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Biomedical subjects

F Vinuela

Publications and source records attributed to F Vinuela.

At least 19 recordsLinked to original sources
PubMed2007

Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years.

BACKGROUND AND PURPOSE: Intra-arterial fibrinolytic therapy is a promising treatment for acute ischemic stroke. Few data are available on its use in elderly patients. The purpose of this study was to compare the baseline characteristics, complications, and outcomes between intra-arterially treated ischemic stroke patients aged > or = 80 years and their younger counterparts. METHODS: Patients aged > or = 80 years (n = 33) were compared retrospectively with contemporaneous patients aged < 80 years (n = 81) from a registry of consecutive patients treated with intra-arterial thrombolysis over a 9-year period. RESULTS: The very elderly and younger cohorts were very similar in baseline characteristics, including pretreatment stroke severity (National Institutes of Health Stroke Scale [NIHSS] 17 versus 16), differing only in history of stroke/transient ischemic attack (42% versus 22%, P = .01) and weight (66.8 versus 75.8 kg; P = .02). Significant differences in recanalization (TIMI 2-3) rates could not be detected between the very elderly and younger patients (79% versus 68%, P = .10). Rates of major symptomatic hemorrhage (7% versus 8%) and any intracerebral hemorrhage (39% versus 37%) did not differ. Outcomes at 90 days showed lower rates of excellent functional outcome (mRS < or = 1, 26% versus 40%, P = .02) and survival (57% versus 80%, P = .01) among the very elderly. CONCLUSIONS: Intra-arterial fibrinolysis in the elderly can be accomplished with recanalization rates and hemorrhage rates equal to that in younger patients. Although mortality rates are higher and good functional outcomes are lower than in younger persons, nondisabling outcomes may be achieved in a quarter of patients. These findings suggest that the investigation and use of intra-arterial thrombolytic treatment in very elderly patients should not be avoided but pursued judiciously.

Adult↗
PubMed2006

Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis.

BACKGROUND: Prestroke statin use may improve ischemic stroke outcomes, yet there is also evidence that statins and extremely low cholesterol levels may increase the risk of intracranial hemorrhage. We evaluated the independent effect of statin use and admission cholesterol level on risk of symptomatic hemorrhagic transformation (sHT) after recanalization therapy for acute ischemic stroke. METHODS: We analyzed ischemic stroke patients recorded in a prospectively maintained registry that received recanalization therapies (IV or intra-arterial fibrinolysis or endovascular embolectomy) at a university medical center from September 2002 to May 2006. The independent effect of premorbid statin use on sHT post intervention was evaluated by logistic regression, adjusting for prognostic and treatment variables known to predict increased HT risk after ischemic stroke. RESULTS: Among 104 patients, mean age was 70 years, and 49% were men. Male sex, hypertension, statin use, low total cholesterol and low-density lipoprotein (LDL) cholesterol, current smoking, elevated glucose levels, and higher admission NIH Stroke Scale (NIHSS) score were all associated with a greater risk of sHT in univariate analysis. After adjusting for covariates, low LDL cholesterol (odds ratio [OR], 0.968 per 1-mg/dL increase; 95% CI, 0.941 to 0.995), current smoking (OR, 14.568; 95% CI, 1.590 to 133.493), and higher NIHSS score (OR, 1.265 per 1-point increase; 95% CI, 1.047 to 1.529) were independently associated with sHT risk. CONCLUSIONS: Lower admission low-density lipoprotein cholesterol level with or without statin use, current smoking, and greater stroke severity are associated with greater risk for symptomatic hemorrhagic transformation after recanalization therapy for ischemic stroke.

Aged↗
PubMed2006

Early MRI and outcomes of untreated patients with mild or improving ischemic stroke.

