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[Recanalization by catheter of the occluded artery after acute myocardial infarction (transluminal recanalization (author's transl)].

Using guide-wires and special catheters the occluded infarct-related coronary artery was recanalized in 10 patients with acute myocardial infarction 6.6 +/- 7.1 hours after the onset of symptoms. There were no complications. Immediately after recanalization there were 80-95% lesions at the site of the previous occlusion. Angiography, performed in 9 patients in the chronic stage of myocardial infarction, revealed patency of the recanalized vessel in all instances. There was a marked decrease in the narrowing at the time of the second angiogram in 6 patients. Changes in left ventricular function from the acute to the chronic stage were assessed in 8 patients: the ejection fraction increased in 6. The results of this pilot study indicate that transluminal recanalization of acutely occluded coronary arteries is possible without harmful side-effects. Early restoration of flow may salvage the jeopardized myocardium. Further application of this method of treatment in selected patients and efforts to improve the technique seem to be justified.

Adult

Early Transcriptional Changes in Neutrophil-Mediated Processes Following Recanalization After Ischemic Stroke.

BACKGROUND: Ischemic stroke is a leading cause of death and long-term disability worldwide. Recanalization therapies, including thrombolysis and mechanical thrombectomy, restore blood flow, yet many patients experience poor outcomes, a phenomenon known as futile recanalization. Given the short therapeutic window for ischemic stroke, identifying early biomarkers to guide targeted interventions and improve outcomes is critical. METHODS: Using a murine middle cerebral occlusion model that mimics a large vessel occlusion with recanalization, a comprehensive microarray analysis from blood samples collected immediately and 3 hours after recanalization (N=44) was performed. Differentially expressed genes, enrichment pathways, immune cell proportions, enriched cell markers, predicted micro-RNAs, and transcription factors were identified using RStudio. Findings in mice were validated with rat middle cerebral artery occlusion (GSE21136) and patients with stroke (GSE16561) data sets to confirm transcriptional changes in peripheral blood postrecanalization. RESULTS: Il1r2, Cd55, Mmp8, Cd14, and Cd69 were early biomarkers poststroke and postrecanalization. Cross-validation revealed Vcan as a differentially expressed gene conserved across species, making it a novel ischemic marker detected as early as 3 hours postrecanalization (4 hours after middle cerebral artery occlusion) in mice, 24 hours after recanalization in rats (middle cerebral artery occlusion-thrombectomy), and within 24 hours from onset in humans receiving recombinant tissue plasminogen activator-thrombolysis. CIBERSORTx and ImmuCellAI-mouse deconvolution showed neutrophil elevation postrecanalization. Leukocyte and neutrophil activation pathways were enriched early after stroke in mice and humans, with stronger upregulation in the female sex. Several regulatory micro-RNAs were identified, and Nuclear Factor Erythroid 4 (NFE4) and Metal Regulatory Transcription Factor 1 (MTF1) emerged as key transcription factors. A coregulatory network underlying neutrophil activity was constructed, highlighting its central role in early responses to ischemia and recanalization, which was enriched in the female sex. CONCLUSIONS: We identified novel early genomic markers for ischemia and recanalization, including the conserved marker Vcan, and highlighted age- and sex-specific immune responses. Mapping a neutrophil-centered coregulatory network provides mechanistic insight into futile recanalization and supports the development of targeted therapies to improve clinical outcomes.

Animals

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

Initial experience with transluminal recanalization of the recently occluded infarct-related coronary artery in acute myocardial infarction -- comparison with conventionally treated patients.

In 7 patients, the recently occluded infarct-related vessel was recanalized by transluminal catheter techniques during acute myocardial infarction (Group A). 4 patients had single-vessel disease, 2 patients two-vessels disease and one, involvement of three vessels. Control angiography was performed in 6 patients, 8 days to 7 months later. Changes of coronary artery anatomy and left ventricular function were compared with a group of 9 conventionally treated patients, who were found to have occlusion of the infarct-related vessel in the acute stage (Group B). Five Group B patients had one-vessel disease, 3 patients two-vessel disease and 1 patient, involvement of all three vessels. In the chronic stage, all transluminally recanalized vessels were found to be patent in Group A. There was spontaneous recanalization of the infarct vessel in 4 of 9 Group B patients. In Group A, the length of the akinetic segment (AKS) decreased significantly (p less than 0.05) from 145.4 +/- 48.5 mm to 73.2 +/- 73.4 mm (mean +/- SD). Volume parameters did not change significantly. In Group B, length of the AKS did not change significantly, EDVI increased significantly from 81.1 +/- 19.8 to 106.8 +/- 4.6 ml/m2 (p less than 0.05); ESVI increased significantly from 41.7 +/- 13.7; ml/m2 to 66.8 +/- 37.9 ml/m2 (p less than 0.01). In the acute stage, length of the AKS and volume parameters did not differ significantly between the two groups. In the chronic stage, AKS was significantly shorter (A: 73.2 +/- 63.4 mm; 144.9 +/- 59 mm (p less than 0.0025) and EF was significantly higher (A: 54.6 +/- 11.6%; B: 40.9 +/- 14.5% (p less than 0.05) in Group A. Peak CPK was lower in Group A (A: 1009 +/- 827 U/l; B: 1324 +/- 655 U/l), but this difference did not achieve statistical significance. Results of this pilot study suggest that transluminal recanalization in the early phases of acute myocardial infarction might result in limitation of myocardial injury. However, further research will be needed to improve the technique and to test its results.

