Yoshinori Terai

Percutaneous balloon angioplasty for acute occlusion of intracranial arteries.

BACKGROUND The benefits of intravenous thrombolysis for acute ischemic stroke are still limited. OBJECTIVE To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries. METHODS Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed. RESULTS The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 × 103 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case. CONCLUSIONS Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications.

The Reconstructions for Vertebral Artery Stenosis at the Origin. A Comparison between PTA and Surgical Reconstructions.

To date in our hospital, surgical reconstructions and percutaneous transluminal angioplasty (PTA) were carried out in 168 patients with vertebral artery (VA) stenosis at the origin. In this article, we discuss the comparison between surgical reconstructions and PTA, especially regarding long term follow up, patency and complications. PTA is a less invasive treatment for VA stenosis at the origin than surgical reconstructions. However, restenosis after PTA occurred in 20% of the patients. On the other hand, restenosis after surgical reconstructions did not emerge even in long term follow up. An embolism after PTA occurred in 2.6% of the cases. However, the embolism occurred in only the first 10 patients of our series, after that there was no embolism. We concluded that PTA was the first choice for VA stenosis at the origin, if the angiogram did not reveal any PTA difficulty. If restenosis after PTA was performed, we selected surgical reconstruction for VA stenosis at the origin.

The rebuilding of normal venous circulation for transverse-sigmoid dural arteriovenous fistulas by percutaneous transluminal angioplasty. A case report.

The etiology of dural arteriovenous fistulas (DAVFs) remains controversial as is the issue of whether occlusion or stenosis of the transverse sinus and sigmoid sinus is a cause or a result of DAVFs. We report a case of DAVFs with transverse-sigmoid sinus occlusion and cortical venous reflux. In this case, the reconstruction of normal venous circulation by percutaneous transluminal angioplasty (PTA) for the occluded sinus was performed and cortical venous reflux diminished. PTA may be a useful treatment for DAVFs with occluded or stenotic sinus.