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Kennith F Layton

Publications and source records attributed to Kennith F Layton.

11 recordsLinked to original sources
PubMed2006

Balloon-assisted coiling through a 5-French system.

INTRODUCTION: We present a catheter technique that utilizes a 5F system for the purpose of balloon-assisted coiling in the setting of intracranial aneurysms. METHODS: A standard 5F short sheath is placed in the common femoral artery, and a 5F diagnostic catheter is placed through the sheath and used for selective vessel angiography. When endovascular intervention is pursued, the diagnostic catheter is placed in the appropriate vessel and systemic heparinization is ensured. Over an exchange length wire, the 5F vertebral catheter and 5F short sheath are exchanged for a 5F Shuttle (Cook) sheath. We then routinely place a 10, 14 or 18 microcatheter over an appropriately gauged microguidewire into the aneurysm. As needed, balloon catheters are then placed across the neck of the aneurysm for remodeling purposes. During the course of the procedure, control angiography is performed through the Shuttle sheath. Following the placement of coils, the microcatheter and balloon catheter are removed and a final biplane image is obtained via the 5F Shuttle sheath. RESULTS: This technique has been employed in 15 patients who required balloon-assisted coiling of an intracranial aneurysm. There were no technical difficulties or arterial access site complications from the procedures. Catheter mobility and torque were not affected, nor was the quality of our imaging. CONCLUSION: We conclude that this small-diameter system provides ample "room" for catheter placement and interventional treatment while reducing the known risks of postprocedural complications. Angiographic images remain excellent and are comparable to those obtained by larger catheters.

Balloon Occlusion↗
PubMed2006

Progression of warfarin-associated intracerebral hemorrhage after INR normalization with FFP.

To identify hematoma progression in patients with warfarin-associated intracerebral hemorrhage (ICH) despite international normalized ratio (INR) normalization with fresh-frozen plasma (FFP), we reviewed 45 patients with warfarin-associated ICH given FFP. The median time for door to INR normalization was 30 hours (14 to 49.5), with 4 patients' hematomas enlarging after INR normalization. FFP is associated with substantial time delay to actual administration and pulmonary edema and may not prevent progression of ICH despite INR normalization.

Aged↗
PubMed2006

Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke.

INTRODUCTION: Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. METHODS: A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. RESULTS: After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. CONCLUSION: We report the use of a new mechanical thrombectomy device 8 h after onset of ischemic symptoms, with substantial subsequent improvement in neurological outcome. In selected cases, use of the Merci Retriever can result in improved outcomes beyond the traditional 6-h window used for intraarterial pharmacological thrombolysis.

Aged↗
PubMed2006

Use of the Perclose ProGlide device with the 9 French Merci retrieval system.

INTRODUCTION: Closure devices are commonly used in neurointerventional procedures to achieve groin hemostasis. These devices are particularly useful in procedures requiring anticoagulation and larger catheters. The suture-mediated Perclose ProGlide device is intended for use with 5F to 8F sheaths. We describe the use of the ProGlide device with 9F sheaths in acute stroke treatment using the Merci retrieval device. METHODS: The ProGlide device is advanced over a wire until the wire exit port is at the skin surface. The wire is removed and the device is advanced until pulsatile blood flow is encountered. The footplates are opened and the stitch is deployed. The footplates are then closed and the device is removed. After advancing the suture to the vessel, it is locked and trimmed. Firm pressure is necessary during deployment to prevent oozing around the device. If continued bleeding is encountered, direct manual pressure is used to achieve hemostasis. RESULTS: We have successfully used the Perclose ProGlide device in four patients following the Merci retriever without groin or extremity complication. The Perclose ProGlide device can be successfully used after placement of a 9F system in patients who have undergone mechanical thrombectomy. CONCLUSION: This technique may be of interest to endovascular surgical neuroradiologists because it affords fast hemostasis in large access sites following mechanical thrombectomy with the Merci retrieval device. Compared to the "Preclose" technique, it saves valuable time at the beginning of the case.

Aged, 80 and over↗
PubMed2006

Vascular anatomic variation in rabbits.

