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At least 37 records · Page 2Linked to original sources
PubMed1990

Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia.

Forty patients with widely disseminated or locally advanced malignant obstruction of the middle or lower third of the oesophagus underwent endoscopic treatment by either NdYAG laser recanalization or intubation. Groups were matched on the basis of tumour location and swallowing was graded clinically before and after treatment. Technical success was achieved in 17 of 20 laser treated and 18 of 20 intubated patients. Pretreatment swallowing ability, histology, tumour location and overall length were unrelated to functional outcome in both groups. However, circumferential tumour length identified endoscopically strongly influenced the quality of swallowing after laser recanalization. Patients with excellent swallowing quality (n = 7) had significantly shorter circumferential tumour lengths, 3.1(1.0) cm, than those with poorer quality swallowing (n = 10), 6.3(1.6)cm, (P less than 0.001). Both methods of treatment had low complication rates and there was one death in the series in the laser-treated group. Laser recanalization provides a better functional result than intubation for short (less than 4 cm) circumferential tumour. Intubation at a single session seems more appropriate than repeated laser therapy when tumour length exceeds 4 cm.

Aged↗
PubMed1992

Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia: a randomized prospective study.

Forty patients with histologically confirmed malignant dysphagia were randomized to either endoscopic intubation or laser recanalization. Age, sex, tumour histology and site were evenly distributed between the groups. Results were analysed on an 'intention to treat' basis. All patients treated by laser achieved patency; there was one failed intubation. The best swallowing grade achieved was significantly better with laser recanalization (median 4 (range 3-4)) than with intubation (median 3 (range 2-4)) (P < 0.001). The median survival was 21.5 (range 4-62) weeks in the group receiving laser treatment, compared with 14.5 (range 7-102) weeks in the intubated group (P = 0.09). The median inpatient stay as a proportion of survival time was 14 per cent in the group receiving laser treatment compared with 15 per cent in the intubated group (P > 0.05). The median weight loss was less in the laser-treated patients (2.0 (range 2-8) versus 3.0 (range 0-10) kg, P = 0.04). These results indicate that laser recanalization provides better palliation of dysphagia than does intubation, but this is not reflected in an improvement in survival time.

Adult↗
PubMed1978

Acute coronary occlusion with impending infarction as an angiographic complication relieved by a guide-wire recanalization.

In a 45 year old male patient with a history of previous inferior myocardial infarction and unstable angina pectoris, coronary angiography revealed two-vessel disease: a 60-70% lesion in the middle third of the LAD, and a 90% lesion in the middle third of the very large RCA. There was only a small akinetic segment in the posterobasal region of the left ventricle. During angiography total occlusion of the RCA occurred followed the clinical and electrocardiographic signs of impending inferior reinfarction. Recanalization of the occluded vessel was accomplished by using a guide-wire, which was passed through a Sones catheter, placed in the RCA. The patient's symptoms subsided and the electrocardiographic signs of acute ischemia reverted within eight minutes. Aortocoronary bypass surgery with revascularization of the LAD and RCA was performed within 3 hours after recanalization. Postoperatively there was no evidence of major tissue loss by enzyme or electrocardiographic criteria. Control angiography, performed on the ninth day postoperatively, revealed the graft to the RCA to be widely patent. Left ventricular function was unchanged. It is concluded, that the combined approach of early transluminal recanalization of the acutely occluded RCA followed by successful construction of a graft to this vessel, has averted necrosis of a major portion of the left ventricle. However, general use of this technique does not seem advisable at the present time.

Acute Disease↗
PubMed1992

Surgical recanalization of occluded peripheral arteries.

This article, reflecting on the surgical recanalization of occluded peripheral arteries, has exposed the very essence of vascular surgery. Only the pioneering cardiac anomalies repaired by Gross (patent duct arteriosus, 1938), Blalock and Taussig (tetralogy of Fallot, 1944), and Crafoord and Nylin (coarctation, 1945) and the legendary aortic grafting operations of Oudot (occlusion, 1950) and Dubost and coworkers (aneurysm, 1951) are not a part of this article. The contributions to surgical recanalization of the occluded peripheral arteries are numerous. Some are well conceived, and others are innovative. Perhaps the most significant technique of all, endarterectomy itself, began purely as a serendipitous event. The startling impact of dos Santos' revolutionaly "disobliteration" was realized at once. Intimal injury during the operation did not cause inevitable thrombosis, as historically taught. Thus, all vascular interventions, either endarterectomy, graft repair, or the newer endovascular techniques discussed in this issue, would not have been developed without the understanding of the tolerance of the human intima to injury. Thromboendarterectomy, the basis of surgical recanalization of occluded arteries, unlocked the mystery of arterial rethrombosis after intervention. Recognizing these crucial facts, it will have a lasting place in the expanded discipline of vascular disease and its treatment. Dos Santos, the European founder of endarterectomy, and Wylie, the American pioneer and proponent of endarterectomy, were great friends in life (Fig. 4) and would certainly be pleased to see the further development of technology aimed at the treatment of atherosclerotic obstruction of the peripheral arteries.

