Browsing by Author "RAO, VRK"

Now showing 1 - 20 of 24
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    ANGIOGRAPHIC ANALYSIS AND RESULTS OF ENDOVASCULAR THERAPY OF ANEURYSMS OF VEIN OF GALEN
    (JOURNAL OF NEURORADIOLOGY, 1994)
    Angioarchitecture of the aneurysmal malformation of the vein of Galen in 9 patients is analysed. An arterial maze arborised directly into the vein of Galen in 6 patients. Direct fistulous communication from one or two pedicles was noted in three children. Unilateral choroidal arterial contribution via an eccentric cul-de-sac in two infants suggested embryonic involvement of the ipsilateral internal cerebral vein along with the median prosencephalic vein of Markowski. Unusually, a sylvian branch of the middle cerebral artery drained directly into the basal vein of Rosenthal which in turn communicated to the aneurysm of vein of Galen in another patient. Two adult patients had curvilinear rim calcification of the venous sac with rapid circulation. All but two showed venous sinus anomalies. Two children had prior shunt surgery at the referring hospitals. The pathophysiology of hydrocephalus and the possible consequences of shunt, question the need for CSF diversion as a routine in these patients. Percutaneous trans-arterial embolotherapy, in five patients achieved complete obliteration of the malformation in four patients and partial reduction of flow in another. While transvenous/trans-torcular approach is reserved for selected patients and direct surgery carries high morbidity, this report emphasises the efficacy of trans-arterial embolotherapy.
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    AORTOARTERITIS OF ABDOMINAL-AORTA - AN ANGIOGRAPHIC PROFILE IN 110 PATIENTS
    (CLINICAL RADIOLOGY, 1993)
    The angiographic appearances in 110 patients (49 males, 61 females, age range 11-46 years, mean 27.8 years) with aortoarteritis involving the abdominal aorta and/or its branches were analysed. There were 41 aneurysms of the abdominal aorta in 37 patients and eight aneurysms of its branches in as many patients. ln 50 patients, 53 obstructive lesions involved the abdominal aorta and were classified as stenoses of focal, segmental and diffuse types and total occlusions. Branch obstructions (182 lesions in 85 patients) affected in order of frequency, the renal, superior mesenteric, coeliac, iliac and the inferior mesenteric arteries. Mesenteric arterial lesions were significantly more common in males (P = 0.01). Collateral circulation through a prominent mesenteric arcade was a distinctive angiographic feature in 28 patients. Computed tomography done in four patients showed peri-adventitial thickening and layered thrombus within aneurysms in three patients, and luminal occlusion of the upper abdominal aorta in one patient.Angiographic appearances in aortoarteritis of the abdominal aorta are characteristic and sufficiently distinctive for definitive diagnosis and appropriate management.
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    ARTERIOVENOUS ANEURYSM OF THE OCCIPITAL ARTERY
    (NEURORADIOLOGY, 1993)
    We report an unique case of a giant aneurysm of the occipital artery, with a venous connection to the transverse sinus via an emissary vein. Because of this connection, the term arteriovenous aneurysm is used.
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    CHRONIC ARTERIAL-OCCLUSION IN A CANINE MODEL - A NOVEL TECHNIQUE
    (AMERICAN JOURNAL OF ROENTGENOLOGY, 1990) RAVIMANDALAM, K; RAO, VRK; KUMAR, S; JOSEPH, S; LAL, AV; MOHANTY, M
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    CORPUS-CALLOSUM LIPOMA WITH FRONTAL ENCEPHALOCELE
    (NEURORADIOLOGY, 1990)
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    CT METRIZAMIDE MYELOGRAPHY IN SYRINGOHYDROMYELIA
    (JOURNAL OF NEURORADIOLOGY, 1987) RAO, VRK; MANDALAM, R; SEOUIERA, R; MOHAN, PK; ROUT, D
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    DISAPPEARANCE OF A CEREBRAL ANEURYSM - AN UNUSUAL ANGIOGRAPHIC EVENT
    (CLINICAL NEUROLOGY AND NEUROSURGERY, 1991)
    Spontaneous thrombosis of cerebral aneurysms demonstrated by angiography is infrequent. This article describes angiographically documented spontaneous thrombosis of an intracranial aneurysm at the posterior cerebral-posterior communicating artery junction in a 40-year-old woman. The initial angiogram done on 16th day after an episode of subarachnoid haemorrhage showed a medium sized aneurysm. Subsequent angiograms done on 30th, 40th and 60th day failed to demonstrate the aneurysm. The factors leading to this rare event remain obscure.
