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PubMed2003

Inflammatory responses and CNS injury: implications, prophylaxis, and treatment.

EXCERPT: Early detection of perioperative stroke is essential if there is to be any opportunity to improve outcome. If there is suspicion of cerebral embolic stroke, scanning with computerized tomography can rule out acute hemorrhage and demonstrate diagnostic changes in a majority of patients within 5 hours of onset of symptoms. Strategies for reperfusion of ischemic tissue may include intraarterial thrombolysis in select patients with acute ischemic stroke even after recent cardiac operation. In one series, 13 patients with acute ischemic stroke within 12 days of cardiac operation underwent intraarterial thrombolysis within 6 hours of stroke symptom onset. Recanalization was complete in 1 patient and partial in 5, and 7 patients had low flow. Neurologic improvement occurred in 5 patients (38%). One patient needed a chest tube for hemothorax; 2 others received transfusions for low hemoglobin. No operative intervention for bleeding was necessary. In addition to thrombolysis, mechanical clot removal may be attempted. Thromboaspiration requires favorable anatomy and a fresh nonadhesive clot. It reduces the time for recanalization, has no hemorrhagic risk, and may prevent distal clot migration. Thromboaspiration may be attempted as an adjunct or alternative to intraarterial fibrinolysis for basilar artery recanalization. If massive cerebral gas embolism is suspected and hyperbaric facilities are available, confirmation can be obtained by early single-photon emission tomography (SPET) and hyperbaric oxygen therapy instituted. This process was successfully undertaken in a case of paradoxical air embolism in a patient undergoing percutaneous nephrolithotripsy in the prone position and presenting with blindness and neurological deficits 8 hours later. Treatment with hyperbaric oxygen therapy was successful in this case.

Animals↗
PubMed1983

Streptokinase thrombolysis in acute myocardial infarction: a turning point.

The initial anatomic findings of angiography during acute myocardial infarction, as well as the techniques used for selective coronary streptokinase infusion, are presented in this report. Preliminary evaluation of streptokinase infusion studies seems to indicate that revascularization of coronary arteries occluded during myocardial infarction is quickly and easily achievable and could constitute the treatment of choice; however, critical questions still remain to be answered. Recanalization rates vary from 75 to 90% in the different, usually small, series. The time of recanalization seems critical to the salvage of ventricular myocardium; e.g., recanalizations accomplished before a time lapse of 3 to 4 hours appear to limit infarct size, whereas, results appear doubtful after that time. The early mortality rate is similar to that of patients not treated with streptokinase, but the mortality at 1 month and 6 months is apparently in favor of the treated group. While thrombolytic agents may not turn out to be the panacea that some researchers have expected, recent experience has greatly contributed to the understanding of the pathophysiology of myocardial infarction and the critical importance of the time factor in planning therapy.

Journal Article↗
PubMed2004

[Relationship between redox state of whole arterial blood glutathione and left ventricular function after acute myocardial infarction].

OBJECTIVES: To investigate the role of oxidative stress in left ventricular function after acute myocardial infarction. METHODS: We studied 41 patients with acute myocardial infarction (30 men and 11 women, mean age 61.7 +/- 11.6 years) with Thrombolysis in Myocardial Infarction grade 3 recanalization of occluded coronary arteries within 12 hr after onset. Cardiac catheterization was performed at the time of admission and before discharge. Three markers for oxidative stress were measured: plasma lipid hydroperoxide, plasma creatol and whole arterial blood glutathione at the time of admission. RESULTS: Mean time from onset to recanalization was 5.2 +/- 0.6 hr. The patients were divided into two groups according to the changes in left ventricular wall motion (LVWM); patients who showed improvement in LVWM and those without improvement. There were no significant differences in age, sex, coronary risk factors, severity of coronary artery disease, time from onset to recanalization or ejection fraction between two groups. Maximum creatine kinase and C-reactive protein levels in patients without LVWM improvement were significantly higher than in patients with improvement. Plasma levels of lipid hydroperoxide and creatol did not differ significantly between two groups. On the other hand, reduced glutathione/oxidized glutathione ratio in arterial blood in patients without LVWM improvement was significantly lower than in patients with LVWM improvement (69.8 +/- 3.4 vs 85.5 +/- 2.9, p < 0.05). CONCLUSIONS: Our results suggest that whole arterial blood glutathione is more oxidized in acute myocardial infarction patients without LVWM improvement than in patients with improvement. Redox state of arterial blood can be a predicting factor for left ventricular function after acute myocardial infarction.