OBJECTIVE: To determine the frequency of early neurologic deterioration with infarct expansion (ENDIE) and poor outcomes among ischemic stroke patients not treated with reperfusion therapies because of rapidly improving or mild symptoms (RIMS) and to study the predictive value of hyperacute MRI in these patients. METHODS: We identified consecutive patients with symptoms of acute stroke undergoing multimodal MRI within 6 hours of onset without evidence of hemorrhage on imaging. Medical records were reviewed for evidence of early neurologic deterioration within 48 hours. All deteriorating patients had repeat MRI to ascertain causes of worsening. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score of > or = 3. RESULTS: We identified 74 patients with stroke symptoms < or = 6 hours from onset. Forty had RIMS, and 39 did not receive reperfusion therapies because of RIMS. Among these 39, 4 experienced ENDIE, and 8 were discharged with mRS score of > or = 3. Eight of the 39 patients had large-vessel occlusions on MR angiography. Three of 8 patients with large-vessel occlusion as against only one of 31 patients without occlusion had ENDIE (odds ratio [OR] 18, 95% CI 1.6 to 209, p = 0.02). Four of 8 patients with large-vessel occlusion as against 4 of 31 patients without occlusion had a discharge mRS score of > or = 3 (OR 7, 95% CI 1.2 to 38, p = 0.04). CONCLUSIONS: About 10% of patients eligible for acute reperfusion therapy excluded on the basis of mild or rapidly improving symptoms show early neurologic deterioration with infarct expansion within 48 hours, and about 20% show poor outcome at discharge. Persisting large-vessel occlusion substantially increases the risk of early worsening and poor functional outcome.

Confidence Intervals↗
PubMed2006

Influence of gender on outcomes after intra-arterial thrombolysis for acute ischemic stroke.

Recent data suggest that women obtain greater benefit than men from IV fibrinolysis for acute ischemic stroke. It is unknown whether this gender-thrombolysis advantage extends to those treated with intra-arterial (IA) thrombolysis. The authors evaluated the independent effect of gender among ischemic stroke patients treated with IA fibrinolysis and found no differences in short-term clinical and angiographic outcomes between men and women who received IA thrombolysis for acute ischemic stroke.

Aged↗
PubMed2001

Diffusion-perfusion MRI characterization of post-recanalization hyperperfusion in humans.

BACKGROUND: Animal and human studies have demonstrated that postischemic hyperperfusion may occur both early and late timepoints following acute cerebral ischemia. OBJECTIVE: To use diffusion-perfusion MRI to characterize hyperperfusion in humans following intra-arterial thrombolysis. METHODS: MRI were performed before treatment, several hours following vessel recanalization, and at day 7 in patients successfully recanalized with intra-arterial thrombolytics. RESULTS: Hyperperfusion was visualized in 5 of 12 patients within several hours after recanalization (mean volume, 18 mL; range, 7 to 40 mL), and in 6 of 11 patients at day 7 (mean volume, 28 mL; range, 4 to 45 mL). Within the core region of hyperperfusion, mean cerebral blood flow was 2.1 times greater than in the contralateral homologous region at the early time point, and 3.1 times greater at day 7. Seventy-nine percent of voxels with hyperperfusion at day 7 demonstrated infarction at day 7, whereas only 36% of voxels (within the initial hypoperfusion region) not showing hyperperfusion at day 7 demonstrated infarction at day 7. Mean pretreatment apparent diffusion coefficient (ADC) and perfusion values were more impaired in voxels that subsequently developed hyperperfusion compared with other at-risk voxels (all p values < 0.0001). There were no significant differences in the degree of clinical improvement in patients with regions of hyperperfusion versus those without, although sample size limited power to detect group differences. CONCLUSIONS: Postischemic hyperperfusion, visualized with perfusion MRI in humans following recanalization by intra-arterial thrombolytic therapy, occurred in about 40% of patients within hours and in about 50% of patients at day 7. Hyperperfusion developed mainly in regions that went on to infarction. Compared with other abnormal regions, tissues that developed postischemic hyperperfusion had greater bioenergetic compromise in pretreatment apparent diffusion coefficient values and greater impairment in pretreatment blood flow measures.

Adult↗
PubMed2001

Intraaneurysmal flow dynamics study featuring an acrylic aneurysm model manufactured using a computerized tomography angiogram as a mold.

OBJECT: To obtain precise flow profiles in patients' aneurysms, the authors developed a new in vitro study method featuring an aneurysm model manufactured using three-dimensional computerized tomography (3D CT) angiography. METHODS: A clear acrylic basilar artery (BA) tip aneurysm model manufactured from a patient's 3D CT angiogram was used to analyze flow modifications during one cardiac cycle. Stereolithography was utilized to create the aneurysm model. Three-dimensional flow profiles within the aneurysm model were obtained from velocity measurements by using laser Doppler velocimetry. The aneurysm inflow/outflow zones changed dynamically in their location, size of their cross-sectional area, and also in their shapes over one cardiac cycle. The flow velocity at the inflow zone was 16.8 to 81.9% of the highest axial velocity in the BA with a pulsatility index (PI) of 1.1. The flow velocity at the outflow zone was 16.8 to 34.3% of the highest axial velocity of the BA, with a PI of 0.68. The shear stress along the walls of the aneurysm was calculated from the fluid velocity measured at a distance of 0.5 mm from the wall. The highest value of shear stress was observed at the bleb of the aneurysm. CONCLUSIONS: This clear acrylic model of a BA tip aneurysm manufactured using a CT angiogram allowed qualitative and quantitative analysis of its flow during a cardiac cycle. Accumulated knowledge from this type of study may reveal pertinent information about aneurysmal flow dynamics that will help practitioners understand the relationship among anatomy, flow dynamics, and the natural history of aneurysms.

