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1.
AJNR Am J Neuroradiol ; 33(3): 481-6, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22158922

RESUMO

BACKGROUND AND PURPOSE: Stent-like, self-expandable devices, the so-called flow diverters, are increasingly used for the treatment of wide-neck cerebral aneurysms. The immediate and short-term results are promising, but no long-term results are available. The purpose of our research was to report the long-term angiographic and cross-sectional imaging results after placement of a PED in 12 patients with wide-neck intracranial aneurysms. MATERIALS AND METHODS: Twelve wide-neck or otherwise untreatable cerebral aneurysms in 12 patients were treated with the PED. Angiography was performed at 6 and 24 months after treatment. Additional MR and CT angiograms were acquired. RESULTS: In all patients, angiographic or cross-sectional imaging follow-up of at least 27 months demonstrated complete occlusion of the aneurysms treated with the PED. There were no cases of aneurysm recurrence. Angiography at around 6 months showed complete occlusion in all cases, except 1 that showed complete occlusion at the 29-month follow-up. In 1 patient, a clinically asymptomatic 75% in-stent stenosis was seen on the angiography at 6 months but was resolved completely by balloon dilation. Device placement was successful in all patients. Distal embolization had occurred in 1 patient, but the clot was resolved completely without clinical sequelae. Almost immediate angiographic occlusion was achieved in 2 aneurysms and flow reduction in 10 aneurysms. CONCLUSIONS: Treatment of wide-neck intracranial aneurysms by PED placement led to successful and durable occlusion in all cases, without severe complications. Endovascular treatment for in-stent stenosis should be considered cautiously, because the underlying stenosis may be transient and disappear within 12 months after treatment.


Assuntos
Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Eur J Neurol ; 16(1): 31-6, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19049506

RESUMO

BACKGROUND AND PURPOSE: About half of all transient ischaemic attacks (TIAs) or strokes in the posterior circulation are caused by the arterial stenosis. The purposes of this study were to determine the safety of stent-assisted percutaneous transluminal angioplasty (stent-PTA) and its efficacy for the prevention of recurrent stroke in patients with symptomatic artery stenosis in the extra- and intracranial posterior circulation. METHODS: Forty-six patients with a previous stroke or TIA who received balloon-mounted coronary stents for vertebral artery origin stenosis (VAOS; 29 patients) or self-expanding nitinol stents for vertebrobasilar intracranial stenosis (VBIS; 17 patients) were followed-up for a mean of 24.1 (VAOS) and 12.7 (VBIS) months. RESULTS: When all cause morbidity/mortality within 30 days from stent-PTA and stroke or death from stroke in the treated vascular territory during the first 12 months of follow-up are combined, the incidence of periprocedural complications and disease progression for the first year is 10.3% in VAOS patients and 17.6% in the VBIS group. Vessel restenosis >/=50% was found in 52.0% of VAOS and in 32.1% of VBIS patients who completed 6 months follow-up. CONCLUSIONS: We observed a higher periprocedural complication rate for patients with VBIS and a higher rate of restenosis in VAOS patients after stent-PTA for symptomatic artery stenosis.


Assuntos
Angioplastia/instrumentação , Stents/estatística & dados numéricos , Insuficiência Vertebrobasilar/fisiopatologia , Insuficiência Vertebrobasilar/terapia , Adulto , Idoso , Angioplastia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/mortalidade , Adulto Jovem
3.
AJNR Am J Neuroradiol ; 28(4): 628-34, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17416811

RESUMO

BACKGROUND AND PURPOSE: 3D time-of-flight MR angiography (3D TOF MRA) may be used as noninvasive alternative to digital subtraction angiography (DSA) for the follow-up of patients with intracranial aneurysms treated with Guglielmi detachable coils (GDCs). We aimed to determine the influence of aneurysm size and location on diagnostic accuracy of 3D TOF MRA for follow-up of intracranial aneurysms treated with GDCs. MATERIALS AND METHODS: Two hundred and one 3D TOF MRAs in 127 consecutive patients with 136 aneurysms were compared with DSA as standard of reference. Sensitivity and specificity of 3D TOF MRA for detection of residual or reperfusion of the aneurysms was calculated with regard to aneurysm size and location. RESULTS: Overall sensitivity and specificity of MRA was 88.5% and 92.9%, respectively. Sensitivity was lower for aneurysms

