2 research outputs found
Direct Puncture of the Superficial Temporal Artery in Embolization of a Scalp Arteriovenous Fistula: A Case Report
We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patientâs scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a âmanual pressure-cooker technique.â The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome
Impact of Number of Passes Before Rescue Therapy in Thrombectomy for Basilar Artery Strokes
Background When standard endovascular thrombectomy techniques fail to achieve a successful recanalization, it is often necessary to use rescue therapies (RTs). RTs are more commonly used in basilar artery occlusions and conventionally thought to represent âa last resort option.â We sought to study the outcomes of basilar artery occlusion patients who received RT, and further hypothesize that the number of instrumental passes before initiation of RT may be associated with increased risk for poor clinical outcomes. Methods We performed a retrospective analysis of the ETIS (âEndovascular Treatment in Ischemic Strokeâ) registry. Our primary analysis included 277 patients who underwent thrombectomy for basilar artery occlusion, of whom 74 patients (26.7%) who received RT, defined as the use of intraâarterial drugs, angioplasty, or stenting. Primary outcome measures included successful or complete reperfusion (final modified thrombolysis in cerebral infarction â„2b or 3), functional independence (modified Rankin scale of 0â2), and mortality at 3Â months. Results RT patients were more likely to have an atherosclerotic cause than nonâRT patients (46/74 [62.2%] versus 38/203 [18.7%]), were more likely to die (42/74 [56.8%] versus 73/203 [36.0%]), and were less likely to achieve functional independence (12/74 [16.2%] versus 84/203 [41.4%]). In the RT cohort, 17 of 74 patients (23.0%) had 1 pass before RT initiation, and 8 of 17 (47.1%) achieved a modified Rankin scale score of 0 to 2 at 3 months, with a mortality rate of 23.5% (4/17). The chance of achieving good clinical outcome decreased with each additional pass, whereas mortality increased. The odds of mortality at 3 months were highest in the >3 passes group, with an odds ratio of 10.29 (95% CI, 2.42â43.81) compared with 1 pass. None of the 25 patients with >3 passes before RT achieved 3âmonth functional independence. Conclusions There is a significant correlation between the number of passes before initiation of RT and 3âmonth clinical outcomes in basilar artery occlusion patients