ABSTRACT
PURPOSE: To determine if complete flow obliteration by covered stents reduces intra-aneurysm pressures in internal carotid artery (ICA) aneurysms. METHODS: A single lumen microcatheter was placed into the aneurysm sac prior to covered stent deployment in 3 patients and connected to a pressure monitoring system. The intra-aneurysm pressure was continuously monitored, and readings were recorded prior to and immediately after stent deployment and at 5-minute intervals up to 20 minutes after stent placement. Complete occlusion of flow into the aneurysms was confirmed by carotid angiography. RESULTS: There was no change in mean pressure within the aneurysm before and immediately after stent placement (80 mmHg) in any patient, nor was there a change in waveform of the intra-aneurysm pressure recording. The average of intra-aneurysm pressures among the 3 patients was higher (99 mmHg) at 10 and 15 minutes after stent placement. In 2 patients, the microcatheter was retracted into the parent arterial lumen; no difference in pressure was noted. CONCLUSION: Our observations suggest no change in the pressures within the aneurysm after complete flow cessation (flow-independent). These findings may assist clinicians in better understanding aneurysm hemodynamics and rupture after covered stent deployment.
Subject(s)
Aneurysm/therapy , Carotid Artery Diseases/therapy , Carotid Artery, Internal/physiopathology , Endovascular Procedures , Hemodynamics , Adult , Aneurysm/complications , Aneurysm/diagnosis , Aneurysm/physiopathology , Aneurysm, Ruptured/etiology , Aneurysm, Ruptured/physiopathology , Blood Flow Velocity , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/physiopathology , Carotid Artery, Internal/diagnostic imaging , Catheterization, Peripheral/instrumentation , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Equipment Design , Female , Humans , Male , Middle Aged , Miniaturization , Predictive Value of Tests , Pressure , Radiography , Regional Blood Flow , Risk Factors , Stents , Time Factors , Treatment Outcome , Vascular Access DevicesABSTRACT
UNLABELLED: Running Title: Sympathetic Block for Ventricular Tachycardia Storm. INTRODUCTION: We present the case of a patient with ventricular tachycardia storm refractory to medical therapy and multiple catheter ablations, successfully managed by percutaneous left inferior cervical sympathetic ganglion block. SUMMARY: A 70-year-old man with a history of ischemic cardiomyopathy and previous placement of implantable defibrillator developed intractable ventricular tachycardia recalcitrant to intravenous amiodarone, lidocaine, and multiple catheter ablations with radiofrequency energy and direct current. The patient received numerous defibrillator shocks that did not result in sustained restoration of sinus rhythm. A percutaneous inferior cervical sympathetic ganglion block was performed under fluoroscopic guidance, with the administration of bupivacaine by infiltration of the tissue between the left internal carotid artery and the cervical vertebral bodies. RESULTS: Two and a half hours after the procedure, ventricular tachycardia converted to sinus rhythm. One month after discharge from the hospital, the patient remained free from sustained ventricular tachycardia and did not report discharges from his implantable defibrillator. CONCLUSION: Percutaneous cervical sympathetic ganglion blockade appears to be an effective intervention in the treatment of ventricular tachycardia storm. Additional data are required before incorporating this technique into the management algorithm of incessant ventricular tachycardia.