Arterial Occlusive Diseases↗
PubMed1992

Ultrasound recanalization of diseased arteries. From experimental studies to clinical application.

At present, percutaneous peripheral ultrasound angioplasty should be considered in those patients with symptoms of claudication or resting limb ischemia. With the development of an over-the-wire system, we treat patients with suprageniculate or infrageniculate lesions. It is expected that the over-the-wire probe will allow application of ultrasound angioplasty not only to lesions below the knee but to contralateral vascular occlusions as well. An intraoperative device for plaque ablation and arterial recanalization is in development for use in less accessible sites such as the coronary arteries. Experimental studies have shown that catheter-delivered therapeutic ultrasound recanalizes complete occlusions, reduces stenoses, dissolves thrombus, vasodilates, and enhances arterial distensibility. The potential clinical applications of therapeutic ultrasound include recanalizing total arterial occlusions, dissolving thrombi, facilitating balloon angioplasty by increasing arterial compliance, and as a stand-alone angioplasty device.

Angioplasty, Balloon↗
PubMed1992

Nd:YAG laser-assisted angioplasty in femoropopliteal artery occlusions: "hot" versus "cold" recanalization with transparent contact probe.

Percutaneous recanalization of femoropopliteal artery occlusions (1-21 cm; median, 8 cm) was attempted in 50 patients. A 2.2-mm-diameter contact probe catheter connected to a continuous-wave neodymium yttrium aluminum garnet (Nd:YAG) laser was used. The laser was activated (15 W, 1-second pulses) only if too much resistance was met. Balloon angioplasty was performed after successful traversal of the occlusion. Primary success was achieved in 40 of 50 patients (80%). In 20 cases, recanalization was achieved mechanically (cold group). In the other 20 cases, recanalization was achieved with the help of laser irradiation (hot group: 15-405 J; median, 90 J). Except for the length of the obstruction (longer in the cold group), the two groups did not differ in baseline characteristics. Neither the length of the occlusion nor the duration of symptoms correlated with failure or success or with the delivered laser energy. Cold and hot groups did not differ with regard to functional improvement and angiographic patency at 3 and 12 months (94% +/- 4). Thus, brief laser activation doubled the cold primary success rate, but the major action of the laser contact probe is mechanical remodeling of the obstruction.

Adult↗
PubMedDate not supplied

Positive scans in angiographically proved cases of recanalized cerebral infarction.

In 20 patients with acute major cerebral arterial occlusion, follow-up angiograms were obtained to inspect the occluded artery. These angiograms were compared with brain scans in the fourth week after the stroke. The angiograms revealed that frequent recanalization of the occluded arteries occurred within a week after the onset. On the other hand, brain scans showed the increased uptake of radioisotopes even in the patients with angiographically demonstrated arterial recanalization. The present study clarified that positive scans could be obtained in the patients with and without recanalization, and emphasized the diagnostic value of brain scans in the subacute or chronic stage of cerebral infarction, especially in patients with no arterial occlusion appearing on the angiograms.

Acute Disease↗
PubMedDate not supplied

Transcervical fallopian tube recanalization: a safe and effective therapy for patients with proximal tubal obstruction.

Over a 13-month period, 14 patients with proximal tubal obstruction underwent transcervical fallopian tube recanalization under fluoroscopic guidance in an outpatient setting at the hospital of the University of Pennsylvania. Twenty-one of 24 attempted tubal dilations (87.5%) were successful, as demonstrated by tubal opacification and contrast spillage into the peritoneal cavity at the conclusion of the procedure. Four intrauterine pregnancies, and no ectopic pregnancies, have followed the recanalization. One pregnancy ended in an early miscarriage, one patient delivered a healthy term female, and two pregnancies are ongoing at greater than twenty weeks' gestation. Two procedure-related complications occurred: in one patient, the isthmic segment of a fallopian tube was perforated, but healed without incident, and another patient experienced a low-grade fever, which resolved with p.o. antibiotics. We therefore conclude that fallopian tube recanalization is a well-tolerated, safe, and effective procedure for the treatment of proximal tubal occlusion.

