). There were no complications associated with the insertion of the tube and all patients subsequently reported improved swallowing. Laser recanalization or endoluminal intubation in isolation provide adequate palliation in the majority of patients with malignant dysphagia. We have shown that the appropriate timed combination of these two modalities may optimize the palliation of dysphagia in patients in whom the primary treatment modality fails.

Adult↗
PubMed1998

[Percutaneous recanalization of proximal venous thromboses in chronic hemodialysis patients].

Occlusion of the proximal vein in chronic hemodialysis patients results in vein hypertension and a "swollen arm". The usual treatment for this "swollen arm" consists in closing up the fistula and making another access on the contralateral member. But this is not always possible and, with some patients, recanalization is the only solution. We have performed 4 recanalizations successfully: 2 accesses remain permeable after 10 and 24 months, another patient needed to be fitted with two endoprosthesis just after recanalization and access, in his case, remained permeable until he died of intestinal ischemic syndrome six months later. The fourth patient presented a reocclusion two months later but could not be reoperated on because of bad general state of health. An attempt to perform recanalization on a fifth patient was a failure. Such results show that recanalization of a thrombosed proximal vein is worth attempting before closing access for good.

Adult↗