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Intraarterial therapy

Vivian L Bishay, Derek M Biederman, Thomas J Ward, Imramsjah Martijn J van der Bom, Rahul S Patel, Edward Kim, Francis S Nowakowski, Robert A Lookstein, Aaron M Fischman
OBJECTIVE: The transradial approach (TRA) has been shown to reduce the morbidity and mortality associated with arterial coronary interventions. Selective internal radiation therapy (SIRT) performed via the TRA can enhance patient comfort, compared with the traditional transfemoral approach (TFA), by allowing immediate ambulation and precluding potential complications associated with the TFA, such as closure device injury or retroperitoneal hematoma. We report our initial experience with and technique for using the TRA for SIRT...
November 2016: AJR. American Journal of Roentgenology
Ahmet Yigit Goktay, Cagin Senturk
Deep venous thrombosis (DVT) is a common disorder with a significant mortality rate. Successful endovascular treatment of acute DVT is most likely to be achieved in patients with recently formed thrombus, (<10-14 days) with acute iliofemoral DVT. Endovascular treatment options include: Catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), percutaneous aspiration thrombectomy (PAT), vena cava filter protection, venous balloon dilatation and venous stent implantation...
September 24, 2016: Advances in Experimental Medicine and Biology
Florian Nima Fleckenstein, Rüdiger Egbert Schernthaner, Rafael Duran, Jae Ho Sohn, Sonia Sahu, Karen Marshall, MingDe Lin, Bernhard Gebauer, Julius Chapiro, Riad Salem, Jean-François Geschwind
PURPOSE: Liver metastases from renal cell carcinoma (RCC) are not uncommon in the course of disease. However, data about tumor response to intraarterial therapy (IAT) are scarce. This study assessed whether changes of enhancing tumor volume using quantitative European Association for the Study of the Liver (qEASL) on magnetic resonance imaging (MRI) and computed tomography (CT) can evaluate tumor response and predict overall survival (OS) early after therapy. METHODS AND MATERIALS: Fourteen patients with liver metastatic RCC treated with IAT (transarterial chemoembolization: n= 9 and yttrium-90: n= 5) were retrospectively included...
October 2016: Translational Oncology
Lalitha Pidaparthi, Anitha Kotha, Venkat Reddy Aleti, Abhijeet Kumar Kohat, Mridula R Kandadai, Suryaprabha Turaga, Jabeen A Shaik, Suvarna Alladi, Meena A Kanikannan, Borgohain Rupam, Subhash Kaul
BACKGROUND: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. OBJECTIVE: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. MATERIALS AND METHODS: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included...
July 2016: Annals of Indian Academy of Neurology
Rafael Duran, Sahar Mirpour, Vasily Pekurovsky, Shanmugasundaram Ganapathy-Kanniappan, Cory F Brayton, Toby C Cornish, Boris Gorodetski, Juvenal Reyes, Julius Chapiro, Rüdiger E Schernthaner, Constantine Frangakis, MingDe Lin, Jessica D Sun, Charles P Hart, Jean-Francois Geschwind
PURPOSE: To evaluate safety and characterize anticancer efficacy of hepatic hypoxia-activated intraarterial therapy (HAIAT) with evofosfamide in a rabbit model. EXPERIMENTAL DESIGN: VX2-tumor-bearing rabbits were assigned to 4 intraarterial therapy (IAT) groups (n=7/group): 1) saline (control); 2) evofosfamide (Evo); 3) doxorubicin-Lipiodol emulsion followed by embolization with 100-300μm beads (conventional, cTACE); or 4) cTACE and evofosfamide (cTACE+Evo). Blood samples were collected pre-IAT and 1/2/7/14 days post-IAT...
July 20, 2016: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Justin M Moore, Christoph J Griessenauer, Raghav Gupta, Nimer Adeeb, Apar S Patel, Christopher S Ogilvy, Ajith J Thomas
The management of cerebrovascular disease has advanced considerably in 2015. Five randomized control trials have firmly established the role of endovascular thrombectomy for ischemic strokes due to large vessel occlusion. The randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN) (Berkhemer et al. NEJM 2015;372:11-20) was the first of a series on the topic. There was a total of 5 randomized controlled trials published showing benefit in terms of functional outcomes at 90days for mechanical thrombectomy including the Endovascular Therapy for Ischemic stroke with perfusion-imaging selection (EXTEND IA) (Campbell et al...
