Mechanical thrombectomy using the Rotarex catheter - safe and effective method in the treatment of peripheral arterial thromboembolic occlusions

Background: The aim of the study was to evaluate the efficacy of mechanical thrombectomy using the Rotarex catheter in the treatment of peripheral arterial thromboembolic occlusions and to assess long-term results. Patients and methods: The Rotarex catheter is a 6F or 8F polyurethane catheter, which contains a steel spiral powered by an electric motor and rotating at a speed of 40.000 rpm. The catheter tip is connected to the spiral. The rotating spiral produces a continuous vacuum and the thromboembolic material "drilled" by the tip is drawn into the catheter, where it is fragmented and transported via the spiral to the collecting bag. Results: We have conducted 43 interventions in 40 patients (20 men, 20 women), age 44 - 92 years (mean 76 years). The occlusion length varied from 2 - 37 cm (mean 8 cm); the duration of symptoms ranged from 2 - 180 days (mean 14 days), Thrombectomy as the only procedure was sufficient in 11 interventions (25.5 %); a combination with PTA was necessary in 21 procedures (49 %) and with stent implantation in 11 procedures (25.5 %). Angiographic success was achieved in 41 interventions (95 %). The most frequent transitory complication was embolization to the calf arteries (9 %). Subsequent thrombolysis was administered after 4 procedures (9 %). In one case (2 %) there was a minor perforation of the peroneal artery. Six-month post-intervention follow-up is available for 34 patients. Patency was preserved in 65 % and amputation had to be performed in 12 %. After 12 months, 12 patients are followed and 67 % of interventions have remained patent. Conclusions: The Rotarex system enables fast and efficient treatment of peripheral arterial thromboembolic occlusions. In most cases, this method is capable of replacing thrombolysis.

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Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

VASA ◽

10.1024/0301-1526/a000495 ◽

2016 ◽

Vol 45 (1) ◽

pp. 49-56 ◽

Cited By ~ 10

Author(s):

Frantisek Stanek ◽

Radoslava Ouhrabkova ◽

David Prochazka

Keyword(s):

Mechanical Thrombectomy ◽

Clinical Success ◽

Major Amputation ◽

Peripheral Arteries ◽

Duration Of Symptoms ◽

Efficient Treatment ◽

Percutaneous Mechanical Thrombectomy ◽

Single Centre Study ◽

Crural Arteries

Abstract. Background: The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients and methods: Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18 - 92 years (median 72 years). In all, 128 procedures were performed. Results: Angiographic success was obtained in 120 interventions (93.8 %). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention - percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5 %. Major amputation was performed in 10 % of cases. Cumulative patency rates were 75 % after one month, 71 % after six months, 38 % after 12 months, 33 % after 18 months and 30 % after 24, 30, 36 and 42 months. Conclusions: Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and efficient treatment of acute and subacute occlusions of peripheral arteries in one session.

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A Reappraisal of Anterior Communicating Artery Aneurysms

Neurosurgery ◽

10.1227/neu.0000000000001161 ◽

2015 ◽

Vol 78 (2) ◽

pp. 200-207 ◽

Cited By ~ 6

Author(s):

Leonardo B.C. Brasiliense ◽

Jang W. Yoon ◽

Josiah N. Orina ◽

David A. Miller ◽

Rabih G. Tawk ◽

...

Keyword(s):

Distal Segment ◽

Long Term Results ◽

Anterior Communicating Artery ◽

Post Intervention ◽

Stent Deployment ◽

Anterior Communicating Artery Aneurysms ◽

Hemorrhagic Events ◽

Retreatment Rate

ABSTRACT BACKGROUND: Wide-necked anterior communicating artery aneurysms represent a subset of lesions with challenging endovascular treatment despite new endoluminal and intrasaccular devices. OBJECTIVE: To assess the long-term clinical and angiographic outcomes of stent-assisted embolization for wide-necked anterior communicating artery aneurysms. METHODS: Between March 2008 and March 2014, 32 patients with unruptured wide-necked AComm aneurysms were treated using stent-assisted embolization. The Glasgow Outcome Scale was reviewed at the time of discharge and at latest follow-up. Ischemic and hemorrhagic events were also recorded and analyzed. Aneurysm occlusion was evaluated post-intervention and on subsequent follow-up evaluations. RESULTS: Successful stent deployment was achieved in all cases, but in 1 patient the coils could not be contained inside the aneurysm, and the procedure was aborted without complications. The distal segment of the stent was positioned in the ipsilateral A2 in 16 patients, in the contralateral A2 in 15 patients, and in the contralateral A1 in 1 patient. There were no periprocedural thromboembolic or hemorrhagic complications. The rate of major complications was 6%. One patient developed intracranial hemorrhage related to antiplatelet therapy and another had ischemic events due to in-stent stenosis. Angiographic follow-up was available for 26 aneurysms and during a mean follow-up of 22 months, 81% of the lesions were completely occluded and 8% had a small residual neck. The retreatment rate for residual aneurysms was 3%. CONCLUSION: Our long-term results suggest that stent-assisted embolization for anterior communicating artery aneurysms may be considered an excellent treatment option with an adequate combination of safety profile and effectiveness.

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Surgical management of bronchopulmonary carcinoids: A single center experience

South Asian Journal of Cancer ◽

10.4103/2278-330x.202568 ◽

2017 ◽

Vol 06 (01) ◽

pp. 006-010 ◽

Cited By ~ 1

Author(s):

Ashish Jakhetiya ◽

Pankaj Kumar Garg ◽

Rambha Pandey ◽

Palaniappan Ramanathan ◽

Sunil Kumar ◽

...

