Jean Baptiste Martin

Role of the Distal Balloon Protection Technique in the Prevention of Cerebral Embolic Events During Carotid Stent Placement

Background and Purpose — We sought to quantitatively and qualitatively evaluate the release of atheromatous plaque debris induced by carotid stenting procedures. Methods — Eight patients with severe carotid atheromatous stenoses were treated by stent implantation under distal balloon protection. Blood samplings were obtained after stent deployment in the blood pooled below the inflated protection balloon. The samples were centrifuged and evaluated for plaque debris with the use of light microscopy. The debris release was quantitatively estimated by dividing the total volume of debris obtained by the mean debris size. Five patients without endovascular procedure were used as a control group. Results — The 2 main debris types found were nonrefringent cholesterol crystals (4 to 389 &mgr;m; 115 to 8697 in number) and lipoid masses (7 to 600 &mgr;m; 341 to 34 000 in number). There was a statistically significant difference compared with the samples obtained in the control group (P =0.017). Conclusions — Blood samples collected during stent implantation procedures contain a large quantity of atheromatous plaque debris. This emphasizes the role of distal protection techniques in avoiding migration of this plaque material into the cerebral circulation.

Cervical Sympathetic Block to Reverse Delayed Ischemic Neurological Deficits After Aneurysmal Subarachnoid Hemorrhage

Background and Purpose— The purpose of the present study was to evaluate the feasibility and safety of a locoregional cervical sympathetic block to improve cerebral perfusion in patients suffering from cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Methods— Nine consecutive patients with symptoms of delayed ischemic deficits, induced by angiographically confirmed cerebral vasospasm, were treated with the injection of locoregional anesthesia to block the ascending cervical sympathetic chain at the level of the superior cervical ganglion. Neurological status was recorded before and after the procedure, and cerebral angiography was performed before and after the procedure. Results— No complications occurred in this short series. The procedure appeared to be simple and safe. Horner’s signs appeared within 12±0.1 minutes and lasted for an average of 6.3±4 hours. In all patients, improved cerebral perfusion was detected at the confirmatory angiography but without change in vessel caliber. One patient died of the complications of the initial hemorrhage, and 2 died of the consequences of the severe vasospasm despite maximal medical treatment. In all the other cases, the neurological status promptly returned to normal within 48 hours after the locoregional treatment. Conclusions— Patients with mild to moderate symptoms seem to benefit greatly from transient ipsilateral cervical sympathetic block. This simple technique may be helpful when used as an adjunct to the standard therapy to improve cerebral perfusion.

Air cysts and bronchiectasis prevail in nondependent areas in severe acute respiratory distress syndrome: a computed tomographic study of ventilator-associated changes.

ObjectiveTo investigate prevalence and spatial distribution of air cysts and bronchiectasis associated with mechanical ventilation in patients with severe acute respiratory distress syndrome. DesignRetrospective observational study. SettingUniversity hospital intensive care division. SubjectsA total of 21 patients with severe acute respiratory distress syndrome requiring prolonged mechanical ventilation and undergoing thoracic computed tomographic scanning. Measurements and Main ResultsLung fields were anatomically divided according to functional bronchial divisions in ten segments on each side. Air cysts, bronchiectasis, and the percentage of normal and abnormal tissue were quantified for each segment and correlated to the duration and variables of mechanical ventilation. Air cysts prevailed in nondependent compared with dependent areas (38% ± 5% vs. 9% ± 3%, respectively;p < .01). With mechanical ventilation longer than 10 days, the odds ratio was 13.1 (95% confidence interval, 1.4–118.7) for air cysts and for bronchiectasis 17.6 (95% confidence interval, 2.8–109.6). The amount of abnormal parenchyma correlated with duration of mechanical ventilation on high end-inspiratory pressure but not with tidal volume or minute ventilation. The presence of pneumothorax was not correlated with ventilation settings but with the amount of consolidated tissue revealed by the computed tomographic scan. ConclusionsThese findings suggest predominant ventilator-induced lung damage in better ventilated areas (i.e., nondependent regions). Severity of changes revealed by computed tomographic imaging seems to be associated mainly with the high inspiratory pressures required and the length of mechanical ventilation.

Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

Abstract. We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm.

Percutaneous Vertebroplasty in Octogenarians: Results and Follow-Up

Objectives:  To determine pain relief, performance status, morbidity, and mortality associated with percutaneous vertebroplasty for spinal pain in patients aged 80 years and older.

In vitro evaluation of the effectiveness of distal protection in the prevention of cerebral thromboembolism during carotid stent placement.

RATIONALE AND OBJECTIVES The purpose of this in vitro study was to evaluate and quantify the benefit of the balloon protection device, to identify the most effective sequence of irrigation or flushing, and to determine the most effective catheter position to remove the maximum number of emboli or debris beneath the flow-arrest balloon. MATERIALS AND METHODS Silicone models of the neurovasculature were attached to a systodiastolic pump. Stents were placed in carotid stenoses by using the distal flow protection technique. Embolic material was released within the stent. The effectiveness of different irrigation techniques was evaluated. RESULTS Aspiration under the balloon through the guiding catheter with a 60-mL syringe followed by one power injection at 40 mL injected at 2 mL/sec will result in removal of about 98% of potential emboli from the internal carotid artery [corrected]. CONCLUSION In vitro evaluation of the distal flow protection technique indicates that it should reduce stroke risk during carotid stent placement.