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2.
Medicine (Baltimore) ; 99(15): e19655, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282715

RESUMO

Endovascular treatment of arterial injuries with stent-graft is a reliable alternative approach in patients not suitable for embolization or at high risk for surgery. The aim of our study was to evaluate the efficacy and the safety of the BeGraft stent-graft, a low-profile balloon expandable covered stent, for emergency endovascular treatment of iatrogenic arterial injuries.Between August 2015 and September 2018, 34 consecutive patients (mean age 71 ±â€Š12 years, 9 females) underwent implantation of BeGraft stent-grafts for iatrogenic arterial injuries (22 active bleedings, 11 pseudoaneurysms, and 1 enteric-iliac fistula). The primary endpoints were technical and clinical success and rates of major and minor complications. The secondary endpoint was the patency of the device during the follow-up. Imaging follow-up was performed by duplex ultrasound and/or computed tomography angiography (according to lesion site/target vessel), at 1-6-12-15 and 24 months.In all 34 patients (100%), the lesion or the defect was effectively excluded with a cumulative amount of 42 stent-grafts. The clinical success was documented in 30/34 patients (88.2%). Neither device- or procedure-related deaths, or major complications occurred. A minor complication was reported in 1 patient (2.9%), successfully treated during the same procedure. Thirty (88.2%) patients were available for a mean follow-up time of 390 ±â€Š168 days (minimum 184, maximum 770), with no observed loss of patency, yielding a 100% Kaplan-Meier cumulative survival patency function. The percentage of patent patients was 30/30 at 6 months, 22/22 at 12 months, and 5/5 at 15 months.Endovascular treatment of iatrogenic arterial injuries with the BeGraft stent-graft is minimally invasive and effective, with good patency rate at midterm follow-up.


Assuntos
Embolização Terapêutica/métodos , Tratamento de Emergência/normas , Doença Iatrogênica/epidemiologia , Lesões do Sistema Vascular/terapia , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/epidemiologia , Falso Aneurisma/terapia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Feminino , Hemorragia/epidemiologia , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento , Fístula Vascular/epidemiologia , Fístula Vascular/terapia , Grau de Desobstrução Vascular
3.
Vasc Endovascular Surg ; 54(5): 389-394, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32281501

RESUMO

BACKGROUND AND AIMS: The management of persistent type II endoleaks (T2E) is often problematic for the endovascular specialist, with a lack of clear evidence for the best approach for embolization. The aim of this study was to evaluate the safety and efficacy of translumbar embolization (TLE) for T2E following endovascular aneurysm repair (EVAR). METHODS: This retrospective review included 27 embolizations performed on 23 patients with a median age of 78 (range 67-94 years; male: female 15:9), during the period September 2006 to July 2018. Primary outcome was freedom from aneurysm sac growth defined as <2 mm sac diameter increase on subsequent computed tomography. RESULTS: The initial technical success rate was 100%, with complete "on table" embolization of the T2E on fluoroscopy; however, 4 (15%) patients needed repeat TLE due to persistent endoleak identified on follow-up computed tomography or because of further sac expansion. Satisfactory stasis was achieved in these 4 cases following a second embolization. The mean volume of embolic injected was 7.4 mL per case. Feeding vessels were identified on angiography in all cases; the nidus was supplied by lumbar branches in 21 cases, by the inferior mesenteric artery in 1 case and by both in a further 5 cases. Freedom from aneurysm sac growth (defined as < 2 mm) following 1 or 2 separate TLE was achieved in 18 (78%) and 20 (86%) patients, respectively. The major complication rate was <5% with one case of psoas abscess presenting 7 months following embolization; there were 2 minor complications in the form of intraprocedural transient abdominal pain. CONCLUSION: The translumbar approach is a safe and effective technique to treat T2E, as evidenced by the low complication and reintervention rate.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Oclusão com Balão , Implante de Prótese Vascular/efeitos adversos , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Oclusão com Balão/efeitos adversos , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(17): e19727, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332612

