rt-PA thrombolysis in acute thromboembolic upper-extremity arterial occlusion.

PURPOSE: Retrospective analysis of the results of rt-PA thrombolysis in the treatment of acute thromboembolic occlusion of the upper limb. METHODS: Of 55 patients with demonstrated acute embolic arterial occlusion, rt-PA thrombolysis was performed on 40 occlusions in 38 patients (23 women with a mean age of 62 years, range 32-85 years; 15 men with a mean age of 65 years, range 32-92 years) according to the following design: 6 mg rt-PA/hr for 30 min, 3 mg rt-PA/hr for the next 30 min, 1 mg rt-PA/hr for 7 hr, and 0.4 mg rt-PA/hr until the end of lysis. Onset of symptoms varied from 1 to 14 days. Included were three isolated upper-arm occlusions, nine combined brachial and forearm occlusions, and 28 forearm and hand artery occlusions. RESULTS: The overall success rate was 55%. The lysis results for isolated upper arm, combined brachial and forearm occlusions, and forearm and hand artery occlusions were 100%, 66%, and 46%, respectively. In eight patients surgical embolectomy had to be performed after failed thrombolysis. No amputation was required in the follow-up period. No lethal complications occurred. CONCLUSIONS: Interventional rt-PA treatment of proximal upper-extremity arterial occlusions may be performed with comparable success rates to surgical embolectomy and without severe complications. For distal occlusions the results are inferior to the success rates obtained with surgery.

Anatomy of the orbital apex and cavernous sinus on high-resolution magnetic resonance images.

Diseases of the orbital apex and cavernous sinus usually present with involvement of multiple cranial nerves, corresponding to the complex anatomy of the region. In nontraumatic disorders, magnetic resonance imaging is the diagnostic modality of choice. However, its capabilities can be fully used only with thorough knowledge of the complicated topographic relationships in this region. This article describes the imaging anatomy of the cranio-orbital junction and adjacent subarachnoid spaces. High-resolution magnetic resonance images of normal subjects are presented, and the results are compared with findings reported in the literature. The following anatomic structures can be visualized on high-resolution magnetic resonance images: extraocular muscles and corresponding connective tissue, major orbital and cerebral arteries, ophthalmic veins, cavernous sinus, and all sensory and motor cranial nerves of the eye along their intraorbital and intracranial course.

[Simple and effective rt-PA thrombolysis design]. / Einfaches und effektives rt-PA Thrombolyse-Design.

PURPOSE: Assessment of a novel, simple and practical thrombolysis scheme for the purposes of a central hospital. MATERIALS AND METHODS: 314 thromboembolic lower extremity occlusions in 260 consecutive patients were treated by thrombolysis as follows: 6 ml rt-PA/h for 30 min; 3 ml rt-PA/h for another 30 min; 1 ml rt-PA/h for 7 hours, and 0.4 ml rt-PA until vessel patency. Antegrade introduction of a 5 F straight end-hole catheter through a 6 F, constantly heparin-flushed sheath, to the level of occlusion was followed by subsequent advancement of the catheter tip according to progress of lysis at time intervals of 2, 4, and 8 hours. The regimen was continued overnight. RESULTS: 82% of arterial occlusions were completely recanalized at the end of thrombolysis. Then, angioplasty was performed if appropriate. Best results (100% recanalization rate) were achieved by treating occlusions of the superficial femoral artery, even in cases of involvement of the entire length of the vessel, and isolated popliteal occlusions. A recanalization rate of 70% was achieved by treating distal crural vessel occlusion. Bypass grafts were recanalized in 50%. COMPLICATIONS: 3 x major hematoma, 2 x transluminal perforation; 16 x minor hematoma from the puncture site at the sheath, 4 x erythema, obviously reaction to rt-PA (together n = 25; 8%). CONCLUSIONS: We empirically found and solidly evaluated an effective thrombolysis scheme. Our results demonstrate that major advances are possible even in this well-grounded field.