1
|
Kubo T, Miyazaki K, Shibuya M, Sugihara E, Nakata M, Okuno Y. Intra-Arterial Injection of Temporary Embolic Material Through a Needle Inserted into the Radial or Ulnar Artery for Distal and Proximal Interphalangeal Joint Osteoarthritis: A Retrospective Study of 92 Patients. Cardiovasc Intervent Radiol 2023; 46:1375-1382. [PMID: 37524895 DOI: 10.1007/s00270-023-03514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To assess the efficacy and safety of intra-arterial injection of imipenem/cilastatin sodium (IPM/CS) via a needle placed into the radial artery or ulnar artery (RA/UA) for distal interphalangeal and proximal interphalangeal joint osteoarthritis (DIP/PIP-OA). MATERIALS AND METHODS This is a retrospective single-arm cohort study. Ninety-two patients [92% women, mean (SD) age 55(8.3) years] with a primary DIP/PIP-OA meet the American College of Rheumatology criteria for hand osteoarthritis with pain ≥ 4 on the 0-10 numeric rating scale (NRS) were enrolled. All procedures were performed by injecting IPM/CS through a 24-gauge needle percutaneously inserted into the RA/UA. Two procedures were planned; the second procedure was scheduled 1-2 months after the first. NRS, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Patient Global Impression of Change (PGIC) scale, and procedure-related adverse events were evaluated. RESULTS Technical success, defined as injection of IPM/CS into the RA/UA, was achieved in all patients. Clinical success, defined as a reduction of 2 points or more in the NRS at 12 months, was 77% (95% confidence interval 68-85%). The NRS improved from the baseline to 3, 6, and 12 months (7.8 ± 1.6 vs. 3.8 ± 2.6, 3.9 ± 2.7, and 4.0 ± 2.8, respectively, all p < 0.001). The QuickDASH score improved from the baseline to 12 months (27 ± 15 vs. 19 ± 17, p < 0.001) respectively. No major adverse events were observed. CONCLUSIONS Intra-arterial injection of IPM/CS is a feasible treatment option for DIP/PIP-OA.
Collapse
Affiliation(s)
- Takatoshi Kubo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Koichi Miyazaki
- Musculoskeletal Intervention Center, Okuno Clinic Osaka, 3rd Fl Shinsaibashi Front Bldg., 3-5-11, Minamifunaba, Chuo-ku, Osaka City, Osaka, 542-0081, Japan
| | - Masahiko Shibuya
- Musculoskeletal Intervention Center, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-ku, Kobe City, Hyogo, 650-0021, Japan
| | - Eiji Sugihara
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Masaya Nakata
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan.
| |
Collapse
|
2
|
Messmer SJ, Fraser JF, Pennypacker KR, Roberts JM. Method of intra-arterial drug administration in a rat: Sex based optimization of infusion rate. J Neurosci Methods 2021; 357:109178. [PMID: 33819555 DOI: 10.1016/j.jneumeth.2021.109178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endovascular thrombectomy is the process of removing a blood clot and re-establishing blood flow in patients with emergent large vessel occlusion. The technique provides an opportunity to deliver therapeutics directly to the site of injury. The intra-arterial (IA) route of drug administration in the mouse was developed to bridge the gap between animal stroke treatments and clinical stroke therapy. Here, we adapted the IA method for use in rats, by investigating various flow rates to optimize the IA injection through the internal carotid artery (ICA). METHODS Male and female Sprague-Dawley rats (∼4 months of age) were subjected to placement of micro-angio tubing at the bifurcation of the common carotid artery for injection into the ICA. We evaluated a range of infusion rates of carbon black ink and its vascular distribution within the brain. RESULTS Optimal injection rates in males was 4-6 μl/min and 2-4 μl/min in females. The IA injection using these sex-specific rates resulted in appropriate limited dye delivery to only the ipsilateral region of the brain, without inducing a subarachnoid hemorrhage. CONCLUSION Upon adapting the IA administration model to rats, it was determined that the rate of infusion varied between males and females. This variability is an important consideration for studies utilizing both sexes, such as in ischemic stroke studies.
