An Effective Guidewire Looping Technique for the Recanalization of Occlusive Segments of Infrapopliteal Vessels

OBJECTIVE: To determine the efficacy, safety and primary follow-up results of a guidewire looping technique for the treatment of infrapopliteal arteries. MATERIALS AND METHODS: From October 2006 to May 2008, an intraluminal angioplasty of the infrapopliteal arteries was attempted in 200 consecutive patients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to 32 cm, were treated as part of this study, including 305 lesions in the anterior tibial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The 'U'-shaped guidewire technique was attempted in 393 lesions from 361 limbs. The tip of a hydrophilic 0.035-inch guidewire was formed into a 'U' shape with the aid of a 4-Fr catheter and collateral branch vessel to recanalize the completely occluded long segment lesions. RESULTS: A successful angioplasty with at least one artery recanalized directly to the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping technique had a success rate of 90% (352 of 393 lesions). After the procedure, the rest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showed improvement for intermittent claudication. Complete wound healing was noted in 21 of 54 patients, while 20 of 54 patients showed an improvement in the wound size or depth. A total of 38 major immediate procedure-related complications were noted, including retroperitoneal hematoma, distal emboli, and vessel rupture. CONCLUSION: The results of this study suggests that the guidewire looping technique is a safe and effective method for the recanalization of the occluded lesions in infrapopliteal vessels.

Differential diagnosis of hyperdensities on computed tomography immediately after intra-arteriai thrombolysis in patients with acute ischemic stroke / 介入放射学杂志

Objective The present study was to differentiate the hyperdensities on CT immediately after intra-arterial thrombolysis in patients with acute isehemic stroke.Methods Twenty two patients with acute ischemic stroke were treated with intra-arterial combining with intravenous thrombolysis within 6 hours after onset.All patients underwent nonenhaneed CT scans before,immediately and 24 hours after thrombolytic therapy.The hyperdensities on CT after intra-arterial thrombolysis were analyzed retrospectively.Results Five hyperdense areas were seen in 22 patients immediately after thrombolytie therapy.According to their locations, CT values and follow-up CT scans,the hyperdensities on CT imaging were classified into two groups:contrast enhancement and hemorrhagic transformation.The former was characterized by rapid clearance of the hyperdensity lesion with maximum Hounsifild Unit＜90,on the contrary,the latter was noted by persistence of hyperdensity lesion after 24 hours CT scan with maximum Hounsifild Unit＞90.Two of the five hyperdense lesion patients were confirmed to be contrast enhancement with location in cerebral cortex,the other were hemorrhagic transformation,mostly located in basal ganglia.Hyperdensity in patients with contrast enhancement showed neurological improvement although no further medical cares were offered.Conclusions Different kind of hyperdensity on CT immediately after intra-arterial thrombolysis in patients with acute ischemic stroke can be differentiated according to its location,CT value and follow-up CT scan.When contrast enhancement occurred,no further medical care is needed.