Adult

Sanguineous cerebrospinal fluid in recanalized cerebral infarction.

To clarify the causal relationship between spontaneous recanalization of the occluded cerebral artery and development of hemorrhagic infarction, 15 patients with internal carotid or middle cerebral arterial axis occlusion were submitted to consecutive lumbar punctures and follow-up cerebral angiography. Consequently, six of seven recanalized patients had sanguineous cerebrospinal fluid (CSF) on the second or third day after ictus, while only one of eight non-recanalized patients had bloody CSF. It was strongly suggested that recanalization might have an initimate relationship with the development of hemorrhagic infarction.

Adult

Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia: a randomized prospective study.

Forty patients with histologically confirmed malignant dysphagia were randomized to either endoscopic intubation or laser recanalization. Age, sex, tumour histology and site were evenly distributed between the groups. Results were analysed on an 'intention to treat' basis. All patients treated by laser achieved patency; there was one failed intubation. The best swallowing grade achieved was significantly better with laser recanalization (median 4 (range 3-4)) than with intubation (median 3 (range 2-4)) (P < 0.001). The median survival was 21.5 (range 4-62) weeks in the group receiving laser treatment, compared with 14.5 (range 7-102) weeks in the intubated group (P = 0.09). The median inpatient stay as a proportion of survival time was 14 per cent in the group receiving laser treatment compared with 15 per cent in the intubated group (P > 0.05). The median weight loss was less in the laser-treated patients (2.0 (range 2-8) versus 3.0 (range 0-10) kg, P = 0.04). These results indicate that laser recanalization provides better palliation of dysphagia than does intubation, but this is not reflected in an improvement in survival time.

Adult

Acute coronary occlusion with impending infarction as an angiographic complication relieved by a guide-wire recanalization.

In a 45 year old male patient with a history of previous inferior myocardial infarction and unstable angina pectoris, coronary angiography revealed two-vessel disease: a 60-70% lesion in the middle third of the LAD, and a 90% lesion in the middle third of the very large RCA. There was only a small akinetic segment in the posterobasal region of the left ventricle. During angiography total occlusion of the RCA occurred followed the clinical and electrocardiographic signs of impending inferior reinfarction. Recanalization of the occluded vessel was accomplished by using a guide-wire, which was passed through a Sones catheter, placed in the RCA. The patient's symptoms subsided and the electrocardiographic signs of acute ischemia reverted within eight minutes. Aortocoronary bypass surgery with revascularization of the LAD and RCA was performed within 3 hours after recanalization. Postoperatively there was no evidence of major tissue loss by enzyme or electrocardiographic criteria. Control angiography, performed on the ninth day postoperatively, revealed the graft to the RCA to be widely patent. Left ventricular function was unchanged. It is concluded, that the combined approach of early transluminal recanalization of the acutely occluded RCA followed by successful construction of a graft to this vessel, has averted necrosis of a major portion of the left ventricle. However, general use of this technique does not seem advisable at the present time.

Acute Disease

Positive scans in angiographically proved cases of recanalized cerebral infarction.

In 20 patients with acute major cerebral arterial occlusion, follow-up angiograms were obtained to inspect the occluded artery. These angiograms were compared with brain scans in the fourth week after the stroke. The angiograms revealed that frequent recanalization of the occluded arteries occurred within a week after the onset. On the other hand, brain scans showed the increased uptake of radioisotopes even in the patients with angiographically demonstrated arterial recanalization. The present study clarified that positive scans could be obtained in the patients with and without recanalization, and emphasized the diagnostic value of brain scans in the subacute or chronic stage of cerebral infarction, especially in patients with no arterial occlusion appearing on the angiograms.

Acute Disease

Transcervical fallopian tube recanalization: a safe and effective therapy for patients with proximal tubal obstruction.