Collapse
Affiliation(s)
- Sarah J Messmer
- Center for Advanced Translational Stroke Science, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neurology, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA
| | - Justin F Fraser
- Center for Advanced Translational Stroke Science, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neurology, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neurosurgery, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neuroscience, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Radiology, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA
| | - Keith R Pennypacker
- Center for Advanced Translational Stroke Science, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neurology, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neuroscience, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA
| | - Jill M Roberts
- Center for Advanced Translational Stroke Science, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neurosurgery, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA; Department of Neuroscience, University of Kentucky, 741 S. Limestone, Lexington, KY 40536, USA.
| |
Collapse
|
3
|
Stephan S, Reiss S, Lottner T, Özen AC, Bock M. Catheter-based Arterial Input Function Determination for Myocardial Perfusion Measurements. Z Med Phys 2020; 31:65-72. [PMID: 32873440 DOI: 10.1016/j.zemedi.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
The quantification of myocardial perfusion with contrast agent (CA) tracers requires the precise knowledge of the arterial input function (AIF). In this study a method for MR-guided vascular interventions is evaluated that determines the AIF via an active tracking catheter during targeted CA injection. A phantom experiment with a dialysis filter was conducted to measure the AIF using an active catheter and a dynamic image series as reference. To compensate for dilution and coil sensitivity effects, correction methods were developed for the catheter-based AIF determination. From the dynamic MR measurements in the perfusion phantom quantitative perfusion maps were calculated by a deconvolution of the measured CA concentration with the AIF, and additional flow measurements were used to normalize the perfusion map. The signal-time-curves of the measured AIF using the catheter-based and imaging-based methods agree while the absolute values differ by a scaling factor of about 9. After normalization to the surrounding flow, both perfusion techniques are in excellent agreement. Catheter-based AIF measurements are feasible but require an additional normalization which can be determined from a flow measurement. The technique might enable faster perfusion measurements during cardiovascular interventions.
Collapse
Affiliation(s)
- Simon Stephan
- Department of Radiology - Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Reiss
- Department of Radiology - Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lottner
- Department of Radiology - Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ali Caglar Özen
- Department of Radiology - Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Department of Radiology - Medical Physics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
4
|
Yanagie H, Yanagawa M, Higuchi T, Mizumachi R, Fujihara M, Morishita Y, Sakurai Y, Mouri K, Dewi N, Nonaka Y, Shinohara A, Matsukawa T, Kubota A, Yokoyama K, Suzuki M, Masunaga SI, Sakurai Y, Tanaka H, Ono K, Yamauchi H, Ono M, Nakajima J, Higashi S, Takahashi H. Single-dose toxicity study by intra-arterial injection of 10BSH entrapped water-in-oil-in-water emulsion for boron neutron capture therapy to hepatocellular carcinoma. Appl Radiat Isot 2020; 163:109202. [PMID: 32561043 DOI: 10.1016/j.apradiso.2020.109202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
We developed a mixing medical device by attaching Shirasu porous glass Millipore membrane to prepare water-in-oil-in-water (WOW) emulsion in a shorter time to be applied as 10B-entrapped WOW emulsion for hepatocellular carcinoma (HCC) treatment. Single-dose toxicity studies by intra-arterial injection of 10BSH-entrapped WOW were performed in rabbits and pig, and no side effects were observed. We hope to proceed to the preclinical and clinical studies for further evaluation of 10B compound as multidisciplinary treatments for HCC.
Collapse
Affiliation(s)
- Hironobu Yanagie
- Institute of Engineering Innovation, School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan; Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Research Institute of Healthy Living, Niigata University of Pharmacy & Applied Life Sciences, Niigata, 956-8603, Japan.
