Techniques in vascular and interventional radiology
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Lower urinary tract symptoms (LUTS) may be a sign of aging rather than a consequence of benign prostatic enlargement (BPE) or benign prostatic obstruction (BPO). Medical or invasive treatments should address the bothersome symptoms and the quality of life of patients. Alpha blockers and 5-alpha reductase inhibitors are most frequently used in benign prostatic hyperplasia (BPH) medical treatments, whereas Transurethral Resection of the Prostate (TURP) remains the "gold standard" for surgical treatments. Several minimal invasive treatments are emerging with promising outcomes.
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Tech Vasc Interv Radiol · Jun 2012
Using magnetic resonance imaging as a means to study chronic cerebral spinal venous insufficiency in multiple sclerosis patients.
The goal of this work is to present a broad magnetic resonance imaging (MRI) protocol for use in the study of chronic cerebrospinal venous insufficiency (CCSVI). The CCSVI MRI protocol includes the following sequences: time-resolved contrast-enhanced 3D MR angiography, 2D time-of-flight MR venography, and 3D volumetric interpolated breath-hold examination to assess venous structural abnormalities; phase-contrast MR imaging at different levels in the neck and thoracic cavity to quantify flow through the veins, arteries, and cerebrospinal fluid; T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and pre- and post-contrast T1-weighted imaging of the brain for examinations of parenchymal lesions; and finally, susceptibility-weighted imaging for quantification of iron deposition in the brain. Data from 111 clinically definite multiple sclerosis patients were assessed for potential structural and flow CCSVI risk criteria, including stenosis, atresia, aplasia, dominant to subdominant venous flow ratio (D:sD), and the sum of their flow rates. ⋯ A sum of dominant and subdominant venous flow rate of <8 mL/s was observed in 22 (36.1%) patients of the ST group and 6 (12.0%) patients of the NST group. MRI provides valuable information in the observation of potential CCSVI risk factors. Low total flow in the 2 dominant veins seemed to be the strongest indicator for risk of having stenoses in the multiple sclerosis population.
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Tech Vasc Interv Radiol · Jun 2012
Intravascular ultrasound in the diagnosis and treatment of chronic cerebrospinal venous insufficiency.
Multiple imaging modalities have been used for the evaluation of chronic cerebrospinal venous insufficiency (CCSVI). These include Doppler ultrasound, magnetic resonance venography, computed tomographic venography, and catheter venography. Although each of these tests is considered to contribute valuable information to the evaluation, each modality has deficiencies, which can impact treatment. ⋯ In addition, intraluminal abnormalities that may be difficult to see with venography can be identified with IVUS, which can further determine when angioplasty for CCSVI is indicated. Finally, IVUS can identify potential complications of angioplasty, including dissection and thrombus formation, allowing for rapid treatment. As a result, IVUS is an important part of an evaluation for CCSVI and, when available, should be used to identify patients who may benefit from endovascular treatment.
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Tech Vasc Interv Radiol · Mar 2012
ReviewPast, present, and future perspectives on the endovascular treatment of acute ischemic stroke.
Interventional neuroradiology plays a continuously expanding and exciting role in the treatment of acute stroke, as evidenced by the development of several important advances, including the advent of multiple new devices and therapies. Furthermore, guidelines regarding endovascular interventions in the setting of acute stroke have been developed and used. In addition to technological advances, the field of pharmacology in the setting of acute stroke is constantly evolving. In a rapidly expanding field, we aim to review significant recent advances related to the endovascular treatment of stroke as well as provide perspective for future directions.
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Tech Vasc Interv Radiol · Mar 2012
ReviewIntra-arterial thrombolysis: tissue plasminogen activator and other thrombolytic agents.
Recanalization rates with the administration of intravenous tissue plasminogen activator in acute ischemic stroke are low. Adjuvant endovascular techniques that achieve recanalization by direct intra-arterial (IA) delivery of thrombolytics, mechanical clot retrieval, clot aspiration, and stenting may complement intravenous pharmacotherapy. IA thrombolytics can be administered within 6 hours of symptom onset in anterior circulation strokes and within 24 hours in posterior circulation strokes. This review describes the indications, patient selection, and technique for IA administration of thrombolytics.