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Biomedical subjects

D Kühne

Publications and source records attributed to D Kühne.

At least 19 recordsLinked to original sources
PubMed2006

Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients.

INTRODUCTION: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid-cavernous sinus fistulas. METHODS: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid-cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. RESULTS: Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. CONCLUSION: The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved.

Adult↗
PubMed2006

[Endovascular occlusion of the basilar artery for the treatment of dissecting and dysplastic fusiform aneurysms].

Dissecting aneurysms of the basilar artery trunk frequently affect young adults. Fusiform shape and narrowing of the proximal parent artery are typical features. Changes in aneurysm size and geometry may be observed more rapidly than in atherosclerotic or dysplastic aneurysms. Dissecting aneurysms carry a significant risk of rupture. Thrombotic or embolic occlusion of small pontine branches may cause ischemic symptoms. Sufficiently large aneurysms compress the adjacent brainstem. The operative treatment of these aneurysms is associated with unacceptable risks. At least one posterior communicating artery with normal calibre together with the ipsilateral P1 segment needs to provide adequate collateral flow to the upper basilar artery to allow endovascular coil occlusion of the segment that is affected by the dissection and/or fusiform aneurysmal dilatation. Four illustrative cases of endovascular coil occlusion of the basilar artery for the treatment of fusiform aneurysms are presented and discussed.

Adult↗
PubMed2006

Endovascular treatment of small intracranial aneurysms: three alternatives to coil occlusion.

INTRODUCTION: Small intracranial aneurysms with a fundus diameter of 2 - 3 mm may rupture and are therefore potential targets for an endovascular approach in treatment. Currently available coil technology is less than optimal for the treatment of aneurysms within this size range. Even the smallest coils are sometimes too large. If such a minute coil can be introduced into a small aneurysm, the hemodynamic effect and the induced thrombosis are frequently inadequate to occlude the aneurysm sufficiently from the parent artery circulation. METHODS: Three technical alternatives for the endovascular treatment of small intracranial aneurysms not suitable for coil occlusion are illustrated with the following three case descriptions. RESULTS: Stent grafts are usable for the intracranial internal carotid artery and for the V4 segment. The stiffness of the stent and the high expansion pressures are the two major drawbacks. Coaxial deployment of two or more self-expanding porous stents can result in sufficient redirection of the blood flow to induce aneurysmal thrombosis. Deployment of multiple stents, however, may require several treatment sessions in order to allow for the integration of the stents into the vessel wall from session to session. A regular microcatheter can block aneurysmal inflow in aneurysms with a very narrow neck. This allows the occlusion of the aneurysm with an appropriate amount of highly concentrated, rapidly polymerizing glue. Polymer emboli may result from excessive or rapid glue injection. CONCLUSION: The available coil technology has inherent limitations in the treatment of very small intracranial aneurysms. Liquid embolic agents and stent-based extrasaccular treatment strategies may provide solutions for these challenging lesions.

Adult↗
PubMed2005

Intravascular pressure measurements in feeding pedicles of brain arteriovenous malformations.

Pressure measurements in arterial feeders of arteriovenous malformations (AVMs) can be easily acquired during endovascular treatment procedures. In this study, mean arterial pressure values in arterial feeders (Pfed) of brain AVMs were determined using a pressure measuring system connected to a standard microcatheter. A total of 148 measurements were performed in 139 patients. Mean systemic arterial pressure values were subtracted for correction. The levels of correlation between the pressure values and various clinical parameters (i.e., AVM location, size, previous hemorrhage) and pathoanatomical features of the AVM (e.g., nidus structure, number of draining veins) were determined. Pfed values were 54.5 mmHg on average. Pfed was lower in more distally located AVMs, in larger lesions and in AVMs with multiple drainage veins. Pressure values were significantly higher in patients with previous hemorrhage and in smaller AVMs. Our results support the importance of hemodynamic parameters in determining the presentation of AVMs. More extensive studies using this simple technique may further elucidate these mechanisms and may result in improved criteria for patient selection and reduction of complications.

Adolescent↗
PubMed2005

Preoperative devascularization of a circumferential osteogenic metastasis to the upper cervical spine by direct percutaneous needle puncture: a technical note.

