Biomedical subjects
Publications and source records attributed to M Allaoui.
A case of a chondroblastoma of the skull-base associated with a persistent hypoglossal artery (PHA) is presented. Neuroradiological findings of the PHA and the tumour are reported. The existence of a carotico-basilar communication such as a PHA should be recognized prior to skull base surgery because of the potential risk of cerebral ischemia.
We report a case of a ventricular dermoid cyst associated with a dermal sinus connected with the ethmoidal cells in a patient who developed rapid symptoms of raised intracranial pressure. Computed tomography showed a cystic mass in the right lateral ventricle with a hydrolipidic image in the left frontal horn of the ventricle and associated hydrocephalus. Magnetic resonance imaging showed a heterogeneous T1 hyperintense mass with a fistulous tract communicating with the ethmoid cells. A cerebrospinal fluid ventriculo-peritoneal shunt was initially established, which required further revision. A right sided transventricular approach was undertaken in a second stage, allowing resection of a dermoid cyst. Obliteration of the dermal sinus tract was obtained using pericranial duraplasty. Clinical and imaging features are discussed. The need for total resection including the tumor capsule and occlusion of the fistula are emphasized if recurrence and infection are to be prevented.
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PURPOSE: To present a single-center experience with a mechanical hydrodynamic thrombectomy system (Hydrolyser) in native arteries, veins, and bypass grafts. METHODS: The Hydrolyser is a 7F, double lumen, over-the-wire thrombectomy catheter. The device was used in 41 patients (22 males; mean age 68 years, range 40 to 90), with recent thromboses (aged 1 to 30 days, mean 8.7+/-8.5), measuring from 4 to 35 cm long (mean 17.7+/-9.5). The occlusions were located in native lower limb arteries (n = 28), bypass grafts (n = 8), superior venae cavae (n = 2), axillary vein (n = 1), and pulmonary arteries (n = 2). RESULTS: Immediate technical success (residual clot < 50% of lumen diameter) was achieved in 34 patients (83%): 22/28 native arteries (78%), 7/8 bypass grafts (87%), and all pulmonary arteries, superior venae cavae, and the axillary vein. The 7 failed patients were treated surgically (bypass graft or Fogarty balloon). Adjunctive procedureswere used to maximize luminal diameter: angioplasty (n = 29, with 13 immediate stent implantations), thromboaspiration (n = 17), and thrombolysis (n = 10). One case of distal embolism was the only complication (treated by thromboaspiration). At 30 days, 30 (73%) vessels remained patent. CONCLUSIONS: The Hydrolyser system is a promising concept for percutaneous thrombectomy. It is a quick, reliable, efficient device that may offer an alternative to thrombolysis and surgical thrombectomy.
PURPOSE: to present our clinical experience with a new mechanical hydrodynamic thrombectomy system (Hydrolyser), using the Venturi effect, applied for thrombus removal in native arteries, arterial grafts, venous system and pulmonary arteries (diameter > 5 mm). MATERIAL AND METHODS: the Hydrolyser, a 7F, double lumen, over the wire catheter, was used in 50 patients (29 males, 21 females), mean age: 66.2 +/- 13.1 years (40-90). Mean occlusion time: 8.7 +/- 7.3 days (1-30), mean thrombus length: 17.7 +/- 10.2 cm (4-35). Thrombus' location: native arteries (35), arterial grafts (9), superior vena cava (2), axillary vein (2), pulmonary artery (2). Approach ways: arterial femoral antegrade (22), retrograde (7), contralateral (14), popliteal arterial (1), veinous femoral (5) and veinous brachial (1). RESULTS: Immediate technical success in 41 patients (82%): native arteries (27/35), arterial graft (7/9), pulmonary artery (2/2), superior vena cava (2/2) axillary vein (2/2). Percentage of thrombus estimated angiographically to be removed by the Hydrolyser: 72.5 +/- 22%. Adjunctive therapy: angioplasty (38, with 19 immediate stents implantations), thromboaspiration (17), reduced time fibrinolysis (11). One complication: distal embolism cured by thromboaspiration. In 9 patients the procedure failed, requiring surgery. CONCLUSION: the Hydrolyser system seems a promising concept for percutaneous thrombectomy. It is a quick reliable, efficient device. This technique may also offer an alternative to thrombolysis and surgical thrombectomy.
