[Endovascular stent-assisted angioplasty after cervical arteries dissection]. / Angioplastie-stenting transluminale percutanée après dissection des troncs supra-aortiques.

INTRODUCTION: Spontaneous dissection of cervical arteries is one of the major causes of stroke in young patients. The recommended treatment is curative anticoagulation. However, in selected cases, this treatment could fail or meet contraindications. In such cases, an endovascular stent-assisted angioplasty could be successful. CASE REPORT: We report the case of a 47-year-old patient with spontaneous dissection of the carotid and vertebral arteries. Despite optimized anticoagulant therapy, cerebral perfusion was low. An endovascular stent-assisted angioplasty was performed in the intra- and extracranial segments of the right internal carotid artery. Consequently by improving the intracranial circulation, normal functioning was restored with no immediate complications and the patient remained free of complications at 16-month follow-up. CONCLUSION: Dissections of cervical arteries that lead to a chronic reduction in brain perfusion might benefit from endovascular stent-assisted angioplasty.

[Iatrogenic tracheal and left bronchial stenoses. Uncommon complication of Carlens tube. Apropos of a case surgically treated in a single stage]. / Sténoses iatrogènes trachéale et bronchique gauche. Complication exceptionnelle d'une sonde de Carlens. A propos d'un cas opéré en un temps.

Independent synchronized ventilation of each lung is a new form of management of severe predominantly pulmonary lesions unaliteral. Mechanical ventilatory assistance is also used via a cuffed double lumen tube (Carlens tube). Tracheal stenosis and bronchial stenosis may result from injury caused by respiratory assistance given via this tube. The etiology of the lesion appears to be direct pressure erosion of the tracheal and bronchial walls by the cuff with subsequent repair by scarformation. These lesions were present in a young man. This report describes the surgical treatment: the double stenosis was treated by resection with end-to-end anastomosis with an excellent result.

[Emboligenic ulcerated plaque of the foramen of the vertebral artery]. / Plaque ulcérée emboligène de l'ostium de l'artère vertébrale.

Atheromatous plaques of the vertebral artery ostium are usually smooth and cause hemodynamic ischemia in the vertebro-basilar territory only when stenosis is severe. A case of crescendo vertebro-basilar attacks is reported and related to an ulcerated plaque of the vertebral artery ostium. The patient underwent surgical endarterectomy after failure of an antiplatelet treatment. He has remained asymptomatic for six months. Diagnosis of vertebral artery ulceration is difficult by ultrasonics or digitalized arteriography because of the small diameter of the vessel and its posterior origin. The frequency of ulcerated plaques of the subclavio-vertebral intersection is probably underestimated in the literature Labauge et al. (1987) emphasized recently the risk of cerebellar infarction during the natural history of vertebral artery occlusion. Crescendo vertebro-basilar transient ischemic attacks can be caused by a plaque rupture of of the vertebral ostium which leads secondarily to vertebral artery occlusion. Therapeutic options for atheromatous lesions of the posterior circulation are not clearly defined by controlled studies. In the reported case and in series reported in the literature, surgery would appear to be an efficient procedure with low mortality and morbidity.

Local fibrinolytic therapy in ischemic carotid pathology.

Sixteen patients underwent local fibrinolytic therapy for thrombosis or embolism of the main trunk or intracranial branches of the internal carotid artery. There were eight cases of complete thrombosis of the internal carotid artery, five proximal stenoses of the internal carotid artery with extensive thrombus, one thrombus of the carotid siphon and two middle cerebral artery emboli. Indications for treatment included transient ischemic attacks in 11 cases, cerebral ischemia after carotid arteriography in two cases, and after surgery for atheromatous lesions of the carotid bifurcation in three cases. The fibrinolytic therapy was initiated during carotid surgery in three cases, where extended thrombosis of the internal carotid artery was discovered, which was inaccessible to a Fogarty catheter. The other 13 cases were treated during arteriography procedures. Lysis of the clot was always obtained. One patient died of hematoma of the frontal lobe. All other patients survived and showed neurologic improvement. The neurologic outcome was dependent on the duration and the degree of initial ischemia. Fibrinolytic therapy appears to be beneficial therapy for certain cases of cerebral ischemia.