| | - Masashi Yanagawa
- Veterinary Medical Center, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, 080-8555, Japan
| | - Tsuyoshi Higuchi
- Department of Pharmacology, Kumamoto Institute Branch, LSI Medience Ltd. Co., Kumamoto, 869-0425, Japan
| | - Ryouji Mizumachi
- Department of Pharmacology, Kumamoto Institute Branch, LSI Medience Ltd. Co., Kumamoto, 869-0425, Japan
| | | | - Yasuyuki Morishita
- Department of Human & Molecular Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Yuriko Sakurai
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Research Institute of Healthy Living, Niigata University of Pharmacy & Applied Life Sciences, Niigata, 956-8603, Japan
| | - Kikue Mouri
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Research Institute of Healthy Living, Niigata University of Pharmacy & Applied Life Sciences, Niigata, 956-8603, Japan
| | - Novriana Dewi
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Research Institute of Healthy Living, Niigata University of Pharmacy & Applied Life Sciences, Niigata, 956-8603, Japan
| | - Yasumasa Nonaka
- Department of Surgery, Keiai-kai Hoyo Hospital, Iwate, 028-3111, Japan
| | - Atsuko Shinohara
- Department of Humanities, The Graduate School of Seisen University, Tokyo, 141-8642, Japan; Department of Hygiene, Faculty of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Takehisa Matsukawa
- Department of Hygiene, Faculty of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Ayano Kubota
- Department of Hygiene, Faculty of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Kazuhito Yokoyama
- Department of Hygiene, Faculty of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Minoru Suzuki
- Kyoto Univ Institute for Integrated Radiation & Nuclear Science, Osaka, 590-0494, Japan
| | - Shin-Ichiro Masunaga
- Kyoto Univ Institute for Integrated Radiation & Nuclear Science, Osaka, 590-0494, Japan
| | - Yohinori Sakurai
- Kyoto Univ Institute for Integrated Radiation & Nuclear Science, Osaka, 590-0494, Japan
| | - Hiroki Tanaka
- Kyoto Univ Institute for Integrated Radiation & Nuclear Science, Osaka, 590-0494, Japan
| | - Koji Ono
- Kansai BNCT Medical Center, Osaka Medical College, Osaka, 569-8686, Japan
| | - Haruo Yamauchi
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Minoru Ono
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Jun Nakajima
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan; Department of Pulmonary Surgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Shushi Higashi
- Department of Surgery, Kojin-kai Medicalcity East Hospital, Miyazaki, 885-0035, Japan
| | - Hiroyuki Takahashi
- Institute of Engineering Innovation, School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan; Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| |
Collapse
|
5
|
Sasaki K, Endo H, Niizuma K, Nishijima Y, Osawa S, Fujimura M, Tominaga T. Efficacy of intra-arterial indocyanine green angiography for the microsurgical treatment of dural arteriovenous fistula: A case report. Surg Neurol Int 2020; 11:46. [PMID: 32257572 PMCID: PMC7110105 DOI: 10.25259/sni_588_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background In this study, we report a case of dural arteriovenous fistula (dAVF) that was successfully treated using intra-arterial indocyanine green (IA-ICG) videoangiography during open surgery. Moreover, the findings of IA-ICG videoangiography were compared with those of intraoperative digital subtraction angiography (DSA). Case Description A 72-year-old male patient with a history of hypertension, hyperlipidemia, and thrombocytosis presented with generalized seizure. DSA revealed Cognard Type III dAVF in the superior wall of the left transverse sinus, which was fed by a single artery (the left occipital artery [OA]) and drained into a single vein (the left temporal cortical vein), without drainage into a venous sinus. Since transarterial embolization was considered challenging due to the tortuosity of the left OA, surgical interruption of the shunt was performed by craniotomy. After excising the feeding artery, we were unable to observed dAVF on intraoperative DSA. However, IA-ICG videoangiography revealed the remaining shunt, which was fed by the collateral route from the feeding artery. The shunting point and draining vein were then surgically resected to eliminate the shunt. The shunt was not observed during the second IA-ICG videoangiography conducted after resection. Conclusion ICG videoangiography is a better method compared with DSA in terms of visualizing fine vascular lesions. In contrast to the typical intravenous administration, selective IA-ICG can be repeatedly injected at a minimal dose. IA-ICG is a useful intraoperative tool that can be used to evaluate the elimination of the dAVF.
