Cases reported "Carotid Stenosis"

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1/12. Endovascular problem solving with intravascular stents.

    BACKGROUND AND PURPOSE: Intravascular stents are being used with increasing frequency in interventional neuroradiology. They provide the potential to expand the therapeutic capabilities of the endovascular therapist and stand to revolutionize endovascular intervention within both the intracranial and extracranial vessels. We present our application of stent technology to further the understanding of endovascular rescue from procedural complications and the solving of complex clinical problems. methods: Three patients underwent unplanned placement of intravascular stents. In two patients a stent was used to provide stabilization of an irretrievable intravascular device; in the third patient a stent was used to provide a scaffolding for proximal external carotid sacrifice. RESULTS: Stent deployment was successful in all patients. The intravascular devices stabilized by stent placement included unraveled fragments of a Guglielmi detachable coil (GDC) and a partially deployed coronary stent. Proximal external carotid sacrifice was achieved with the aid of a stent in one patient to control hemorrhage from recurrence of laryngeal cancer. No periprocedural neurologic complications were encountered. Six-month follow-up angiography in one patient showed only minimal myointimal hyperplasia induced by stent-stabilized GDC fragments adjacent to the internal carotid vessel wall. CONCLUSION: stents can be used to provide stabilization of irretrievable intravascular devices or as a scaffolding for proximal vessel sacrifice. These applications may allow endovascular rescue of procedural complications and solve unique clinical problems.
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ranking = 1
keywords = cancer
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2/12. Carotid stenting for radiation-induced stenoses: A report of 7 cases.

    BACKGROUND AND PURPOSE: radiation-induced stenoses of the carotid artery are associated with fibrosis of the arterial layers and tissue planes that renders their surgical treatment difficult. We present our clinical experience in carotid angioplasty stenting (CAS) of patients harboring such stenoses. methods: Seven patients underwent transfemoral CAS of 10 radiation-induced stenoses located on either the common or the internal carotid artery. Six patients presented neurological symptoms. Four patients had undergone previous radical neck dissection, and 3 had permanent tracheostomies. Stenoses were primarily covered with a self-expandable stent before carotid dilation. RESULTS: All interventions were successful, with residual stenoses <20%. No permanent complication occurred. The mean follow-up was 8 months. patients were symptom free at the last clinical examination, and Doppler control showed no evidence of restenosis. CONCLUSIONS: Carotid stenting appears very attractive for such "hostile neck" patients and seems a safe and efficient treatment for radiation-induced stenoses.
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ranking = 47929.578151042
keywords = radiation-induced
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3/12. Endovascular repair of radiation-induced bilateral common carotid artery stenosis and pseudoaneurysms: a case report.

    BACKGROUND: radiation-induced damage to small and medium-sized vessels has been observed in both animals and humans. Changes may appear in the immediate postradiation period or many years later. In this case, we report an unusual presentation of bilateral radiation-induced carotid artery stenoses associated with pseudoaneurysms, and a previously unreported application of a recently established treatment. CASE DESCRIPTION: A 72-year-old African-American male presented with recurrent right hemispheric transient ischemic attacks (TIA) and neck pain. Thirteen years previously, the patient had received radiation therapy for laryngeal carcinoma. Diagnostic carotid angiography demonstrated moderate radiation-induced bilateral carotid artery stenosis and associated common carotid pseudoaneurysms. The patient was treated with bilateral endovascular stents and electrolytically detachable coils in staged procedures. At his most recent follow-up, there is no evidence of re-stenosis and the patient remains asymptomatic. CONCLUSIONS: This case illustrates a novel and successful treatment for the endovascular repair of post-radiation bilateral carotid artery stenosis and pseudoaneurysms. In our practice, we have seen three such cases of radiation-induced vasculopathy. Therefore, patients with a previous history of radiation therapy for head and neck neoplasms merit cautious monitoring and judicious use of stents and secondary coils, when necessary.
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ranking = 55917.841176215
keywords = radiation-induced
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4/12. Concomitant coronary and multiple arch vessel stenoses in patients treated with external beam radiation: pathophysiological basis and endovascular treatment.

    External beam radiation-induced stenoses isolated to the coronary arteries or peripheral vessels have been previously described. We report for the first time the clinical presentation of two patients with concomitant coronary artery and multiple arch vessel disease following external beam radiation of the chest. We review the pathophysiology, discuss the treatment options and describe the percutaneous treatment of coronary, carotid, subclavian, and axillary stenoses related to this rare but likely underdiagnosed disorder.
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ranking = 7988.2630251736
keywords = radiation-induced
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5/12. Carotid stenting for symptomatic radiation-induced arteritis complicated by recurrent aneurysm formation.

    We describe a 56-year-old male who underwent successful carotid stenting (CS) with adjuvant distal protection in response to symptomatic radiation-induced carotid disease. During the CS procedure, it was incidentally noted that the lesion yield pressure was surprisingly low (2 atm). The patient returned with local symptoms from common carotid aneurysmal dilation at the proximal edge of the stent that was successfully treated with a stent graft. A second aneurysm developed proximal to the stent graft and, based on intravascular ultrasound mapping, he ultimately underwent venous bypass covered by a free-muscle graft. We believe the low lesion yield pressure in this case reflected loss of vessel integrity and it may be prudent to avoid oversizing the stent in such patients.
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ranking = 39941.315125868
keywords = radiation-induced
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6/12. Endovascular management of carotid artery disease after radiation therapy and radical neck dissection.