RESUMO

Successful treatment of esophagogastric varices (EGV) with giant portal-systemic shunt is challenging. To explore the feasibility and safety of a novel hybrid procedure involving interventional radiology and endoscopy in the same sitting.Three cases clinically diagnosed to have decompensated cirrhosis and EGV with giant gastrorenal shunt (GRS) on contrast-enhanced computed tomography (CT) were included. The hybrid procedures included: indirect portography, hepatic vein pressure gradient (HVPG) measurement, HVPG-based partial splenic embolization (PSE), retrospective GRS balloon occlusion, endoscopic histoacryl injection (EHI), balloon catheter radiography and withdrawal. All the procedures were done in the same operation room. Main outcomes measurements included operation time, complications, and re-bleeding events.Hybrid interventions were performed successfully in 3 cases with a mean operation time of 63.3 minutes without any major intra- and post-operation complications. No rebleeding occurred at 6-month follow-up.Synchronous hybrid intervention combining radiology and endoscopy is feasible and safe for patients with EGV and giant GRS, preliminary study with limited cases deserves further exploration.


Assuntos
Endoscopia Gastrointestinal/métodos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/terapia , Derivação Portossistêmica Cirúrgica/métodos , Radiologia Intervencionista/métodos , Oclusão com Balão/efeitos adversos , Oclusão com Balão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Cirúrgica/normas , Estudos Retrospectivos
7.
Nursing ; 50(4): 24-29, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32142014

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has reemerged as a treatment for noncompressible torso hemorrhage. This article discusses indications and contraindications for REBOA, describes the procedure, and reviews nursing considerations for patients undergoing REBOA.


Assuntos
Aorta , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Hemorragia/enfermagem , Ressuscitação/métodos , Tronco/fisiopatologia , Humanos
8.
J Spec Oper Med ; 20(1): 34-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203602

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to augment resuscitation in patients with noncompressible torso hemorrhage, which is a leading cause of death on the battlefield. However, the implementation of REBOA has resulted in considerable debate within the military medical community. We present a case of the first successful placement of an REBOA by a small surgical team within a mobile rotary wing platform.


Assuntos
Arteriopatias Oclusivas/terapia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Hemorragia/terapia , Ressuscitação/métodos , Lesões Relacionadas à Guerra/terapia , Aorta Abdominal , Humanos , Unidades Móveis de Saúde , Resultado do Tratamento
9.
J Spec Oper Med ; 20(1): 81-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203611

RESUMO

BACKGROUND: Early hemorrhage control using resuscitative endovascular balloon occlusion of the aorta (REBOA) can save lives. This study was designed to evaluate the ability to train Quick Response Team Fire Fighters (QRT-FF) to gain percutaneous femoral artery access and place a REBOA catheter in a model, using a comprehensive theoretical and practical training program. METHODS: Six QRT-FF participated in the training. SOF medics from a previous training served as the control group. A formalized training curriculum included basic anatomy and endovascular materials for percutaneous access and REBOA placement. Key skills included (1) preparation of an endovascular toolkit, (2) achieving vascular access in the model, and (3) placement and positioning of REBOA. RESULTS: QRT-FF had significantly better scores compared with medics using endovascular materials (P = .003) and performing the procedure without unnecessary attempts (P = .032). Basic surgical anatomy scores for QRT-FF were significantly better than SOF medics (P = .048). QRT-FF subjects demonstrated a significantly higher overall technical skills point score than medics (P = .030). QRT-FF had a median total time from start of the procedure to REBOA inflation of 3:23 minutes, and medics, 5:05 minutes. All six QRT-FF subjects improved their procedure times-as did four of the five medics. CONCLUSIONS: Our training program using a task training model can be utilized for percutaneous femoral access and REBOA placement training of QRT-FF without prior ultrasound or endovascular experience. Training the use of advanced bleeding control options such as REBOA, as a secondary occupational task, has the potential to improve outcomes for severely bleeding casualties in the field.