Collapse
Affiliation(s)
- Keisuke Sasaki
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Hidenori Endo
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Kuniyasu Niizuma
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Japan.,Departments of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Medicine, Tohoku University, Japan
| | - Yasuo Nishijima
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Shinichiro Osawa
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan
| |
Collapse
|
6
|
Abstract
BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is a mesenteric ischemic disease with considerably high mortality rate, although little has been known about what factors affect the patients' prognosis. The purpose of this study was to investigate prognostic factors of clinical data and computed tomography (CT) findings in patients with NOMI. METHODS This was a single institutional, retrospective study, reviewing 21 consecutive patients diagnosed with NOMI on angiography. Patients were divided into either ''survivor'' group or ''non-survivor'' group based on their clinical courses 1 month after diagnosis. Clinical information such as laboratory data, Charlson Comorbidity Index, and time from CT to injecting vasodilator was obtained from patients' medical records. Contrast-enhanced CT images were assessed in following items: defect of mural enhancement, pneumatosis intestinalis, hepatic portal venous gas, paralytic bowel dilatation, bowel wall thinning, and diameters of the relevant vessels. RESULTS Eight patients belonged to ''survivor'' group, whereas eleven were allocated to ''non-survivor'' group. None of CT findings showed significant difference between survivor group and non-survivor group [defect of mural enhancement: 75% and 100% (p = 0.16), pneumatosis intestinalis: 50% and 45.5% (p = 1.00), hepatic portal venous gas: 37.5% and 45.5% (p = 1.00), paralytic bowel dilatation: 12.5% and 63.6% (p = 0.06), and bowel wall thinning: 50% and 45.5% (p = 1.00)]. The diameters of the relevant vessels did not have significant difference either. Time from CT to injecting vasodilator was revealed to be significantly shorter in survivor group [187.5 (122.5-294) min and 310 (187-925.5)] (p = 0.048). None of the other clinical information had significant difference between each group. CONCLUSION Prompt angiography may be a key to improve the prognosis of NOMI patients.
Collapse
|
7
|
Azedi F, Mehrpour M, Kazemnejad S, Mousavizadeh K, Zarnani AH, Joghataei MT. Intra-arterial Drug Delivery to the Ischemic Brain in Rat Middle Cerebral Artery Occlusion Model. Bio Protoc 2019; 9:e3438. [PMID: 33654933 DOI: 10.21769/bioprotoc.3438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/28/2019] [Accepted: 11/29/2019] [Indexed: 01/29/2023] Open
Abstract
Rat transient middle cerebral artery occlusion (tMCAO) model is one of the most commonly used animal models in ischemic stroke studies. In the model, increasing safety and efficacy of therapeutic agent administration, such as stem cells and drugs directly to the ischemic brain using the internal carotid artery (ICA) is essential, because using the common carotid artery (CCA) for injection can close CCA completely and cause many complications after tMCAO surgery. Also, the pterygopalatine artery (PPA) is an arterial branch of the ICA that supplies blood circulation of the external part of the brain and removing the blood circulation of the PPA is required for more complete induction of ischemia to the brain. Herein, we present the insertion of intra-arterial catheter in the ICA via the external carotid artery (ECA) after the PPA in rats subjected to tMCAO surgery.
Collapse
Affiliation(s)
- Fereshteh Azedi
- Department of Neuroscience Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Somaieh Kazemnejad
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Kazem Mousavizadeh
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Hassan Zarnani
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.,Cellular and molecular research center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Nie F, Xie H, Wang G, An Y. Risk Comparison of Filler Embolism Between Polymethyl Methacrylate (PMMA) and Hyaluronic Acid (HA). Aesthetic Plast Surg 2019; 43:853-860. [PMID: 30824948 PMCID: PMC6522461 DOI: 10.1007/s00266-019-01320-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/25/2019] [Indexed: 11/24/2022]
Abstract
Background The incidence of vascular complications varies among different fillers. The main purpose of this study was to compare the risk of embolism between PMMA (Artecoll) and hyaluronic acid (HA, Restylane) after artery injection. Methods Rabbit ears were injected via the central artery with 0.1 ml PMMA (group A), 0.1 ml HA (group B), 0.2 ml PMMA (group C), or 0.2 mL HA (group D), respectively. The formation of transparent emboli was monitored right after injection. Tissue necrosis and histopathological changes were analyzed on day 7. Results With 0.1 ml injected volume, PMMA was dispersed within a few minutes and only 5% of the injected ears had mild necrosis on day 7, while HA tended to form obvious transparent emboli, an indication of blood vessel clotting, and 60% of injected ears showed necrosis on day 7. With 0.2 ml injected volume, PMMA had a risk of complete blood vessel clotting in between 0.1 ml PMMA group and 0.1 ml HA group, and 30% of injected ears had necrosis; in contrast, 100% of 0.2 ml HA-injected ears showed transparent emboli and necrosis. The necrosis areas were significantly increased in the HA groups compared with PMMA groups at the same injection volumes. HA injection also caused dilation of small blood vessels. Conclusion At the same injection volume, PMMA had less risk of embolism compared with HA. With increased injection volume, there were increased risks of embolism and necrosis for both PMMA and HA. No Level Assigned This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (10.1007/s00266-019-01320-w) contains supplementary material, which is available to authorized users.