Direct percutaneous needle puncture (DPNP) for presurgical devascularization of head and neck as well as skull base tumours is an established, yet not widespread method. We present a case of a large and highly vascularized metastasis with partial destruction of the first two cervical vertebrae and encasement of the spinal cord that was successfully treated by DPNP for preoperative devascularization after an attempted endovascular embolization had failed. The lesion was safely and effectively devascularized, which facilitated the surgical removal. The case presented illustrates the technique and furthermore demonstrates its value.

Aged↗
PubMed2005

Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment.

Various techniques for the endovascular treatment of dural arteriovenous fistulas (dAVFs) of the transverse and sigmoid sinus have recently evolved. Transvenous coil occlusion of the involved segment and transarterial embolization of the feeding arteries with liquid agents are the commonest treatments utilized. However, with respect to venous hypertension as the probable pathogenic cause of this disorder, a nonocclusive or remodeling technique might be preferable. We will present a series involving four patients, treated with transvenous angioplasty and stent deployment as a definitive treatment of dAVFs of the transverse and sigmoid sinus. This method was used as a primary treatment or as an adjunct to previous noncurative transarterial n-butyl cyanoacrylate and particle embolization. In three of the four cases, complete occlusion of the fistula was achieved with confirmation of occlusion seen on follow-up angiographical studies. In one case a negligible and nonsymptomatic remnant of the fistula fed by the tentorial artery was left untreated. From our experience, we conclude that transvenous stent deployment is an alternative to traditional concepts. Additionally, the pathological theory of dAVFs in this region located in venous pouches of the sinus wall is supported by the fact that they can be occluded by mechanical compression during angioplasty and subsequently maintained by a stent.

Adult↗
PubMed2005

Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan).

The endovascular treatment of atherosclerotic intracranial arterial stenoses has previously been based on balloon dilatation or the deployment of a balloon expandable stent. Both methods have advantages (balloon: flexibility; balloon expandable stent: high radial force) and drawbacks (balloon: risk of elastic recoil and dissection; balloon expandable stent: limited flexibility, risk of injury to the vessel due to excessive straightening, overexpansion at ends of stent). A new combination of balloon dilatation, followed by the deployment of a self-expanding microstent has been applied in 15 patients with atherosclerotic arterial stenoses, symptomatic despite medical treatment. An anatomically and clinically adequate result was achieved in all patients. The initial degree of stenosis was 72% (mean). Balloon dilatation resulted in an average residual stenosis of 54% (mean), reduced further to a mean of 38% after stent deployment. Arterial dissection, occlusion of the target artery or symptomatic distal emboli was not encountered. In one patient, a side branch occlusion occurred after dilatation of a M1 stenosis, with complete neurological recovery. All patients were either stable or improved 4 weeks after the treatment. Recurrent TIA did not occur in any patient. Balloon dilatation and subsequent deployment of a self-expandable stent for the treatment of symptomatic intracranial arterial stenoses combines the advantages of both techniques and allows a rapid, clinically effective and technically safe treatment of these frequently challenging lesions.

Aged↗
PubMed2004

Coil treatment of a fusiform upper basilar trunk aneurysm with a combination of "kissing" neuroform stents, TriSpan-, 3D- and fibered coils, and permanent implantation of the microguidewires.

Endovascular coil occlusion of fusiform intracranial aneurysms without sacrifice of the parent artery can be technically challenging. Bridging of wide aneurysm necks with stents is common practice for side-wall aneurysms but is less frequently used for bifurcation aneurysms. We describe the technical aspects of the successful coil occlusion of a fusiform aneurysm of the upper basilar trunk, with preservation of the parent vessel. The procedure comprised the following steps: (a) stenting of the left V1- and proximal V2 segments; (b) simultaneous deployment of two Neuroform stents from both P1 segments down to the basilar artery ("kissing" stents) (c) using a TriSpan device to hold (d) three-dimensional electrolytically detachable coils in place and (e) filling the aneurysmal lumen mainly with fibered electrolytically detachable coils; and finally (f) cutting the extracorporeal part of both microguidewires below the skin level in both groins, leaving the microguidewires as they were used for the deployment of the stents in place, thus reaching from both P2 segments down to the basilar artery and further proximally.