September 2016: Clinical Neurology and Neurosurgery
Sidhartha Tavri, Suvranu Ganguli, Roy G Bryan, Jeremy Goverman, Raymond Liu, Zubin Irani, T Gregory Walker
PURPOSE: To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury. MATERIALS AND METHODS: A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondary to frostbite injury and treated with catheter-directed tissue plasminogen activator (t-PA) thrombolysis. Amputation data were assessed on follow-up (mean, 23 mo; range, 9-83 mo)...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
De-Hua Wu, Min-Ju Li, Da-Xing Tang, Shan Xu, Yong Huang, Jin-Hu Wang, Qiang Shu
Six patients (aged 3-36 mo) with vaginal tumors (rhabdomyosarcoma and endodermal sinus tumor [EST]; n = 3 each) received intraarterial chemotherapy (IAC) and intravenous chemotherapy. Patients underwent internal iliac artery infusion with cisplatin, pirarubicin, and vindesine. Intravenous chemotherapy with vindesine, ifosfamide, and etoposide was administered after 3 weeks. Vaginal tumors disappeared in all patients after 2 or 3 cycles of alternating therapy. Two patients underwent resection of pelvic metastases...
July 2016: Journal of Vascular and Interventional Radiology: JVIR
Tanja Djurdjevic, Rafael Rehwald, Michael Knoflach, Benjamin Matosevic, Stefan Kiechl, Elke Ruth Gizewski, Bernhard Glodny, Astrid Ellen Grams
OBJECTIVES: After intraarterial recanalisation (IAR), the haemorrhage and the blood-brain barrier (BBB) disruption can be distinguished using dual-energy computed tomography (DECT). The aim of the present study was to investigate whether future infarction development can be predicted from DECT. METHODS: DECT scans of 20 patients showing 45 BBB disrupted areas after IAR were assessed and compared with follow-up examinations. Receiver operator characteristic (ROC) analyses using densities from the iodine map (IM) and virtual non-contrast (VNC) were performed...
June 2, 2016: European Radiology
Jae Seung Lym, Quang Vinh Nguyen, Da Woon Ahn, Cong Truc Huynh, Hwan Jun Jae, Young Il Kim, Doo Sung Lee
UNLABELLED: Transcatheter arterial chemoembolization (TACE) is the most common palliative therapy for unresectable hepatocellular carcinoma (HCC). The conventional TACE technique, which employs the Lipiodol® emulsion, has been widely used for human cancer treatments. However, this delivery system seems to be inconsistent and unstable in maintaining a high concentration of drugs at tumor sites. An alternative approach for TACE is loading drugs into a liquid embolic solution that exists as an injectable solution and can exhibit a sol-to-gel phase transition to form a solidified state once delivered to the tumor site...
September 1, 2016: Acta Biomaterialia
Hagen Bomberg, Heinrich V Groesdonk, Miriam Raffel, Peter Minko, Wolfram Schmied, Matthias Klingele, Hans-Joachim Schäfers
BACKGROUND: Vasopressin is used as an adjunct to norepinephrine to support blood pressure in vasodilatory shock after cardiopulmonary bypass (CPB). In this study, we report our observation of vasopressin treatment in 11 patients with nonocclusive mesenteric ischemia (NOMI). METHODS: In an observational cohort study, 78 patients were studied after having been treated for NOMI with intraarterial iloprost infusion after elective cardiac operation. All patients received norepinephrine as vasopressor for marked vasodilation...
September 2016: Annals of Thoracic Surgery
S Claiborne Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, J Donald Easton, Scott R Evans, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A Molina, Yongjun Wang, K S Lawrence Wong
BACKGROUND: Ticagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. METHODS: We conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere ischemic stroke or high-risk transient ischemic attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90)...
July 7, 2016: New England Journal of Medicine
Karim Lakhal, Maëlle Martin, Sofian Faiz, Stephan Ehrmann, Yvonnick Blanloeil, Karim Asehnoune, Bertrand Rozec, Thierry Boulain
BACKGROUND: Continuous and intermittent noninvasive measurements of arterial blood pressure (BP) have not been compared in the same population. In a large panel of intensive care unit patients, we assessed the agreement between CNAP™ (Continuous Noninvasive Arterial Pressure) finger cuff beat-to-beat monitoring of BP and reference intraarterial measurements. Two automated oscillometric brachial cuff devices were also tested: CNAP brachial cuff (used for CNAP finger cuff calibration) and an alternative device...
