PubMed Health⌕ Search

Biomedical subjects

R T Higashida

Publications and source records attributed to R T Higashida.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Subclavian arteritis and pseudoaneurysm formation secondary to stent infection.

Technically uncomplicated percutaneous angioplasty and stent placement of a left subclavian artery stenosis was performed in a 56-year-old man for treatment of subclavian steal syndrome and vertebrobasilar insufficiency. Six days later the patient was readmitted with Staphylococcus aureus bacteremia and stigmata of septic emboli isolated to the ipsilateral hand. Nine days later he had computed tomography (CT) evidence of a contrast-enhancing phlegmon surrounding the stent. Despite clinical improvement and resolution of bacteremia on intravenous antibiotic therapy, the phlegmon progressed, and at day 21 a pseudoaneurysm was angiographically confirmed. The patient underwent surgical removal of the stented arterial segment and successful autogenous arterial reconstruction. The possible contributory factors leading to stent infection were prolonged right femoral artery access and an infected left arm venous access. Although the role of prophylactic antibiotics remains to be defined, it may be important in cases where the vascular access sheath remains in place for a prolonged period of time.

Aneurysm, False↗
PubMedDate not supplied

Transarterial embolization of vertebral hemangioma.

PURPOSE: The authors retrospectively reviewed their 4-year clinical experience to determine the role of transarterial embolization in the treatment of symptomatic vertebral hemangioma. PATIENTS AND METHODS: Eight patients (age range, 12-56 years) underwent a total of 10 embolization procedures; one patient underwent three procedures. The lesions were located between T-5 and L-5, and all patients presented with pain and symptoms referable to the lower extremities. RESULTS: Embolization was technically successful in all patients, and no complications were encountered. Six of eight patients underwent surgery within 48 hours of embolization; four of the six showed significant clinical improvement immediately after surgery and on follow-up (average, 34 months). Two patients did not improve postoperatively. Two patients initially underwent embolization as the sole therapy. The first refused surgery and did not improve clinically; the second underwent two embolization procedures without clinical improvement and eventually underwent a third followed by surgery, which resulted in clinical improvement. All patients were hemodynamically stable during surgery, and blood loss was not problematic in any patient. CONCLUSIONS: Overall, surgery was an effective treatment for symptomatic vertebral hemangioma and the authors conclude that transarterial embolization of vertebral hemangioma is a safe and efficacious adjunctive procedure to such surgery. However, embolization was not as promising as a sole therapeutic modality in this small group of patients.

Adolescent↗
PubMedDate not supplied

Simultaneous subarachnoid hemorrhage and carotid cavernous fistula after rupture of a paraclinoid aneurysm during balloon-assisted coil embolization.

We describe an iatrogenic perforation of a paraclinoid aneurysm during balloon-assisted coil embolization that resulted in simultaneous subarachnoid contrast extravasation and a carotid cavernous fistula. The causative factors specifically related to the balloon-assisted method that led to aneurysm rupture are discussed as well as strategies for dealing with this complication.

Aged↗
PubMedDate not supplied

Embolization of the meningohypophyseal trunk as a cause of diabetes insipidus.

We present an unusual case of diabetes insipidus occurring after selective embolization of 50% dextrose and pure ethanol into an enlarged left meningohypophyseal trunk (MHT) supplying a dural carotid cavernous fistula. The inferior hypophyseal artery was not opacified during the selective preembolization MHT injection; however, diabetes insipidus developed abruptly a few hours after the procedure. The patient required intranasal 1-deamino-(8-D-arginine)-vasopressin for approximately 3 months, after which his symptoms resolved. The hazards of using liquid embolic agents, especially ethanol, in the cavernous branches of the internal carotid artery should always be borne in mind.

Angiography, Digital Subtraction↗
PubMedDate not supplied

Program requirements for residency/fellowship education in neuroendovascular surgery/interventional neuroradiology: a special report on graduate medical education.