PURPOSE: To explore the vascular anatomic variation along the aortic arch in New Zealand White rabbits with the goal of highlighting potential anatomic configurations that might be encountered in the performance of preclinical endovascular research in rabbits. MATERIALS AND METHODS: Digital subtraction angiography images of the brachiocephalic artery (BCA) and aortic arch in New Zealand White rabbits were obtained after creation of elastase-induced aneurysms at the origin of the right common carotid artery (RCCA) in 214 animals. The patterns of origin of the RCCA and left common carotid artery (LCCA), right subclavian artery (RSCA) and left subclavian artery (LSCA), and right vertebral artery (RVA) and left vertebral artery (LVA) were analyzed. RESULTS: Five predominant variations of vessel origin were identified. In 200 of 214 cases (93%), the LCCA originated from the bifurcation of the BCA and aorta. In eight cases (4%), the LCCA directly originated from the aorta. In two cases (1%), the LCCA originated from the BCA. Aberrant RSCA anatomy in which the RSCA originated from the aortic arch instead of the BCA was found in three cases (1.5%). In a single case (0.5%), aberrant RSCA anatomy with the RVA originating from the BCA was encountered. CONCLUSIONS: Anatomic variation of the BCA in New Zealand White rabbits is similar to that seen in humans. Understanding of the normal and variant anatomy of the rabbit will aid investigators who use the rabbit model for endovascular research.

Angiography, Digital Subtraction↗
PubMed2006

Vertebral endplate fractures: an indicator of the abnormal forces generated in the spine after vertebroplasty.

UNLABELLED: Vertebroplasty alters spinal biomechanics and may lead to incident vertebral fractures. The endplate localization of prevalent and incident fractures was evaluated in 86 patients. In the absence of vertebroplasty, superior endplate fractures predominate. After the procedure, inferior endplate fractures are disproportionately common in adjacent vertebrae immediately above the treated level, potentially supporting a causative relationship between vertebroplasty and incident fractures. INTRODUCTION: To determine retrospectively whether new-onset fractures after vertebroplasty tend to cluster in the endplate immediately adjacent to the cemented vertebra. MATERIALS AND METHODS: Institutional Review Board approval and patient consent for use the use of medical records were obtained for this study. We performed a retrospective review of patients with new (incident) vertebral fractures after vertebroplasty. The median age for these patients was 72.5 years, and 58 (67.4%) were women. Fractures were diagnosed on the basis of MRI or bone scan and were catalogued based on their location within the vertebral body (superior endplate, inferior endplate, or holo-vertebral). Chi(2) and generalized estimating equation (GEE) analyses were used to compare the distribution of fracture subtypes among pre-existing (prevalent) and incident fractures. RESULTS: The patients had 313 prevalent osteoporotic vertebral fractures and were treated at 137 vertebral levels. Among prevalent fractures, superior endplate fractures predominated (57% superior, 11% inferior; p < 0.0001). After vertebroplasty, 186 incident fractures developed in these 86 patients. Seventy-seven (41%) of these incident fractures occurred adjacent to treated vertebrae. Nonadjacent, incident fractures, like prevalent fractures, occurred predominantly along superior endplate. Incident fractures immediately above treated levels, however, localized disproportionately to the inferior endplate (30% superior, 57% inferior; p < 0.0001). CONCLUSIONS: There are an increased number of inferior endplate fractures of the vertebral body immediately cephalad to the treated level.

Adult↗
PubMedDate not supplied

Use of covered stent grafts in the extracranial carotid artery: report of three patients with follow-up between 8 and 42 months.

Currently, most carotid artery pathologic abnormalities resulting in pseudoaneurysm formation or stenosis are repaired by surgical intervention. Because surgical intervention requires proximal and distal control of the artery, pseudoaneurysms near the skull base may be very difficult to repair and pose greater risk to the patient. As a result, endovascular techniques have evolved in an effort to reduce morbidity associated with surgical techniques. Parent vessel occlusion and coil placement are the most frequently used endovascular techniques for carotid artery repair of pseudoaneurysms. Intimal hyperplasia is generally treated with balloon angioplasty, often in conjunction with uncovered stent placement. Parent vessel occlusion may be impractical if the patient is unable to tolerate occlusion of that artery. We report our experience in treating three patients with carotid artery stent grafts.

Adult↗