Assuntos
Angiografia Digital , Angiografia Cerebral , Embolização Terapêutica , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética , Adolescente , Adulto , Idoso , Artefatos , Meios de Contraste , Feminino , Humanos , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Reperfusão , Sensibilidade e Especificidade
4.
J Neuroimaging ; 11(3): 280-6, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11462295

RESUMO

BACKGROUND AND PURPOSE: This study was carried out to determine whether high-resolution 3-dimensional prospective-volume-rendered computed tomographic (CT) angiography can replace conventional intra-arterial digital subtractional angiography in the diagnostic evaluation of patients with an acute subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm. METHODS: Both techniques were performed in 30 consecutive patients within 2 to 12 hours after their admission to the hospital. RESULTS: In this group of 30 patients, CT angiography with 3-dimensional volume-rendered reconstruction detected 31 aneurysms in 25 patients. Two aneurysms were missed on CT angiography. Conventional angiography detected 33 aneurysms in 27 patients. The authors considered angiograms in 3 patients presenting with SAH as normal. In all cases where an aneurysm was detected on CT angiography, the finding was confirmed by conventional angiography. CONCLUSIONS: CT angiography with 3-dimensional post-processing is a sensitive, noninvasive method that provides a 3-dimensional view of intracranial vessels and the aneurysm. It is also very useful in planning either surgical or endovascular treatment.


Assuntos
Angiografia/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Criança , Feminino , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hemorragia Subaracnóidea/etiologia
5.
AJNR Am J Neuroradiol ; 20(1): 101-6, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9974063

RESUMO

BACKGROUND AND PURPOSE: The purpose of our study was to examine the clinical value of echo-enhanced transcranial power Doppler sonography (EE-TCD), including it ability to assess hemodynamic parameters of the intracranial vasculature, in patients with suspected cerebral arteriovenous malformations (AVMs) and to compare this method with angiography. METHODS: Sixteen patients with suspected cerebral AVMs were examined with EE-TCD and angiography. As an echo-enhancing agent, SHU 508A (Levovist) was administered intravenously by bolus injection in nine patients and by continuous infusion in seven. Sonograms were reviewed without knowledge of other imaging results and were correlated with angiographic findings. RESULTS: Angiography showed AVMs in 12 of 16 patients. Eleven lesions were located in the anterior or middle fossa and one was in the posterior fossa. EE-TCD was slightly less sensitive in the detection of AVMs (92%, 11/12 lesions), since in one patient the lacking acoustic window did not allow a transcranial examination. EE-TCD slightly underestimated AVM size compared with angiographic findings but showed feeding arteries with sufficient acoustic properties. In seven patients (58%), angiography revealed a coincidental blood supply from another intracranial or extracranial vessel, which was missed by EE-TCD in all cases. Assessment of peak systolic velocities and resistive indexes resulted in a higher (mean, 191.1 cm/s) and a lower (mean, 45.7%) value, respectively, in the feeding arteries as compared with the contralateral arteries (mean, 101.8 cm/s and 55.6%, respectively). Side-to-side differences were significantly higher in patients with AVMs than in those without a malformation. Signal enhancement was markedly longer with continuous infusion (mean, 520 seconds +/- 28.2) than with bolus injection (mean, 145 seconds +/- 10.5) of the contrast agent. CONCLUSION: In our limited study group, EE-TCD was a sensitive method for the detection of AVMs, and Levovist proved to be a safe and effective echo-enhancing substance.