BACKGROUND AND PURPOSE: Neuroendovascular surgery/interventional neuroradiology is a relatively new subspecialty that has been evolving since the mid-1970s. During the past 2 decades, significant advances have been made in this field of minimally invasive therapy for the treatment of intracranial cerebral aneurysms; acute stroke therapy intervention; cerebral arteriovenous malformations; carotid cavernous sinus fistulas; head, neck, and spinal cord vascular lesions; and other complex cerebrovascular diseases. Advanced postresidency fellowship programs have now been established in North America, Europe, and Japan, specifically for training in this new subspecialty. METHODS: From 1986 to the present, an ad hoc committee of senior executive committee members from the American Society of Interventional and Therapeutic Neuroradiology, the Joint Section of Cerebrovascular Neurosurgery, and the American Society of Neuroradiology met to establish, by consensus, general guidelines for training physicians in this field. RESULTS: In April 1999, the Executive Committee of the Joint Section of Cerebrovascular Neurosurgery voted unanimously to endorse these training standard guidelines. In May 1999, the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology also unanimously voted to endorse these guidelines. In June 1999, the Executive Council of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons unanimously voted to endorse these guidelines. CONCLUSION: The following guidelines for residency/fellowship education have now been endorsed by the parent organization of both the interventional and diagnostic neuroradiology community, as well as both senior organizations representing neurosurgery in North America. These guidelines for training should be used as a reference and guide to any institution establishing a training program in neuroendovascular surgery/interventional neuroradiology.

Curriculum↗
PubMedDate not supplied

Acute thrombosis of the intracranial dural sinus: direct thrombolytic treatment.

Acute intracranial dural sinus thrombosis may have severe morbidity or fatal complications without appropriate treatment. Direct dural sinus venography can be performed safely with a soft Tracker catheter to document the fresh thrombus as an adjunct to CT or MR. We are reporting our experience with successful direct urokinase thrombolytic therapy in three cases of superior sagittal sinus and two cases of transverse and sigmoid sinus thrombosis. All five patients have recovered completely without any residual clinical deficit.

Acute Disease↗
PubMedDate not supplied

Particulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations.

The anterior choroidal artery is commonly recruited to supply arteriovenous malformations in the temporal lobe, basal ganglia, lateral ventricle, and internal capsule. Embolization of this artery is theoretically hazardous owing to its supply to important motor territory, relative lack of collaterals, and small caliber. However, this procedure can be a beneficial adjunct to surgery or radiation in the treatment of arteriovenous malformations. We describe our experience in performing particulate embolization of the anterior choroidal artery in 15 patients (16 procedures). Significant flow reduction was achieved in 14 patients. Two symptomatic and two asymptomatic complications arose, including permanent hemiparesis in one patient.

Adolescent↗
PubMedDate not supplied

Management of vascular perforations that occur during neurointerventional procedures.

This article describes a number of treatment strategies for the management of perforations that occur during neurointerventional procedures. During the past 5 years, we have performed over 1200 endovascular procedures to treat vascular disorders involving the brain and spinal cord (400 cerebral arteriovenous malformations, 230 tumors, 197 carotid cavernous fistulas, 183 aneurysms, 130 dural fistulas, 80 spinal arteriovenous malformations, 18 vein of Galen aneurysms, and 20 cases of vasospasm). Fifteen patients (1.1%) sustained a vascular perforation as a direct result of these procedures. Among these 15 patients, indications for endovascular treatment were six symptomatic arteriovenous malformations, two spinal cord arteriovenous malformations, two cavernous sinus dural fistulas, one transverse sinus fistula, one case of vasospasm following subarachnoid hemorrhage, one direct carotid cavernous fistula, one vein of Galen malformation, and one ruptured basilar artery aneurysm. The vascular perforations were grouped into three probable mechanisms: mechanical perforation of a normal vessel (six patients), mechanical disruption of a dysplastic vessel or aneurysm (five patients), and fluid overinjection (four patients). Treatment of the perforations included immediate reversal of anticoagulants (12 patients) and direct closure of the perforation site with coils (five patients). In addition, closure of the intravascular compartment adjacent to the perforation was achieved with coils (six patients), liquid adhesives (four patients), balloons (two patients), or particles (two patients). In two patients a detachable balloon was placed transiently across the perforation site for several minutes, deflated, and removed when no further extravasation was noted. Five patients were started on anticonvulsant therapy, two of whom have had a new onset seizure related to the perforation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Transarterial platinum coil embolization of carotid-cavernous fistulas.

Of the 227 embolization procedures performed by our neurointerventional section for symptomatic carotid-cavernous fistulas over the past 10 years, five involved placement of platinum coils in the cavernous sinus from a transarterial route. In four patients, prior transarterial balloon procedures had failed to produce fistula closure. In the fifth patient, with Ehlers-Danlos syndrome, a prior transvenous embolization attempt was unsuccessful. In three patients, complete closure of the carotid-cavernous fistula was achieved with preservation of the parent artery. In one patient, the earliest treated, a portion of a platinum coil projected through the fistula into the parent artery. To eliminate the risk of clot formation and distal embolization, internal carotid occlusion was performed and tolerated without deficits. In the last patient, closure of the anterior drainage was achieved, but complicated by distal migration of the platinum coils with transient aggravation of ocular symptoms. Attempts to occlude the remaining cortical drainage were unsuccessful with platinum coils; therefore, a balloon was used to obliterate the small remaining fistula. Transarterial platinum coil embolization is an alternative treatment for symptomatic carotid-cavernous fistulas that cannot be closed successfully by other embolization techniques. The development of shorter, more thrombogenic, detachable or retrievable coils may make this technique more promising in the future.

