1/15. Rheolytic thrombectomy of the occluded internal carotid artery in the setting of acute ischemic stroke.BACKGROUND AND PURPOSE: Acute thromboembolic stroke complicated by ipsilateral carotid occlusion may present both mechanical and inflow-related barriers to effective intracranial thrombolysis. We sought to review our experience with a novel method of mechanical thrombectomy, in such cases, using the Possis AngioJet system, a rheolytic thrombectomy device. methods: A review of our interventional neuroradiology database revealed three patients in whom an occluded cervical internal carotid artery was encountered during endovascular treatment for acute stroke and in whom thrombectomy was attempted, using the 5F Possis AngioJet thrombectomy catheter. The medical records and radiographic studies of these patients were reviewed. RESULTS: Three patients were identified (ages, 52--84 years). Two patients had isolated occlusion of the internal carotid artery; in one patient, thrombus extended down into the common carotid artery. Treatment was initiated within 190 to 360 minutes of stroke onset. thrombectomy of the carotid artery was deemed necessary because of poor collateral flow to the affected hemisphere (chronic contralateral internal carotid artery occlusion [one patient] and thrombus extending to the carotid "T" [one patient]) or inability to pass a microcatheter through the occluded vessel (one patient). Adjunctive therapy included pharmacologic thrombolysis with tissue plasminogen activator (all patients), carotid angioplasty and stenting (two patients), and middle cerebral artery angioplasty (one patient). Patency of the carotid artery was reestablished in two patients, with some residual thrombus burden. In the third patient, the device was able to create a channel through the column of thrombus, allowing intracranial access. CONCLUSION: Rheolytic thrombectomy shows potential for rapid, large-burden thrombus removal in cases of internal carotid artery thrombosis, allowing expedient access to the intracranial circulation for additional thrombolytic therapy.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/15. Intra-operative monitoring of brain tissue O2 (PtiO2) during aneurysm surgery.BACKGROUND: Regional cerebral blood flow may be compromised during aneurysm surgery. This may occur during vessel occlusion by temporary cliping or result from the malposition of an aneurysm clip. In this report we monitored intra-operatively the brain tissue oxygen concentration (PtiO2) to visualize regional ischaemic events. METHOD: During surgery of 10 intracranial aneurysms, monitoring of PtiO2 was performed using a polarographic microcatheter (Licox, GMS-Kiel-germany), which was placed in the vascular territory of the artery harboring the aneurysm. FINDINGS: No complications were observed after implantation of Licox electrodes. In 6 patients PtiO2 decreased during transient clipping. In two patients PtiO2 decreased below 2 mmHg without morphological or clinical signs cerebral ischemia. In four patients, without incidence during surgery, only minor oscillations were observed. CONCLUSION: Intra-operative monitoring of PtiO2 is a complimentary procedure to monitor cerebral perfusion and detect episodes of ischaemia. Given the rapid detection of these events, therapeutic intervention may be initiated before irreversible neuronal damage occurs.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
3/15. Oropharyngeal airway appliance for infant with upper airway obstruction: report of a case.A palatal appliance with oropharyngeal tube that reduces the upper airway obstructions of an eleven-month-old male infant with severe cerebral palsy is presented. The palatal appliance was composed of the base plate, the outer guide tube that held the oropharyngeal tube inside it, and the extra outer guide tube for the suction catheter. After the setting of the appliance, respiratory distress was improved without side effects.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
4/15. case reports on emergency treatment of cardiovascular syndromes through heparin-mediated low-density lipoprotein/fibrinogen precipitation: a new approach to augment cerebral and myocardial salvage.We report the first experiences with HELP apheresis as an emergency treatment for acute cardiovascular syndromes; two patients who were not eligible for lysis therapy and catheter intervention were treated with HELP apheresis instead. Both patients had a most severe, generalized atherosclerosis and reached the hospital too late for conventional measures. In both cases, the use of the apheresis dramatically improved the clinical situation to such an extent that the possibilities of this apheresis system urge further investigation.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
5/15. Thromboembolic cerebral ischaemic attack complicating cardiac catheterization. Successful local thrombolytic therapy with reduced dose rt-PA.Cerebral ischaemia caused by thromboembolism is a possible complication of diagnostic and interventional cardiac catheterization. In this case report we describe the diagnostic steps and successful treatment strategy in the management of a patient who suffered from cerebral ischaemia during cardiac catheterization. Initial CT scanning to exclude cerebral haemorrhage was followed by angiography through the cardiac catheterization sheath in the right femoral artery. Occlusion just before the intracranial bifurcation of the right internal carotid artery was found and local thrombolysis given with a reduced dose of 34 mg rt-PA. The subsequent angiogram showed restored perfusion in the affected vessel after completion of thrombolytic therapy and resolution of neurological symptoms.- - - - - - - - - - ranking = 3.5keywords = catheter (Clic here for more details about this article) |
