Treatment of mandibular arteriovenous malformation by embolization : a case report

Mandibular arteriovenous malformations(AVM) are relatively rare and potentially life threatening lesions. Surgical treatment consists of wide resection of the mandible, which is difficult and potentially hazardous due to significant blood loss during surgery. Therefore, some authors advocate that transvenous embolization may be a safer and more effective method in the treatment of mandibular AVM. We report a treatment case of mandibular AVM in a 9-year-old-girl for episodes of spontaneous bleeding for 6 days using by selective transarterial embolization ,direct puncture embolization and microcoil embolization.

A Comparison Study on Therapeutic Efficacy of Urokinase vs. Heparin in Acute Ischemic Stroke

Early thrombolytic therapy may be beneficial for patients with acute focal cerebral ischemia. To compare the therapeutic efficacy of urokinase and heparin in acute cerebral infarction, we made a protocol for a randomized trial of intravenous (IV) urokinase and heparin begun within 12 hours of the stroke onset. Intraarterial (IA) urokinase theatment was also evaluated for the stroke within 6 hours of onset. Eligible patients had pretreatment computed tomographic scanning and gave informed consent. Forty-six patients were sutdied : 19 for IV urokinase, 19 for heparin, and 8 for IA urokinase. Baseline demographic values and risk factor profiles were similar among the respective groups. The degree of improvement on the stroke scale score after treatment in IA uroki-nase-treated group was statistically significant (p<0.05, Wilcoxon Signed Rank Test), while insignificant in IV urokinase and heparin-treated groups. Five of eight patients treated with IA urokinase improved by 4 or more points on the score or made an exellent recovery at the time of discharge, whereas similar improvement occurred in 4 patients in both IV urokinase group and the heparin group (p=0.052, Fisher's Exact Test). All of the improved patients by IA urokinase demonstrated immediate recannalization of the occluded arteries. Out of 46 study patients, there were three fatal intracerebral hemorrhages, all in IV urokinase group. These observations suggest that IA urokinase infusion within 6 hours may be safe and effica- cious for the treatment of acuted cerebral infarction. Further stydy is warranted so that the efficacy and safety of IV urokinase treatment within 6 hours can be assesed with regard to IA urokinase treatment.

Cerebral Arterial Embolism Treated by Intra-Arterial Infusion of Urokinase Which Was Occurred during Percutaneous Balloon Mitral Valvuloplasty

Cerebral arterial embolism which resulted in total occlusion of right proximal middle cerebral artery was occured in 33 years old female patients with severe mitral stenosis and atrial fibrillation during percutaneous mitral balloon valvuloplasty(PMV). The occluded artery could be detected by transfemoral carotid angiography and recanalized immediately by intra-arterial infusion of urokinase. There were no cerebral hemorrhage by CT scan after intra-arterial urokinase infusion and the patients discharged without any neurologic sequale 7 days after thrombolysis. We report a case of successful recanalization with intraarterial infusion of urokinase in patient with cerebral arterial embolism occurred during PMV.