Assuntos
Angiografia Cerebral , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Adolescente , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Circulação Cerebrovascular , Criança , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissacarídeos , Ultrassonografia Doppler Transcraniana/métodos , Resistência Vascular
7.
Minim Invasive Neurosurg ; 41(2): 81-5, 1998 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9651916

RESUMO

We reviewed the medium-term results of endovascular treatment of intracranial aneurysms and compared patient selection and results with those of open surgery. Between January 1992 and December 1995, a total of 248 consecutive patients were treated for 297 aneurysms (61 unruptured and 236 ruptured). 162 aneurysms in 142 patients (mean age, 48.5 years) were treated microsurgically and 134 aneurysms in 106 patients (mean age, 54.2 years) were treated by endovascular embolization with Guglielmi detachable coils (GDC). The mean follow-up was 2.6 years (range, 1.5 to 4.5 years). There was no significant difference in patient population and selection in terms of age, sex or location of aneurysms between both methods. Both modalities achieved excellent results (defined as no neurological deficit) in patients with unruptured aneurysms and with no or minor deficits after subarachnoid hemorrhage (SAH) between 71% and 88%. Patients with moderate deficits after SAH had excellent outcomes in 49% after open surgery, and 47% after embolization. Poor grade patients had, equally, as well an acceptable as a pour outcome, between 0% and 50%. There was no significant difference between the outcome of surgical or endovascular patients. We conclude that GDC embolization is not associated with a higher risk of morbidity and mortality than open surgery. This risk may even be lower for lesions in surgically unfavorable locations. The GDC technique is a less invasive, effective option to prevent re-bleeding in early stage, even in poor-grade patients. However, these encouraging medium-term results have to be confirmed by a longer observation period.


Assuntos
Embolização Terapêutica/normas , Aneurisma Intracraniano/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/terapia , Artérias Cerebrais/patologia , Artérias Cerebrais/cirurgia , Constrição , Embolização Terapêutica/métodos , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/normas , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
8.
Rofo ; 169(6): 633-8, 1998 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-9930218

RESUMO

PURPOSE: To report the early clinical experience with the Talent stent-graft system in the treatment of infrarenal aortic aneurysms. MATERIALS AND METHODS: The study group comprised 15 males aged from 51-79 years. A bifurcated Talent stent-graft was implanted in 9 patients with type B or C aneurysms, a tube graft in 6 patients with a type A aneurysm. The stent-grafts were introduced via a surgical femoral cut-down, for a bifurcated graft a bilateral surgical access was needed. All procedures were performed as teamwork by radiologists and vascular surgeons under general anaesthesia in the angiography suite. RESULTS: Primary and secondary technical successes were 80 and 86%, respectively. Technical failures were due to access site problems (n = 1; elective open repair), malpositioning of the prosthesis (n = 1; immediate conversion to open surgery), and primary distal leakage (n = 1; elective occlusion by means of distal stent-graft extension). One patient died 15 days after an uneventful stent-graft insertion (30-day mortality 6%). No complications were observed during a mean follow-up period of 7.8 months. The aneurysmal diameter decreased in 6 patients and remained unchanged in the others. CONCLUSIONS: The Talent system revealed satisfactory early results which are comparable to competitive stent-graft systems. An advantage of this stent-graft device is the availability in a wide range of dimensions. A major disadvantage is the large introducer system (french size 22-27).


Assuntos
Angioplastia com Balão/instrumentação , Aneurisma da Aorta Abdominal/terapia , Prótese Vascular , Materiais Revestidos Biocompatíveis , Stents , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aortografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Taxa de Sobrevida , Tomografia Computadorizada por Raios X
9.
Radiology ; 205(1): 191-6, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9314984

RESUMO

PURPOSE: To determine the safety and effectiveness of Guglielmi detachable coils in the endovascular treatment of ruptured and nonruptured basilar tip aneurysms. MATERIALS AND METHODS: A basilar tip aneurysm was occluded with Guglielmi detachable coils in 21 patients. The aneurysmal diameter was small (less than 12 mm) in 15 patients, large (12-25 mm) in four patients, and giant (more than 25 mm) in two patients. Angiographic follow-up ranged from 6 to 48 months (mean, 26 months); clinical follow-up ranged from 1 to 48 months. RESULTS: Embolization was technically successful in all patients. Complete occlusion was achieved in 14 (67%) patients; 90% occlusion was achieved in seven (33%) patients. There was partial reperfusion of the aneurysm in three patients (14%) after 6 months, which necessitated repeated embolization. The clinical results were excellent in 13 patients, good in six, and fair in one. One patient died 2 months after the embolization due to pulmonary complications. A posterior cerebral artery was occluded in five (24%) patients; one of these patients developed a permanent neurologic deficit, one developed a transient neurologic deficit, and three had no clinical symptoms. CONCLUSION: Endovascular treatment of a basilar tip aneurysm with Guglielmi detachable coils seems to be a safe and less invasive alternative to surgical clipping.