Acrylic Resins↗
PubMed2001

Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors.

OBJECT: The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors. METHODS: Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surgery after failed embolization: and 16 underwent embolization alone. The outcomes of gait and micturition disability, were analyzed. Follow up averaged 3.4 years (range 1 month-11.8 years). Age, duration of symptoms, pre- and postintervention magnetic resonance (MR) imaging findings, and preintervention disability were correlated with outcome. Seventeen patients (57%) experienced improved gait, 12 (40%) were unchanged, and one (3%) was worse. In 11 patients (37%) micturition function was improved, in 15 (50%) it was unchanged, and in four (13%) it was worse. Gait disability, as measured by the Aminoff-Logue Scale, was significantly improved after treatment, from 3.4+/-1.4 (average +/- standard deviation) to 2.7+/-1.5 (p = 0.007). Mean micturition disability scores decreased, but not significantly, from 1.9+/-1 to 1.6+/-1.1 (p = 0.20). Preintervention gait disability was not associated with improvement except for patients with Aminoff-Logue Scale Grade 4 disability (eight of nine improved; p = 0.024). For patients treated within 13 months of symptom onset, mean micturition disability decreased (p = 0.035). No association was found between clinical improvement and age, a symptom duration less than 30 months, or pre- and postintervention MR imaging-documented spinal cord edema. CONCLUSIONS: Spinal DAVF treatment significantly improved patients' mean gait disability score by almost one grade at last follow up. The mean micturition disability score was not significantly improved, unless treatment was performed within 13 months of symptom onset. Longer and more uniform follow-up study is needed to determine if improved and stabilized clinical outcomes are sustained.

Aged↗
PubMed2000

Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations in children.

BACKGROUND: Reports of the complicating side effect of pulmonary embolism (PE) following endovascular therapy of cerebral arteriovenous malformations (AVM) in children have been limited in number. Details of its occurrence are yet to be fully elucidated. OBJECTIVE: The hypothesis is that inadvertent pulmonary migration of embolic material is common and may go unrecognized. MATERIALS AND METHODS: Forty-seven patients (ages 1 day to 16 years and 11 months) underwent embolization of a cerebral AVM with at least one material (cyanoacrylate, platinum coils, detachable balloons, polyvinyl alcohol particles). The medical records and chest radiographs were reviewed retrospectively. Chest radiographs were available in 34 patients. The radiographs were analyzed for the presence or absence of foreign material in the lungs. RESULTS: The chest radiographs in 12 patients (35%) showed pulmonary deposits of embolic material; cyanoacrylate in 10 patients and platinum coils in 2. Two of the patients with cyanoacrylate deposits in the lungs developed respiratory distress that required endotracheal intubation. The patients gradually improved after a time period of 7-10 days with conservative treatment. CONCLUSION: PE is not an uncommon complication in children undergoing embolization of brain AVM. Although usually asymptomatic, PE may cause severe symptoms.

Adolescent↗
PubMed2000

Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms.