Adult↗
PubMed1992

[Neodymium--Yag laser in the recanalization of arterial occlusions].

Failure of the guide-wire to recanalize some arterial total occlusion does not preclude balloon angioplasty. Nowadays there are recanalization devices such as the mechanical atherectomy and Lasers. The following report describes the successful use of the Nd: YG Laser in the recanalization of a common iliac artery total occlusion in a patient with claudication, rendering possible balloon angioplasty and a Palmaz Stent implantation, which is the first case performed in our country.

Aged↗
PubMedDate not supplied

Peroperative arterial recanalization with Kensey dynamic angioplasty. Histopathologic studies.

The morphology of occluded superficial femoral artery segments and of particles in the effluent fluid after dynamic Kensey catheter angioplasty was analyzed in six patients treated with an intraoperative retrograde technique. The effluent was collected during the procedure and the arteries were extirpated for microscopy after the recanalization attempt. In three patients with easy recanalization, histologic study showed highly cellular, proliferating connective tissue. In three patients with unsuccessful recanalization, mature, cell-poor connective healing tissue obliterated the lumen. The effluent contained particles measuring 14 to 320 microns, the largest of which had the potential to occlude small arteries. The results of this pilot study are to be regarded as preliminary.

Aged↗
PubMed1991

[Transcutaneous transcatheter use of laser recanalization of coronary arteries in patients with ischemic heart disease].

The paper discusses the potential possibility and effectiveness of X-ray endovascular laser recanalization (ELR) of the coronary arteries in order to treat coronary atherosclerosis in patients with coronary heart disease. The intervention was performed in 4 patients (into the anterior interventricular artery in 3 and into the right coronary artery in 1). In 3 of 4 cases, X-ray ELR proved to be successful, in one case the intervention failed due to technological reasons. Recanalization of a completely occluded segment of the coronary artery with a residual stenosis of no more than 40% was observed in two cases. Laser recanalization of profound local coronary stenosis was made in the mid-third of the vessel in one case. It can be stated that X-ray ELR of the coronary artery may extend the scope of X-ray surgical therapeutical tools of the treatment of coronary atherosclerosis. At the same time, accumulation of clinical experience and further improvement of laser and laser catheter engineering are essential in defining the value and possible scope for the application of this method.

Angioplasty, Laser↗
PubMed1991

[Recanalization of chronically obstructed coronary vessels using ROTACS (low-speed rotational angioplasty. Early and long-term results in 152 patients following unsuccessful conventional angioplasty].

Total coronary artery occlusion is the main limiting factor of non-surgical recanalization procedures. With conventional methods, recanalization of total occlusions older than 6 months has a low success rate. Low-speed rotational angioplasty (ROTACS, Osypka, Medtronic) was employed in 152 patients with chronic coronary occlusions in whom conventional guide wire techniques failed. The average success rate was 60% and, although not correlated to site of occlusion, revealed a clear correlation to the duration of the occlusion: 93% (1-3 months), 74% (4-6 months), 52% (6-12 months) and 8% (greater than 12 months). Emergency surgery was needed in 2 patients in whom an attempt was made to recanalize an occluded LAD branch. In both cases, the occlusion was located in the immediate vicinity of the main trunk of the left coronary artery. Thereafter, this anatomical situation was considered a contraindication and no further complications occurred in the subsequent 120 patients. Among the 152 patients, no deaths, no myocardial infarction and no perforation of the vessel wall occurred. Long-term results were monitored by angiography in 95% of successfully treatment patients; good results were documented in 72%.

Angioplasty, Balloon↗
PubMed1991

New option for balloon recanalization of total coronary occlusions.

In 9 out of 12 patients with a total coronary occlusion but definite signs of viable myocardium a new approach for the recanalization procedure was successfully employed: Following recanalization using an on-the-wire 2.0 or 2.5 mm angioplasty catheter, a standard coronary guidewire was placed along the angioplasty catheter. After withdrawal of the catheter, over-the-wire angioplasty with an appropriately sized balloon was performed for final dilatation. Pending further studies in a larger patient population, this new method may offer an alternative approach for revascularization of total coronary occlusions.