Aged↗
PubMed2005

Intracranial aneurysms treated with Guglielmi detachable coils: usefulness of 6-month imaging follow-up with contrast-enhanced MR angiography.

BACKGROUND AND PURPOSE: This study was undertaken to assess the utility of contrast-enhanced MR angiography at 6 months after endovascular treatment of intracranial aneurysms with Guglielmi detachable coils. METHODS: Contrast-enhanced MR angiography was performed in 47 patients at 6 and 12 months after endovascular treatment of intracranial aneurysms (48 aneurysms). Digital subtraction angiography (DSA) was used as reference and was performed at 12 months after the treatment in all patients. MR angiographs were analyzed independently by two senior radiologists. DSA and MR angiography findings were assigned into one of three categories: complete obliteration, residual neck, or residual aneurysm. RESULTS: All examinations were assessable. Interobserver agreement was judged as very good for contrast-enhanced MR angiography (kappa=0.96), with one discrepancy between examiners. Comparison between MR angiography at 6 months and DSA at 12 months showed an excellent agreement between techniques (kappa=0.93). Two cases of complete occlusion at DSA were misclassified as a residual neck at 6-month MR angiography. All aneurysm recanalizations at DSA already were detected on MR angiography at 6 months. The size of aneurysm recanalization did not increase between both MR angiographs performed at 6 and 12 months. CONCLUSION: Contrast-enhanced MR angiography after selective embolization of intracranial aneurysm seems to predict properly early aneurysm recanalizations.

Adult↗
PubMed2005

[Value of ST-segment elevation resolution after primary coronary angioplasty in predicting early and late left ventricular function in patients with anterior acute myocardial infarction].

UNLABELLED: The aim of our study was to define a predictive value of ST-segment resolution after coronary reperfusion for early and late left ventricular (LV) function. We also studied its relation to angiographic marker of myocardial reperfusion, myocardial blush grade (MBG). MATERIALS AND METHODS: Study population consisted of 105 patients (75 men, 30 women, mean age 62+/-13 years) treated with primary PTCA for anterior myocardial infarction (AMI) within 12 hours from symptoms onset. ECG was performed before - and 30 min. after PTCA. We evaluated angiographic markers of recanalization (TIMI, corrected TIMI frame count) and myocardial reperfusion - MBG. Echocardiography was performed 3 days and 6 months after AMI. Patients were divided into 2 groups regarding reduction -50% in ST segment elevation after recanalization (rST): group I (n=37) with rST, and group 2 (n=68) without rST RESULTS: In group I we noticed higher CPK level (2890,2+/-2404,2 U/I vs. 3980,9+/-2812,2 U/I, p<0,01). MB grade 3 was significantly more often found in group 1 at 29 pts (78,4%) than in group 2 at 18 pts (23,5%), p<0,0001. MG grade 0 or 1 were more often in group 2 (57,3% vs. 2,7%, p<0,01). Ejection fraction (EF) was higher in group 1 after 3 days (48,9+/-9,5% vs. 44,2+/-14,3%, p<0,01), as well as after 6 months (56,4+/-14,4% vs. 49,5+/-14,3%, p=0,001). After 6 months end-diastolic volume (EDV) was higher in group 2 (128,1+/-46,1 ml vs. 110,2+/-49,7 ml, p<0,008). CONCLUSIONS: ST-resolution after successful PTCA is a simple and effective marker of myocardial reperfusion after recanalization which correlates with angiographic markers of tissue reperfusion. Early ST-segment resolution is connected with better early and late LV function. Patients without early ST-segment elevation resolution have a higher risk of LV remodelling.

Aged↗
PubMed1992

[Spontaneous regression of significant stenoses and occlusions of the internal carotid artery].

19 patients with severe stenoses or occlusions of the internal carotid artery showed spontaneous recanalization at follow-up. The cause of the stenotic process was spontaneous or traumatic dissection, fibromuscular dysplasia, ergotism or arteriosclerotic disease. Total recanalization occurred in carotid artery dissections coinciding with the best clinical outcome. In fibromuscular dysplasia and arteriosclerotic process, recanalization was seldom found, incomplete, and the clinical course was less favourable.