Basilar Artery↗
PubMed2002

[Diagnosis and embryogenesis of partial anomalous pulmonary venous connection].

In Anomalous Pulmonary Venous Drainage one or more pulmonary veins are not connected with left atrium, but drain into systemic circulation or right atrium. The clinical signs of the shunt between pulmonary and systemic circulation increase during lifetime, thus the abnormality gets late or not diagnosed. Partial Anomalous Pulmonary Venous Drainage is a developmental disorder, according to embryogenesis we recommend a classification of this abnormality. Two case reports are given to illustrate difficulties in diagnosis of this relatively common abnormality. A diagnostic standard of assessment of pulmonary venous disorders is discussed. The "Gold Standard" of selective pulmonary Angiography in combination with oxygen measurement is widely used for diagnosis of Partial Anomalous Pulmonary Venous Drainage. In the future improvement and common use of modern cross sectional imaging techniques will redefine the value of conventional Angiography.

Adolescent↗
PubMed2001

Haemangiopericytoma of the nasal cavity.

Haemangiopericytomas (HPC) are rare vascular tumours originating from a pericytes, a term coined by Zimmermann to refer to the main location of this cell line in the pericapillary connective tissue. HPC may arise in any part of the body. We report a 29-year-old man with a histologically proven nasal haemangiopericytoma-like tumour. The lesion was embolised through the ophthalmic artery before it was removed surgically. The main symptoms of nasal HPC are epistaxis and obstruction of the nose. Malignant and benign clinical courses have been described. Local recurrence and metastases may be observed years after initial diagnosis.

Adult↗
PubMed2001

Noninvasive follow-up of GDC-treated saccular aneurysms by MR angiography.

The aim of this study was to determine sensitivity and specificity of magnetic resonance angiography (MRA) for the assessment of durable occlusion of intracranial aneurysms with Guglielmi detachable coils (GDC) and to point out the influence of MRA results in re-intervention strategies. Forty-five patients with 54 aneurysms that were previously treated by endovascular occlusion with GDC were selected for this study. All patients underwent digital subtraction angiography (DSA) and MRA examinations on the same day. The time-of-flight MRA studies were performed on a 1-T scanner. The MRA images were first read by radiologists who were not aware of the DSA results. In a second consensus reading by the neuroradiologists who had performed all interventional procedures of this series, the decision was made as to whether re-treatment was necessary. The distribution of aneurysm sizes, configurations and treatment results were sufficient for an unbiased evaluation. The first blinded evaluation revealed a sensitivity of 71% and a specificity of 95% for MRA assessment of aneurysm reperfusion. In the second consensus reading, the sensitivity increased to 92% and the specificity was 98%. The blinded reading indicates that MRA is a useful adjunct to DSA for the assessment of durable results after endovascular treatment of intracranial aneurysms. In the consensus reading it became obvious that sensitivity and specificity of MRA can be increased to 92 and 98%, respectively, if the results were evaluated by experienced neuroradiologists, including prior knowledge of all other examinations. We have already increased the follow-up intervals for DSA and use MRA intermittently, based on these results.

Adult↗
PubMed2001

Mechanical detachable platinum coil: report of the European phase II clinical trial in 60 patients.

PURPOSE: To determine the safety and reliability of the mechanical detachment system of a platinum coil (Detach-18) when used for neurovascular embolization. MATERIALS AND METHODS: Sixty patients (21 men, 39 women; age range, 26-75 years; mean age, 56.2 years) were treated in seven centers. Ease of introduction of the coil to the microcatheter, effect of coil passage on the microcatheter shape and stability during its delivery, retrievability of the coil before and after the transition zone passed beyond the microcatheter, detachment of the coil, and effect of coil rotation on the microcatheter stability were evaluated. The detachment system itself was evaluated for premature detachment, failure of the coil to detach, detachment time, number of turns, visibility of radiopaque markers, number of coils deployed per patient, and percentage of vessel occlusion obtained. A 0.015-inch-diameter regular coil and a 0.014-inch-diameter soft coil were used. RESULTS: A total of 1,061 coils were used; 1,009 were detached. The number of coils deployed ranged from four to 104 (mean, 17 coils). The coils passed easily through the microcatheter. The detachment maneuver occurred within 5-25 seconds, with five to 60 turns of the introducing wire. One premature coil detachment occurred without clinical sequela; 100% occlusion of the vessel lumen was achieved in 53 patients; 80%-90%, in four; and 70%-80%, in two. There were no device-related complications. CONCLUSION: The detachment system was safe and reliable. This is a useful system for coil embolization in neurovascular diseases.

