Intraarterial therapy for acute ischemic strokes.

PURPOSE: To determine the safety and feasibility of intraarterial stroke therapy for acute ischemic strokes at a community-based medical center. MATERIALS AND METHODS: This is a retrospective analysis of data gathered from consecutive stroke patients treated between June 2004 and April 2007. The following therapies were used to treat acute ischemic stroke within 6 hours of symptom onset: intraarterial thrombolytic drugs, intraarterial vasodilators, mechanical clot retrieval, intravascular stents, and angioplasty. The outcomes measured included posttherapy National Institutes of Health Stroke Score (NIHSS), neurologic function at 90 days graded according to the modified Rankin Scale (mRS), recanalization, symptomatic intracranial hemorrhage, and 90-day mortality. RESULTS: Eighty-three patients with a median baseline NIHSS of 17 (range, 3-30) were treated with intraarterial therapy. The median posttherapy NIHSS was 5 (range, 0-33). Forty-two patients (51%) [corrected] had an mRS score of 2 or less at 90 days. The recanalization rate was 76%. Five patients (6%) had symptomatic intracranial hemorrhage, and the 90-day mortality was 22%. CONCLUSIONS: The results of this review showed that an intraarterial therapeutic approach to acute ischemic stroke was feasible at a community-based heath center and demonstrated encouraging data for outcome and safety.

Acute right lower extremity iliofemoral deep venous thrombosis secondary to an anomalous inferior vena cava: a report of two cases.

A congenital anomaly of the inferior vena cava is an increasingly identified risk factor for iliocaval deep venous thrombosis in young patients. We present two cases of acute right lower extremity iliofemoral deep venous thrombosis in 16 and 18-year-old patients that were ultimately diagnosed with an underlying anomalous iliocaval venous system. In one patient, the inferior vena cava was congenitally absent and the right iliac vein was diffusely stenotic with a proximally located high-grade stricture. In the other subject, the infrarenal inferior vena cava and right iliac vein were diffusely hypoplastic. Compensatory venous flow in both subjects was via large perilumbar venous collateral veins and a prominent azygous system. Both patients were successfully treated with a combination of initial catheter-directed thrombolysis followed by balloon angioplasty and venous stent placement.