PURPOSE: To define the long-term outcome of stent placement in iliac and femoropopliteal arteries. MATERIALS AND METHODS: Three hundred ten patients received 418 balloon-expandable Palmaz stents. Two hundred thirty stents were implanted in iliac arteries of 184 patients, and 188 stents were implanted in femoropopliteal arteries in 126 patients. Restenosis rates were based on results of angiography performed 4-6 months after stent placement. Long-term patency rates were determined with duplex ultrasound. RESULTS: Immediate procedural success was achieved in 309 patients. Acute thrombosis ( < 24 hours) occurred in five patients, and immediate clinical success in 288. The 30-day mortality and morbidity rates were 0% and 8%, respectively. Angiography performed at 6 months in 299 patients revealed restenosis rates of 0.5% in iliac lesions, 11% in superficial femoral artery (SFA) lesions, and 20% in popliteal lesions. Survival analysis revealed 4-year primary patency rates of 86% +/- 4.1 for iliac artery lesions, 65% +/- 7.5 for SFA lesions, and 50% +/- 17.7 for popliteal artery lesions. Most restenotic lesions were successfully treated with repeat angioplasty. CONCLUSION: Implantation of Palmaz stents in iliac arteries allows long-term primary patency to be maintained in most patients.
PURPOSE: In order to assess the role of percutaneous peripheral rotational ablation using Rotablator, 150 symptomatic patients (94 males, 56 females; mean age 73 +/- 1 years, range 42 to 90) having 212 complex peripheral vascular lesions were treated. METHODS: Fifty percent of lesions were below the knee; 65% of patients had severe claudication, 11% moderate (24% were in stage III or IV Fontaine classification). The femoral lesions were significantly longer than those at other sites (5.7 +/- 0.4 versus 2.9 +/- 0.3 cm, p < 0.001). The mean length was 4.0 +/- 0.2 cm (range 1 to 20). All the lesions were considered complex; 93% of the lesions were clacified, and 63% were located at a bifurcation. Complementary balloon dilation (percutaneous transluminal angioplasty [PTA]) was significantly (p < 0.001) more frequent in femoropopliteal lesions (70 PTAs in 86 femoral arteries, 10 PTAs in 19 popliteal arteries) than in distal leg lesions (14 in 106 arteries). RESULTS: After Rotablator therapy alone, the percent stenosis decreased from 81.0% +/- 0.8% to 18.0% +/- 1.1%. The residual stenosis was greater at the femoral (44%) than at the distal level (19%) (p < 0.01). Adjunctive PTA (47 lesions) lowered residual stenosis to 10% at the femoral level and 3% at the distal level. Thirty-seven intraprocedural complications occurred (spasm, thrombosis, dissection, perforation, distal emboli, no reflow); seven procedures subsequently failed for an overall technical success of 97%. The mean follow-up period was 14.4 +/- 1.0 months (range 1 to 51). Among 125 patients having a follow-up period > or = 4 months, 114 patients representing 163 lesions underwent angiography. One hundred twenty-three lesions (76%) were patent, and 40 lesions (24%) showed restenosis (> or = 50% luminal narrowing) of 82.0% +/- 21%. The restenosis rate was higher in femoral (36%) than in distal (21%) or popliteal arteries (7%). Restenosis was more frequent for all lesions > or = 7 cm (p < 0.001) and for both above- and below-knee locations: 55% versus 19% for < 7 cm at the femoropopliteal level (p < 0.03), and 80% versus 18% at the distal level (p < 0.01). CONCLUSIONS: In our experience, percutaneous peripheral rotational ablation has taken a pre-eminent position in the treatment of distal leg arteries, especially in complex lesions. Our results have led us to broaden its indications to complex vascular lesions < or = 6 cm. In particular, the use of this technique for treatment of runoff vessels should improve the long-term patency of proximal PTA and bypass grafts. This device has become indispensable in our laboratory, where Rotablator therapy comprises 15% of all PTA procedures.