Collapse
|
9
|
Zhang H, Kumar S. Unintended intra-arterial injection of contrast of an intracranial CT angiography. Radiol Case Rep 2018; 14:41-43. [PMID: 30305864 PMCID: PMC6175775 DOI: 10.1016/j.radcr.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/02/2022] Open
Abstract
Computed tomography angiography (CTA) is widely used to evaluate intracranial vascular disease. We report a case of intracranial CTA with unintended intra-arterial (IA) injection of contrast due to IA placement of an intravenous cannula, which results in a selective left vertebral artery IA CTA. Knowledge of anatomy is essential in analyzing the whole study and identifying the error. In clinical practice, it is important to avoid and recognize a wrongly placed intravenous cannula. And bolus tracking protocol might play a role as a gatekeeper.
Collapse
Affiliation(s)
- Han Zhang
- Neuroradiology, Level B1, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Sumeet Kumar
- Neuroradiology, Level B1, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| |
Collapse
|
10
|
Salama T, Aghoutane EM, Fezzazi RE. [Gangrene of the hand due to accidental intra-arterial injection of floxacilline: about a case]. Pan Afr Med J 2017; 25:221. [PMID: 28293337 PMCID: PMC5337270 DOI: 10.11604/pamj.2016.25.221.10803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
La floxacilline appartient à la classe des pénicillines bêta lactames. Dans notre contexte elle est très utilisée pour lutter contre les infections à germes Gram positif dont le staphylocoque doré. Cependant son utilisation doit être très prudente car elle n’est pas dénuée de complications. Nous rapportons l’observation d’un garçon de 6 ans opéré pour fracture de l’humérus. L’enfant a été mis sous floxacilline injectable après suspicion d’une infection sur matériel 2 mois après son opération. Le lendemain du début de l’antibiothérapie, l’enfant a présenté une ischémie aigue de la main droite. Il nous a alors été adressé pour prise en charge. Les explorations ont objectivé une obstruction de l’artère radiale. Une aponévrotomie de décharge a été réalisée et une héparinothérapie post opératoire a été démarrée. L’évolution a été marquée par une gangrène de toute la main. A travers cette observation nous voulons sensibiliser le personnel soignant sur le risque de survenue de cette complication désastreuse, et les mesures à prendre pour la prévenir.
Collapse
Affiliation(s)
- Tarik Salama
- Service de Chirurgie Pédiatrique A, Départment des maladies de L'Enfant, CHU Mohammed VI, Université Cadi Ayyad, Marrakech, Maroc
| | - El Mohtadi Aghoutane
- Service de Chirurgie Pédiatrique A, Départment des maladies de L'Enfant, CHU Mohammed VI, Université Cadi Ayyad, Marrakech, Maroc
| | - Rédouane El Fezzazi
- Service de Chirurgie Pédiatrique A, Départment des maladies de L'Enfant, CHU Mohammed VI, Université Cadi Ayyad, Marrakech, Maroc
| |
Collapse
|
11
|
Na Kim H, Yeol Kim D, Hee Oh S, Sook Kim H, Suk Kim K, Hyu Lee P. Feasibility and Efficacy of Intra-Arterial Administration of Mesenchymal Stem Cells in an Animal Model of Double Toxin-Induced Multiple System Atrophy. Stem Cells Transl Med 2017; 6:1424-1433. [PMID: 28296268 PMCID: PMC5442709 DOI: 10.1002/sctm.16-0438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/21/2016] [Indexed: 01/08/2023] Open
Abstract