Over a 13-month period, 14 patients with proximal tubal obstruction underwent transcervical fallopian tube recanalization under fluoroscopic guidance in an outpatient setting at the hospital of the University of Pennsylvania. Twenty-one of 24 attempted tubal dilations (87.5%) were successful, as demonstrated by tubal opacification and contrast spillage into the peritoneal cavity at the conclusion of the procedure. Four intrauterine pregnancies, and no ectopic pregnancies, have followed the recanalization. One pregnancy ended in an early miscarriage, one patient delivered a healthy term female, and two pregnancies are ongoing at greater than twenty weeks' gestation. Two procedure-related complications occurred: in one patient, the isthmic segment of a fallopian tube was perforated, but healed without incident, and another patient experienced a low-grade fever, which resolved with p.o. antibiotics. We therefore conclude that fallopian tube recanalization is a well-tolerated, safe, and effective procedure for the treatment of proximal tubal occlusion.

Adult

Infarction and circulation in cerebrum. Effect of recanalization and/or collateral circulation on the lesion and prognosis.

Findings of computed tomography (CT) and angiography in supratentorial cerebral infarction associated with complete stroke were compared with regard to prognosis. It was found that the extent of low-density areas on CT was perfectly in accordance with the areas of occluded arteries on angiograms. However, the low-density areas on CT were always smaller than the areas involved angiographically when early recanalization and/or collateral circulation were carried out within 2 to 3 days of onset. It was also found that smaller low-density areas only had favorable effect. We concluded that the prognosis was better with early recanalization and/or collateral circulation, despite the general acceptance of its poor prognostic implication.

Adult

Fallopian tube recanalization by selective salpingography: an alternative to more invasive techniques?

Selective salpingography was used in a total of 64 patients, engaged in evaluation for infertility and in whom standard hysterograms showed no tubal passage of contrast medium. Fallopian tube catheterization was successful in 92% of the cases; a peritoneal spill of contrast medium was obtained in 74% of the cases by manual injection. Recanalization of an obstructed oviduct was successful in 61% of the cases. Thus, after the procedure, 82% of the patients had at least one patent tube. We conclude that selective tubal catheterization, and recanalization when needed, should be included in the therapeutic procedures for tubal infertility, prior to in-vitro fertilization or tubal microsurgery.

Adult

Technical report: fallopian tube recanalization facilitated by a hydrophillic glide wire.

Fallopian tube recanalization is now a well established radiological procedure (1). We describe a case in which the tubal obstruction was resistant to the standard technique of recanalization by the passage of a platinum tipped wire but in which we were able to achieve success with the aid of a hydrophillic "glide" wire (Radifocus angled tip, Terumo Corporation, Tokyo, Japan).

Adult

Obstruction and normal recanalization of the ureter in the human embryo. Its relation to congenital ureteric obstruction.

In this work, after the study of 45 normal human embryos of 5-55 mm from vertex to coccyx, it is shown that the ureteric ducts, which in the first phases of development are permeable (embryos of 5-13 mm), constantly undergo a process of obstruction and posterior recanalization of their lumen, which takes place when they are from 14 to 22 mm. These processes begin in the middle zone of the ureters and progress proximally and distally until they cover its entire length, for which these ducts, which in embryos of approximately 17 mm in length form solid cords, but in the embryos of 23 mm are totally permeable. This obstructive process is found in relation to atrophy and loss of activity of the mesonephros, while that of recanalization follows the intense longitudinal growth of the ureters in this phase of development. These modifications, which the ureteric lumen normally undergoes during its embryonic development, are of great importance for correct interpretation of the pathogenic mechanism of congenital ureteric strictures and valves.

Cell Differentiation

[Recanalization of the thrombus as a way for secondary blood flow restoration in a prosthetic major vein].

According to the authors data a secondary restoration of the lumen of a previously obstructed prothesis approaching a half of the initial diameter of the vein is not infrequent in the plasty of the main veins of a growing organism. This restoration results from pronounced processes of the recanalization of the intraprosthetic thrombus, which are observed in the plasty of the external jugular vein and anterior vena cava. It has been found that the recanalization occurs through the formation of some longitudinal canals in the thrombus. These canals join the capillaries growing through the pores of the prothesis which transform into venous vessels with the endothelial lining, vascular apparatus and directed blood flow,

Animals

Angiographic demonstration of recanalization of the basilar artery.

This report details the clinical course and angiographic findings of a patient with intermittent vertebrobasilar insufficiency. Recanalization of the basilar artery was demonstrated during anticoagulant therapy. A review of the literature failed to disclose a previous report of this occurrence.

Basilar Artery

[Percutaneous transluminal recanalization in a patient with arterial occlusive disease and multiple injuries (author's transl)].

A case of a 66 year old patient with multiple injuries is reported. A combination of conventional trauma treatment and percutaneous transluminal angioplasty (PTR) of a segmented superficial femoral artery occlusion prevented leg amputation. When the patient died 8 weeks later from trauma sequelae the successful recanalization was demonstrated in histopathology investigation. It is concluded that PTR is an ideal accessory to the present therapeutic spectrum in vascular surgery.

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