Critical care clinics
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Endovascular treatment of cerebral vasospasm induced by subarachnoid hemorrhage has become a useful therapy. The two main treatments that have been used are balloon angioplasty and intra-arterial papaverine infusion. ⋯ Balloon angioplasty is superior to papaverine for treatment of proximal vessel vasospasm by virtue of a more sustained effect on the vessels. Papaverine can be useful as an adjunct to balloon angioplasty and also for the treatment of distal vessels that are not accessible for balloon angioplasty.
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Critical care clinics · Oct 1999
ReviewEndovascular therapy of traumatic injuries of the extracranial cerebral arteries.
The field of neuroendovascular therapy is rapidly growing. New technology and operators' expertise are developing at a pace that will make this discipline progressively more available and successful. ⋯ Because many of these patients are likely to be critically ill, it is important to keep in mind the principles of their management before, during, and after the procedure, thus assuring the best chance for a successful outcome. Furthermore, some of the issues related to their neurointensive care will serve as guides for the need for endovascular therapy, as well as its timing.
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Critical care clinics · Oct 1999
ReviewEndovascular therapy of traumatic injuries of the intracranial cerebral arteries.
Traumatic intracranial arterial injuries represent uncommon complications of both closed-head injury and penetrating head trauma. These injuries include arterial dissections, pseudoaneurysms, and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia, or, occasionally, severe epistaxis. ⋯ Embolization of pseudoaneurysms with balloons or detachable coils, the use of embolic particles for small arterial injuries, and large vessel occlusion with detachable balloons represent current treatment strategies that have evolved over the past three decades. Angioplasty and stent deployment may have a future role to play in the management of arterial dissection. Principles of neurologic critical care that minimize secondary brain injury are essential adjuncts in the management of these patients before, during, and after endovascular treatment.
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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.