PURPOSE: Given the increasing number of percutaneously applied endovascular therapies, the incidence of access-related vascular complications can be expected to rise, particularly in association with those techniques requiring large sheaths or anticoagulation. The need exists for a safe, easy to use, and effective hemostatic technique to replace the labor-intensive method of manual compression. METHODS: A bioabsorbable, sheath-delivered vascular device (Angio-Seal) has been developed that deposits a small collagen plug within the arterial wall to mechanically seal the puncture defect. An anchor connected by suture to the plug is first deployed in the arterial lumen and pulled flush against the interior wall to guard against intraluminal deposition of the collagen. RESULTS: The Angio-Seal device was deployed successfully in 80 (96%) of 83 attempts involving common femoral arteries accessed for peripheral angioplasty (n = 30), coronary angiography (n = 30), and coronary angioplasty (n = 16). Three popliteal artery access sites and one femoropopliteal bypass graft were also treated. Hemostasis was immediate in 78 cases (98%); 2 sites required a 5-minute manual compression to effect a secure seal. Three devices failed to deploy, and manual pressure was used to close the puncture. Nondeployment did not cause any sequelae, and no complications were encountered with the technique. CONCLUSIONS: This novel vascular closure device is quick (< 1 minute application time) and simple to use, providing a positive seal of common femoral artery puncture sites for both peripheral and coronary interventions. It appears to be a reliable alternative to standard manual hemostasis.
PURPOSE: To evaluate the safety and efficacy of a new covered stent, the Cragg Endopro System 1, for intraluminal treatment of peripheral vascular disease in the iliac and femoropopliteal arteries. METHODS: Forty symptomatic patients with predominantly lengthy stenotic (24) or occlusive (13) lesions or aneurysms (3) in the iliac (19), femoral (19), or popliteal (2) arteries were treated percutaneously with balloon angioplasty followed by implantation of the self-expanding nitinol Cragg stent covered by a woven polyester fabric coated with low-molecular-weight heparin. The mean length of femoropopliteal lesions was 13.0 +/- 1.8 cm, as compared to 6.7 +/- 0.8 cm (p < 0.01) for iliac lesions. Mean percent stenosis was 89% +/- 2% with no significant difference between the arterial segments. RESULTS: With a total of 52 covered stents implanted, technical success was achieved in 98% (39/40 patients). One tortuous femoral artery aneurysm was not satisfactorily excluded to prevent leakage. Clinical success was seen in all patients with demonstrable improvements in the claudication stage and the ankle-brachial index from a mean 0.54 to 0.92. Three local complications (one hematoma, two false aneurysms) required surgical repair. One distal embolism, one acute thrombosis, and three subacute thromboses were encountered and successfully treated by thrombolysis and/or surgery. One patient with two iliac stents developed contralateral common iliac artery occlusion from a stent partially obstructing the aorta; placement of a covered stent in the blocked artery re-established normal flow. Over an 8-month follow-up with arteriographic re-examination, all iliac stents remained patent. At the femoropopliteal level, two stents were occluded at 4 months; one was successfully dilated, but the other required surgical bypass grafting. A third patient developed a stenotic lesion proximal to the stent; dilation restored adequate inflow to the stent. CONCLUSIONS: The Cragg Endopro System 1 appears to be effective as an "internal bypass" for iliac and femoropopliteal occlusive disease. More complications and restenosis were seen in femoropopliteal implantations; however, a change in postoperative medication may improve these results. Long-term results will determine if the Cragg Endopro System 1 can achieve a patency equal to conventional bypass grafting.
PURPOSE: To evaluate the long-term results of stent placement in the renal arteries. PATIENTS AND METHODS: From January 1990 to August 1994, 59 hypertensive patients underwent 64 stent placement procedures. Indications were residual stenosis after percutaneous transluminal renal angioplasty in 42 patients, restenosis in 20 patients, and acute dissection in two patients. Follow-up (mean, 14 months) was obtained in 54 patients. Six-month restenosis rates were based on results of arteriography, and even more long-term patency rates were based on duplex ultrasound. RESULTS: Technical success was achieved in all patients. Major complications occurred in two patients. No minor or puncture-site complications were observed. The overall 6-month restenosis rate was 1.6% (2.9% for ostial lesions). Survival analysis with the Kaplan-Meier method showed primary and secondary patency rates of 92% +/- 3.6 and 98% +/- 1.9, respectively, at 1 year and 79% +/- 8.8 and 92% +/- 6.1, respectively, at 2 years. Seventy-six percent of hypertensive patients benefited from the procedure. However, renal function was not improved by stent placement. CONCLUSION: Stent placement in renal arteries is a useful adjunct to percutaneous transluminal angioplasty for atherosclerotic renal-artery stenoses.