Spasm induced by protection balloon during carotid artery stenting

PURPOSE

The PercuSurge system is a distal balloon embolic protection device used for carotid artery stenting (CAS). We performed a retrospective study on the prognosis and clinical effects of spasms induced by the PercuSurge GuardWire system (PercuSurge-induced spasm).

MATERIALS AND METHODS

We performed CAS in 118 carotid stenoses using the PercuSurge system. Of the 118 procedures, 31 (26.3%) of the patients experienced PercuSurge-induced spasm, and all underwent postoperative follow-up studies by cerebral angiography and antiplatelet treatment.

RESULTS

On follow-up angiograms obtained a mean of 5.2 months (range 3-10 months) after CAS, all 31 PercuSurge-induced spasms had disappeared, and no delayed stenosis was found at the sites where the spasms had occurred. No ischemic events due to the spasms occurred during a mean follow-up of 13 months (range 3-32 months).

CONCLUSION

In the hands of physicians experienced in endovascular surgery, CAS using the PercuSurge system is a safe method with which to treat patients with carotid stenosis. Our study demonstrated that PercuSurge-induced spasms had no morphological or clinical adverse effects.

Paradoxical effects of beta-estradiol on epidermal permeability barrier homeostasis

BACKGROUND

Previous studies have demonstrated that sex hormones modulate epidermal permeability barrier homeostasis, and when the balance of these hormones is altered at menopause or during the menstrual cycle, skin sensitivity or barrier function is changed.

OBJECTIVES

To observe the direct effects of sex hormones on epidermal homeostasis.

METHODS

We examined the effects of topical application of sex hormones on permeability barrier recovery after tape stripping in the hairless mouse. To avoid the influence of systemic hormonal alteration, we employed male animals.

RESULTS

Application of androgen (testosterone or androsterone) delayed the barrier recovery, and the delay was overcome by co-application of beta-estradiol. Progesterone also delayed the barrier recovery, but in this case the delay was enhanced by beta-estradiol.

CONCLUSIONS

These results suggest that changes in sex hormone balance might be associated with the skin dysfunction that often occurs during menopause, and at certain points during the menstrual cycle.

[Clinical efficacy of blood flow interruption using the HyperForm in right vertebral arteriovenous fistula--case report]

A 44-year-old male with right vertebral arteriovenous fistula accompanied with tinnitus, underwent endovascular treatment using GDC. A digital subtraction angiography clearly showed one fistula flowed from the right vertebral artery (VA) to the vertebral venous plexus, while the right VA close to the fistula was interupped with HyperForm. The tip of the micro catheter was placed in the vertebral venous plexus through fistula from the right VA, and the vertebral venous plexus around the fistula was embolized with 4 GDCs. Blood flow of the right VA was maintained. Follow-up angiography undertaken 6 months after the operation didn't show the recurrence of arteriovenous fistula.

Mechanisms of perianeurysmal edema following endovascular embolization of aneurysms

SUMMARY

After coil embolization for an aneurysm, edema surrounding the aneurysm revealed by magnetic resonance imaging (MRI) is rarely seen and is usually associated with neurological symptoms. Perianeurysmal edema was found by postoperative MRI in three out of 182 patients with cerebral aneurysm, which was treated with Guglielmi Detachable Coil (GDC), and neurological symptoms developed simultaneously. In cases where neurological symptoms improved with conservative medical treatment, a temporary increase in the volume of an aneurysm, due to coil and thrombus formation, may result in edema. In cases where symptoms were not alleviated with conservative medical treatment, persistent water-hammer effect against the residual lumen of the aneurysm as well as an increase in the volume of aneurysm by hemorrhage in the aneurysmal wall may contribute to the development of perianeurysmal edema. Consideration of the mechanism of edema development by neurological symptoms, MRI findings, and angiographic findings is needed in order to select appropriate treatment.