6/15. brain stem ischemia from intracranial dural arteriovenous fistula: case report.BACKGROUND: Intracranial dural arteriovenous fistulas (AVFs) with spinal perimedullary venous drainage are rarely reported, but most of the patients initially have presented with myelopathy or subarachnoid hemorrhage. This is the first report of the intracranial dural AVF patient who presented with brain stem infarction. CASE DESCRIPTION: A 38-year-old woman experienced nausea and vomiting with an acute onset, followed by vertigo. magnetic resonance imaging showed ischemic lesion in the medulla oblongata, and she was then sent to our hospital. On admission, she had nystagmus, swallowing difficulties, Homer syndrome, and right hemiparesis and hemisensory disturbance. cerebral angiography revealed dural AVF draining into spinal perimedullary veins at the left transverse-sigmoid sinus. The patient was treated by transvenous embolization under local anesthesia. A microcatheter proceeded to the left sigmoid sinus via the internal jugular vein, and embolization of the sinus was performed using coils without complications. The patient's swallowing difficulties improved over a few days after the embolization, and one month later, there remained only a slight mild hemiparesis and hemisensory disturbance. Six months after the onset, there was no ischemic lesion in the brain stem on magnetic resonance imaging. CONCLUSIONS: In this case, we showed the possibility of brain stem infarction, caused by the intracranial dural AVF.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
7/15. The "drip-and-ship" approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center.PURPOSE: Acute stroke therapy with intravenous (IV) tissue plasminogen activator (t-PA) is vastly underutilized. Increasingly, patients are being started on IV t-PA and being transferred to regional stroke Center programs, where additional therapies can be offered in a multimodal format. We describe our experience at the stroke Center at Hartford Hospital with interhospital patient transfers who received IV t-PA prior to transfer to our medical center. methods: A retrospective analysis of our Acute stroke Therapies database was undertaken, encompassing the intial four-year period of our stroke Center program (May 1, 2001 to April 30, 2005). We evaluated the patient characteristics, clinical outcomes, and adjunctive therapies of patients who were started on IV t-PA at referring hospitals prior to their emergent transfer to our stroke Center. RESULTS: From a total of 229 patients who received IV and/or IA thrombolysis and newer catheter-delivered devices or clinical trials at our stroke Center, a total of 33 (14.4%) were started on IV t-PA at an outside hospital prior to transfer. Symptomatic hemorrhage occurred in one of the 33 patients (3.0%), and in-hospital mortality rate for these patients was 6.1%. A total of 26 patients (78.8%) had a positive outcome in that they were discharged either to home or to acute rehabilitation. CONCLUSIONS: Use of IV t-PA in a "drip-and-ship" approach is growing at the regional stroke Center at Hartford Hospital. This protocol is safe and offers several advances for the care of patients with AIS: (a) empowering emergency physicians and neurologists at outside hospitals, via access to a 24/7 Acute stroke Hotline, to treat patients with AIS; (b) facilitating the early initiation of IV t-PA; and (c) offering adjunctive therapeutic approaches, following arrival at our facility, for patients not sufficiently improving with IV t-PA alone.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
8/15. Delayed cerebral ischemia following arteriography.Cerebral ischemic events associated with arteriography are usually attributed to catheter-induced emboli. We present three patients with cerebral ischemia occurring 6 to 48 hours post-arteriography. We suspected that alternate pathogenic mechanisms were in effect. To evaluate the possibility that sustained platelet activation occurs in association with arteriography, we measured the platelet-specific protein beta thromboglobulin (BTG) prior to and 24 hours following arteriography in two groups of patients. Group I had arteriography performed shortly after venipuncture, while Group II patients did not have arteriography between samples. Seven of eight Group I patients had an increase of BTG on day two, compared with two of eight group II patients (p less than 05). When compared to Group II changes, Group I had a significant increase of BTG on day two (p less than .05). We conclude that cerebral ischemic events associated with arteriography may occur on a delayed basis, and that platelet activation, manifested by increased BTG levels, may be one mechanism contributing to this phenomenon.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
9/15. Local fibrinolytic therapy in ischemic carotid pathology.Sixteen patients underwent local fibrinolytic therapy for thrombosis or embolism of the main trunk or intracranial branches of the internal carotid artery. There were eight cases of complete thrombosis of the internal carotid artery, five proximal stenoses of the internal carotid artery with extensive thrombus, one thrombus of the carotid siphon and two middle cerebral artery emboli. Indications for treatment included transient ischemic attacks in 11 cases, cerebral ischemia after carotid arteriography in two cases, and after surgery for atheromatous lesions of the carotid bifurcation in three cases. The fibrinolytic therapy was initiated during carotid surgery in three cases, where extended thrombosis of the internal carotid artery was discovered, which was inaccessible to a Fogarty catheter. The other 13 cases were treated during arteriography procedures. Lysis of the clot was always obtained. One patient died of hematoma of the frontal lobe. All other patients survived and showed neurologic improvement. The neurologic outcome was dependent on the duration and the degree of initial ischemia. Fibrinolytic therapy appears to be beneficial therapy for certain cases of cerebral ischemia.- - - - - - - - - - ranking = 0.5keywords = catheter (Clic here for more details about this article) |
10/15. Percutaneous transluminal angioplasty for acute stroke due to stenosis of major cerebral vessels: report of two cases.The Stealth dilation catheter was introduced for the intravascular treatment of two patients with acute and unstable ischemic stroke due to hemodynamically significant stenosis in the one case of the middle cerebral artery and in the other of the vertebral artery. Cerebral perfusion study on the two cases showed a moderately low flow area in the right cerebral hemisphere and in the left cerebellar hemisphere, respectively. Percutaneous transluminal angioplasty (PTA) using the Stealth catheter was conducted. The two cases showed marked improvement in their neurologic state just after PTA with marked increase in cerebral perfusion in the relevant regions.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
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