Assuntos
Bombeiros/educação , Hemorragia/prevenção & controle , Aorta , Oclusão com Balão , Cateterismo Periférico , Procedimentos Endovasculares , Estudos de Viabilidade , Artéria Femoral , Humanos , Avaliação de Programas e Projetos de Saúde , Ressuscitação
10.
Br J Radiol ; 93(1108): 20190751, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32017608

RESUMO

OBJECTIVE: To determine the utility of low-dose gelatin sponge particles and 5% ethanolamine oleate iopamidol (EOI) mixture in retrograde transvenous obliteration (GERTO) for gastric varices (GV). METHODS: 57 consecutive patients who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) for GV were divided into three groups with Hirota's grade by balloon-occluded retrograde transvenous venography. Hirota's Grade 1 patients were assigned to G1 group and underwent treatment with 5% EOI. Grade ≥ 2 patients prior to August 2015 were G ≥ 2 group treated with 5% EOI, and those treated thereafter were GERTO group. The amount of EOI used per unit GV volume (EOI/GV ratio), the times to embolization and recurrence rate of GV were evaluated. RESULTS: The EOI/GV ratio was 0.66 ± 0.19 in G1, 1.5 ± 0.8 in G ≥ 2, and 0.58 ± 0.23 in GERTO (G ≥ 2 vs GERTO, p < 0.0001). The times to embolization were 26.5 ± 10.5 min for G1, 39.2 ± 26.8 for G ≥ 2, and 21.4 ± 9.4 for GERTO (G ≥ 2 vs GERTO, p = 0.005). The recurrence rate was not significantly different in any of the groups. CONCLUSION: GERTO was performed in lower amount of sclerosants and in less time compared to conventional B-RTO in Hirota's grade ≥2. ADVANCES IN KNOWLEDGE: Feasibility of low-dose gelatin sponge particles and 5% EOI mixture as sclerosants for GV.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Gelatina/administração & dosagem , Iopamidol/administração & dosagem , Ácidos Oleicos/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Idoso , Oclusão com Balão/efeitos adversos , Combinação de Medicamentos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Flebografia/métodos
11.
J Cardiothorac Surg ; 15(1): 32, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013986

RESUMO

BACKGROUND: Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs. CASE PRESENTATION: A case of a 52 year-old female with 10 years history of typical palpitations and chest tightness was presented. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs. The patient was successfully treated with coil embolization. CONCLUSIONS: We presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs. The fistulas were safely and successfully closed by coil embolization. We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon. FFR could be a promising means for the treatment of decision making of the CPFs.


Assuntos
Fístula Artério-Arterial/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Artéria Pulmonar/fisiopatologia , Fístula Artério-Arterial/congênito , Fístula Artério-Arterial/diagnóstico por imagem , Oclusão com Balão , Angiografia Coronária , Doença da Artéria Coronariana/congênito , Doença da Artéria Coronariana/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Embolização Terapêutica , Feminino , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem
13.
World Neurosurg ; 136: 220, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954888

