ABSTRACT
We report a patient with an important scenario that may arise in the management of an acute ischemic stroke: the need for a repeated mechanical thrombectomy in the same intracranial artery segment. The patient had a history of atrial fibrillation and a mechanical mitral valve replacement. In her first stroke, she had an occlusion of the proximal segment of the right middle cerebral artery; 58 days later, she presented with an occlusion in the same segment of that cerebral artery. In both instances, the thrombus was extracted by a stent retriever with good clinical and radiographic results. To the best of our knowledge, this is the first report of a repeated mechanical thrombectomy in the same intracranial artery segment using stent retriever devices.
Subject(s)
Infarction, Middle Cerebral Artery/therapy , Thrombectomy/methods , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Cerebral Angiography/methods , Computed Tomography Angiography , Female , Heart Valve Prosthesis Implantation/adverse effects , Humans , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/etiology , Middle Aged , Recurrence , Retreatment , Stents , Thrombectomy/instrumentation , Treatment OutcomeABSTRACT
OBJECTIVES: To review imaging features of paragangliomas. To determine the usefulness of pre-operative embolization. MATERIAL AND METHOD: From January 1994 to December 2004, 30 patients at our institution were found to have 33 paragangliomas of the head and neck. They were evaluated with US, CT, MRI, and angiography. RESULTS: Location distribution was: 16 carotid (1 case of bilateral and 2 of multi-centric presentation are reported), 14 in temporal bone, and 3 vagal. Embolization was performed in 22 cases. It was palliative in 2 cases and adjuvant to surgery (18) or to surgery and radiation therapy (2), resulting in a reduction of surgical complications. Eight patients were operated on and 3 rejected any treatment. CONCLUSIONS: Imaging studies are essential in the differential diagnosis of head and neck masses. Pre-operative embolization is a major advance in the surgical management of paragangliomas because it decreases potential intra-operative bleeding.
Subject(s)
Carotid Body Tumor/pathology , Carotid Body Tumor/therapy , Embolization, Therapeutic/methods , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/therapy , Magnetic Resonance Imaging , Female , Humans , Male , Middle AgedABSTRACT
Objetivos: Revisar los hallazgos de imagen de los paragangliomas. Determinar la utilidad de la embolización preoperatoria. Material y método: De enero de 1994 a diciembre de 2004, en nuestro hospital se diagnosticó a 30 pacientes de 33 paragangliomas de cabeza y cuello. Fueron estudiados mediante ultrasonografía, tomografía computarizada, resonancia magnética y arteriografía. Resultados: Distribución según localización: 16 carotídeos (incluidos 1 caso de bilateralidad y 2 de presentación multicéntrica), 14 en el hueso temporal y 3 vagales. La embolización se realizó en 22 casos. Fue paliativa en 2 y adyuvante a la cirugía (18) o a la cirugía y radioterapia (2), y consiguió la reducción del número de complicaciones quirúrgicas. Se operó a 8 pacientes y 3 rechazaron cualquier tratamiento. Conclusiones: Los estudios de imagen son esenciales en el diagnóstico diferencial de las masas de cabeza y cuello. La embolización preoperatoria es el mayor avance en el manejo quirúrgico de los paragangliomas porque disminuye las potenciales hemorragias intraoperatorias
Objectives: To review imaging features of paragangliomas. To determine the usefulness of pre-operative embolization. Material and method: From January 1994 to December 2004, 30 patients at our institution were found to have 33 paragangliomas of the head and neck. They were evaluated with US, CT, MRI, and angiography. Results: Location distribution was: 16 carotid (1 case of bilateral and 2 of multi-centric presentation are reported), 14 in temporal bone, and 3 vagal. Embolization was performed in 22 cases. It was palliative in 2 cases and adjuvant to surgery (18) or to surgery and radiation therapy (2), resulting in a reduction of surgical complications. Eight patients were operated on and 3 rejected any treatment. Conclusions: Imaging studies are essential in the differential diagnosis of head and neck masses. Pre-operative embolization is a major advance in the surgical management of paragangliomas because it decreases potential intra-operative bleeding