May 6, 2016: Anesthesia and Analgesia
Shailendra Joshi, Johann R N Cooke, Darren K W Chan, Jason A Ellis, Shaolie S Hossain, Rajinder P Singh-Moon, Mei Wang, Irving J Bigio, Jeffrey N Bruce, Robert M Straubinger
Nanoparticles such as liposomes may be used as drug delivery vehicles for brain tumor therapy. Particle geometry and electrostatic properties have been hypothesized to be important determinants of effective tumor targeting after intraarterial injection. In this study, we investigate the combined roles of liposome size and surface charge on the effectiveness of delivery to gliomas after intraarterial injection. Intracarotid injection of liposomes was performed in separate cohorts of both healthy and C6 glioma-bearing Sprague Dawley rats after induction of transient cerebral hypoperfusion...
June 2016: Drug Delivery and Translational Research
Yonatan Y Greenstein, Seth J Koenig, Paul H Mayo, Mangala Narasimhan
OBJECTIVE: Current guidelines recommend the use of intraosseous access when IV access is not readily attainable. The pediatric literature reports an excellent safety profile, whereas only small prospective studies exist in the adult literature. We report a case of vasopressor extravasation and threatened limb perfusion related to intraosseous access use and our management of the complication. We further report our subsequent systematic review of intraosseous access in the adult population...
September 2016: Critical Care Medicine
Heather L Lewis, Mark Bloomston
Hepatic artery infusion (HAI) therapy is a well-studied and viable regional therapy for patients with hepatic metastases. Implantable pump devices may be safely placed intraarterially with minimal morbidity and HAI treatments can be used as an adjunct to systemic therapy. Future trials may address sequencing of regional and systemic therapies. However, HAI is not without complications and requires close monitoring and attention to detail but can offer reasonable control of liver tumor burden when managed jointly between medical and surgical oncologists...
April 2016: Surgical Clinics of North America
Jeong-Ho Hong, Jae Seung Bang, Jin-Heon Chung, Moon-Ku Han
A continuous electroencephalography (cEEG) can be helpful in detecting vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (SAH). We describe a patient with an aneurysmal SAH whose symptomatic vasospasm was detected promptly by using a real-time cEEG. Patient was immediately treated by intraarterial vasodilator therapy. A 50-year-old woman without any significant medical history presented with a severe bifrontal headache due to acute SAH with a ruptured aneurysm on the anterior communicating artery (Fisher grade 3)...
March 2016: Journal of Korean Neurosurgical Society
Fernando Gonzalez, Christophe Marti, Maria Chrysafi, Nicolas Beysard, Olivier Grosgurin, Pierre-Nicolas Carron, Olivier Rutschmann
The year 2015 was marked by several publications questioning the practice of emergency medicine. The systematic administration of oxygen in STEMI patients offers no benefit. Similarly, medical expulsive therapy in patients with ureteric stones was questioned. Administration of steroids for acute radiculopathy showed only short-term, but no mid-term pain improvement. Several studies have demonstrated the benefit combining intraarterial and intravenous thrombolytic therapy for ischemic stroke. However, studies assessing optimal management strategy for patients hospitalized with community acquired pneumonia, showed conflicting results...
January 13, 2016: Revue Médicale Suisse
Seunghong Rhee, Sungeun Kim, Jaehyuk Cho, Jukyung Park, Jae Seon Eo, Soyeon Park, Eunsub Lee, Yun Hwan Kim, Jae-Gol Choe
OBJECTIVES: The purpose of this study is to evaluate the correlation between pretreatment planning technetium-99m ((99m)Tc) macroaggregated albumin (MAA) SPECT images and posttreatment transarterial radioembolization (TARE) yttirum-90 ((90)Y) PET/CT images by comparing the ratios of tumor-to-normal liver counts. METHODS: Fifty-two patients with advanced hepatic malignancy who underwent (90)Y microsphere radioembolization from January 2010 to December 2012 were retrospectively reviewed...
March 2016: Nuclear Medicine and Molecular Imaging
Leonardo Rangel-Castilla, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, Nelson L Hopkins
Acute ischemic stroke (AIS) is the leading cause of long-term disability and the second cause of death worldwide. Intravenous (IV) tissue plasminogen activator (tPA) remains the only FDA-approved treatment for AIS. The use of IV tPA in AIS related to large-vessel occlusion (LVO) has shown low recanalization rates and poor clinical outcomes. Over the last decade, endovascular treatment has demonstrated safety and effectiveness in the management of LVO-associated AIS due to the evolution of endovascular techniques and technologies, beginning with intraarterial thrombolysis, aspiration, self-expanding intracranial stents, and now retrievable stents...
February 2016: Journal of Cardiovascular Surgery
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