Direct superficial temporal vein approach for dural carotid cavernous fistula

SUMMARY

We present an alternative endovascular approach to treat dural carotid cavernous fistulae (dural CCF) that drain only into the superior ophthalmic vein. Four cases of cavernous dural AVFs that could not be treated via the inferior petrosal vein were accessed via the direct superficial temporal vein approach through the superior ophthalmic vein. Successful embolization was documented radiographically and clinically in all patients. The trans-superficial temporal vein approach is safe and useful for inaccessible dural CCFs through the inferior petrosal sinus.

siRNA-mediated knockdown of connective tissue growth factor prevents N-nitrosodimethylamine-induced hepatic fibrosis in rats

Hepatic fibrosis is a dynamic process that involves the interplay of different cell types in the hepatic tissue. Connective tissue growth factor (CTGF) is a highly profibrogenic molecule and plays a crucial role in the pathogenesis of hepatic fibrosis. The aim of the present investigation was three-fold. First, we studied the expression of CTGF in the cultured hepatic stellate cells using immunohistochemical technique. Second, we induced hepatic fibrosis in rats through serial intraperitoneal injections of N-nitrosodimethylamine (NDMA; dimethylnitrosamine, DMN) and studied the upregulation of CTGF and TGF-beta1 during hepatic fibrogenesis. Third, we downregulated CTGF expression using CTGF siRNA and examined the role of CTGF siRNA to prevent the progression of NDMA-induced hepatic fibrosis. The results depicted strong staining of CTGF in the transformed hepatic stellate cells in culture. Serial administrations of NDMA resulted in activation of hepatic stellate cells, upregulation of CTGF and TGF-beta1 both at mRNA and protein levels and well-developed fibrosis in the liver. Immunostaining, Western blot analysis, semiquantitative and real-time RT-PCR studies showed downregulation of CTGF and TGF-beta1 after treatment with CTGF siRNA. The results of the present study demonstrated that CTGF gene silencing through siRNA reduces activation of hepatic stellate cells, prevents the upregulation of CTGF and TGF-beta1 gene expression and inhibits accumulation of connective tissue proteins in the liver. The data further suggest that knockdown of CTGF upregulation using siRNA has potential therapeutic application to prevent hepatic fibrogenesis.

Accordion effect during carotid artery stenting: report of two cases and review of the literature

INTRODUCTION

The term "accordion effect" is used to describe a mechanical distortion of tortuous arteries mimicking spasm or dissection. This phenomenon has been reported in patients undergoing percutaneous coronary intervention. To our knowledge, this is the first documentation of the accordion effect during carotid artery intervention.

METHODS

Two patients who developed the accordion effect during carotid artery stenting (CAS) are described.

RESULTS

Angiograms obtained just after CAS showed a stenosing lesion with wall irregularity at the distal part of the stent. This lesion disappeared and tortuosity of the internal carotid artery developed after withdrawing the guidewire until its floppy segment rested equally on the lesion. In another patient, the lesion did not disappear completely until the guiding catheter had been withdrawn to the proximal portion of the common carotid artery. We conclude that these stenosing lesions reflected the accordion effect.

CONCLUSION

It is essential to differentiate the accordion effect from dissection, spasm, and thrombosis because the management is importantly different. We report our findings and present a review of the literature.

Construction of monoenergetic neutron calibration fields using 45Sc(p, n)45Ti reaction at JAEA

The 8 and 27 keV monoenergetic neutron calibration fields have been developed by using (45)Sc(p, n)(45)Ti reaction. Protons from a 4-MV Pelletron accelerator are used to bombard a thin scandium target evaporated onto a platinum disc. The proton energies are finely adjusted to the resonance to generate the 8 and 27 keV neutrons by applying a high voltage to the target assemblies. The neutron energies were measured using the time-of-flight method with a lithium glass scintillation detector. The neutron fluences at a calibration point located at 50 cm from the target were evaluated using Bonner spheres. A long counter was placed at 2.2 m from the target and at 60 degrees to the direction of the proton beam in order to monitor the fluence at the calibration point. Fluence and dose equivalent rates at the calibration point are sufficient to calibrate many types of the neutron survey metres.