Adult↗
PubMedDate not supplied

Multiple dural arteriovenous fistulas of the cranium and spine.

Dural arteriovenous fistulas are acquired lesions that usually involve the dura around the cavernous sinus. The transverse, sigmoid, and superior sagittal sinuses may be affected occasionally. With the exception of bilateral cavernous sinus dural arteriovenous fistulas, the simultaneous occurrence of dural arteriovenous fistulas at two locations is rare. Among 105 patients evaluated for dural arteriovenous fistulas, we identified seven patients with fistulas at two sites. The age of the patients ranged from 27 to 74 years. Presentation was related to hemorrhage in three patients, loss of vision in four, and a bruit and headaches in one. Patients were treated with combined surgical and endovascular techniques. All treated lesions were completely closed with no mortality or permanent morbidity. The presence of multiple fistulas must be considered in patients being evaluated for dural arteriovenous fistulas. Patients with multiple fistulas usually present with life-threatening hemorrhages or acute neurologic decline; the risk factor for hemorrhages, including those related to venous outflow obstruction, is high in patients with multiple dural arteriovenous fistulas.

Adult↗
PubMedDate not supplied

Aneurysms of the petrous portion of the internal carotid artery: results of treatment with endovascular or surgical occlusion.

Seven patients with symptomatic aneurysms involving the petrous segment of the internal carotid artery were treated by endovascular techniques (six patients) or surgical ligation (one patient). Patients' ages at the time of treatment ranged from 7 to 62 years (mean, 30 years). The presenting symptoms were pain (seven patients), eighth nerve dysfunction (three patients), seventh nerve dysfunction (one patient), fifth nerve dysfunction (two patients), and bruit (one patient). Two patients, ages 7 and 19, respectively, presented with giant, partially thrombosed petrous aneurysms and had hemiatrophy of the body ipsilateral to the side of the aneurysm. Only one patient had a history of trauma; aneurysms in the remaining patients were presumed to be congenital in origin. In one patient with a saccular aneurysm, a balloon could be navigated into the aneurysm, obliterating it but preserving the parent artery. The remaining six patients had fusiform aneurysms with intraluminal thrombus and underwent proximal occlusion (four patients) or trapping procedure (two patients). In all patients, symptoms were alleviated after thrombosis of the aneurysm. The only complication was a transient visual loss in a hypercoagulable patient, occurring after carotid occlusion. Petrous carotid aneurysms can produce a wide clinical spectrum of signs and symptoms in younger patients; these aneurysms frequently are fusiform and contain chronic thrombus. They can be treated effectively by endovascular or surgical occlusive procedures.

Adolescent↗
PubMedDate not supplied

Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients.

Treatment of intracranial arterial aneurysms by interventional neurovascular techniques is now being performed in selected cases. From a transfemoral approach, under local anesthesia, a detachable silicone microballoon can be guided through the intracranial circulation, directed into the aneurysm, inflated with a polymerizing agent for solidification, and detached. The goal is to exclude the aneurysm from the circulation and preserve flow through the parent artery. Since 1984, 84 patients have been treated by this technique. The patients ranged in age from 15 to 83 years (mean age, 48) and included 63 females and 21 males. The distribution of aneurysms included 59 in the anterior circulation and 25 in the posterior circulation. The presenting symptom or cause was mass effect in 45 patients (53.6%), subarachnoid hemorrhage in 31 patients (36.9%), carotid-cavernous sinus fistula resulting from rupture of an intracavernous aneurysm in six cases (7.1%), trauma in one case, and transient cerebral ischemia due to emboli in one case. Permanent complications directly related to therapy included 15 deaths and nine cases of stroke. Clinical and radiologic follow-ups were performed 1, 3, and 12 months after treatment; duration of follow-up ranged from 3 to 68 months (mean, 35.5 months). In 65 cases (77.4%) there was evidence of complete aneurysmal occlusion, and in 19 cases 922.6%) there was subtotal occlusion greater than 85%. Interventional techniques for treatment of intracranial aneurysms may be useful as a therapeutic alternative in those patients not amenable to standard surgical therapy.

Adolescent↗
PubMedDate not supplied

Transfemoral venous embolization of vein of Galen malformations.

