Balloon catheter disruption of middle cerebral artery thrombus in conjunction with thrombolysis for the treatment of acute middle cerebral artery embolism

BACKGROUND AND PURPOSE

The goal of this study was to prospectively assess the feasibility, safety, and efficacy of balloon disruption of the middle cerebral artery (MCA) by using a deflated balloon catheter combined with an intra-arterial thrombolysis for the treatment of acute ischemic stroke.

MATERIALS AND METHODS

Seven consecutive patients with clinical findings of acute major-vessel stroke met our criteria and underwent balloon disruption of an MCA thrombus with a deflated balloon catheter. The balloon disruption was performed with a low-profile microballoon catheter. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, an intra-arterial thrombolysis of the MCA was applied. The maximum time from the onset of symptoms to the start of treatment and maximum dosage of urokinase was 6 hours and 600,000 U. The outcome was classified as good for a modified Rankin Scale (mRS) score of 0 or 1, moderate for a score of 2 or 3, and poor for a score of 4 or 5.

RESULTS

Complete recanalization was achieved in 5 patients and partial recanalization in 3. Three patients recovered to an mRS score of 0 or 1; 3, to scores of 2 or 3; and 1, to a score of 4. No patients died. There was no major intracerebral hemorrhage.

CONCLUSIONS

The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke.

Poststenotic signal attenuation on 3D phase-contrast MR angiography: a useful finding in haemodynamically significant carotid artery stenosis

We performed blinded visual evaluation of MR angiography (MRA) films in 44 patients with unilateral carotid artery stenosis to determine whether a flow gap and poststenotic signal attenuation on 3D-PC MRA were useful signs of severe carotid artery stenosis. Although nine patients with a flow gap alone had various degrees of stenosis ranging from 22.2 to 77.3% without any decrease in regional cerebral blood flow (rCBF), 13 patients with both a flow gap and poststenotic signal attenuation had severe stenoses of 80% or more, with a definite decrease in baseline rCBF. The presence of both a flow gap and poststenotic signal attenuation on 3D-PC MRA appeared to be a reliable marker of severe carotid artery stenosis with a decrease in rCBF.

Radiographic and scintigraphic courses of union in cervical interbody fusion: hydroxyapatite grafts versus iliac bone autografts

This study investigated the radiographic and scintigraphic courses of union in cervical interbody fusion using hydroxyapatite (HA) grafts or iliac bone autografts.

METHODS

Twelve patients underwent both serial plain radiography and bone scintigraphy during the 12 mo after surgery. Serial plain radiographs were obtained every month until the end of the study period. Bone scintigrams with 99mTc-hydroxymethylene diphosphonate (HMDP) were obtained at 2 wk and at 1, 2, 3, and 6 mo. Uptake of 99mTc-HMDP in the graft was expressed as a ratio of the counts in the graft to those in the axis.

RESULTS

In the HA graft group, the plain radiographs of all patients showed a radiolucent stripe that disappeared 7.3 +/- 1.5 (mean +/- SD) months after surgery. In the autograft group, a radiolucent stripe around the graft was not seen for any patient, and union was confirmed by follow-up radiographs within 6 mo after surgery. The serial changes in the 99mTc-HMDP uptake ratio showed no difference between the 2 groups. The 99mTc-HMDP uptake ratio peaked 1 mo after surgery and decreased rapidly to a plateau within 2 mo.

CONCLUSION

In the HA graft group, despite the presence of a radiolucent stripe around the graft for more than 6 mo, the scintigraphic course of union was not different from that in the autograft group. The likelihood is that the presence of a radiolucent stripe around the HA graft in the early months after surgery is not always a sign of pseudoarthrosis.

Reperfusion therapy for acute vertebrobasilar occlusion

SUMMARY

We reviewed retrospectively our experience in treating 10 patients with acute vertebrobasilar occlusion. Nine patients were treated with interventional reperfusion therapy and the remaining one patient with top of the basilar embolism was treated conservatively because of deep coma and decerebrate rigidity with severely reduced cerebral blood flow (CBF) in the brain stem. Among 9 patients with reperfusion therapy, 8 patients underwent intra-arterial thrombolytic therapy and the other one patient had direct percutaneous transluminal angioplasty (PTA). Eight patients had basilar artery occlusion, 1 patient treated with direct PTA had bilateral intracranial vertebral artery occlusion and the other patient had left posterior cerebral artery occlusion presumably preceding top of the basilar embolism. In 4 of 10 patients, residual CBF was evaluated by single photon emission computed tomograpy (SPECT). Successful recanalization with clinical improvement was achieved in 6 of 9 patients (66.7%) treated with reperfusion therapy. In patients with progression or fluctuation of incomplete brain stem syndrome, SPECT revealed preserved residual CBF and successful recanalization with clinical improvement was achieved by interventional reperfusion therapy. On the other hand, in patients with persistent deep coma and decerebrate rigidity, SPECT revealed marked reduction of residual CBF in the brain stem and recanalization could not improve clinical outcome. Preoperative SPECT may be useful to make a decision whether rep er fusion therapy should be performed or not in case of vertebrobasilar occlusion.