RESUMO

We report the case of a 15-year-old male patient with polyarteritis nodosa who presented with ruptured lenticulostriate artery (LSA) aneurysm and was successfully treated with endovascular N-butyl-2-cyanoacrylate (Histoacryl, B. Braun, Melsungen, Germany) acrylic glue embolization. Selective catheterization of LSA is sometimes difficult even with a low-profile microcatheter (Magic 1.2 FM, Balt Extrusion, Montmorency, France) due to acute angulation at the origin of the artery. In this 2-dimensional video illustration of the roadmap in digital subtraction angiography, reproduced after informed consent of the patient, we illustrate the balloon blocking technique to safely and effectively navigate the microcatheter through the small perforator with difficult angulation at the origin. A Magic microcatheter was passed via a distal access catheter 070 (Concentric Medical, Mountain View, California, USA) 105 cm in the internal carotid artery. The Magic microcatheter advancement was supported with a 0.008-inch guidewire (Hybrid 008, Balt Extrusion, Montmorency, France). Initial catheterization of LSA even with a low-profile Magic microcatheter was difficult as the origin of LSA was acute angled. While trying the navigate the microcatheter into the perforator, it was continuously flopping into the distal M1 segment of the middle cerebral artery. The balloon microcatheter (Scepter XC 4 × 11mm, Microvention, Tustin, California, USA) was passed separately via 5 French Envoy guiding catheter (Codman, Raynham, Massachusetts, USA) 100 cm in the proximal ICA using a contralateral left femoral artery puncture. The Balloon microcatheter advancement into the middle cerebral artery was supported with a Traxcess 0.014-inch microguidewire (Microvention). It was then inflated just beyond the origin of LSA which provided support to the magic microcatheter and thus allowing its easy navigation into the LSA. Super-selective microcatheter injection confirmed filling of the LSA aneurysm. A dilute 33% concentration of the liquid embolic agent N-butyl-2-cyanoacrylate mixed with Lipiodol (Guerbet, Aulnay-sous-Bois, France) was injected slowly under direct vision. The final-check angiogram revealed complete occlusion of the aneurysm (Video 1). Patient underwent craniotomy and hematoma evacuation 1 day after the procedure in view of his rapidly deteriorating neurological status. He was later discharged with Modified Rankin Scale of 3. Follow up angiography after 3 months showed completely occluded aneurysm (Video 2).


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adolescente , Artérias Cerebrais , Corpo Estriado/irrigação sanguínea , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino
14.
J Trauma Acute Care Surg ; 88(2): 298-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31996655

RESUMO

BACKGROUND: Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) and intermittent REBOA (iREBOA) are techniques to extend the therapeutic duration of REBOA by balloon titration for distal flow or cyclical balloon inflation/deflation to allow transient distal flow, respectively. We hypothesized that manually titrated pREBOA would reduce blood losses and ischemic burden when compared with iREBOA. METHODS: Following 20% blood volume controlled hemorrhage, 10 anesthetized pigs underwent uncontrolled hemorrhage from the right iliac artery and vein. Once in hemorrhagic shock, animals underwent 15 minutes of complete zone 1 REBOA followed by 75 minutes of either pREBOA or iREBOA (n = 5/group). After 90 minutes, definitive hemorrhage control was obtained, animals were resuscitated with the remaining collected blood, and then received 2 hours of critical care. RESULTS: There were no differences in mortality. Animals randomized to iREBOA spent a larger portion of the time at full occlusion when compared with pREBOA (median, 70 minutes; interquartile range [IQR], 70-80 vs. median, 20 minutes; IQR, 20-40, respectively; p = 0.008). While the average blood pressure during the intervention period was equivalent between groups, this was offset by large fluctuations in blood pressure and significantly more rescue occlusions for hypotension with iREBOA. Despite lower maximum aortic flow rates, the pREBOA group tolerated a greater total amount of distal aortic flow during the intervention period (median, 20.9 L; IQR, 20.1-23.0 vs. median, 9.8 L; IQR, 6.8-10.3; p = 0.03) with equivalent abdominal blood losses. Final plasma lactate and creatinine concentrations were equivalent, although iREBOA animals had increased duodenal edema on histology. CONCLUSION: Compared with iREBOA, pREBOA reduced the time spent at full occlusion and the number of precipitous drops in proximal mean arterial pressure while delivering more distal aortic flow but not increasing total blood loss in this highly lethal injury model. Neither technique demonstrated a survival benefit. Further refinement of these techniques is necessary before clinical guidelines are issued.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Animais , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Modelos Animais de Doenças , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Análise de Sobrevida , Sus scrofa , Fatores de Tempo , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
15.
J Comput Assist Tomogr ; 44(3): 399-404, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929377

RESUMO

To report feasibility, safety, and technical advantages of flat-detector computed tomography perfusion (FD-CTP) during balloon test occlusion (BTO) angiography studies, 10 patients patients scheduled for BTO were evaluated. Cerebral blood volume maps were extracted from FD-CTP images acquired during the test. The FD-CTP perfusion combined with BTO is feasible and safe in intracranial tumor, and aneurysm cases in which vessel sacrifice should be considered.