Keyword(s):

Surgical Treatment ◽

Histopathological Examination ◽

Postoperative Mortality ◽

North India ◽

Biological Behavior ◽

Long Term Results ◽

Surgical Approaches ◽

Delayed Presentation ◽

Duration Of Symptoms ◽

Tertiary Teaching

Abstract Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

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Effects of adjuvant therapy on long-term results of peripheral arterial reconstruction.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.18.757 ◽

1989 ◽

Vol 18 (5) ◽

pp. 757-758

Author(s):

T. Nishiyama

Keyword(s):

Adjuvant Therapy ◽

Long Term Results ◽

Arterial Reconstruction ◽

Peripheral Arterial

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Intravascular Catheter Colonization and Related Bloodstream Infection in Critically III Neonates

Infection Control and Hospital Epidemiology ◽

10.1086/646175 ◽

1990 ◽

Vol 11 (6) ◽

pp. 301-308 ◽

Cited By ~ 13

Author(s):

Wendy A. Cronin ◽

Teresa P. Germanson ◽

Leigh G. Donowitz

Keyword(s):

Bloodstream Infection ◽

Insertion Site ◽

Bloodstream Infections ◽

Coagulase Negative Staphylococcus ◽

Intravascular Catheter ◽

Catheter Colonization ◽

Catheter Tip ◽

Critically Ill Neonates ◽

Peripheral Arterial ◽

Intravenous Catheters

AbstractIntravascular catheter tip colonization was prospectively evaluated in critically ill neonates to determine its relationship to the type of device used, duration of catheterization, insertion site and nosocomial bloodstream infection. Sixty-one percent (376 of 621) of all intravascular catheter tips were retrieved from 91 infants. Thirteen percent (41 of 310) of peripheral intravenous, 14% (6 of 42) of umbilical, 21% (3 of 11) of central venous, 36% (4 of 11) of peripheral arterial and 100% (2 of 2) of femoral catheters were colonized. Duration of catheterization was significantly longer for colonized lines (p < .001). Eight of 26 (30.8%) peripheral intravenous catheters remaining in place for more than three days were colonized, compared with 33 of 284 (11.6%) at three days or less (p= 0.012). Coagulase-negative staphylococcus was the organism most frequently isolated from catheter tips and bloodstream infections. Catheter colonization rates in this population were higher than those found in adults. Heavily manipulated devices and those in place for longer periods of time were the most frequently colonized.

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A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401346 ◽

2019 ◽

Vol 4 (01) ◽

pp. 27-30

Author(s):

Sandeep T. Laroia ◽

Justin J. Guan ◽

Archana T. Laroia ◽

Lucas Lenhart ◽

Antony J. Hayes

Keyword(s):

Inferior Vena ◽

Vena Cava ◽

Complication Rates ◽

Ivc Filter ◽

Filter Placement ◽

Femoral Access ◽

Catheter Technique ◽

Ivc Filters ◽

Catheter Tip ◽

A Minor

Abstract Introduction Inferior vena cava (IVC) filter tilt is a common complication that occurs during and after filter placement. Severe tilting leads to reduced filter efficacy, lower retrieval success, and higher complication rates during retrieval. We present a novel catheter technique to correct severely tilted cone-shaped IVC filters without having to retrieve and replace the existing filter. Methods A retrospective review was performed for patients at our institution over three years who had severely tilted filters and underwent correction with the catheter technique. Indications for filter placement were categorized, and patient age, gender, tilt correction outcome, and complication rates were collected and analyzed. After severe tilting was noted on post-IVC filter deployment venogram, a Sos catheter was passed via the same femoral access site used for the filter placement. The catheter tip was reformed inside the cone of the filter and was used to push the filter tip back toward midline. Completion venogram was taken to document the amelioration of the tilt. Results Out of 28 patients who were found to have severely tilted filters on deployment and underwent correction with the catheter technique, 27/28 (96.4%) had successful correction. One (3.6%) had a minor complication where the filter struts became entangled with the catheter tip; however, simple maneuvering of the catheter and use of a stiff wire to straighten the catheter loop freed up the entanglement. No major complications occurred. Conclusion This technique is safe, effective, obviates filter replacement, and can be considered an additional management option for severe IVC filter tilt during placement.

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Factors Predicting the Outcome of Intraarterial Thrombolysis in Peripheral Arterial and Graft Occlusions

Acta Radiologica ◽

10.1177/02841851960371p163 ◽

1996 ◽

Vol 37 (1P1) ◽

pp. 299-304 ◽

Cited By ~ 2

Author(s):

G. Sandbæk ◽

L. E. Staxrud ◽

L. Rosen ◽

D. Bay ◽

M. Stiris ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Chi Square ◽

Catheter Position ◽

Intraarterial Infusion ◽

Duration Of Symptoms ◽

Intraarterial Thrombolysis ◽

Peripheral Arterial ◽

Catheter Localization

Purpose: To determine the association between successful intraarterial thrombolysis and the following factors: sex, age, symptoms, duration of symptoms, length of occlusion, conduit type, runoff, and catheter localization. Material and Methods: Forty-six patients with acute or subacute occlusions of peripheral native arteries and grafts were treated with continuous intraarterial infusion of streptokinase or urokinase. A univariate chi-square test and logistic regression analysis were used. Results: Successful lysis was achieved in 27 of 46 patients (59%). The logistic regression analysis revealed a significant association between successful thrombolysis and good runoff (p<0.01). A catheter position above the occlusion resulted in lysis in only one of 11 patients. The variables rest pain and claudication were slightly significant (p=0.07). None of the other variables were significant, but a trend toward a separate effect of duration of occlusion was found. Conclusion: Good runoff and intrathrombotic infusion are virtual necessities in obtaining a positive immediate outcome in peripheral arterial and graft occlusions. In our study, other factors were less important.

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