Efficacy Of Endovascular Treatment Research Articles

Endovascular therapy in the emergent management of intractable hemorrhage associated with head and neck neoplasms

To evaluate the feasibility, safety, and efficacy of endovascular interventions in the emergent management of life-threatening hemorrhage associated with head and neck neoplasm. Over the past 5 years, 4 patients were subjected to emergent angiography to identify the sources of intractable bleeding and to endovascular interventions in an attempt to stop bleeding and salvage patient life. Selective bilateral CCA, ICA, and ECA arteriographies were initiated to document the underlying pathology and transcatheter arterial embolization with various embolic agents and stent deployment were carried out for cessation of intractable bleeding. The overall technical success rate is 75% (3/4). Two patients with buccal carcinoma were successfully treated with gelatin sponge pledgets and polyvinyl alcohol particles embolizations. One patient with a bulky ruptured RICA pseudoaneurysm associated with neurofibromatosis was successfully embolized with a 2–4 mm fibered platinum coil. The remaining patient with a wide-neck LCCA pseudoaneurysm resulted from IAIC for left buccal carcinoma was treated with two superimposing Easy Wallstents in the distal LCCA-LICA followed by 10 platinum coils embolizations due to non-availability of stent-graft (Covered stent). Unfortunately, despite sluggish flow leading to the pseudoaneurysm appreciated on fluoroscopy, the fragile pseudoaneurysm ruptured approximately 8 minutes thereafter while waiting for complete thrombosis. With the stents in place at LCCA-LICA, the vascular surgeon was able to ligate the LCCA and LICA to exclude the psendoaneurysm. No complications were encountered in all patients. Endovascular therapy with various embolic agents and stent deployments were feasible, safe, and efficacious in the acute management of intractable hemorrhage associated with head and neck neoplasms.

Valutazione peri-operatoria e post-operatoria del trattamento endovascolare nella patologia steno-ostruttiva carotidea

We evaluated peri-operative and 30 days post-operative efficacy of endovascular treatment of carotid stenosis performed with percutaneous angioplasty and stenting. From June 1996 to October 2002 we performed 156 endovascular treatments of carotid artery stenosis in 150 symptomatic patients with ages ranging from 40 to 87. We treated with angioplasty and stent 110 patients with primitive carotid plaque (70.5%) and 44 patients with non-atherosclerotic lesion: 34 were post-surgical restenosis (21.7%) of the carotid bifurcation after carotid endarterectomy, 6 post-actinic stenosis, 2 carotid stenosis in Takayasu disease and 2 post-stent restenosis. Twelve patients were treated before cardio-surgical intervention and 8 were stroke patients performed in acute phase. Angioplasty alone was done in 11 cases (7.1%) while stent placement was performed in 145 cases (92.9%). In 71 patients (50%) the endovascular treatment was performed during distal cerebral protection. We achieved the dilatation of the stenotic tract in all the patients with residual stenosis less than 30% in 98% of cases. Two permanent neurological deficits (1.28%) and 4 transient neurological deficit (3.2%) were observed. One patient died 20 days after the procedure because of cardio-surgical complications. Fifteen patients (9.6%) complained a transient orthostatic hypotension. No new clinical complication was observed during 30 days follow-up. Our results with the endovascular treatment of the carotid stenosis appear not significantly different from recent literature data and main surgical publications and trails about the carotid endarterectomy in symptomatic patients. Our complication rate is similar to surgery, probably because of our patient selection and to the evolution of the materials for endovascular therapy. Our results underline the efficacy and safety of the endovascular technique with possible extension of its indications to primitive stenosis in selected cases and in the treatment of acute stroke.

Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas--initial success and long-term results.

To evaluate safety and efficacy of endovascular interventions in failing antebrachial Brescia-Cimino hemodialysis fistulas in consecutive patients. Altogether, 103 interventions were performed in 53 Brescia-Cimino shunts in 51 patients by means of antegrade brachial arterial access. Twelve interventions were initiated with pharmacomechanical thrombolysis and/or thromboaspiration. All interventions included balloon angioplasty that was completed with stent placement in eight cases and with endovascular brachytherapy with an iridium 192 source in five cases. The technical success rate of the primary interventions was 92% (49 of 53) and that for all interventions was 95% (98 of 103). The rate of major complications was 4% (four of 103). Clinical success was achieved in 92% (95 of 103) of the interventions. By including the initial failures, 58% +/- 7 (standard error of the estimate), 44% +/- 8, 40% +/- 8, and 32% +/- 10 primary and 90% +/- 5, 85% +/- 5, 79% +/- 7, and 79% +/- 7 secondary clinical patency rates were registered at 6 months and 1, 2, and 3 years, respectively, by means of Kaplan-Meier analysis. The location of the main treated lesion at the arteriovenous anastomosis (P =.03) was a predictor of poorer long-term patency. Endovascular interventions with antegrade brachial arterial access are highly effective in restoring function in failing Brescia-Cimino fistulas.

Multicenter Evaluation of the Efficacy of Endovascular Treatment for Symptomatic Vasospasm unresponsive to Hypervolemic and Hypertensive Therapy in Patients with Subarachnoid Hemorrhage.