Assuntos
Artéria Basilar , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Adulto , Idoso , Angiografia Digital , Artéria Basilar/diagnóstico por imagem , Angiografia Cerebral , Embolização Terapêutica/métodos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiologia Intervencionista
11.
Br J Urol ; 79(6): 852-60, 1997 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9202549

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of endovascular occlusion of true renal artery aneurysms (RAAs) with conventional non-detachable microcoils (NDCs) and Guglielmi detachable coils (GDCs). PATIENTS AND METHODS: Over a 5-year period, 12 RAAs were treated by endovascular selective embolization. Four RAAs were occluded using NDCs and eight were treated with GDCs. All coils were delivered through a microcatheter. Eight RAAs were located in the bifurcation of the main renal artery, two in the main renal artery and two were intrarenal. Before treatment, four patients presented with hypertension, one associated with renal infarction and a second had flank pain due to microembolization. Two other patients had renal infarction, associated with haematuria in one; one other patient also had haematuria and five patients were asymptomatic. All patients were followed using clinical and angiographic examinations after 6 months, 1 and 2 years. RESULTS: All RAAs were occluded successfully. In two patients treated with NDCs there were minor complications, i.e. one subsegmental peripheral infarction and one misembolization, both without clinical symptoms. In the group treated with GDCs there were no complications. Five of seven patients were clinically improved, while two patients remained clinically unchanged. CONCLUSION: Superselective endovascular treatment of RAAs with microcoils is a safe, efficient, and less invasive alternative to surgical treatment. The high flexibility and softness of the GDC and the controlled detachment enables a safer and more complete occlusion of RAA than current alternatives.


Assuntos
Aneurisma/terapia , Prótese Vascular , Embolização Terapêutica/instrumentação , Artéria Renal , Adulto , Idoso , Aneurisma/diagnóstico por imagem , Angiografia Digital , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Recidiva , Resultado do Tratamento
12.
Cardiovasc Intervent Radiol ; 20(3): 191-6, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9134842

RESUMO

PURPOSE: To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. METHODS: Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethanecovered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope. RESULTS: In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n = 1) to subtotal (n = 8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them. CONCLUSION: PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months.


Assuntos
Ductos Biliares Extra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/patologia , Colestase Extra-Hepática/diagnóstico , Colestase/diagnóstico , Endoscopia do Sistema Digestório , Stents , Idoso , Bile , Neoplasias dos Ductos Biliares/complicações , Biópsia , Colestase/etiologia , Colestase Extra-Hepática/etiologia , Constrição Patológica/diagnóstico , Feminino , Tecido de Granulação/patologia , Humanos , Masculino , Neoplasias Pancreáticas/complicações
14.
Laryngorhinootologie ; 76(2): 83-7, 1997 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-9172634

RESUMO

BACKGROUND: Intractable epistaxis has been treated with surgical intervention for many years, including ligation of the internal maxillary artery. As an alternative approach, endovascular therapy has gained increased acceptance. The purpose of our study was to evaluate the efficacy and safety of endovascular treatment of untractable epistaxis. METHODS: Embolotherapy was performed in 26 patients. The indication for embolization was persistent epistaxis even after anterior and posterior nasal packing. In all but two patients, who required general anesthesia, the procedure was performed in local anesthesia. Endovascular embolization of the internal maxillary artery was performed by using microcatheters, which were introduced intraarterially. Particulate embolic agents were used in all but one patient, who was treated by means of minicoils. RESULTS: The embolization of the territory of the internal maxillary artery was possible in all cases, the technical success rate was 96%, the clinical success rate was 100%. No complications were encountered. Because of an acute recurrent bleeding in one case, a second embolization was performed. No delayed hemorrhages were noted. CONCLUSIONS: Endovascular embolotherapy seems to be an excellent, safe, and less invasive alternative to surgery in patients with intractable epistaxis.


