ABSTRACT
O tromboembolismo pulmonar (TEP) maciço é uma importante causa de mortalidade. A principal causa de óbito é a disfunção do ventrículo direito, provocada pela alta resistência ao seu fluxo de ejeção, e a sobrevida do paciente, nessas situações, depende da pronta desobstrução das artérias pulmonares. A anticoagulação, o uso de trombolíticos e a embolectomia pulmonar representam opções terapêuticas consolidadas para diferentes cenários clínicos de TEP. A Radiologia Intervencionista representa hoje uma alternativa terapêutica para pacientes com TEP maciço e contraindicação ao uso de trombolíticos, sendo uma escolha menos invasiva do que a embolectomia. Os autores relataram um caso de paciente com TEP maciço e contraindicação à trombólise, a qual foi submetida a aspiração percutânea dos trombos das artérias pulmonares, e discutiram os principais mecanismos de técnicas endovasculares para tratamento de TEP.
Massive pulmonary thromboembolism is an important cause of mortality. Its main cause of death is the failure of the right ventricle, due to the high resistance to its outflow, and the patient survival, on these cases, depends on prompt recanalization of the pulmonary arteries. Anticoagulation, use of thrombolytics and pulmonary embolectomy represent established therapeutic options to different clinical scenarios of pulmonary thromboembolism. Nowadays, Interventional Radiology represents an alternative to treat patients with massive pulmonary thromboembolism and contra-indications to thrombolytics, and is a less invasive option compared to embolectomy. The authors reported a case of a patient with massive pulmonary thromboembolismand contra-indication to thrombolysis, who was submitted to percutaneous clot aspiration of the pulmonary arteries, and discussed the main mechanisms of endovascular techniques of pulmonary thromboembolism treatment.
Subject(s)
Humans , Pulmonary Embolism/therapy , Blood Vessel Prosthesis/trends , Radiology, Interventional/trends , Heart Ventricles/abnormalities , Embolectomy/nursing , Fibrinolytic Agents , Suction/adverse effectsABSTRACT
BACKGROUND: The proportionally higher incidence of intracranial atherosclerosis among Asian and black patients and a greater proclivity for intracranial artery stenosis in the Hispanic population merit drawing attention to a Latin American experience with intracranial arterial stenting. METHODS: This is a retrospective analysis of an observational study of 33 intracranial lesions (each >50% stenosis) in 32 patients treated by intracranial angioplasty in 6 Latin American centers over a 3-year period. The investigation used a unique device, a balloon-expandable stent (Lekton Motion stent system, now Pharos, Biotronik, AG, Bülach, Switzerland). RESULTS: The treated patients ranged in age from 30 to 81 years (mean, 59.3 years; SD, 12 years), including 24 male and 8 female patients (sex ratio, 4:1). Two were Asians, 4 were blacks, and the rest were white Hispanic. Our mean follow-up is of 10.2 months (SD, 7.84 months), with a mortality rate of 9.4% (3/32), a nonfatal complication rate of 6.2%, and a stroke rate (rate of recurrence) of 0%. The mean pretreatment stenosis of 68.75% (SD, 14%) was reduced to a residual of 5.16% (SD, 16%) (P = .000; 95% confidence interval, 56.8%-70.3%). A control angiogram was performed in 82% of patients, and in that case, the restenosis 50% or greater was of 8.7% during the follow-up period. CONCLUSION: The treatment of intracranial stenosis with the Lekton Motion stent (Pharos) is feasible with a high technical success rate. Restenosis as well as the rate of new neurologic events during follow-up suggests some efficacy of stroke prevention by using the latest-generation, highly trackable, balloon-expandable stents.
Subject(s)
Cerebral Arterial Diseases/surgery , Stents , Adult , Aged , Aged, 80 and over , Angioplasty , Anticoagulants/therapeutic use , Atherosclerosis/complications , Cerebral Angiography , Cerebral Arterial Diseases/etiology , Cerebral Arterial Diseases/mortality , Constriction, Pathologic , Endpoint Determination , Female , Follow-Up Studies , Humans , Latin America , Male , Middle Aged , Neurosurgical Procedures , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Preoperative Care , Recurrence , Retrospective StudiesABSTRACT
We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its etiological, physiopathological, diagnostic and therapeutic aspects.
Subject(s)
Arteriovenous Fistula/diagnostic imaging , Dura Mater , Intracranial Arteriovenous Malformations/diagnostic imaging , Spinal Cord/blood supply , Spinal Cord/diagnostic imaging , Arteriovenous Fistula/therapy , Cerebral Angiography , Humans , Intracranial Arteriovenous Malformations/therapy , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
Apresentamos um caso típico de fístula arteriovenosa dural intracraniana com drenagem para o plexo venoso peribulbar e veias perimedulares. Discutimos seus aspectos etiológicos e fisiopatológicos, bem como os critérios de diagnóstico e tratamento deste tipo de lesäo