Adult↗
PubMed2006

Protective effect of agmatine on a reperfusion model after transient cerebral ischemia: Temporal evolution on perfusion MR imaging and histopathologic findings.

BACKGROUND AND PURPOSE: The goal of thrombolytic therapy in patients with acute ischemic stroke is early recanalization, but this may result in delayed reperfusion injury. The purpose of this study was to evaluate the neuroprotective effect of agmatine in a transient ischemic cat model by using MR perfusion imaging and histopathologic analyses. METHOD: One-hour temporary occlusion of the left middle cerebral artery of cats was performed in the control ischemia group (n = 10), and 100 mg/kg of agmatine was intravenously injected immediately after recanalization in the agmatine-treated group (n = 15). MR imaging was performed at 1, 24, and 48 hours after recanalization, and the perfusion patterns were investigated. Terminal-deoxynucleotidyl transferase mediated nick and end-labeling (TUNEL) and hematoxylin-eosin (H&E) stainings were performed at the corresponding sections. RESULTS: In the control ischemia group, the number of TUNEL-positive cells was significantly increased in the areas with reperfusion hyperemia (P < .05). In the agmatine-treated group, no significant increase in the number of TUNEL-positive cells was noted in the areas of reperfusion hyperemia. The difference in the number of TUNEL-positive cells between the control ischemia and agmatine-treated group in the areas of reperfusion hyperemia was significant (P < .05). The total number of TUNEL-positive cells and the area of severe ischemic neuronal damage on H&E stain were also significantly attenuated in the agmatine-treated cats compared with the control ischemia cats (P < .05). CONCLUSION: Our results suggest that agmatine has neuroprotective effects against reperfusion injury and ischemia.

Agmatine↗
PubMed1991

[Intraarterial injection of low molecular weight dextran and urokinase for acute cerebral infarction].

Strategic recanalization of the occluded cerebral vessels has shown promise as a therapy for embolism and thrombosis in the acute stage. A single-dose of urokinase (UK) administered by intravenous and intraarterial routes was usually designed to restore patency of the infarct-related arteries and reperfuse the area of infarction. However, thrombolytic agents which have been available to date may lack resoluvability, limiting the amount of doses, because overdosage may induce hemorrhagic complication. This newly-designed therapy, intraarterial injection of UK-low molecular dextran (LMWD) complex was introduced in order to overcome the danger shown in the previous study. A high-resolvent allows cut-down of urkinase doses. Patients with acute cerebral infarction were selected for treatment with the resolvent if they satisfied the following conditions: 1) up to 79 years old without serious systemic diseases, 2) less than 12 hours from the onset, 3) better than the score of 8 in GCS, 4) no abnormality in CT scan, 5) apparent neurological deficit and 6) responsible pathology in angiography. LMWD of 15ml, UK of 240000IU and 15ml saline-complex was injected as one course at 2.0-2.5ml/min for 11 cases. Recanalization was observed in seven cases of embolism, and lack of reperfusion in five cases of thrombosis. The minimum effective dose was determined as 480000IU of UK in two courses. In terms of time lag from the onset, six hours may be the inferior limit, within which five of six cases (83%) succeeded in the recanalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Unsuspected preexisting saphenous vein disease: an unrecognized cause of vein bypass failure.

Our prior anecdotal experience with unsuspected preexisting saphenous vein disease prompted us to study its incidence, its relation to graft failure, and to identify techniques for its detection. Thick-walled, postphlebitic sclerotic occluded, postphlebitic sclerotic recanalized, calcified, and varicose vein lesions were detected in 63 (12%) of 513 infrainguinal vein bypasses. In 13 (2% to 5%) cases, severe saphenous vein disease precluded use of the vein. In the remaining 50 cases, the entire vein or a portion thereof, with minimal or unsuspected disease, was used for bypass. Early graft failures occurred in 10 (20%) of the 50 cases. The cumulative primary patency rate at 30 months for bypasses performed with diseased veins was 32%. This was significantly less than the 73% cumulative primary patency rate for bypasses with veins without detectable disease (p less than or equal to 0.001). Retrospective evaluation of preoperative duplex ultrasonography (n = 21) originally used to evaluate saphenous vein length and diameter correctly identified thick-walled, occluded, calcified, and varicose veins in 62% of cases. Intraoperative methods of vein evaluation included inspection, palpation, irrigation, catheter or valvulotome insertion to identify obstruction, and intraoperative arteriography. Histologic examination of diseased veins demonstrated a spectrum of disease with thickening of the intima and media, vein wall calcification, and luminal recanalization. We conclude that (1) unsuspected preexisting saphenous vein disease occurs in approximately 12% of cases and results in both early and late graft failures; (2) detection, in some cases, is possible with duplex ultrasonography and intraoperative techniques; and (3) diseased veins that are recanalized, calcified, or thick-walled should not be used if an alternative vein is available.