Aged↗
PubMed1992

Intravascular ultrasound guided holmium:YAG laser recanalization of occluded arteries.

Current angioplasty devices are limited by arterial wall dissection and perforation, and by early recurrence from inadequate debulking of lesions. This study evaluated intravascular ultrasound (IVUS) as guidance for concentric laser recanalization of arterial occlusions. Twelve, 2-4-cm-long canine iliac artery occlusions were treated at 2 weeks (organizing thrombus) to 12 weeks (firm fibrous lesions) using a Holmium:YAG laser (2,100 nm wavelength) in free running mode, FRM, (250 musec pulse, 5 Hz), n = 9; and Q-switched mode, QSM (200 ns pulse, 6 Hz), n = 3. A 200 microns (n = 2) or 600 microns (n = 10) optic fiber was centered in the artery coaxial to a 5Fr rotating A scan IVUS probe. The fiber was positioned in the center of the artery distal to the lesion and slowly advanced through the obstruction. In 8 occlusions the same fiber was used as a guidewire for passage of either a 1.6-mm-(n = 2) and/or 3.0-mm (n = 6) diameter multifiber catheter (19 x 100 and 19 x 200 microns fibers, respectively) using FRM energy to further debulk the lesion. In all cases, IVUS guidance enabled concentric initial recanalization of occlusions, although 3 vessel perforations resulted from fiber deviation off the center of the lumen at a distance of 2 to 4 cm from the IVUS imaging element. Both QSM and FRM modes ablated tissue, with FRM modes producing more tissue fragmentation and thermal effect. IVUS images accurately diagnosed the location of lesions compared to angioscopic views and pathologic analysis of the specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Laser↗
PubMed1978

Infarction and circulation in cerebrum. Effect of recanalization and/or collateral circulation on the lesion and prognosis.

Findings of computed tomography (CT) and angiography in supratentorial cerebral infarction associated with complete stroke were compared with regard to prognosis. It was found that the extent of low-density areas on CT was perfectly in accordance with the areas of occluded arteries on angiograms. However, the low-density areas on CT were always smaller than the areas involved angiographically when early recanalization and/or collateral circulation were carried out within 2 to 3 days of onset. It was also found that smaller low-density areas only had favorable effect. We concluded that the prognosis was better with early recanalization and/or collateral circulation, despite the general acceptance of its poor prognostic implication.

Adult↗
PubMed1991

Laser-assisted versus mechanical recanalization of femoral arterial occlusions.

A randomized clinical trial was performed to test the hypothesis that a laser-heated probe is superior to standard techniques to reopen occluded femoral arteries. Twenty patients were treated with a standard guidewire and balloon dilation method. In a second group of 20 patients, the laser probe was initially used as a nonheated mechanical device. If the probe was unsuccessful in mechanically reopening the artery, an Argon laser was activated to heat the probe. The mean length of occlusion was 15.9 +/- 10.3 cm. The success rate for the laser probe was 15 of 20 (75%), which was not significantly different from the standard method, 19 of 20 (95%). Most of the success in the laser-probe group was due to the probe's mechanical properties. The laser probe was successful as a cold, mechanical device in 13 of 15 (87%) arteries. It was necessary to heat the probe in 5 patients. When heated, the laser probe assisted recanalization in 2 but perforated the artery in 3 cases. The results of this randomized trial do not support the hypotheses behind the use of the thermal laser probe. The laser probe functions primarily as a mechanical device. The thermal activation does not significantly improve the success rate without increasing the risk of perforation. This small additional benefit does not justify the large cost of current thermal laser devices. This controlled study also demonstrates a higher success rate in long occlusions than previous reports of mechanical balloon recanalization. This is due to a combination approach of retrograde and anterograde probing of the occluded segment.

Adult↗
PubMed1992

Fallopian tube recanalization by selective salpingography: an alternative to more invasive techniques?

Selective salpingography was used in a total of 64 patients, engaged in evaluation for infertility and in whom standard hysterograms showed no tubal passage of contrast medium. Fallopian tube catheterization was successful in 92% of the cases; a peritoneal spill of contrast medium was obtained in 74% of the cases by manual injection. Recanalization of an obstructed oviduct was successful in 61% of the cases. Thus, after the procedure, 82% of the patients had at least one patent tube. We conclude that selective tubal catheterization, and recanalization when needed, should be included in the therapeutic procedures for tubal infertility, prior to in-vitro fertilization or tubal microsurgery.

Adult↗