Rupture of abdominal aortic aneurysm into the inferior vena cava: a study of seven cases.

The authors report seven cases of abdominal aortic aneurysm rupturing into the inferior vena cava system. Symptoms were protean, but included local clinical manifestations and general findings due to the high-flow arteriovenous fistula. In spite of different types of clinical presentation, the correct preoperative diagnosis was made when a continuous bruit with systolic accentuation was heard over the abdomen. Venous repair consisted of simple closure of the fistula from within the aneurysm in six cases. In one case, treatment required ligation of the right common iliac vein. There were two cases of paraplegia, one before and one after the operation. Two of the seven patients died.

[Percutaneous transluminal angioplasty in atheromatous stenosis of the proximal supra-aortic trunks: the brachiocephalic trunk and the subclavian artery]. / L'angioplastie endoluminale percutanée des sténoses athéromateuses des troncs supra-aortiques proximaux. Tronc artériel brachio-céphalique, artères sous-clavières.

The authors are reporting their experience about percutaneous transluminal angioplasty (PTA) in atheromatous stenosis of proximal supra-aortic arteries. In this series of 17 patients, with a 6-month follow-up, vertigos were the main clinical symptoms (8 cases), and it must be pointed out that 5 of these 8 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Three subclavian steal-syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and four asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity nor mortality.

[Rare mechanical complications of right ventricle infarction. Value of two-dimensional echocardiography]. / Complications mécaniques rares de l'infarctus du ventricule droit. Intérêt de l'échocardiographie bidimensionnelle.

Two rare mechanical complications of right ventricular infarction are reported: myocardial dissection and rupture of the RV free wall. The diagnosis was made by 2D echocardiography in both cases. Myocardial dissection resulted in the formation of an oblong, expansive, intraparietal space. The rupture of the RV free wall was visualised as a breach of the continuity of the ventricular wall. These cases underline the importance of 2D echocardiography in the acute phase of myocardial infarction for the diagnosis of these complications.

[Echocardiographic diagnosis of a rare mechanical complication of biventricular infarction. Rupture of the free wall of the right ventricle]. / Diagnostic échocardiographique d'une complication mécanique rare de l'infarctus biventriculaire. La rupture de la paroi libre du ventricule droit.

The authors report a case of rupture of the free wall of the right ventricle, diagnosed by two dimensional echocardiography. This examination revealed an intrapericardial clot associated with a fissure of the diaphragmatic wall of the right ventricle. This case emphasises the value of two dimensional echocardiography in the acute phase of myocardial infarction for the diagnosis of complications which require urgent surgical treatment.

[Endoluminal angioplasty for atheromatous stenoses of supra-aortic trunks. The brachiocephalic arterial trunk, subclavian arteries]. / L'angioplastie endoluminale des sténoses athéromateuses des troncs supra-aortiques. Tronc artériel brachio-céphalique, artères sous-clavières.

The authors are reporting their experience about percutaneous transluminal angioplasty in atheromatous stenosis of proximal supra-aortic arteries. In this series of 12 patients, with an 6 months follow-up, vertigo was the main clinical symptom (6 cases), and it must be pointed out that 5 of these 6 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Two subclavian steal syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and two asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity, nor mortality.

[Pulmonary atresia with major hypoplasia of the pulmonary branches. A radical 2-stage correction]. / Atrésie pulmonaire avec hypoplasie majeure des branches pulmonaires. Cure radicale en deux temps.

Pulmonary atresia with ventricular septal defect (VSD) and severe hypoplasia of the pulmonary branches is a serious malformation and reputedly inoperable. The surgical restoration of a pulmonary outflow tract may nevertheless dilate the pulmonary arterial branches in the long term. The probable mechanism of this effect is related to high right ventricular and pulmonary pulse pressures due to the absence of the pulmonary valve. The right to left shunt, initially, reverses after a few weeks so authorizing closure of the VSD. Two patients, an adult and a child, were successfully treated by this technique.