Chi-Square Distribution↗
PubMed1991

[Experimental study on brain reversibility following temporary regional cerebral ischemia; from the point of view of vessel behavior and histological changes].

Using a middle cerebral artery occlusion model in adult cats, we investigated the ischemic time threshold for inflicting damage on cerebral vessel behavior and brain tissue. With the transorbital approach, a middle cerebral artery (MCA) was exposed and temporarily obstructed by a Zen's clip. Animals were divided into ten groups (each group: N = 8) according to the ischemic time of 10, 20, 30 minutes, 1, 2, 4, 6, 8, 12, 24 hours. Five hours after the recanalization, Evans' blue dye was injected intravenously and after further 30 minutes, the brain was fixed with transaortal perfusion for histological examinations. A cranial window was made above the ectosylvian gyrus which has poor anastomosis. The pial vessel behavior was observed through the cranial window and evaluated using an intravital microscope and a videoangiometer. Considering the correlation between functional change of vessel behavior and pathological change in the brain, the threshold time of ischemia inflicting irreversible damage was estimated. In the 30 minute ischemia group, deterioration of vessel behavior began to be observed as well as extravasation of Evans' blue dye. As the ischemic duration became longer, infarction and hemorrhage, which showed close correlation, increased. When the duration of ischemia was 6 hours, the infarcted area was significantly larger than that of the 4-hour ischemia group. Intracranial pressure (ICP) markedly increased as soon as recanalization took place. We think this phenomenon is due mainly to swelling. About three hours after recanalization, ICP further increased due to severe vasogenic edema in addition to the brain swelling.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Interventional radiology in the area of the renal blood vessels. Percutaneous transluminal angioplasty and embolization].

Recanalization (angioplasty) and occlusion (embolization) are the major interventional radiological procedures used in renal vessels. In recanalization of the renal artery, percutaneous transluminal angioplasty of renal arterial stenosis is the most common procedure. About 80% of renal arterial stenoses are suitable for this procedure, that is, about 80% of patients can be spared major abdominal surgery. Methods, results and complications are discussed. Local lysis of acute renal arterial occlusions is rarely employed, since the diagnosis is usually made too late. Functional improvements may be expected even when recanalization is successful only when the procedure is performed within one hour of the occlusion or when collaterals suffice for organ-preserving metabolic activities. Embolization of the renal artery is employed in particular in the case of tumors of the kidneys, more frequently with a pre-operative rather than a palliative intent. Pre-operative embolization aims at facilitating surgery and reducing the need for transfused blood. The palliative procedure employed in inoperable tumors aims at prolonging life, controlling acute bleeds, and combatting paraneoplastic syndromes. The method is described.

Angioplasty, Balloon↗
PubMed1991

[Pericardial effusion in acute myocardial infarction: clinical feature and significance].

To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 137 consecutive patients. Pericardial effusion was observed in 45 patients (33%), of whom 22 were followed until they recovered and were discharged. Pericardial effusion was more frequent in patients with anterior acute infarction than those with inferior acute infarction, and so it was in non-recanalized patients than in recanalized ones. Patients with pericardial effusion had higher peak levels of creatine kinase, higher wall motion score indices, and higher defect scores of thallium imagings. The improvement of regional wall motion at an infarct zone in patients with pericardial effusion was less regardless of the successful early recanalization. These results show that pericardial effusion is a common event in patients with acute myocardial infarction and observation of transition of pericardial effusion is important for predicting prognosis.

Aged↗
PubMed1991

Thrombolytic therapy for stroke.