OBJECT: The goal of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography in patients with intracranial aneurysms. The authors compared the abilities of CT angiography, digital subtraction (DS) angiography, and three-dimensional time-of-flight magnetic resonance (MR) angiography to characterize aneurysms. METHODS: Helical CT angiography was performed in 45 patients with suspected intracranial aneurysms by using volume-rendered multiplanar reformatted (MPR) images. Digital subtraction angiography was performed using biplane angiography. These studies and those performed using MR angiography were interpreted in a blinded manner. Two neurosurgeons and two interventional neuroradiologists independently graded the utility of CT angiography with respect to aneurysm characterization. Fifty-five aneurysms were detected. Of these, 48 were evaluated for treatment. Computerized tomography angiography was judged to be superior to both DS and MR angiography in the evaluation of the arterial branching pattern at the aneurysm neck (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.007), aneurysm neck geometry (compared with DS angiography, p = 0.001, and with MR angiography, p = 0.001), arterial branch incorporation (compared with DS angiography, p = 0.021, and with MR angiography, p = 0.001), mural thrombus (compared with DS angiography, p < 0.001), and mural calcification (compared with DS angiography, p < 0.001, and with MR angiography, p < 0.001). For surgical cases, CT angiography had a significant impact on treatment path (p = 0.001), operative approach (p = 0.001), and preoperative clip selection (p < 0.001). For endovascular cases, CT angiography had an impact on treatment path (p < 0.02), DS angiography study time (p = 0.01), contrast agent usage (p = 0.01), and coil selection (p = 0.02). Computerized tomography angiography provided unique information about 39 (81%) of 48 aneurysms, especially when compared with DS angiography (p = 0.003). The sensitivity and specificity of CT angiography compared with DS angiography was 1. The sensitivity and specificity of CT and DS angiography studies compared with operative findings were 0.98 and 1, respectively. CONCLUSIONS: Computerized tomography angiography is equal to DS angiography in the detection and superior to DS angiography and MR angiography in the characterization of brain aneurysms. Information contained in volume-rendered CT angiography images had a significant impact on case management.

Adolescent↗
PubMed2000

Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging.

Diffusion magnetic resonance imaging provides an early marker of acute cerebral ischemic injury. Thrombolytic reversal of diffusion abnormalities has not previously been demonstrated in humans. Serial diffusion and perfusion imaging studies were acquired in patients experiencing acute hemispheric cerebral ischemia treated with intra-arterial thrombolytic therapy within 6 hours of symptom onset. Seven patients met inclusion criteria of prethrombolysis and postthrombolysis magnetic resonance studies, presence of large artery anterior circulation occlusion at angiography, and achievement of vessel recanalization. Mean diffusion-weighted imaging lesion volume at baseline was 23 cm3 (95% confidence interval [95% CI], 8-38 cm3) and decreased to 10 cm3 (95% CI, 3-17 cm3) 2.5 to 9.5 hours after thrombolysis. Mean apparent diffusion coefficient lesion volume decreased from 9 cm3 (95% CI, 2-16 cm3) at baseline to 1 cm3 (95% CI, 0.4-2 cm3) early after thrombolysis. A secondary increase in diffusion volumes was seen in 3 of 6 patients at day 7. In all 4 patients in whom perfusion imaging was obtained before and after treatment, complete resolution of the perfusion deficit was shown. Diffusion magnetic resonance signatures of early tissue ischemic injury can be reversed in humans by prompt thrombolytic vessel recanalization. The ischemic penumbra includes not only the region of diffusion/perfusion mismatch, but also portions of the region of initial diffusion abnormality.

Acute Disease↗
PubMed1999

Intraarterial thrombolysis for treatment of acute stroke: experience in 26 patients with long-term follow-up.

BACKGROUND AND PURPOSE: Since the approval of intravenous tissue plasminogen activator for acute ischemic stroke, great interest has been generated in cerebral fibrinolysis. Our purpose was to assess long-term outcome and hemorrhagic risk in patients with anterior circulation ischemic stroke treated with intraarterial urokinase. METHODS: Twenty-six patients were treated within 6 hours of ictus; of these, 21 were followed up for an average of 23 months. Angiographic reperfusion was classified according to thrombolysis in myocardial infarction (TIMI) grades. The Rankin Scale (RS) and the modified Barthel Index (mod BI) were used as outcome measures (good outcome: RS = 0-2, mod BI = 16-20; poor outcome: RS = 3-5, mod BI < or = 15). RESULTS: Ten of the 21 patients (average age, 48 years) had a good outcome; three (average age, 71 years) had a poor outcome; eight patients (average age, 78 years) died. Partial/complete (successful) recanalization was observed in 11 of 26 patients and minimal or no (unsuccessful) recanalization in 15. Recanalization favored a better outcome: nine of 21 had successful recanalization, with a good outcome in seven; 12 of 21 had unsuccessful reperfusion, with poor outcome/death in nine. Poor outcome was noted in five patients with internal carotid artery (ICA) bifurcation occlusions, four of whom had unsuccessful recanalization and poor outcome or death. Hemorrhage occurred in 10 of the 26 patients, with clinical deterioration in three. The average dose of urokinase was higher in the hemorrhage group, and mortality was higher in patients who hemorrhaged. CONCLUSION: Intraarterial thrombolysis is feasible in the setting of acute stroke. Successful reperfusion is associated with a better outcome, and the prevalence of hemorrhage does not exceed that which occurs in the natural history of embolic stroke. Poor outcome or death is associated with nonrecanalization, older age, hemorrhage, and ICA bifurcation occlusions.

