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71.
Intracranial Angioplasty and Stenting in the Awake Patient 总被引:1,自引:0,他引:1
Alex Abou-Chebl MD Derk W. Krieger MD Christopher T. Bajzer MD Jay S. Yadav MD FACC 《Journal of neuroimaging》2006,16(3):216-223
BACKGROUND AND PURPOSE: Endovascular treatment for intracranial atherosclerosis is evolving, but complications remain an issue. Most interventions are performed under general anesthesia, preventing intraprocedural clinical evaluations. We describe our approach to intracranial angioplasty and stenting, using local rather than general anesthesia, and intraprocedural neurological assessment. METHODS: We prospectively collected procedural and outcome information on all patients undergoing intracranial angioplasty and stenting. Patients underwent interventions under local anesthesia with mild intravenous sedation or analgesia only if needed. Intraoperative neurological evaluations were performed, and symptomatology was used to guide the interventional technique. RESULTS: Forty-eight arteries in 40 patients with a mean age of 65.2 years were treated. Thirty-two anterior and 16 posterior circulation segments were treated. Technical success was achieved in 100% of patients with reduction of the mean pretreatment stenosis from 85 +/- 8.6% to 7 +/- 10.1%. Stents were deployed in 40 segments; five patients were treated with drug-eluting stents. The cobalt-chromium coronary stents were the easiest to deliver. Thirty-seven patients were treated under local anesthesia and, of those, 61.4% experienced intraprocedural symptoms that led to some alteration of the interventional technique. Headache was the most common symptom, and, when persistent, it heralded the occurrence of subarachnoid hemorrhage. There were seven total neurological complications, but only five (10.5%) led to permanent morbidity (4 strokes) or mortality (1 death). CONCLUSIONS: Intracranial angioplasty and stenting can be successfully performed using coronary techniques and equipment including drug-eluting stents. Local anesthesia permits neurological evaluations and often leads to the adjustment of the interventional technique, potentially making the procedure safer. 相似文献
72.
Hidehito Sakaguchi Tetsuji Kawata Shigeki Taniguchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(2):71-74
The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain
in terms of the indication for operation and the short-and long-term outcomes. We performed concomitant mitral valve repair,
left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation,
inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association
functional class I without mitral regurgitation 8 months after operation. We discuss, and review the procedures reported in
the literature. 相似文献
73.
Stroke-induced hemiballismus (HB) has been reported to improve motor function in people with Parkinson's disease (PD). We report on a patient who developed HB from a parietal infarct. The HB was improved by very low-dose clozapine but the HB did not improve the parkinsonism. This suggests that HB itself, whether from a lesion in the subthalamic nucleus or elsewhere, is not what improves motor function in PD; instead, the physiological function of the damaged structure is the determining factor. 相似文献
74.
75.
A. Satish Chandra Sanjeev Mohanty 《Indian journal of otolaryngology and head and neck surgery》2007,59(1):43-44
Role of Embolisation in preoperative management of Nasopharyngeal angiofibroma is well established in present day therapeutic
modalities. An improvised technique i.e., subselective embolisation has been provided by Interventional radiologists to fortify
the therapeutic results. This study compares the final outcome of seven cases, four of which were embolised pre operatively.
Each case was dealt with varying surgical approaches. 相似文献
76.
大鼠脑缺血再灌注后水孔蛋白-4的免疫组化表达与脑水肿关系的研究 总被引:3,自引:0,他引:3
目的 研究大鼠脑缺血再灌注后脑组织中水孔蛋白 - 4 (AQP- 4 )的表达与脑水肿的关系。方法 采用大鼠大脑中动脉栓塞 (MCAO)模型 ,经免疫组化法测定 AQP- 4表达阳性细胞数 ,干、湿重法测定脑水含量 ,脑水肿以脑水含量评价。结果 脑缺血再灌注后 12 h,脑缺血坏死周边区 AQP- 4表达阳性细胞及脑水含量增加 ,于 4 8~ 12 0 h 达到高峰 ,16 8h后仍处于较高水平 ,两者之间呈正相关 (r=0 .95 8,P<0 .0 1)。结论 脑缺血再灌注后AQP- 4参与脑水肿的发生 ,为脑缺血再灌注损伤的重要因素之一。 相似文献
77.
目的探讨1,6-二磷酸果糖(FDP)治疗新生儿缺氧缺血性脑病(HIE)合并心肌损伤的疗效.方法随机分成治疗组和对照组,均给予常规治疗,治疗组加用FDP 0.25~0.4g/(kg·次),1 次d静滴,10 d为一疗程,治疗前后均进行心肌酶测定.结果治疗组临床症状改善及心肌酶恢复效果均优于对照组,两组差异有显著性(P<0.05).结论 FDP对HIE时的脑损伤及心肌损伤均有良好效果. 相似文献
78.
79.
A. Rocco J. Afra M. Toscano G. Sirimarco L. Di Clemente M. Altieri G. L. Lenzi V. Di Piero 《European journal of neurology》2007,14(12):1378-1382
The intensity dependence of the auditory-evoked potentials (IDAP) is inversely related to serotonergic tone. Depression is frequently observed after stroke, associated with cognitive impairment and increased mortality. Aim of this study was to investigate the serotonergic tone in acute stroke patients by IDAP. Consecutive patients with an acute stroke admitted in our stroke unit were evaluated using clinical and instrumental examinations and compared with healthy controls. The IDAP was calculated as the linear amplitude/stimulus intensity function (ASF) slope, by measuring the peak-to-peak amplitude of Nl-P2 on four blocks of different stimulus intensities. Twenty patients were enrolled; 11 had a right brain infarction; nine had depressive symptoms (DS). The ASF slope of the auditory-evoked potentials was markedly increased in stroke patients compared with controls ( P = 0.021). Stroke patients with DS had a significant steeper ASF slope than controls ( P = 0.017). There was no statistical difference in ASF slope between stroke patients without DS and controls. Post-stroke depression pathophysiology is still debated. Our study suggests that in acute stroke patients with DS, there is a direct involvement of the serotonergic system, regardless the degree of disability and the site of the lesion. 相似文献
80.
动脉瘤术后血管痉挛的综合治疗(附284例报告) 总被引:3,自引:0,他引:3
目的总结动脉瘤手术后血管痉挛及延迟性缺血性神经功能障碍(DIND)的防治经验。方法回顾性分析284例接受颅内动脉瘤夹闭术病人的临床资料,对颅多普勒超声(TCD)的结果与DIND的发生情况进行统计分析。结果137例病人手术后发生血管痉挛,79例发生DIND。TCD所示血流速度与DIND的发生有密切的相关关系。经治疗,62例DIND病人(78.5%)症状消失。病死率2.5%。结论血管痉挛是导致DIND的主要因素,个体化的综合治疗能明显提高疗效。 相似文献