Assuntos
Oclusão com Balão/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/cirurgia , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias Encefálicas/cirurgia , Circulação Cerebrovascular/fisiologia , Estudos de Viabilidade , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Software , Tomografia Computadorizada por Raios X/métodos
16.
Ultraschall Med ; 41(2): 157-166, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30909311

RESUMO

PURPOSE: To assess liver stiffness (LS) and spleen stiffness (SS) values measured by virtual touch quantification (VTQ) technique in the monitoring of portal pressure and their usefulness for the prediction of the exacerbation of esophageal varices (EV) in patients with gastric varices undergoing balloon-occluded retrograde transvenous obliteration (B-RTO). MATERIALS AND METHODS: The LS, SS, and hepatic venous pressure gradient (HVPG) were measured in 20 patients both before and after B-RTO. The change in each parameter between the two groups (EV exacerbation and non-exacerbation groups) was compared by analysis of variance. The efficacy of the parameters for the prediction of the exacerbation of EV was analyzed using a receiver operating characteristic (ROC) curve analysis. RESULTS: 9 patients (40.9 %) exhibited an exacerbation of EV within 24 months after B-RTO. Significant changes were observed in the HVPG and SS after B-RTO between the two groups (EV exacerbation group vs. non-exacerbation group: HVPG before 12.7 ±â€Š4.4 mmHg vs. 11.0 ±â€Š4.4 mmHg; HVPG after 19.6 ±â€Š6.0 mmHg vs. 13.6 ±â€Š3.1 mmHg P = 0.003; SS before 3.40 ±â€Š0.50 m/s vs. 3.20 ±â€Š0.51 m/s; SS after 3.74 ± 0.53 m/s vs. 3.34 ±â€Š0.43 m/s P = 0.016). However, no significant changes in LS were observed between the two groups. The area under the ROC curves of elevation in HVPG and SS for the prediction of the exacerbation of EV after B-RTO were 0.833 and 0.818, respectively. CONCLUSION: Elevation of the HVPG and SS measured by VTQ after B-RTO was useful for the prediction of the exacerbation of EV.


Assuntos
Oclusão com Balão , Varizes Esofágicas e Gástricas , Fígado , Baço , Interface Usuário-Computador , Elasticidade , Varizes Esofágicas e Gástricas/complicações , Humanos , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Baço/diagnóstico por imagem , Baço/fisiopatologia , Resultado do Tratamento
18.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479795

RESUMO

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Artérias Temporais/cirurgia , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Circulação Cerebrovascular , Transtornos Cognitivos/etiologia , Estudos de Viabilidade , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Adulto Jovem
20.
World Neurosurg ; 134: 62-66, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669689

RESUMO

BACKGROUND: Spinal arteriovenous fistulas (AVFs) are a rare entity that can have devastating neurologic outcomes. Currently, these lesions are treated via open microsurgical resection or transarterial embolization with good success. However, some patients cannot be treated with a minimally invasive endovascular technique secondary to difficulty catheterizing their vascular anatomy. Our aim is to present a case of balloon-assisted Onyx embolization of a spinal AVF. CASE DESCRIPTION: We present the case of a 59-year-old male with progressive lower back pain with lower-extremity weakness. We performed a spinal angiogram where an AVF was identified with very torturous anatomy. The patient was originally treated with open microsurgical resection; however, ≈6 weeks later the fistula and symptoms returned. At that time, we were able to treat the lesion with the Scepter-C balloon. CONCLUSIONS: We present a challenging case in which normal embolization microcatheters were unable to navigate difficult anatomy, but we were able to gain access and obliterate the fistula by using a balloon catheter.


Assuntos
Oclusão com Balão/métodos , Malformações Vasculares do Sistema Nervoso Central/terapia , Dimetil Sulfóxido/uso terapêutico , Embolização Terapêutica/métodos , Polivinil/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
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