Critical care clinics
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Critical care clinics · Oct 1999
ReviewEndovascular therapy of traumatic carotid-cavernous fistulas.
Traumatic carotid-cavernous fistulas (CCF) are capable of causing a large variety of signs and symptoms, including visual loss, glaucoma, chemosis, exophthalmos, and orbital cranial nerve palsies. The high pressure in the veins that normally drain the globe can cause them to engorge and produce local compression of adjacent structures. ⋯ Endovascular repair of CCF most commonly involves the use of detachable balloons, although coils are also used. Effective closure of the fistula leads to rapid resolution of the symptoms.
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Critical care clinics · Oct 1999
ReviewEndovascular treatment and neurointensive care of ruptured aneurysms.
The acute management of aneurysmal SAH requires a comprehensive approach entailing acute critical care and stabilization, occlusion of the aneurysm, and intensive care management of acute neurologic complications. The development of endovascular treatment of aneurysms has added an important, less-invasive treatment to the regimen available in treating aneurysms. ⋯ Nonetheless, some aneurysms may require both surgery and endovascular treatment. Finally, close neurologic observation and directed specialized monitoring techniques are required for providing directed critical care in the acute period after SAH.
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Critical care clinics · Oct 1999
ReviewNeuroendovascular rescue. Nonthrombolytic approach to acute brain ischemia.
The field of neuroendovascular therapy is rapidly growing. New technology and operators' expertise is developing at a pace that will make this discipline progressively more available and successful. ⋯ Thus, the concept of neuroendovascular rescue has gone beyond the use of thrombolytic drugs, expanding our capability to restore flow to ischemic brain tissue after prolonged therapeutic windows. It is important for the interventionalist and the intensivist to work closely together to guarantee the most favorable outcome possible.
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Critical care clinics · Oct 1999
ReviewIntra-arterial thrombolysis for vertebrobasilar circulation ischemia.
Acute basilar artery occlusion is usually associated with a poor prognosis despite therapy with antiplatelet and anticoagulant agents. The natural history of this disorder should be fully understood before clinicians make decisions on therapy. Recent advances in angiography technique and the use of newer mobile microcatheters have made intra-arterial thrombolysis therapy feasible. There have been several small, uncontrolled series of intra-arterial thrombolysis in basilar artery occlusion with promising results.
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Serious consequences of stroke dictate that new approaches to the treatment of stroke be investigated. We have developed a method for perfusing the patient's own arterial blood retrograde through the venous system to ischemic brain tissue. ⋯ The laboratory investigation has also demonstrated that this therapy, retrograde transvenous neuroperfusion, can be coupled with hypothermia to potentially increase its benefit. History, experimental development, and the clinical trial are reviewed in this article.