Thrombolytic therapy has recently been shown to be beneficial in the setting of acute myocardial infarction, and thrombolysis resulting in vascular recanalization has been achieved in several other human disease states, including stroke. Advances in the understanding of the fibrinolytic system have led to the development of several new and distinctive thrombolytic strategies. Animal studies of stroke have been encouraging with regard to arterial recanalization and safety. Clinically, the availability of brain computed tomography has allowed pilot studies to proceed by providing rapid identification of patients with nonhemorrhagic stroke. Arterial recanalization has been demonstrated in patients with ischemic stroke following the administration of any one of several thrombolytic drugs. Placebo-controlled trials have not been completed, and so clinical benefit has not been established. Even though the development of brain hemorrhage has been an infrequent complication, the very high morbidity and mortality have been worrisome. Ironically, thrombolytic therapy holds promise for treatment of subarachnoid hemorrhage and perhaps also for spontaneous intracerebral hemorrhage. Human studies have been limited, but complications have been modest, and clinical outcomes have been encouraging.

Animals↗
PubMed1990

[Electrocardiographic indices of reperfusion and limitation of the necrotic area in acute myocardial infarct].

The aim of this study was to assess the evolution of ST segment displacement and the formation of new Q waves in relation to the late angiographic demonstration of recanalization of the infarct-related vessel in 36 patients with acute myocardial infarction admitted in our Institution within 8 hours from the onset of symptoms. Eighteen patients were treated with intravenous urokinase (200,000 + 1,200,000 UI) followed by sodium-heparin 1,000 U/ev/hour for 48 hours and calcium-heparin 3,000 UI/10 Kg/12 hours from the third day to discharge. Eighteen patients were treated from admission only with calcium-heparin as seen before. All the patients have been followed with serial electrocardiograms; we evaluated the sum of ST displacements (ST12) and Q waves score (Q12) in the 12 standard leads on admission, and on the twelfth, twenty-fourth, forty-eighth hour, and on discharge. On the basis of the late angiographic findings and apart from the treatment, we divided the patients into 2 groups: patients with recanalization of infarct-related vessel (20 patients, 55.5%) and patients with occlusion of the infarct-related vessel (16 patients, 44.6%). We did not observe statistically significant differences between the 2 groups for decrease of ST segment displacement of formation of new Q waves, even if reperfused patients showed a more rapid and complete decrease of ST segment displacement and a more rapid formation of new Q waves with respect to occluded patients. Our data indicate that from a clinical point of view electrocardiographic indices are not a sensitive marker of recanalization of infarct-related vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1990

Early versus late opening of coronary arteries: the effect of timing.

Intuitively, one would assume that the benefit from the use of thrombolytic therapy in reducing mortality in acute myocardial infarction (AMI) is directly related to early recanalization of the thrombosed infarct-related artery. However, a meta-analysis of early clinical trials and the ISIS-II trial results suggests that thrombolysis initiated between 6 and 24 h after the onset of infarction still reduces mortality. Verification of this observation is currently being sought in three ongoing trials of late reperfusion. These are the EMERA trial in South America, using streptokinase; the LATE study involving several European countries, the United States, Canada, and Australia, using tissue plasminogen activator (tPA); and the TAMI-6 trial, in which either tPA or placebo is given 6 to 24 h postinfarction, and patients with closed infarct-related arteries are randomized further to either angioplasty or no angioplasty. There are theoretical reasons that late reperfusion may be beneficial. These reasons include the prevention of infarct expansion and ventricular remodeling leading to ventricular dilatation, the provision of electrophysiologic stability lessening the likelihood of malignant ventricular arrhythmias, and the ability of collaterals emanating from the recanalized artery to perfuse ischemic but still viable myocardium. There are also reasons that late reperfusion might be harmful, including myocardial stunning, microvascular damage, and intramyocardial hemorrhage leading to an increased likelihood of myocardial rupture. It does appear, however, that once recanalization occurs, maintenance of patency improves late outcome, as shown in the Western Washington Intracoronary Streptokinase Trial, the TAMI trial, the TIMI trial, and the Duke study.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1990

Percutaneous peripheral ultrasonic angioplasty.