Acute Disease↗
PubMed1998

Multiple cerebral pseudoaneurysms and hemorrhages: the expanding spectrum of metastatic cerebral choriocarcinoma.

Cerebral metastases occur in 10-20% of patients with choriocarcinoma. Although single oncotic and pseudoaneurysms have been reported, multiple pseudoaneurysms and hemorrhages are rare. A 33-year-old woman developed 10 intracerebral hemorrhages over a 30-day period. Angiogram showed multiple focal areas of delayed contrast washout in distal vessels. Autopsy revealed intravascular choriocarcinoma without true aneurysm formation. A diagnosis of choriocarcinoma should be considered for women of childbearing age presenting with cerebrovascular syndromes, especially those found to have cerebral aneurysm pseudoaneurysm and/or hemorrhage.

Adult↗
PubMed1997

Pituitary gland enlargement secondary to dural arteriovenous fistula in the cavernous sinus: appearance at MR imaging.

PURPOSE: To evaluate pituitary gland size in cases of dural arteriovenous (AV) fistula in the cavernous sinus and to correlate the size with the degree of AV fistula. MATERIALS AND METHODS: Magnetic resonance images in 21 patients with angiographically proved dural AV fistula of the cavernous sinus were retrospectively reviewed. In four patients, findings obtained before and after embolization therapy were compared. RESULTS: The 21 patients were divided into group 1 (severe AV fistula) and group 2 (moderate or mild AV fistula). The superior contour of the pituitary gland was convex or flat in group 1 and flat or concave in group 2. The mean height of the pituitary gland was 9.4 mm +/- 1.5 (standard deviation) in group 1 and 6.7 mm +/- 1.2 in group 2 (P = .0002). After embolization therapy, pituitary gland height decreased and signal intensity voids improved in the four patients and no AV fistula was observed in three. CONCLUSION: In cases of severe dural AV fistula in the cavernous sinus, the pituitary gland is enlarged, which should not be misdiagnosed as pathologic.

Adult↗
PubMed1997

Transcranial color Doppler imaging of brain arteriovenous malformations in adults.

This study was performed to investigate the utility of transcranial color Doppler sonography in evaluating adult cerebral arteriovenous malformations. Twelve patients with such malformations underwent sonography. Spectral Doppler sonographic assessment included peak systolic velocity, end diastolic velocity, and resistive index within the intracranial and extracranial vessels. Color Doppler sonography was used to visualize the site of shunting. Paired and unpaired Student's t-tests were used to determine significance of spectral findings. The nidus was seen in eight of 10 pial malformations. The nidi in two patients were located in the parietal region and not visualized. When compared with the corresponding contralateral artery, feeding arteries (identified in all 10 of the pial lesions) demonstrated diminished resistive indices (P = 0.09). Similarly, the end diastolic velocity was increased in all feeding arteries (P = 0.03). When compared with published normal values, the peak systolic and end diastolic velocities were significantly elevated and the resistive indices were low (P < 0.0003). Transcranial color Doppler sonography depicted the nidi of pial arteriovenous malformations in 80% of cases. Feeding arteries demonstrated abnormal peak systolic velocity, end diastolic velocity, and resistive index in all cases when compared with published values. Transcranial color Doppler sonography is not a good screening tool due to limited acoustical window, but it may be useful for noninvasive study of the physiology of arteriovenous malformations as they are treated.

Adult↗
PubMed1997

[An experimental study of the treatment of aneurysms using an intravascular prosthesis].