Investigation of properties of the TIARA neutron beam facility of importance for calibration applications

Evaluation of the properties for quasi-monoenergetic neutron calibration fields of high energies more than 20 MeV at TIARA is proceeding for development of the field. Among the properties needed for the development as the standard calibration field, we report on measurement of the neutron beam profile using an imaging plate with a polyethylene converter and on estimation of the contribution of scattered neutrons into the irradiation field based on pulse height distribution at various off-beam positions measured using an organic liquid scintillation detector.

Cerebral Protection During Retrograde Carotid Artery Stenting for Proximal Carotid Artery Stenosis-Technical Note-

Carotid artery stenting for carotid bifurcation stenosis usually uses the transfemoral approach. However, in patients with proximal common carotid artery (CCA) stenosis, the guiding catheter is difficult to introduce into the narrow origin of the CCA without risking cerebral embolization before activation of the protection device. A technique of cerebral protection by internal carotid artery (ICA) clamping with or without simultaneous external carotid artery (ECA) clamping was used to treat patients with proximal CCA stenosis by the retrograde direct carotid approach. The carotid bifurcation was surgically exposed and retrograde catheterization was performed to approach the stenosis. The ICA was clamped during angioplasty and stenting to avoid cerebral embolization. The ECA was clamped simultaneously if any extracranial-intracranial anastomosis was present. None of five patients treated with this technique experienced ischemic complications attributable to this technique.

Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis

INTRODUCTION

We assessed the long-term follow-up examinations and complications of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic ostial vertebral artery (VA) stenosis.

METHODS

A retrospective study was done to evaluate 12 patients with symptomatic ostial VA stenosis who underwent PTAS. Six patients were treated with the Palmaz stent and six with a balloon-expandable coronary stent. Initial angiographic follow-up examination was conducted about 12 months after PTAS in all patients. Simple radiographic, ultrasonographic and clinical follow-up examinations were scheduled every 6 months.

RESULTS

Excellent dilatation was achieved in all patients without any procedural complications. Initial angiographic follow-up obtained at a mean of 13 months after PTAS detected no restenosis. However, an asymptomatic severe restenosis was detected at 24 months after PTAS in one patient (8%). During a mean follow-up of 31.5 months, three stent fractures were detected in deployed coronary stents (50%). None of the stent fractures was associated with either recurrent stroke or restenosis. No patients developed recurrent symptoms during the follow-up period.

CONCLUSION

PTAS for symptomatic ostial VA stenosis is effective in preventing recurrent stroke. As the open-cell single-joint type of stent is associated with the risk of fracture, long-term follow-up examinations including simple radiography are needed.

Non-bifurcating cervical carotid artery

Three cases of an extremely rare anomaly of the carotid artery are described herein. In these patients, the common carotid arteries, without bifurcation in the cervical portion, supplied multiple arterial branches, which are more commonly branches of the external carotid artery. The non-bifurcating carotid artery continued into the cranium as a normal internal carotid artery. This anomaly can be attributed to a maldevelopment of the vascular network during embryogenesis.

Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms

We report the usefulness of Guglielmi detachable coil (GDC) embolization by direct carotid puncture for anterior circulation aneurysms. For all 27 patients, GDC embolization by direct carotid puncture was safely performed by using a 5F sheath introducer 5 cm long and a Tracker-38 catheter. Neurologic deficits and hemorrhage were not found in any patient during the follow-up period. If the transfemoral approach cannot be applied, GDC embolization should be considered as an alternative method.

The significance of incomplete stent apposition in patients undergoing stenting of internal carotid artery stenosis

BACKGROUND AND PURPOSE

Incomplete stent apposition after carotid angioplasty and stent placement (CAS) is often seen but little is known about how the incomplete attachment goes after stent placement. For example, some may change into restenosis around the stent edge and some may remain unchanged. The purpose of this study is to clarify the morphologic prognosis of an incomplete stent apposition at the stent edge.

METHODS

CAS was attempted on 135 consecutive stenotic lesions (124 patients). Angiograms were then evaluated immediately after the procedure. An incomplete stent apposition at stent edge was found in 15 patients, and all of them were followed up by angiography and MR imaging with antiplatelet therapy.