We previously reported the initial use of percutaneous catheter delivered ultrasound energy for arterial recanalization in eight patients with peripheral vascular disease. All patients had severe claudication. There were four cases with total occlusion and four with high grade stenoses in a superficial femoral or popliteal artery. A prototype ultrasound probe, with a frequency of 20 kHz and a power output of 20 to 25 watts/cm2 was ensheathed in a 7F catheter and advanced to the occlusions with angiographic guidance. Three of four complete occlusions were recanalized in less than 120 s resulting in a 54 +/- 5% residual diameter stenosis. Ultrasound energy applied to isolated stenoses reduced them by 40%, from 77 +/- 14% to 37 +/- 21%. Further treatment with balloon angioplasty resulted in a mean residual stenosis of 20 +/- 9%. There was no angiographic or clinical evidence of arterial emboli, dissection, spasm, or perforation. Clinical follow-up and Doppler ankle-brachial indices were performed at one, three and six months after combined ultrasound and balloon angioplasty. Two occlusions recurred, both within the first three months, detected by return of claudication and an abnormal ankle/brachial index, and documented by angiography. Repeat balloon angioplasty of standard methods was performed in one, but the vessel again reoccluded. The other five patients with primary technical success have continued patency both clinically and by ankle/brachial index measurement. Percutaneous catheter delivered ultrasound energy appears promising in peripheral vessels to reduce arterial stenoses and recanalize complete arterial obstructions. The long-term findings from this pilot study were insufficient to assess if ultrasound has any effect on restenosis.

Aged↗
PubMed1990

[Intraarterial urokinase infusion therapy for arterial occlusive disease of the pelvis and extremities with special reference to short-term high dose infusion].

Thirty-five complete arterial occlusions of pelvis and extremity in 29 patients were treated with intraarterial urokinase infusion therapy. In 28 limbs, the occlusions were due to arteriosclerotic change and in 7 lesions, the occlusions were due to Burger's disease. The patients with arteriosclerotic change ranged in age from 52 to 84 years with a mean age of 68 years, and the patients with Burger's disease ranged in age from 35 to 47 years with a mean age of 43 years. There were 24 men and 5 women. The estimated duration of the occlusion was from 5 days to 5 years with a mean duration of 11 months. The length of the occluded segments ranged from 1 to 45 cm with a mean length of 13.9 cm. The occlusion was located in the iliac artery in 13 patients, the femoral artery in 11 patients, both the iliac and the femoral artery in 2 patients, the popliteal artery in 5 patients, the femoro-popliteal artery in 1 patient, the brachial artery in 2 patients and the radial artery in 1 patient. The infusion catheter was gently advanced into the proximal portion of the clot over a flexible guide wire, and urokinase was infused at a rate of 5000-10000 IU/min, as a short term high dose infusion (SHI), until antegrade blood flow was reestablished. The catheter was then withdrawn to a point proximal to all of the remaining clot, and the infusion rate was reduced to 10000-20000 IU/h as a continuous low dose infusion (CLI). After thrombolytic recanalization, a percutaneous transluminal angioplasty (PTA) was performed in those cases which demonstrated a residual narrowing of the lumen. The initial success rate was 86%. Reocclusions were observed in 5 lesions (17%) and a second recanalization was successful in 2 of 3 patients. The 1-year cumulative patency rate following recanalization was 88.4% and the 2-year patency rate was 78.6%. No significant complications directly related to the procedure were observed. SHI combined with CLI and PTA appears to be an effective and safe therapy for chronic long segmental arterial occlusion.

Adult↗
PubMedDate not supplied

Dissolution of isobutyl 2-cyanoacrylate on long-term follow-up.

Eight patients with arteriovenous malformations (AVMs) in the basal ganglionic and deep parietooccipital regions and one patient with an AVM in the shoulder region showed resorption of the isobutyl 2-cyanoacrylate cast and recanalization of the arteries after delayed follow-up angiography. All the AVMs were large, had multiple arterial pedicles, and revealed significant obliteration of the AVM immediately after embolotherapy. Although a 50-75% obliteration was achieved immediately after embolization, follow-up angiography 6-20 months later revealed almost the original status. The residual bucrylate cast was disproportionately small compared with the recanalized malformation in seven patients, while in two patients there was no evidence of bucrylate on plain films. Degradation of bucrylate probably is due to the lysosomal activity of the endothelial cells. The results from our nine patients with some degree of resorption of isobutyl 2-cyanoacrylate and six with recanalized AVMs 6-20 months after embolization suggest that operable AVMs should be excised soon after embolotherapy and inoperable AVMs should be embolized as completely as possible.

Absorption↗