Recanalization of Acute Intracranial Artery Occlusion Using Temporary Endovascular Bypass Technique

PURPOSE: The purpose of this study is to present our preliminary experience of the temporary endovascular bypass (TEB) technique using an Enterprise stent for recanalization of acute intracranial artery (IA) occlusion. MATERIALS AND METHODS: Patients treated by TEB were enrolled in this retrospective study from January 2009 to May 2010. All the procedures consist of temporary partial deployment and subsequent retrieval of Enterprise stent, supplemented by intra-arterial infusion of urokinase (UK) and/or tirofiban. According to the thrombolysis in cerebral infarction (TICI) classification, recanalization was evaluated with initial and postprocedural angiography. Safety was evaluated related to the procedure and clinical outcomes were assessed by National Institute of Health Stroke Scale (NIHSS) score at discharge and modified Rankin scale (mRS) score at 3 months. RESULTS: Eleven patients (median NIHSS 12.8, mean age 61.6 years, male: female = 8:3) with acute IA occlusion were treated with TEB. All the patients presented with TICI 0, and the occluded vessel was the middle cerebral artery (n=7), the basilar artery (n=1), and the distal ICA occlusion (n = 3). IV infusion of tissue plasminogen activator (tPA) was done in 4 patients and mechanical thrombolysis with intra-arterial UK was performed in 9. Recanalization was achieved in 73% (8 patients; TICI ≥ 2). There were no procedure-related complications except for two asymptomatic intracranial hemorrhages. Improvement (≥ 4 points on the NIHSS) and good outcome (mRS ≤2) after 90 days was shown in six patients (55%). One patient died 6 days after procedure. CONCLUSION: TEB may be a valuable treatment option in acute thromboembolic IA occlusion without stent implantation.ope

Malperfusion Syndrome in the Setting of Type A Aortic Dissection

Background: Acute Type A aortic dissection (TAAD) patients who experience malperfusion syndrome (MPS) are at the greatest risk of major morbidity and mortality. However, the appropriate timing for open proximal aortic repair in the presence of MPS is still uncertain due to variations in clinical manifestations and diverse treatment approaches. Methods: We conducted a comprehensive literature review to understand the importance of MPS in the setting of TAAD. Then, we conducted a national survey to understand the perception of cardiovascular surgeons across Canada and their approach for those patients. Furthermore, we performed a retrospective analysis of our local data to analyze the outcomes of TAAD with and without malperfusion syndrome from December 1999 to December 2021. Finally, we started a prospective pilot study to assess the feasibility and safety of using intravascular ultrasound (IVUS) to assess and early diagnose MPS in the setting of TAAD. Results:The mortality of TAAD ranges from 17% to 31%, with a third of patients presenting with MPS. Mortality of TAAD patients increases significantly in the presence of MPS Specialized centers across the world have adopted new approaches to address malperfusion syndrome and have reported improved outcomes. From the national survey that we conducted, there is awareness of the significance of malperfusion syndrome in the setting of TAAD among the cardiac surgeons across Canada. From our local institution, the 30-day in-hospital mortality of TAAD is 13.6%. The mortality of patients with malperfusion is 36.2%, while without malperfusion is 6.2% (p Conclusion: Adopting new approaches to address malperfusion syndrome in the setting of TAAD is critical to improving mortality and morbidity outcomes

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

The Unrestricted Use of Paclitaxel-Eluting Stents and Sirolimus-Eluting Stents in the Rotterdam T-SEARCH and RESEARCH Registries: Studies on Efficacy, Safety, Stent Thrombosis, Cost Effectiveness and the Future

This year, 2007, marks the 30th anniversary of the first percutaneous coronary intervention, in the form of a percutaneous transluminal coronary angioplasty (PTCA) or balloon angioplasty, by Andreas Gruentzig. 1 It is also the 20th anniversary of the first report of the use of a stent to maintain vessel patency following balloon angioplasty. 2 Up until recently, the major limitation to stent implantation was restenosis, or renarrowing, at the site of stent implantation, leading to recurrence of angina. Th s occurred in between 10 to 50% of patients. In 2000, the first reports of a revolutionary new stent, the drug-eluting stent began to emerge, with early promises of zero restenosis. 3 In 2003, the fi rst drug-eluting stent was commercialised, coated with the immunosuppressive agent sirolimus, leading to the sirolimus-eluting stent, and followed in 2004 by the paclitaxel-eluting stent. The trials performed that led to the commercialisation of drug-eluting stents were in simple lesions, to reduce the number of confounding factors. 4 The patients studied in these trials make up only 25% of the typical patient population seen in a cardiac catheterisation laboratory. For the remaining 75%, it was extrapolated that these drug-eluting stents would be safe and efficacious, but that assumption required proving