Intracranial aneurysms occur frequently with the risk of major damage. Neurosurgery or endovascular techniques can be used for treatment. Current techniques are not well adapted for aneurysms with a wide implantation (or neck). The aim of this experimental work was to study a technique for treating aneurysms which can be used for wide neck aneurysms. A metal stent is implanted facing the neck of the aneurysm to allow occlusion. In the first part of the study, the stent was inserted alone. Ten aneurysms were created surgically in five dogs. The stents were positioned facing seven of the ten aneurysms. The stent led to immediate occlusion of the aneurysm in six of the cases. One aneurysm remained patent despite the correct position of the stent. One dog developed secondary thrombosis of the carotid. Three dogs have been followed for sixty days after insertion of the stent. Two aneurysms thrombosed and one was patent. Since these results were less than satisfactory, a second part of the study was undertaken to cover the stent with a fragment of the autologous vein. Results in five aneurysms, evaluated three and eight weeks after treatment, showed partial or total repermeabilization of the aneurysms. In the third part of the study, we associated stents and detachable coils. Twelve aneurysms of the carotid artery in pigs were thrombosed and two aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms remained patent despite the stent and treatment was then completed with a coil. Six of the animals have been followed for thirteen weeks. One carotid artery thrombosed. In the five other cases, the carotid arteries were patent and the aneurysms were occluded at the control angiogram. Histology results showed the presence of a fibromuscular endothelialized neointima at the neck of the aneurysm in four of the five cases. The technique described here could be proposed for the treatment of wide-neck aneurysms implanted low on the carotid artery in man. Improvements should render the system more flexible.

Aneurysm↗
PubMed1996

Management of cavernous sinus-dural fistulas. Indications and techniques for primary embolization via the superior ophthalmic vein.

OBJECTIVE: To describe indications and surgical techniques for embolization of cavernous sinus-dural fistulas (CDF) by passing platinum coils through a cannulated superior ophthalmic vein based on our clinical experience. DESIGN: Retrospective clinical review. SETTING: University tertiary referral hospital and eye institute. PATIENTS: Over a 3-year period, 10 consecutive patients with CDF and progressive orbital congestion underwent transvenous embolization. All patients had a dilated superior ophthalmic vein. All 10 patients had indications for treatment of fistulas on the basis of progressive glaucoma refractory to medical management, venous stasis retinopathy with retinal ischemia, optic neuropathy, diplopia, exophthalmos with exposure keratopathy, cortical venous congestion with risk for intracranial hemorrhage, or a combination of these findings. INTERVENTION: Nine of the 10 patients underwent anterior orbitotomy via a lid-crease or sub-brow incision with cannulation of the ipsilateral superior ophthalmic vein and embolization of the cavernous sinus with platinum coils, following an unsuccessful transarterial embolization. One patient underwent a primary transvenous embolization. MAIN OUTCOME MEASURES: Successful closure of the fistula on angiography, return of baseline visual acuity, normalization of postoperative intraocular pressure, and cosmetically acceptable cutaneous scar. RESULTS: All 10 patients had prompt resolution of symptoms and halt of progressive visual loss following occlusion of the fistulas. Two patients had no flow in the anterior superior ophthalmic vein on angiography suggesting thrombosis, yet the superior ophthalmic vein was easily accessed in the anterior orbit, and transvenous embolization was successfully performed. In 2 additional patients with nondilated superior ophthalmic veins, we were unable to gain surgical access and in 1 case severe bleeding occurred during attempted access of the small vein. CONCLUSIONS: When performed by an experienced orbital surgeon and neuroradiology team, transvenous embolization of CDF via a dilated anterior superior ophthalmic vein is a technically straightforward, safe, and effective treatment for CDF and perhaps should be employed as primary therapy in cases with progressive orbital congestive symptoms. If the superior ophthalmic vein is not dilated or if it is located deep in the orbit, transorbital venous access may not be possible.

Adult↗
PubMed1996

Laboratory simulations and training in endovascular embolotherapy with a swine arteriovenous malformation model.

We assessed the suitability of a swine experimental arteriovenous malformation model for laboratory simulations and training in endovascular embolotherapy. Embolizations with liquid glue or particles were performed in 10 animals. The parameters of injection (microcatheter position, concentration and volume of embolic agent, injection rate) were deliberately varied to simulate results that may be observed in clinical practice. A range of successful and less desirable therapeutic outcomes or complications was simulated. In one model, intravascular mean blood pressure in the "terminal feeder" rose after "nidus" embolization, consistent with observations in feeders of cerebral arteriovenous malformations. Experience in the technical aspects of embolotherapy was gained by repeated performances using this model. Simplicity of creation, clear angiographic visibility of feeders, a nidus and a draining vein, and hemodynamic similarities with cerebral arteriovenous malformations make this an attractive in vivo experimental model for learning the principles of embolotherapy, testing new embolic agents, and training/gaining experience in embolization techniques.

Animals↗