RESULTS

No ischemic event caused by the lesions occurred during the mean follow-up period of 11 months (from 4 to 32 months). The angiography findings of 15 lesions at a mean of 8.8 months (from 2 to 28 months) after CAS showed that all remained unchanged. No patients required any additional intervention. No new ischemic lesions were detected in any of the 15 patients who underwent follow-up MR imaging at a mean of 10 months (from 2 to 32 months) after CAS.

CONCLUSION

In this study, the existence of a segment of incomplete stent apposition had no adverse morphologic or clinical effect.

Hyperform Remodeling Balloon for the Balloon Occlusion Test of Persistent Primitive Trigeminal Artery Aneurysm-Case Report-

A 17-year-old woman presented with a rare aneurysm at the junction of the persistent primitive trigeminal artery (PPTA) and the internal carotid artery (ICA) manifesting as left abducens nerve paresis. The aneurysm and the ICA were both successfully occluded with coils. The balloon occlusion test used the HyperForm balloon microcatheter to seal the PPTA and ICA, which is very important to determine the optimal treatment strategy for a PPTA aneurysm.

Spontaneous improvement of persistent ulceration after carotid artery stenting

BACKGROUND AND PURPOSE

Because carotid plaque ulceration is associated with an increased risk of cerebral embolism, residual carotid plaque ulceration directly around a stent (persistent ulceration) after carotid angioplasty and stent placement (CAS) could still be a risk factor for a stroke. The purpose of this study is to understand the morphologic and clinical prognosis of persistent ulceration.

PATIENTS AND TECHNIQUES

CAS was attempted on 91 consecutive stenotic lesions (80 patients). Of these, 54 lesions (48 patients) had ulceration before CAS. Angiograms were evaluated immediately after the procedure. Persistent ulceration was found in 34 lesions (30 patients). The mean depth and length of persistent ulcers were 2.1 mm (range, 1-4.7 mm) and 8.9 mm (range, 1.5-22 mm), respectively. All patients with persistent ulceration were followed with antiplatelet therapy.

RESULTS

No ischemic event due to the lesions occurred during the mean follow-up period of 25.5 months (range, 3-48 months). Angiography on 25 lesions (21 patients) at a mean of 5.8 months (range, 1-21 months) after CAS showed that persistent ulceration disappeared in 12 lesions (48%), improved in 11 lesions (44%), and remained unchanged in 2 lesions (8%). Nine lesions (36%) showed restenosis, which were < or =30% and did not require any additional intervention. New ischemic lesions were not detected in any of the 14 patients (17 lesions) who underwent follow-up MR imaging at a mean of 9 months (range, 1-32 months) after CAS.

CONCLUSION

We conclude that persistent ulceration after CAS improves spontaneously and is not a risk factor for cerebral embolism.

Development and characterization of a photoautotrophic cell line of pak-bung hairy roots

A cell line of photoautotrophic pak-bung hairy roots was established from photomixotrophic ones by acclimation cultivations with a stepwise change of sucrose concentration in a medium with 3.0% CO2-enriched air supplied under continuous light irradiation. The derived photoautotrophic hairy roots had high chlorophyll content and activity of 1,5-ribulose-bisphosphate carboxylase/oxygenase, the values of which were 4.1- and 2.0-fold more than those of the parent photomixotroph, respectively. Electron microscopic observation revealed that the photoautotrophic hairy root cells possessed well-developed chloroplasts. The activities of ascorbate peroxidase and guaiacoal peroxidase found in the hairy roots were comparable to those found in the leaves and roots of parent plants of pak-bung, respectively. The elongation rate of growing points of the hairy roots was maximum at 5.0% CO2 concentration in gas phase and an incident light intensity of 10 W/m2 under the photoautotrophic conditions examined. Although light was indispensable for ensuring photoautotrophy of the hairy roots, it was found that exposure of the roots to strong light resulted in the reduction in the number of viable growing points governing the overall growth rate of the hairy roots.

Hemodynamic stability under general anesthesia in carotid artery stenting

PURPOSE

The purpose of our study was to investigate the frequency of hemodynamic instability in patients undergoing carotid artery stenting (CAS) under general anesthesia using sevoflurane and nitrous oxide in oxygen.