Three infants with vein of Galen malformations, all presenting with congestive heart failure, underwent a total of five embolization procedures that employed a percutaneous transfemoral venous approach to catheterize the vein of Galen. In one instance, direct retrograde catheterization of feeding arterial pedicles to the vein of Galen and embolization of the fistulous connections was achieved via this route. The indications for transfemoral venous treatment included persistent symptoms despite transarterial and transtorcular embolization in one patient, an unsuccessful transarterial embolization attempt (complicated by catheter fracture) in another, and the inadvisability of transarterial embolization because of an excessive number of feeding arteries in a third. Complete obliteration of the malformation was achieved in one patient and significant flow reduction in the other two. Vein of Galen perforation with the catheter tip complicated one procedure. All three patients were stable after clinical follow-ups (9-12 months). The transvenous route to the vein of Galen can be undertaken from a transfemoral approach, obviating surgical exposure of the torcular Herophili. In addition, we introduce the concept of direct retrograde catheterization of the feeding arteries to the vein of Galen malformation by a transfemoral venous approach, a procedure that has not been reported previously.

Cerebral Veins↗
PubMedDate not supplied

New microballoon device for transluminal angioplasty of intracranial arterial vasospasm.

A new microballoon device has been developed to treat intracranial arterial vasospasm by transluminal angioplasty. The balloon is composed of a unique silicone elastomer that will elongate and conform to the blood vessel lumen, thereby decreasing the risk of vessel rupture. The balloon device, which can be either flow-directed or catheter-guided, is permanently affixed to a 2.0-French microcatheter and introduced from a transfemoral arterial approach. Two balloon sizes are currently available. The smaller-sized balloon, used in most cases, measures 0.85 x 3.50 mm uninflated, will accept a volume of 0.10 ml, and will expand to 3.5 x 12.5 mm. The larger balloon, used in six of 14 cases, measures 1.5 x 3.9 mm uninflated, accepts a volume of 0.50 ml, and expands to 7.5 x 13.5 mm. In clinical trials, this device has been successful in dilating both focal and diffuse areas of vasospasm in multiple territories. Thus far, 40 vascular territories have been successfully treated in 14 patients 15-73 years old. In each case, there was angiographic evidence of successful dilatation, and in 10 patients (71%), clinical improvement in the neurologic condition. Transluminal angioplasty techniques may be useful for reversing some of the serious neurologic sequelae associated with acute intracranial arterial vasospasm.

Angioplasty, Balloon↗
PubMedDate not supplied

Embolization of branches arising from the cavernous portion of the internal carotid artery.

Seven patients with vascular disease (four with cavernous and two with transverse sinus dural fistulas and one with a facial arteriovenous malformation, all supplied primarily from cavernous branches of the internal carotid artery) underwent subselective catheterization and embolization. Ten branches were catheterized (seven meningohypophyseal trunks and three inferolateral trunks) and eight branches were embolized. The embolic agents were as follows: polyvinyl alcohol particles in five, hypertonic glucose in two, and liquid adhesive in one. All four cavernous sinus dural fistulas were occluded after embolization. In the two transverse sinus fistulas, the goal of embolization was to obliterate the tentorial supply prior to surgery. This goal was achieved in both cases. In the remaining patient, who had a large facial arteriovenous malformation and recurrent epistaxis, the embolization obliterated the cavernous supply to the nasal cavity and the patient remains hemorrhage-free. Despite one complication, which occurred in the first case when a thrombus formed and dislodged, resulting in an embolic stroke, this study shows that subselective catheterization and embolization can obliterate lesions of the branches arising from the cavernous internal carotid artery.

Adult↗
PubMedDate not supplied

Direct puncture of the proximally occluded internal carotid artery for treatment of carotid cavernous fistulas.

Three patients with symptomatic carotid cavernous fistulas (CCFs) characterized by complete occlusion of the proximal internal carotid artery were treated by percutaneous puncture and embolization. Two patients had CCFs associated with traumatic dissections of the internal carotid artery and were treated initially with trapping procedures. Both patients had persistent symptoms related to the CCF and underwent additional surgical procedures (ophthalmic artery ligation and intraoperative embolization) without improvement. The third patient had traumatic occlusion of the internal carotid artery. After direct percutaneous puncture of the carotid artery above the occlusion, a catheter was advanced into the petrous internal carotid artery. Balloons (one case) or coil emboli (two cases) were placed into the cavernous sinus to produce CCF closure. There were no complications from this procedure. Direct puncture of the carotid artery is an alternative treatment for patients lacking safe access for CCF embolization.

Arterial Occlusive Diseases↗