[Local intra-arterial thrombolysis. Results in arterial thromboses and graft occlusions]. / Lokal intraarteriel trombolysebehandling. Resultater ved arterielle tromboser og graft-okklusioner.

The purpose of this study was to evaluate the efficacy of intraarterial low-dose recombinant tissue plasminogen activator (rt-PA) in patients with acute or subacute thrombosis of the native arterial system or in an arterial artificial or venous by-pass graft. Twenty patients with 22 cases of thrombosis received intraarterial thrombolysis during the period 1.1.1995 to 31.12.1995. Ten patients (50%) achieved complete radiological thrombolysis, and in seven patients (35%) partial thrombolysis was achieved. Half of these patients required a subsequent PTA or an operation. There were only three patients (15%) where no lysis occurred. The results seemed very satisfactory and we conclude that thrombolysis should be considered as the first-choice treatment in this category of patients. The indications may be extended to patients with critical ischaemia with the introduction of the pulse-spray technique as the time to complete lysis is considerably shorter with this technique.

[Thromboendarterectomy of chronic thromboembolic pulmonary hypertension]. / Trombendarterektomi af kronisk tromboembolisk pulmonal hypertension.

Chronic thromboembolic pulmonary hypertension has a five year survival rate of less than 10% in patients with a systolic pulmonary artery pressure of 50 mmHg with no convincing effect of medical treatment. The operative mortality from pulmonary thrombendarterectomy in specialised centres has been reduced to 9%, suggesting this treatment as being an option. The results from thrombendarterectomy of two Danish patients are reported. The first patient, a 34 year-old woman was operated at the centre in San Diego with the assistance of a Danish thoracic surgeon. The second, a 60 year-old man was operated at our institution by this surgeon. Following removal of sufficient amount of embolic masses and intimal tissue, the patients were discharged from hospital with a substantial improvement in their clinical status and near normalisation of pulmonary artery pressure, which remained at the latest follow-up (3 to 22 months).

[Diagnosis of suspected thoracic aortic dissection. Focused on transesophageal echocardiography]. / Diagnostik ved mistaenkt torakal aortadissektion. Fokus på transøsofageal ekkokardiografi.

Over a five-year period (1990-1994), 72 consecutive patients were referred to transoesophageal echocardiography (TEE) on suspicion of thoracic aortic dissection. TEE was performed as the only or last investigation in 42 patients (58%). In 44 patients one or more other investigations were carried out before final clinical decision making: aortography (n = 30), X-ray computer tomography (CT, n = 18), and magnetic resonance imaging (MRI, n = 12). The final diagnosis was based on the combination of clinical information, the available examination results, and findings at surgery or autopsy; 31 of the patients were diagnosed as having aortic dissection. One patient with aortic dissection died during TEE while none of the other patients suffered major complications. The sensitivity (demonstration of dissection including correct classification in type A or B) was 81%, 80%, 45%, and 83% for TEE, aortography. CT, and MRI, respectively. The specificities were 88%, 93%, 71%, and 100%, respectively. Dissection of the thoracic aorta is a life-threatening condition demanding prompt and accurate diagnosis. None of the four techniques employed in the present study is ideal. Although TEE is adequate for immediate bedside examination our results show that more time-consuming and resource demanding investigations are sometimes required. Proper training and improved equipment may, however, increase the usefulness of TEE in patients with suspected aortic dissection.

[CT in the prognostic evaluation of apoplexy]. / CT i prognostisk apopleksivurdering.

The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke. Two-hundred and forty-five consecutive stroke patients were included. Each underwent detailed neurological assessment and cranial computed tomography without intravenous contrast injection. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model. Computed tomography showed that 76% of the patients had infarcts. 11% had haemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarcts. The temporal, parietal and frontal regions and the basal ganglia were most often affected. We concluded that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.

[Excimer laser-assisted balloon angioplasty of the femoro-popliteal segment]. / Excimer-laser-assisteret ballonangioplastik af det femoropopliteale segment.

In the Department of Vascular Surgery RK, The University Hospital in Copenhagen, the authors have treated 16 patients with ischaemia in the lower limb by means of laser-assisted balloon angioplasty. A pulsed ultraviolet excimer-laser was employed. It proved possible to break down the occluding arterial lesion in 12 patients (75%). In one patient, this was not followed-up by balloon angioplasty and, in another patient, the reconstruction closed on the first day after operation. The primary success of the procedure, defined as breaking down of the occlusion with the laser-catheter followed by balloon angioplasty and an increase in the ankle/brachial index of greater than 15%, was found to be 10/16 or 62%. The remaining four patients, in whom it did not prove possible to break down the arterial lesion with laser, were treated by means of conventional vascular surgical reconstruction. On follow-up examination after an average of nine months, nine out of the ten patients (90%) still had a patent reconstruction after laser-assisted balloon angioplasty. This new endovascular laser-procedure appears to be suitable for selected patients, but must be assessed more meticulously before it is possible to determine its future placing in the vascular surgical therapeutic armamentarium.

Asymptomatic carotid lesions after endarterectomy of contralateral carotid artery. Five-year follow-up study and prognosis.

Of 185 patients who consecutively underwent carotid endarterectomy five years ago, 135 had a patent asymptomatic contralateral internal carotid artery (ICA). During follow-up (median, 59 months), 36 patients developed new neurologic symptoms (18 strokes and 18 transient ischemic attacks). Thirteen patients developed symptoms referable to the territory of the previously asymptomatic ICA (five strokes and eight transient ischemic attacks). Using life-table analysis, the annual stroke rate was estimated to be 1% and 2.2% considering the previously asymptomatic and symptomatic ICA, respectively. Separating patients according to the degree of stenosis on the preoperative angiogram and according to the presence of ulceration revealed a significantly higher incidence of neurologic events and strokes in patients with stenoses exceeding 50% and/or patients with obvious ulcerations. Although the risk of stroke without warning was increased in these subgroups, we did not consider the risk high enough to warrant prophylactic endarterectomy. An exception enough to warrant prophylactic endarterectomy. An exception may be the patient with a more than 90% stenosis.