Assuntos
Embolização Terapêutica/instrumentação , Epistaxe/terapia , Adolescente , Adulto , Idoso , Epistaxe/diagnóstico por imagem , Epistaxe/etiologia , Feminino , Seguimentos , Humanos , Masculino , Artéria Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , Recidiva
15.
Acta Neurochir (Wien) ; 139(10): 923-7, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9401651

RESUMO

A case of a ruptured saccular aneurysm arising from the proximal portion of a partially duplicated basilar artery in a 36-year-old woman is reported. CT and lumbar puncture confirmed subarachnoid haemorrhage. Cerebral angiography detected a vertebrobasilar junction aneurysm associated with basilar artery fenestration. The patient underwent successful clipping and coating of the aneurysm by a right lateral suboccipital osteoclastic approach. Embryological development, pathogenesis, diagnostic and therapeutic difficulties of this vascular malformation are discussed in this report.


Assuntos
Aneurisma Roto/cirurgia , Artéria Basilar/anormalidades , Aneurisma Intracraniano/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Hemorragia Subaracnóidea/cirurgia , Insuficiência Vertebrobasilar/cirurgia , Adulto , Aneurisma Roto/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Angiografia Cerebral , Craniotomia , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Microcirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Insuficiência Vertebrobasilar/diagnóstico por imagem
16.
Radiology ; 201(2): 489-94, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8888247

RESUMO

PURPOSE: To evaluate the feasibility and safety of Guglielmi detachable coils for endovascular treatment of extracranial aneurysm and arteriovenous fistula. MATERIALS AND METHODS: Embolization with Guglielmi detachable coils delivered through Tracker-18 microcatheters was performed in 16 patients. This patient group had eight renal artery aneurysms and 11 arteriovenous fistulas (three cases of patent ductus arteriosus, one associated with aneurysm; one fistula between the maxillary artery and jugular vein; two fistulas between the subclavian and pulmonary arteries; four fistulas between the pulmonary artery and vein; and one fistula between the anterior tibial artery and vein). Efficacy of the procedure was assessed by means of short-term follow-up (clinical examination, angiography, and/or Doppler sonography) 3 and 6 months later. RESULTS: No complications were encountered. Embolization was technically and clinically successfully in all eight aneurysms (100%) and in nine arteriovenous fistulas (82%). In two cases (fistula between the subclavian and pulmonary arteries and fistula between the anterior tibial artery and vein) endovascular placement of Guglielmi detachable coils failed to occlude the vessel. Results of short-term follow-up examinations confirmed the initial results in all cases. CONCLUSION: Guglielmi detachable coils are feasible, safe, and effective for endovascular treatment of extracranial aneurysm and arteriovenous fistula.


Assuntos
Aneurisma/terapia , Fístula Arteriovenosa/terapia , Embolização Terapêutica/instrumentação , Artéria Renal , Adulto , Idoso , Permeabilidade do Canal Arterial/terapia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Veias Jugulares/anormalidades , Masculino , Artéria Maxilar/anormalidades , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Subclávia/anormalidades
17.
Radiology ; 201(1): 167-72, 1996 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8816539

RESUMO

PURPOSE: To compare the clinical efficacy and treatment costs of plastic versus metal biliary stents. MATERIALS AND METHODS: In a randomized trial, 101 patients with malignant common bile duct obstruction underwent transhepatic stent implantation and were followed up until death. Patients were stratified into risk and nonrisk groups. Forty-nine patients received 12-F plastic stents, and 52 received expandable metal stents. Plastic endoprostheses were placed in a two-step procedure; metal stent, in a single procedure. Kaplan-Meier analyses were used to compare patient survival and stent patency rates. RESULTS: The 30-day mortality rate was significantly lower for metal stents (five of 52 [10%]) than plastic stents (12 of 49 [24%]; P = .05). The obstruction rate was 19% (10 of 52; median patency, 272 days) for metal stents and 27% for plastic stents (13 of 49; median patency, 96 days; P < .01). Median time until death or obstruction was longer for metal stents (122 vs 81 days; P < .01). Placement of metal stents was associated with shorter hospital stay (10 vs 21 days; P < .01) and lower cost ($7,542 vs $12,129; P < .01). CONCLUSION: Use of self-expanding metal stents appears to show substantial benefits for patients and to be cost-effective.


