Microcatheter embolization of Intractable Idiopathic Epistaxis

Leppänen, M.; Seppänen, Seppo; Laranne, Jussi; K, Kuoppala

doi:10.1007/s002709900439

Cited by 35 publications

(29 citation statements)

References 17 publications

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“…In addition, there is the risk of embolization across ECA–ICA anastomosis, including the vidian artery, middle meningeal artery, accessory meningeal accessory meningeal artery, and superficial temporal arteries. This could lead to major complications, such as cerebral infarction or retinal artery occlusion 5 6. As such, it was decided to maneuver the guide sheath into the ECA and then dislodge the thrombus into the external carotid origin.…”

Section: Discussionmentioning

confidence: 99%

Last resort: case of clot translocation in intra-arterial stroke therapy

John

Burgess

Cheng-Ching

et al. 2014

J NeuroIntervent Surg

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A patient was taken for emergent intra-arterial stroke therapy for an acute left middle cerebral artery stroke syndrome, with CT angiography showing a left internal carotid artery (ICA) occlusion. Through a 6 F Neuron MAX sheath, a 5 Max ACE Penumbra aspiration catheter was advanced to the thrombus and direct suction was performed through the ACE catheter and Neuron MAX sheath. Upon pull back, the thrombus became wedged in the Neuron MAX sheath and despite several attempts to aspirate the thrombus, no clot could be obtained. The Neuron MAX sheath was withdrawn to the left common carotid artery, and gently advanced to the origin of the external carotid artery (ECA). A glide wire was advanced and the thrombus dislodged into the ECA. Another pass with the 5 Max ACE was used to remove a remaining thrombus in the left ICA terminus, resulting in Thrombolysis in Cerebral Infarction (TICI) 3 flow. With improved devices for embolectomy, large and rigid emboli that exceed the inner diameter of large guide sheaths and balloon guide catheters can become lodged, and cannot be withdrawn through a catheter. While uncommon, strategies to overcome this are important to keep in mind during acute stroke intervention.

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Section: Discussionmentioning

confidence: 99%

Last resort: case of clot translocation in intra-arterial stroke therapy

John

Burgess

Cheng-Ching

et al. 2014

J NeuroIntervent Surg

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“…These should be identified by conventional angiography after selective catheterization of the external carotid artery (Figs. [2][3][4][5][6][7][8][9][10].…”

Section: Practical Radiological Anatomymentioning

confidence: 99%

“…More than 70% of cases are ''idiopathic'' or ''essential'' [2]. The majority of cases of essential epistaxis are related to risk factors [3], which are hypertension, hypercholesterolemia, smoking, the NSAID (mostly aspirin) and coagulation disorders.…”

Section: General Pointsmentioning

confidence: 99%

Epistaxis: The role of arterial embolization

Reyre

Michel

Santini

et al. 2015

Diagnostic and Interventional Imaging

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Epistaxis is defined as flow of blood from the nasal fossae and is a common and benign disorder in the great majority of cases which does not require medical care. It may however become a genuine medical or surgical emergency because of the amount, repeated episodes or patient's medical vulnerability (such as coronary artery disease patients). Epistaxis may be either primary or a symptom of an underlying disease. Four levels of problems need to be answered faced with epistaxis: recognizing it, and in particular not missing "epistaxis" due to swallowed blood or venous hemorrhage, which falls outside of the scope of interventional radiology; establishing the amount and its repercussions, particularly as a decompensating factor in another disease; investigating its cause and in particular never missing a tumor (male adolescents); obtaining hemostasis. Epistaxis varies not only in type and cause but must be considered in its clinical context. Arterial embolization is a treatment of choice for severe refractory epistaxis and some hemorrhages. When carried out by trained operators, it is an effective method with few risks of complications and is increasingly being used in reference centers (Brinjikji et al.). It remains, however, a method which is less widely used than surgery, particularly in the United States where in a series of 69,410 patients treated over the last 10 years for refractory epistaxis, 92.6% underwent surgical ligation, 6.4% embolization and 1% combined treatments (Brinjikji et al.). Epistaxis is occasionally catastrophic and requires extremely urgent management. In each case, close collaboration with the surgeon, the presence of an intensive care anesthetist and at least sedation are all factors which improve management and therefore the results of embolization. All patients and/or their friends/close family should have given "reliable, clear and appropriate" information.

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“…Plus de 70 % des épistaxis sont « idiopathiques » ou « essentielles » [2]. La majorité des épistaxis essentielles sont liées à des facteurs de risque [3] qui sont l'hypertension artérielle, l'hypercholestérolémie, le tabagisme, l'éthylisme, les anti-inflammatoires non stéroïdiens, l'aspirine et les troubles de la coagulation.…”

Section: Généralitésunclassified