Journal of neurointerventional surgery
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9 patients with 10 arteriovenous fistulas were treated with Onyx at our institution over a period of 19 months: 4 direct and indirect carotid-cavernous fistulas (CCFs) and 6 dural arteriovenous fistula (DAVFs). Complete occlusion was achieved with no recurrences or permanent complications in our small series. We report hemodynamic instability, including severe bradycardia and asystole, during embolization of DAVF and CCF with Onyx in several patients. These changes were reversible with interruption of Onyx injection and administration of atropine. No recurrence of symptoms after atropine administration was noted as Onyx embolization continued during the same session or during postprocedural 24 h monitoring. No adverse clinical consequences were noted. ⋯ Proposed measures to prevent this complication include pretreatment with atropine or prophylactic placement of transvenous pacemakers in patients with underlying heart block and patients with contraindications to atropine use.
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Thromboembolic events are the primary complications encountered during endovascular treatment (EVT) of intracranial aneurysms. Intraprocedural heparinization is common during EVT but is less common post-procedure. The safety of heparinization following EVT is unknown, especially for ruptured aneurysms. ⋯ Administration of systemic heparinization may be safe during the first 24 h post-EVT of a ruptured intracranial aneurysm in patients without recent craniotomy. Further study in determining the benefit of this protocol in reducing post-embolization thromboembolic complications may be warranted.
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Clinical Trial
Prospective assessment of pain and functional status after vertebroplasty for treatment of vertebral compression fractures.
There has been no prospective evaluation of vertebroplasty using a validated instrument. We describe the pain and functional status of 72 patients before and after vertebroplasty, as prospectively evaluated by the Vertebral Compression Fracture Pain and Functional Disability Questionnaire. ⋯ PV resulted in substantial, lasting reduction in pain and improvement in ability to perform ADLs.