Biomedical subjects

Charles J Prestigiacomo

Publications and source records attributed to Charles J Prestigiacomo.

5 recordsLinked to original sources

PubMed2006

Surgical endovascular neuroradiology in the 21st century: what lies ahead?

Few could have imagined the tremendous growth of endovascular surgery over the past 40 years. Endovascular therapy has greatly enhanced the care of the patient in neurosurgery, spine surgery, and head and neck surgery. Progress in technology and techniques continue to push forward the boundaries of what is deemed "treatable," assuming acceptable risk. This article will briefly review the current state of endovascular surgery and speculate about what its role will be in the near and far future. Endovascular therapy provides a minimally invasive approach to the central nervous system and other systems via natural and, at times, highly selective pathways. Maximizing the accessibility of these routes to highly specific regions of the central nervous system provides an elegant and minimalist approach to treating diseases of the central nervous system with almost no "footprints" of ever having accessed the region. In the future, safe, efficient and intelligent delivery systems that may enhance or alter the tissue's response may result in successful treatment of cerebrovascular diseases, as well as other diseases of the craniospinal axis. The growth of nanotechnology, metallurgy, synthetic polymers, imaging, and training will all combine to help grow the technology and the science that is surgical endovascular neuroradiology.

Catheterization↗

PubMed2006

Historical perspectives: the microsurgical and endovascular treatment of aneurysms.

The history of aneurysm therapy is rich in parallelisms that exist between the once-fledgling field of aneurysm surgery and the now-growing field of endovascular aneurysm treatment. The treatment of aneurysms has had a cyclic progression. The indirect and safest approach to the treatment of aneurysms was seen in the development and use of Hunterian ligation in the 19th century. During the past few decades, nascent technology and a better understanding of the pathophysiology of aneurysms resulted in a more direct intracranial, extravascular approach to aneurysm therapy, with the focal point being the use of the aneurysm clip to secure an aneurysm at its neck. Interestingly, alternative and, arguably, even more direct approaches to aneurysm therapy developed in the surgical suites. These techniques became the seeds for the birth of direct endovascular aneurysm treatment in particular and endovascular surgery in general. As endovascular technology continues to develop, somewhat more sophisticated, indirect approaches to aneurysm therapy (the use of stents to modify flow, for example) are being investigated. The treatment of intracranial aneurysms has a rich history. First thought to be inoperable lesions, aneurysms have challenged neurosurgeons and their colleagues since they were first recognized in the 18th century. Treatment for these lesions did not begin until the 19th century with the use of Hunterian ligation. This review describes the many milestones in the field of aneurysm surgery and endovascular surgery, tracing the many parallelisms contained within the birth and growth of each field and their respective significance.

Catheterization↗

PubMed2005

Thrombolysis for ischemic stroke in the United States: data from National Hospital Discharge Survey 1999-2001.

OBJECTIVE: Although some data regarding the use of thrombolysis are available from community-based studies, national estimates of the use of thrombolysis for ischemic stroke are not available. We performed this study to determine the frequency of thrombolysis for ischemic stroke in the United States and associated in-hospital outcomes. METHODS: National estimates of thrombolysis, associated in-hospital outcomes, and mortality were obtained from National Hospital Discharge Survey data from 1999 to 2001. Patient numbers and frequency distributions were calculated for a nationally representative sample of patients hospitalized with a primary diagnosis of ischemic stroke. Thrombolysis was further stratified into thrombolysis with (intra-arterial) or without (intravenous) cerebral angiography. RESULTS: There were 1,796,513 admissions for ischemic stroke between 1999 and 2001. Of these admitted patients, 1,314 (0.07%) underwent intra-arterial thrombolysis and 11,283 (0.6%) underwent intravenous thrombolysis. The days of hospitalization (mean +/- standard deviation) were significantly higher for patients admitted with ischemic stroke treated with intra-arterial thrombolysis (10.7 +/- 4.8) or intravenous thrombolysis (7.1 +/- 3.6) compared with non-thrombolytic admissions (5.4 +/- 5.7). We observed a trend toward a higher frequency of use of intravenous and intra-arterial thrombolysis and hospitals with greater number of beds (P < 0.01). The mortality rates for hospitalizations were not significantly different for admissions with ischemic stroke treated with intra-arterial or intravenous thrombolysis compared with other ischemic strokes. The rates of discharge to home after hospitalizations were significantly lower for patients treated with intravenous thrombolysis (19.8%) compared with those not treated with thrombolysis (53.1%). CONCLUSION: The present study provides national estimates of patients undergoing thrombolysis for ischemic stroke. Further efforts need to be made to increase the proportion of patients with ischemic stroke who receive thrombolysis in the United States.

Aged↗

PubMed2004

Advanced imaging application for acute ischemic stroke.

With the approval of intravenous recombinant tissue plasminogen activator (r-TPA) in 1995, acute ischemic stroke therapy is increasingly being administered. Currently the approach to imaging these patients is very simplistic. Typically, noncontrast head computed tomography (CT) is the only study performed prior to treatment. Advanced imaging using CT or magnetic resonance imaging (MRI) can play a very important role in the triage and classification of patients with acute ischemic stroke. With knowledge of the location and size of the occlusion as well as the collateral circulation, the best treatment can be selected, minimizing any morbidity from treatment and maximizing the chance of success. The identification and stratification of patients according to their imaging and clinical features will further individualize treatment and allow tailored therapy. This review will discuss rapid imaging techniques that are easily available and the rationale for their use.

Animals↗

PubMed2003

Three-dimensional rotational spinal angiography in the evaluation and treatment of vascular malformations.

BACKGROUND AND PURPOSE: Conventional spinal angiography, although useful in providing angioarchitectural details of spinal vascular disease, has limitations. The advent of 3D angiography has provided a better comprehension of angioarchitectural detail when evaluating the intracranial circulation. The purpose of this study was to evaluate the usefulness of 3D angiography in the diagnosis and treatment of vascular malformations of the spine. METHODS: This retrospective analysis included 17 3D spinal angiograms acquired in 14 consecutive patients examined at our institution for a spinal vascular lesion, which included nine spinal cord arteriovenous malformations (AVMs), one perimedullary arteriovenous fistula (AVF), three spinal dural AVFs, and one nerve root AVM. 3D angiography was obtained with apnea under general anesthesia by using a 14-second acquisition and 200 degrees rotation of the gantry during injection of 300 mg I/mL nonionic contrast material at a rate of 0.5-3.5 mL/s. Multiple reconstructed images were obtained with or without opacification of the surrounding structures. These images were then evaluated by the interventionalists at the time of the procedure and compared with findings obtained by conventional subtraction angiography. RESULTS: 3D angiography was useful in differentiating intramedullary lesions from perimedullary surface lesions; detecting arterial, nidal, or venous aneurysms; and evaluating the 3D structure of the lesion as well as the relationship between the malformation and its draining veins or surrounding bony structures. In specific situations, it obviated the need for contrast-enhanced conventional or 3D CT, as well as for lateral or oblique angiographic views, which are sometimes difficult to obtain with good quality. No 3D angiography-related complications were experienced. Some limitations in the definition of small vessel anatomy in the reconstructed images were noted. CONCLUSION: In this small series of patients, 3D angiography was safe and useful for evaluation of the 3D vascular anatomy of spinal vascular malformations.

Adolescent↗