Multiple system atrophy (MSA) is a sporadic neurodegenerative disease of the central and autonomic nervous system. Because no drug treatment consistently benefits MSA patients, neuroprotective strategy using mesenchymal stem cells (MSCs) has a lot of concern for the management of MSA. In this study, we investigated the safety and efficacy of intra‐arterial administration of MSCs via internal carotid artery (ICA) in an animal model of MSA. The study was composed of feasibility test using a ×10 and ×50 of a standard dose of MSCs (4 × 107 MSCs) and efficacy test using a ×0.2, ×2, and ×20 of the standard dose. An ultrasonic flow meter and magnetic resonance imaging (MRI) showed that no cerebral ischemic lesions with patent ICA blood flow was were observed in animals receiving a ×10 of the standard dose of MSCs. However, no MSA animals receiving a ×50 of the standard dose survived. In efficacy test, animals injected with a ×2 of the standard dose increased nigrostriatal neuronal survival relative to a ×0.2 or ×20 of the standard dose. MSA animals receiving MSCs at ×0.2 and ×2 concentrations of the standard dose exhibited a significant reduction in rotation behavior relative to ×20 of the standard dose of MSCs. Cerebral ischemic lesions on MRI were only observed in MSA animals receiving a ×20 of the standard dose. The present study revealed that if their concentration is appropriate, intra‐arterial injection of MSCs is safe and exerts a neuroprotective effect on striatal and nigral neurons with a coincidental improvement in motor behavior. Stem Cells Translational Medicine2017;6:1424–1433
Collapse
Affiliation(s)
- Ha Na Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University, Seoul, South Korea
| | - Dong Yeol Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University, Seoul, South Korea
| | - Se Hee Oh
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University, Seoul, South Korea
| | - Hyung Sook Kim
- Bioengineering Institute, CORESTEM Inc., Gyeonggi, South Korea
| | - Kyung Suk Kim
- Bioengineering Institute, CORESTEM Inc., Gyeonggi, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University, Seoul, South Korea
| |
Collapse
|
12
|
He Q, Li Y, Ma L, Ji X, Li G. Application of FLEEOX Preoperative Chemotherapy via Intra-arterial and Intravenous Administration in Treatment of Unresectable Locally Advanced Gastric Cancer. J Gastrointest Surg 2016; 20:1421-7. [PMID: 27114248 DOI: 10.1007/s11605-016-3153-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognosis of unresectable locally advanced gastric cancer is poor. We applied preoperative chemotherapy via intra-arterial and intravenous administration to convert an initially unresectable gastric cancer to a resectable cancer. METHODS From January 2005 to December 2010, 105 patients with unresectable locally advanced gastric cancer (T3-4N1-3M0) were selected for preoperative chemotherapy with 5-FU + leucovorin + etoposide + oxaliplatin + epirubicin (FLEEOX) regimen. 5-Fu (370 mg/m(2)) and leucovorin (200 mg/m(2)) were administered by intravenous infusion on days 1-5. Intra-arterial administration of etoposide (80 mg/m(2)), oxaliplatin (80 mg/m(2)), and epirubicin (30 mg/m(2)) was performed by Seldinger method on days 6 and 20, repeated two cycles. Patients who achieved partial response (PR) or complete response (CR) underwent D2 dissection, followed by four to six cycles of XELOX chemotherapy. The response rate, 1- and 3-year survival rate, and R0 resection rate were evaluated. RESULTS The response rate of preoperative chemotherapy was 78.1 % (82 of 105 patients), with 7 cases of CR and 75 cases of PR, respectively. After chemotherapy, a total of 78 patients (74.3 %) underwent surgery, and 67 cases achieved R0 resection (85.9 %). The 1- and 3-year overall survival (OS) rate of all 105 patients was 71.9 and 31.7 % (median survival time, 18 months). The 1- and 3-year OS rate among the 78 patients treated with chemotherapy plus surgery was 84.5 and 40 % (median survival time, 30 months). Patients treated with chemotherapy plus surgery had significantly longer OS times than patients who underwent chemotherapy alone (P < 0.01). CONCLUSIONS Patients with unresectable gastric cancer may obtain a survival benefit from preoperative chemotherapy via intra-arterial and intravenous administration and subsequent surgery.
