BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right c...BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. Transvenous routes to the sinus were failed due to the tortuous facial vein. The fistula was treated by Matrix detachable coils and Fibered detachable coils through the transarterial approach. Results The patient was successfully treated by means of transarterial embolization, and symptoms improved within a week. Conclusions Although other techniques using a transvenous approach may also be useful, transarterial embolization with detachable coils should be a safe and effective method to immediately occlude the fistula.展开更多
Objective Introduction When we perform transvenous embolization of carotid cavernous fistula, we selectively occluded the venous outflow to the retrograde cortical venous drainage and retrograde ophthalmic venous drai...Objective Introduction When we perform transvenous embolization of carotid cavernous fistula, we selectively occluded the venous outflow to the retrograde cortical venous drainage and retrograde ophthalmic venous drainage as the initial steps before the rest of the cavernous sinus. The rationale is to prevent re-diversion of flow into the ophthalmic veins and cortical veins in a subtotally occluded carotid cavernous fistula.Method From 1997 to 2004, a total of 46 patients with carotid cavernous fistula were treated by transvenous embolization using the proposed selective occlusion strategy. There were 6 direct and 40 dural cartoid cavernous fistulae. The embolic agents were Guglielmi detachable coils and fibered platinum coils. Transvenous embolization routes included inferior petrosal sinus (IPS) alone (32 patients), IPS and intercavernous sinus (9 patients), and superior ophthalmic vein (5 patients).Result The follow-up period ranged from 4 months to 7 years. One patient developed retinal hemorrhage due to ophthalic vein thrombosis one week after the embolization procedure. Two patients had transient ophthalmoplegia and 2 patients had symptomatic recurrence of the carotid cavernous fistula during the follow-up. Clinical cure was achieved in 44 patients (96%).Conclusion The sequential occlusion strategy offers a safe and effective method in the transvenous embolization of carotid cavernous fistula.展开更多
Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive u...Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.展开更多
Embolic detection is very important to the early diagnosis of vessel disease. The Doppler ultrasound technique is one of the common methods to detect the emboli non-invasively. When the emboli pass through the sample ...Embolic detection is very important to the early diagnosis of vessel disease. The Doppler ultrasound technique is one of the common methods to detect the emboli non-invasively. When the emboli pass through the sample volume of the Doppler ultrasound instrument, there exist high intensity transient Doppler signals. Thus the emboli can be detected directly from the variation of Doppler signal amplitude. Since there may be some disturbance in the system, this general detection method has great limitation. To improve the accuracy of emboli auto-detection, several novel methods are studied to obtain the sensitive characteristic of the emboli signals using the new signal processing theories.展开更多
文摘BACKGROUND AND PURPOSE We evaluated our experience in placing detachable coils in the management of spontaneous CCFs due to rupture of a primitive trigeminal artery. Methods A 48-year-old female presented with right conjunctival chemosis and right abducens nerve paresis. Cerebral angiography demonstrated a right carotid-cavernous sinus fistula associated with persistent primitive trigeminal artery. Transvenous routes to the sinus were failed due to the tortuous facial vein. The fistula was treated by Matrix detachable coils and Fibered detachable coils through the transarterial approach. Results The patient was successfully treated by means of transarterial embolization, and symptoms improved within a week. Conclusions Although other techniques using a transvenous approach may also be useful, transarterial embolization with detachable coils should be a safe and effective method to immediately occlude the fistula.
文摘Objective Introduction When we perform transvenous embolization of carotid cavernous fistula, we selectively occluded the venous outflow to the retrograde cortical venous drainage and retrograde ophthalmic venous drainage as the initial steps before the rest of the cavernous sinus. The rationale is to prevent re-diversion of flow into the ophthalmic veins and cortical veins in a subtotally occluded carotid cavernous fistula.Method From 1997 to 2004, a total of 46 patients with carotid cavernous fistula were treated by transvenous embolization using the proposed selective occlusion strategy. There were 6 direct and 40 dural cartoid cavernous fistulae. The embolic agents were Guglielmi detachable coils and fibered platinum coils. Transvenous embolization routes included inferior petrosal sinus (IPS) alone (32 patients), IPS and intercavernous sinus (9 patients), and superior ophthalmic vein (5 patients).Result The follow-up period ranged from 4 months to 7 years. One patient developed retinal hemorrhage due to ophthalic vein thrombosis one week after the embolization procedure. Two patients had transient ophthalmoplegia and 2 patients had symptomatic recurrence of the carotid cavernous fistula during the follow-up. Clinical cure was achieved in 44 patients (96%).Conclusion The sequential occlusion strategy offers a safe and effective method in the transvenous embolization of carotid cavernous fistula.
文摘Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.
文摘Embolic detection is very important to the early diagnosis of vessel disease. The Doppler ultrasound technique is one of the common methods to detect the emboli non-invasively. When the emboli pass through the sample volume of the Doppler ultrasound instrument, there exist high intensity transient Doppler signals. Thus the emboli can be detected directly from the variation of Doppler signal amplitude. Since there may be some disturbance in the system, this general detection method has great limitation. To improve the accuracy of emboli auto-detection, several novel methods are studied to obtain the sensitive characteristic of the emboli signals using the new signal processing theories.