    OBJECT: More patients with head and neck cancers who undergo radical neck dissection and adjuvant radiation are experiencing prolonged survival times. Because of their improved survival, patients are living long enough to suffer the delayed effects of radiation therapy. radiation-induced carotid artery (CA) stenosis in patients with or without radical neck dissection often requires extensive exposure and vessel reconstruction. The aim of this study was to evaluate the efficacy of endovascular treatment as an alternative therapy for radiation-induced CA stenosis. methods: Coinciding with the improved longevity of these patients, CA angioplasty and stent placement has become a definitive treatment strategy for this particularly challenging group of individuals. Long lesions are easily addressed with multiple telescoped stents. The tendency toward early restenosis can now be addressed with cutting balloon angioplasty. A review of the authors' institutional database yielded five patients (four men and one woman) with a history of radiation treatment ipsilateral to their CA stenosis. Three of five patients were symptomatic, and the interval between radiation therapy and endovascular treatment ranged from 1 to 47 years (mean 16.6 years). Four of the five patients were treated using distal embolic protection devices, and all patients underwent balloon dilation after stent placement. CONCLUSIONS: As advancements are made in the technology and techniques for CA angioplasty and stent placement, the safety and durability of treatments in patients with radiation-induced atherosclerotic disease will improve.
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ranking = 15977.526050347
keywords = radiation-induced, cancer
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7/12. Case report: radiation-induced vasculopathy implicated by depressed blood flow and metabolism in a pineal glioma.

    A case of radiation-induced vasculopathy of a pineal glioma was presented with haemodynamic and metabolic changes before and after radiotherapy. After radiation of 60 Gy with conventional fractionation (1.8-2.0 Gy daily, 5 days per week), regional blood flow, oxygen extraction fraction, metabolic rate of oxygen, kinetic metabolic rate of glucose and the rate constants (K2, K3) were markedly depressed (20% or greater) compared with the pre-irradiated study. 7 months after radiotherapy, the patient developed transient transient episodes of both right and left upper limb convulsion, terminating in generalized convulsion. When she developed status epilepticus, computed tomography showed extensive low density areas in the territory supplied by the right middle cerebral and the right posterior cerebral arteries. cerebral angiography revealed diffuse stenosis at both carotid bifurcations and at the origins of the right posterior communicating and posterior cerebral arteries. Haemodynamic and metabolic depression therefore implicated radiation-induced vasculopathy in the present case.
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ranking = 47929.578151042
keywords = radiation-induced
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8/12. angioplasty for symptomatic radiation-induced extracranial carotid artery stenosis: case report.

    A patient with cervical lymphoma received chemotherapy and radiation to the neck. He later presented with crescendo transient ischemic attacks. Angiography demonstrated bilateral cervical carotid stenosis, which was presumed to be the result of previous radiation therapy. Percutaneous transluminal angioplasty with balloon dilation of the symptomatic lesion resulted in an immediate cessation of the patient's transient ischemic attacks. Nine months later, he developed a symptomatic cervical carotid stenosis of the contralateral carotid artery, which also was treated successfully with angioplasty, resulting in a good clinical outcome. The patient has experienced no further ischemic events in the 2 years after treatment.
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ranking = 31953.052100694
keywords = radiation-induced
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9/12. Progressive cerebral occlusive disease after radiation therapy.

    BACKGROUND: A case of progressive irradiation-induced cerebral vasculopathy with abnormal netlike vessels and transdural anastomoses (moyamoya syndrome) is presented. Radiological findings in an additional 40 cases reported in the literature are analyzed, and their clinical relevance is discussed. CASE DESCRIPTION: A 19-year-old woman presented with recurrent ischemic brain lesions after radiation therapy for treatment of a craniopharyngioma during childhood. cerebral angiography 6 and 12 years after completion of radiation therapy revealed progressive cerebral arterial occlusive disease involving the internal carotid artery on either side of the circle of willis, with abnormal netlike vessels and transdural anastomoses (moyamoya syndrome). CONCLUSIONS: Extensive similarities between irradiation-induced cerebral vasculopathy and primary moyamoya syndrome (Nishimoto's disease) support the notion that both disorders share common pathophysiological mechanisms. The occurrence of moyamoya-like vascular changes may not depend on specific trigger mechanisms but may rather represent a nonspecific response of the developing vascular system to a number of various noxious events.
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ranking = 15976.526050347
keywords = radiation-induced
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10/12. Carotid artery stenosis following adjuvant radiotherapy for a parotid pleomorphic adenoma.

    Carotid artery stenosis following radiotherapy for head and neck cancer is probably underdiagnosed. We report a symptomatic case and suggest that greater awareness of the condition should result in suitable investigation and appropriate medical or surgical treatment.
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ranking = 1
keywords = cancer
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