METHODS

A total of 97 consecutive CAS procedures were performed in 84 patients under sevoflurane anesthesia. The following hemodynamic variables were assessed: degree of systolic blood pressure change (deltaSBP) during CAS, hypotension, and bradycardia during and after CAS.

RESULTS

During CAS, hypotension occurred in 43% of the patients, and bradycardia occurred in 14%. There was individual variation in the deltaSBP during CAS. Systolic blood pressure (SBP) change >50 mmHg was not seen in this series. After CAS, hypotension occurred in 24%, and bradycardia occurred in 10%. Cerebral infarction occurred in three cases. The stroke rate was 3.1% in this series.

CONCLUSION

General anesthesia using sevoflurane and nitrous oxide in oxygen depressed barorecepter reflex sensitivity, induced hemodynamic stability under CAS, and may decrease the rate of occurrence of complications.

[Localized fibrous mesothelioma with bloody pleural effusion; report of a case]

Diffuse malignant mesothelioma with bloody pleural effusion is not rare, but a localized fibrous mesothelioma with bloody pleural effusion is relatively rare. A 45-year-old woman presented with a localized fibrous mesothelioma causing a bloody pleural effusion. Her chief complaint was right-sided lateral chest pain. A chest roentgenogram demonstrated a right-sided pleural effusion, so a chest tube was inserted, and the bloody fluid drained. A preoperative diagnosis of localized fibrous mesothelioma was made based on chest computed tomography and examination of computed tomographic guided percutaneous needle biopsy specimen. At operation, the tumor seemed to have originated from the right lung parenchyma or had invade the right lower lobe because tumor had penetrated deeply in the lung. Tumor and part of the parietal pleura were resected by right lower lobectomy. Final pathology established that the tumor was adherent to the right lung and was only encapsulated by the lung.

Improved cerebral perfusion after simultaneous stenting for tandem stenoses of the internal carotid artery--two case reports

Two patients with extracranial internal carotid artery (ICA) stenosis and tandem stenosis of the ipsilateral intracranial ICA were treated simultaneously by angioplasty with stenting. A 68-year-old man who presented with neovascular glaucoma had 90% stenosis of the right cervical ICA and 80% stenosis of the ipsilateral petrous ICA. A 74-year-old man who suffered from transient ischemic attack had 75% stenosis of the left cervical ICA and 90% stenosis of the ipsilateral cavernous ICA. Hemodynamic compromise was confirmed in both patients. Tandem stenting of both extracranial and intracranial ICA stenoses was performed simultaneously in both patients without complications. Poststenting angiography demonstrated excellent dilation of both lesions and normalization of cerebral perfusion. Simultaneous tandem stenting for extracranial ICA stenosis with intracranial tandem stenosis is less invasive than open surgery in high-risk patients with hemodynamic compromise, especially if the major lesion responsible for cerebral hypoperfusion is difficult to determine.

Dural AVFs of the cavernous sinus: transvenous embolization using a direct superficial temporal vein approach

We present an alternative endovascular approach to treat dural anterio-venous fistulas (AVFs) of the cavernous sinus that drain only into the superior ophthalmic vein. Two cases of dural AVFs of the cavernous sinus producing increased intraocular pressure and diminishing visual acuity are reported. The cavernous sinus was accessed via the direct superficial temporal vein approach through the superior ophthalmic vein. Successful embolization was documented radiographically and clinically.

Effectiveness of an oral health promotion programme at the workplace

The purpose of the study was to evaluate the effectiveness of an oral health promotion programme at the workplace. The programme was given once a year at offices or factories, which was voluntary and free for all employees. The programme consisted of clinical examinations followed by oral health guidance, oral hygiene instruction and oral prophylaxis of anterior lower teeth. Oral health status was compared by the times of participation in the programme. It was shown that three times or more participants in the programme had fewer decayed, missing and filled teeth (DMFT) and lower percentage of Community Periodontal Index (CPI) sextants 3 and 4. The oral health promotion programme was effective in keeping or maintaining good oral health among workers. In addition to current activities, the programme should include education to motivate subjects to receive regular check-ups.