P231 BACKGROUND AND PURPOSE: Symptomatic vasospasm remains an important cause of morbidity and mortality in patients with subarachnoid hemorrhage (SAH). Endovascular techniques have recently been introduced for treatment of vasospasm resistant to medical treatment. We performed this study to determine the safety and efficacy of these techniques in a large series of patients with SAH. METHODS: We reviewed the medical records, angiograms, and computed tomographic (CT) scans for patients who underwent endovascular treatment for symptomatic vasospasm at 3 university-affiliated centers. The following outcomes were analyzed; angiographic improvement, neurological improvement, ability to prevent cerebral infarction as demonstrated by serial CT scans, and outcome at 3 months using Glasgow Outcome Scale (GOS). RESULTS: Forty-five patients (mean age 51 ±10 years; 13 were men) were treated for symptomatic vasospasm. The vasospasm was graded as severe (n=27), moderate (n=16), and mild (n=2) by angiographic criteria. Angioplasty was performed in 26 patients; intra-arterial papaverine was administered as adjunctive therapy in 11 procedures. Nineteen patients were treated with intra-arterial papaverine alone. Angiographic improvement was documented in all patients. Cerebral infarction was observed in 29 (64%) of 45 patients on follow-up CT scan. Good outcome (minimal or no disability by GOS) was seen in 12 (27%) patients. CONCLUSIONS: Although endovascular treatment of symptomatic vasospasm results in good angiographic response, a high proportion of cerebral infarction and poor outcomes is still observed in patients who failed medical treatment. New strategies need to be developed to improve outcome in this subset of patients with SAH.

Multicenter Evaluation of the Efficacy of Endovascular Treatment for Symptomatic Vasospasm unresponsive to Hypervolemic and Hypertensive Therapy in Patients with Subarachnoid Hemorrhage.

P231 BACKGROUND AND PURPOSE: Symptomatic vasospasm remains an important cause of morbidity and mortality in patients with subarachnoid hemorrhage (SAH). Endovascular techniques have recently been introduced for treatment of vasospasm resistant to medical treatment. We performed this study to determine the safety and efficacy of these techniques in a large series of patients with SAH. METHODS: We reviewed the medical records, angiograms, and computed tomographic (CT) scans for patients who underwent endovascular treatment for symptomatic vasospasm at 3 university-affiliated centers. The following outcomes were analyzed; angiographic improvement, neurological improvement, ability to prevent cerebral infarction as demonstrated by serial CT scans, and outcome at 3 months using Glasgow Outcome Scale (GOS). RESULTS: Forty-five patients (mean age 51 ±10 years; 13 were men) were treated for symptomatic vasospasm. The vasospasm was graded as severe (n=27), moderate (n=16), and mild (n=2) by angiographic criteria. Angioplasty was performed in 26 patients; intra-arterial papaverine was administered as adjunctive therapy in 11 procedures. Nineteen patients were treated with intra-arterial papaverine alone. Angiographic improvement was documented in all patients. Cerebral infarction was observed in 29 (64%) of 45 patients on follow-up CT scan. Good outcome (minimal or no disability by GOS) was seen in 12 (27%) patients. CONCLUSIONS: Although endovascular treatment of symptomatic vasospasm results in good angiographic response, a high proportion of cerebral infarction and poor outcomes is still observed in patients who failed medical treatment. New strategies need to be developed to improve outcome in this subset of patients with SAH.

Central Venous Stenosis in the Hemodialysis Patient: Incidence and Efficacy of Endovascular Treatment

Central venous stenosis occurs as a complication of central venous catheterization and significantly complicates delivery of dialysis through arteriovenous grafts in the ipsilateral upper limb. This report includes two separate studies. Functioning expanded polytetrafluorethylene grafts have been prospectively evaluated using duplex scanning and angiography performed in all patients with stenoses >50%. From this, it has been prospectively established that the incidence of unsuspected central venous stenoses in patients with functioning grafts is 29%. In the second part of the report, the authors' experience in the treatment of 25 central venous stenoses with percutaneous angioplasty and stent placement has been retrospectively reviewed. Initial technical success rate was 88%. Primary patency was 84% at 1 month, 42% at 6 months, and 17% at 1 year. Mean primary patency was 5.7 months. Stents were placed in five patients. Prevention of central venous stenosis by avoiding subclavian catheterization is optimal. Balloon angioplasty provides short-term patency, but it is the only option in most cases. The role for endovascular stent placement remains to be defined but early results are not optimistic.

Central venous stenosis in the hemodialysis patient: incidence and efficacy of endovascular treatment

Central venous stenosis occurs as a complication of central venous catheterization and significantly complicates delivery of dialysis through arteriovenous grafts in the ipsilateral upper limb. This report includes two separate studies. Functioning expanded polytetrafluorethylene grafts have been prospectively evaluated using duplex scanning and angiography performed in all patients with stenoses >50%. From this, it has been prospectively established that the incidence of unsuspected central venous stenoses in patients with functioning grafts is 29%. In the second part of the report, the authors' experience in the treatment of 25 central venous stenoses with percutaneous angioplasty and stent placement has been retrospectively reviewed. Initial technical success rate was 88%. Primary patency was 84% at 1 month, 42% at 6 months, and 17% at 1 year. Mean primary patency was 5.7 months. Stents were placed in five patients. Prevention of central venous stenosis by avoiding subclavian catheterization is optimal. Balloon angioplasty provides short-term patency, but it is the only option in most cases. The role for endovascular stent placement remains to be defined but early results are not optimistic.