Adult↗
PubMed2001

Cure of a direct carotid cavernous fistula by endovascular stent deployment.

A 53-year-old woman underwent surgical thrombendarterectomy for treatment of artherosclerotic stenoses of her left internal carotid artery (ICA). A Fogarty catheter was used during this operation. The postoperative course was complicated by the development of a sixth cranial nerve palsy, protrusio, chemosis and ciliar injection of both eyes. Digital subtraction angiography showed a direct fistula between the cavernous segment of the left ICA and the cavernous sinus, with early and retrograde opacification of both superior ophthalmic veins. Endovascular occlusion of the fistula was achieved with preservation of the ICA by stent deployment over the rupture site of the ICA, as two detachable balloons could not obliterate the fistula while preserving the ICA patent. Follow-up angiography 7 months after the endovascular treatment confirmed persisting occlusion of the fistula with a patent ICA. Highly flexible porous coronary stents can easily be introduced into tortuous vessels, including the distal ICA. The haemodynamic effects achieved by stent deployment together with two balloons detached in the cavernous sinus may be sufficient to interrupt a direct carotid cavernous fistula.

Angiography, Digital Subtraction↗
PubMed2001

A report of the clinical use of the detach-18 mechanical detachable platinum coil in 41 patients.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the safety and reliability of the mechanical detachment system of a new platinum coil, Detach-18, when used as a vascular occlusive device for neurovascular disease. METHODS: Forty-one patients (nine male and 32 female patients; age range, 26-75 years; mean age, 54.4 years) underwent treatment at seven centers. Twenty-two patients had dural arteriovenous fistulae of the transverse sinus treated by a transvenous route. Fourteen patients underwent internal carotid artery occlusion in the treatment of aneurysms, meningioma, facial tumor, or carotid injury. One patient underwent occlusion of the basilar artery and one patient underwent occlusion of the vertebral artery for treatment of aneurysms. In two patients, coils were used as part of the treatment of their arteriovenous malformations. In all cases, the Detach-18 coils were delivered through a microcatheter with two distal markers. Two types of coils, a 0.015-inch-diameter "regular" coil and a 0.014-inch-diameter "soft" coil, were used. RESULTS: A total of 569 coils were used, 541 of which were detached. The number of coils in ranged from four to 53 (average number of coils, 14). The coils passed easily through the microcatheter. The detachment maneuver occurred within 10 to 25 s with 20 turns of the introducing wire. No premature coil detachment occurred. Complete occlusion of the vessel lumen was achieved in 35 cases. In three cases, 80% to 90% occlusion was achieved. In two cases, 70% to 80% occlusion was achieved. There were no device-related complications. CONCLUSION: The detachment system was safe, reliable, consistent, and fast. This is a useful system for coil embolization in neurovascular applications.

Adult↗
PubMed2000

[Stent implantation into the basilar artery for supporting endovascular aneurysm treatment].

In aneurysms with a neck:dome ratio of 1:2 or more or with a wide neck, endovascular treatment is less effective. In this situation, the rate of thrombotic and thromboembolic complications is increased. Recently available highly flexible balloon expandable coronary stents improved the technique of endovascular aneurysm treatment. Two patients with wide neck midbasilar aneurysms were successfully treated endovascularly using a combination of stent deployment into the basilar artery and coil occlusion of the aneurysm. The creation of an artificial boundary between a side wall aneurysm and the parent artery by stent deployment improves the conditions for subsequent coil occlusion of the aneurysm. If, after detachment, coils protrude from the lumen of a side wall aneurysm into the parent vessel, stenting of this vessel can prevent thrombotic and thromboembolic complications.

Aortic Dissection↗