Prophylactic Dual Catheter Technique to Prevent Side Branch Snowplowing Complications during Angioplasty and Stenting

OBJECTIVE: Angioplasty and Stenting of intracranial atherosclerotic lesions have a higher complication rate and a large proportion of this is attributable to side branch arterial occlusion from forceful displacement of the atheroma into the ostia or snowplowing effect. This can result in severe disabilities when it result in small infarcts involving eloquent areas in the posterior circulation or the motor tracts. MATERIALS AND METHODS: We present a series of 6 cases utilizing a new dual catheter technique for maintaining the patency of at-risk vessels during angioplasty and stenting. There are several methods previously described to help reduce the incidence of stroke but because they do not have a physical presence in the ostia to protect it, they are unable to guarantee the patency of the vessel. RESULTS: All 6 patients underwent angioplasty and stenting with the technique. The patients were assessed for complications with post-procedure magnetic resonance imaging and no complications were found. CONCLUSION: In this preliminary series, the dual catheter technique appears to safe and effective in preventing occlusion of the adjacent branch arteries. This technique may facilitate the use of the Wingspan stent in the treatment of intracranial atherosclerotic stenotic segments by reducing the risk of peri-procedural stroke.

Donor kidney recovery methods and the incidence of lymphatic complications in kidney transplant recipients

Lymphatic leak and lymphocele are well-known complications after kidney transplantation. To determine the incidence of lymphatic complications in recipients of living donor kidneys. Among 642 kidney transplants performed between 1999 and 2007, the incidence of lymphatic com- plications was retrospectively analyzed in recipients of living donor kidneys procured by laparoscopic ne- phrectomy [LP, n=218] or by open nephrectomy [OP, n=127] and deceased donor kidneys [DD, n=297]. A Jackson-Pratt drain was placed in the retroperitoneal space in all recipients and was maintained until the output became less than 30 mL/day. Although the incidence of symptomatic lymphocele, which required therapeutic intervention, was comparable in all groups, the duration of mean +/- SD drain placement was significantly longer in the LP group 8.6 +/- 2.7 days compared to 5.6 +/- 1.2 days in the OP group and 5.4 +/- 0.7 days in the DD group [p<0.001]. Higher output of lymphatic drainage in recipients of LP kidneys could lead to a higher incidence of lymphocele if wound drainage is not provided. More meticulous back table preparation may be required in LP kidneys to decrease lymphatic com- plications after kidney transplantation. These observations also support the suggestion that the major source of persistent lymphatic drainage following renal transplantation is severed lymphatics of the allograft rather than those of the recipient's iliac space