Collapse
Affiliation(s)
- Qi He
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China
| | - Yang Li
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China
| | - Long Ma
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China
| | - Xiang Ji
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China
| | - Guoli Li
- Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China.
| |
Collapse
|
13
|
Ryu S, Yoshida M, Hironori O, Tsutsui N, Suzuki N, Ito E, Nakajima K, Yanagisawa S, Kitajima M, Suzuki Y. Intraoperative ICG fluorescence contrast imaging of the main artery watershed area in colorectal cancer surgery: Report of a case. Int J Surg Case Rep. 2016;26:176-178. [PMID: 27497042 PMCID: PMC4976611 DOI: 10.1016/j.ijscr.2016.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 01/01/2023] Open
Abstract
We have reported the case that underwent colorectal resection with intraoperative indocyanine green (ICG) fluorescence angiography from the resection-side of the superior rectal artery. Watershed area of the SRA fluoresced 33 s after the intra-arterial injection of ICG. PINPOINT, a brightfield color fluorescence camera was used for ICG fluorescence. This method can be expected to provide useful information for maintaining the blood flow at the anastomotic site.
Introduction Visualization of the main artery watershed area may be useful for determining the area that should be resected in colorectal cancer surgery. Resection of the main artery watershed area may result in complete resection of lymph nodes along the main artery and area of potential ischemia. Presentation of case A man in his 60 s with a chief complaint of hematochezia visited our hospital, was diagnosed with colorectal cancer and underwent surgery. A case that underwent colorectal resection with intraoperative indocyanine green (ICG) fluorescence angiography from the resection-side of the superior rectal artery (SRA) in order to confirm the watershed area is reported. Observation was performed using a PINPOINT® bright-field, color, near-infrared fluorescence camera, and the watershed area of the SRA fluoresced 33 s after the intra-arterial injection of ICG. After observation resection and anastomosis was performed. The patient’s postoperative course was good. Discussion The method is simple and can be performed within a short time, and it enables visual evaluation of the blood flow in the intestinal tract before anastomosis. Conclusion This method can be expected to provide useful information for complete resection of lymph nodes along the main artery and area of potential ischemia.
Collapse
|
14
|
Foster SD, Lyons MS, Runyan CM, Otten EJ. A mimic of soft tissue infection: intra-arterial injection drug use producing hand swelling and digital ischemia. World J Emerg Med 2015; 6:233-6. [PMID: 26401188 DOI: 10.5847/wjem.j.issn.1920-8642.2015.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed. METHODS A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology. RESULTS As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit. CONCLUSION Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.
Collapse
Affiliation(s)
- Sean D Foster
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christopher M Runyan
- Department of Plastic, Reconstructive & Hand Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Edward J Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
15
|
Prabhu R, Shenoy R, Thinda N, Patel A, Sadhu S. Be Careful with an IV Line. J Clin Diagn Res 2014; 8:166-7. [PMID: 24783122 DOI: 10.7860/jcdr/2014/7937.4150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/11/2014] [Indexed: 11/24/2022]
Abstract
Obtaining an intravenous (IV) access is a simple procedure which can be done in almost any hospital setting. One of the most dreaded complications of this procedure is an inadvertent intra-arterial cannulation. This can result in an accidental injection of medications intra-arterially, which can potentially lead to life altering consequences. In the hope that these types of events can be prevented, we are presenting a case of a 57-year-old male who underwent bougie dilatation for an oesophageal stricture and was accidentally given medication for pain management intra-arterially through an improperly placed IV line, which resulted in ischaemia, gangrene and subsequent loss of the hand. Those who try to obtain an IV access should always be on the lookout for possible clues that can prevent an inadvertent IA injection, especially if cannulation is in an area where an artery is in close proximity to a vein; these clues include but are not limited to the following: a bright-red flash of blood in the cannula, pulsatile movement of blood in the IV line, and intense pain or burning at the site of injection. These signs, as well as educating the patient on early symptoms of ischaemia, may allow early action to be taken, to prevent irreparable damage. We always have to be careful when we insert an I.V line.