Assuntos
Colestase Extra-Hepática/terapia , Doenças do Ducto Colédoco/terapia , Plásticos , Aço Inoxidável , Stents , Idoso , Colestase Extra-Hepática/etiologia , Colestase Extra-Hepática/mortalidade , Doenças do Ducto Colédoco/etiologia , Doenças do Ducto Colédoco/mortalidade , Análise Custo-Benefício , Neoplasias do Sistema Digestório/complicações , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Tempo de Internação/economia , Masculino , Estudos Prospectivos , Fatores de Risco , Stents/economia , Taxa de Sobrevida , Fatores de Tempo
18.
HNO ; 44(9): 510-3, 1996 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-9005232

RESUMO

During surgical resections carotid body tumors may bleed profusely due to their vascularity. Preoperative angiographic embolization of tumor-supplying arteries has reduced intraoperative blood loss significantly. The present study reviews our clinical experiences with 13 paragangliomas of the carotid bifurcation in 12 patients during the past 5 years. In 6 patients (46.1%) computed tomography and magnetic resonance imaging demonstrated extensive spread of the tumor up to the base of the skull. Tumors of this size were initially assessed as being inoperable but curative surgical resections were performed after embolization of tumor-supplying arteries by intravascular injections of Gelfoam and implantations of microcoils. Vascular reconstruction of the internal carotid artery by a saphenous vein graft was required in 4 patients (30.7%). In 3 malignant paragangliomas (23.0%) adjuvant radiotherapy of 50-60 Gy was administered to the tumor site after surgery. During an average follow-up of 29 months, one malignant paraganglioma was found to have recurred locally 13 months after initial therapy.


Assuntos
Angiografia Digital , Tumor do Corpo Carotídeo/cirurgia , Embolização Terapêutica , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Tumor do Corpo Carotídeo/diagnóstico por imagem , Terapia Combinada , Feminino , Seguimentos , Esponja de Gelatina Absorvível , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Próteses e Implantes , Veia Safena/transplante , Tomografia Computadorizada por Raios X
19.
Radiology ; 200(2): 437-41, 1996 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8685339

RESUMO

PURPOSE: To evaluate the effectiveness of the self-expanding Wallstent in the treatment of benign biliary strictures. MATERIALS AND METHODS: Twenty patients with benign biliary strictures were included in this retrospective study. Seven patients had chronic pancreatitis, two had fibrous papillary stenosis, one had primary sclerosing cholangitis, and 10 had postsurgical strictures, including four who had a stenosed bilidigestive anastomosis. Primary and secondary patency of the stents and clinical outcome after stent insertion were evaluated. RESULTS: Stent placement was successful in all patients. At the end of the observation period, which lasted 3-78 months (mean, 31.2 months +/- 4.5 [standard error]), 10 patients were alive. Median primary patency was 32 months +/- 8.7. In 10 patients, patency was preserved during the observation period (two with secondary patency). Six patients had a good clinical result. Among the other four patients, one had recurrent cholangitis, one had a biliary abscess, and two had stent revisions. In the other patients, stents became occluded after 3-55 months. The reason for stent occlusion was a stone in one patient; in the others, the causes were not proved. CONCLUSION: Results of stent placement for treatment of benign biliary strictures are not encouraging. However, the patient population is too limited to allow final conclusions.


Assuntos
Colestase/terapia , Doenças do Ducto Colédoco/terapia , Stents , Colestase/diagnóstico por imagem , Colestase/epidemiologia , Doenças do Ducto Colédoco/diagnóstico por imagem , Doenças do Ducto Colédoco/epidemiologia , Desenho de Equipamento , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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