Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Mar 2012
ReviewEndovascular treatment of acute ischemic stroke: current indications.
Endovascular stroke therapy is an effective means of achieving reperfusion in stroke patients with proximal cerebral artery occlusions. However, current guideline recommendations express uncertainty regarding the clinical efficacy of catheter-based treatments, given the lack of supportive trial data. ⋯ This article will review the existing data to discuss the clinical and imaging factors that are relevant to patient outcomes, and which may be used to guide endovascular treatment decisions. Anterior circulation strokes represent the primary focus of this review.
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Tech Vasc Interv Radiol · Mar 2012
Acute stroke: postprocedural care and management of complications.
Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. ⋯ Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.
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Tech Vasc Interv Radiol · Mar 2012
Current indications and results of thrombolysis by intravenous recombinant tissue plasminogen activator.
A number of landmark trials have proven the efficacy of thrombolysis by intravenous recombinant tissue plasminogen activator in the acute phase of the ischemic stroke. Despite the recently extended time window of 4.5 hours, the number of people who are being treated in most centers is low. ⋯ A major effort is to extend the time window by bridging the treatment with neuroprotective approaches, or by identifying subgroups that may particularly benefit from recanalization and reperfusion. Procedures using ultrasounds or alternative intravenous compounds are also being investigated with promising results.
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Non-tunneled central venous access has become an important tool in the management of the sick patient, particularly in the intensive care unit. Image guidance allows more precise placement of lines with overall lower complication rates compared with guidance by physical landmarks. The use of image guidance has brought a procedure traditionally performed by surgeons into the realm of the interventional radiologist. Techniques for placement of non-tunneled central venous catheters, hemodialysis catheters, and peripherally inserted central catheter lines will be discussed.
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Tech Vasc Interv Radiol · Dec 2011
ReviewEvaluation and management of central venous access complications.
Venous access is 1 of the most common interventional procedures in the USA. Using image guidance in the last 2 decades, obtaining venous access has become increasingly routine, and the complications commonly associated with the procedure have significantly decreased. ⋯ This article discusses the most common and some unusual complications seen with the placement of these devices. We also briefly discuss the management of these complications.