Collapse
Affiliation(s)
- Raghunath Prabhu
- Assistant Professor, Department of Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Rajgopal Shenoy
- Professor, Department of Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Nitin Thinda
- Intern, Department of Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Anisha Patel
- Intern, Department of Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Sakshi Sadhu
- Intern, Department of Surgery, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| |
Collapse
|
16
|
Yanagie H, Higashi S, Seguchi K, Ikushima I, Fujihara M, Nonaka Y, Oyama K, Maruyama S, Hatae R, Suzuki M, Masunaga SI, Kinashi T, Sakurai Y, Tanaka H, Kondo N, Narabayashi M, Kajiyama T, Maruhashi A, Ono K, Nakajima J, Ono M, Takahashi H, Eriguchi M. Pilot clinical study of boron neutron capture therapy for recurrent hepatic cancer involving the intra-arterial injection of a (10)BSH-containing WOW emulsion. Appl Radiat Isot 2014; 88:32-7. [PMID: 24559940 DOI: 10.1016/j.apradiso.2014.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
A 63-year-old man with multiple HCC in his left liver lobe was enrolled as the first patient in a pilot study of boron neutron capture therapy (BNCT) involving the selective intra-arterial infusion of a (10)BSH-containing water-in-oil-in-water emulsion ((10)BSH-WOW). The size of the tumorous region remained stable during the 3 months after the BNCT. No adverse effects of the BNCT were observed. The present results show that (10)BSH-WOW can be used as novel intra-arterial boron carriers during BNCT for HCC.
Collapse
Affiliation(s)
- Hironobu Yanagie
- Department of Innovative Cancer Therapeutics: Alpha particle and Immuno-therapeutics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan; Department of Nuclear Engineering & Management, Graduate School of Engineering, The University of Tokyo, Japan; Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, Japan.
| | - Syushi Higashi
- Department of Surgery, Kojin-kai Medical City East Hospital, Miyazaki, Japan
| | - Koji Seguchi
- Department of Surgery, Kojin-kai Medical City East Hospital, Miyazaki, Japan
| | - Ichiro Ikushima
- Department of Innovative Cancer Therapeutics: Alpha particle and Immuno-therapeutics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan; Kyushu Medical & Industrial Sources Foundation, Miyazaki, Japan; Department of Radiology, Miyakonojyo Metropolitan Hospital, Miyazaki, Japan
| | | | | | - Kazuyuki Oyama
- Department of Radiology, Shin-Yamate Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Syoji Maruyama
- Department of Surgery, Shin-Yamate Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Ryo Hatae
- Department of Surgery, Shin-Yamate Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Minoru Suzuki
- Research Reactor Institute, Kyoto University, Osaka, Japan
| | | | - Tomoko Kinashi
- Research Reactor Institute, Kyoto University, Osaka, Japan
| | | | - Hiroki Tanaka
- Research Reactor Institute, Kyoto University, Osaka, Japan
| | - Natsuko Kondo
- Research Reactor Institute, Kyoto University, Osaka, Japan
| | | | - Tetsuya Kajiyama
- Department of Innovative Cancer Therapeutics: Alpha particle and Immuno-therapeutics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | | | - Koji Ono
- Research Reactor Institute, Kyoto University, Osaka, Japan
| | - Jun Nakajima
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, Japan; Department of Respiratory Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Ono
- Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, Japan; Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Nuclear Engineering & Management, Graduate School of Engineering, The University of Tokyo, Japan; Cooperative Unit of Medicine & Engineering, The University of Tokyo Hospital, Tokyo, Japan
| | - Masazumi Eriguchi
- Department of Surgery, Shin-Yamate Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| |
Collapse
|
17
|
Patil MB, Patil SM. Accidental Intra-arterial Injection of Adenosine in a Child with Supraventricular Tachycardia. Iran J Pediatr 2013; 23:368-9. [PMID: 23795267 PMCID: PMC3684489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/17/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Mandar B. Patil
- DY Patil Deemed University and Medical College, Kolhapur, Maharashtra, India,Corresponding Author:Address: Plot No 23, Anita Vandan Sahanivas colony, Nagala Park, Kolhapur –416001, Maharashtra, India. E-mail:
| | - Sunita M. Patil
- Sangeeta Hospital for Children, Near Rankala, Kolhapur, Maharashtra, India
| |
Collapse
|
18
|
Kim SS, Park DH, Lim DJ, Kang SH, Cho TH, Chung YG. Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm. J Korean Neurosurg Soc 2012; 52:172-8. [PMID: 23115657 PMCID: PMC3483315 DOI: 10.3340/jkns.2012.52.3.172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/23/2012] [Accepted: 09/17/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. METHODS We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. RESULTS For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022). CONCLUSION IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.
Collapse
Affiliation(s)
- Sang-Shin Kim
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|