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    DISSOLUTION OF ISOBUTYL 2-CYANOACRYLATE ON LONG-TERM FOLLOW-UP
    (AMERICAN JOURNAL OF NEURORADIOLOGY, 1989)
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    ENDOVASCULAR EMBOLIZATION USING HYDROGEL MICROSPHERES
    (JOURNAL OF MATERIALS SCIENCE-MATERIALS IN MEDICINE, 1994) JAYAKRISHNAN, A; MOHANTY, M; MANDALAM, R; RAO, VRK; GUPTA, AK; JOSEPH, S
    Controlled alkaline hydrolysis of crosslinked poly(methyl methacrylate) (PMMA) microspheres produced highly hydrophilic, smooth, compressible, nearly perfect microspheres having a range of water content 40-95%. These particles were found to possess many desirable properties as a material for therapeutic embolization. After successful toxicological and animal evaluation, these particles were used to treat various ailments such as arteriovenous malformations (AVM) of the brain, spinal cord, limbs, face and trunks, preoperative devascularization of tumours and in the management of severe life-threatening haemoptysis and haematemesis in clinical trials involving over 90 patients at this Institute. The results of these studies appeared to be very encouraging. The material is found to be an ideal embolic agent in all these clinical situations.
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    ENDOVASCULAR MANAGEMENT OF CAROTID-CAVERNOUS FISTULAS - OBSERVATION ON ANGIOGRAPHIC AND CLINICAL-RESULTS
    (ACTA NEUROLOGICA SCANDINAVICA, 1993)
    Twenty-five patients with carotid cavernous fistulae (CCFs) were managed at our institute during a five-year period. Transarterial and transvenous treatment of traumatic carotid cavernous fistulae using the detachable balloon technique was performed in 21 patients resulting in angiographic and clinical cure in 20 patients and fatal outcome in one patient following venous rerouting. Surgical ligation of the infraclinoid internal carotid artery was needed in one patient. Preservation of the carotid artery was possible in 16 patients. Four patients with spontaneous CCFs were advised digital compression of carotid arteries resulting in complete closure of the fistula in one and considerable clinical improvement in two patients. One patient required transarterial obliteration of the fistula via the middle meningeal artery by means of a platinum coil and normal butyl cyanoacrylate (NBCA) resulting in total radio anatomical cure.
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    HISTOPATHOLOGICAL EVALUATION OF POLYMETHYL METHACRYLATE AS AN EMBOLIC AGENT
    (ACTA NEUROCHIRURGICA, 1992)
    Polymethyl methacrylate (PMMA) microspheres were used as an embolic agent to reduce the vascularity in eight patients with intracranial vascular tumours. Post embolization angiograms showed 30-60% reduction in the vascularity of-the tumours. No patient developed any neurological complications in the immediate post-embolization period. These eight patients subsequently underwent surgery for the removal of their tumours. During surgery there was minimal blood loss and a good plane of cleavage was obtained between the tumour and the adjacent brain. The surgical specimens were examined histopathologically for the effects of PMMA. PMMA microspheres, in contrast to other cyano-acrylates-Isobutyl-2-cyanoacrylate (IBCA) - did not elicit either inflammatory reaction or mural angionecrosis within the wall of the embolised vessels. The histopathological studies suggest that PMMA microspheres are an inert material and can be used as an adjunct in the management of intracranial vascular tumours.
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    HYDROGEL MICROSPHERES FROM CROSSLINKED POLY(METHYL METHACRYLATE) - SYNTHESIS AND BIOCOMPATIBILITY STUDIES
    (BULLETIN OF MATERIALS SCIENCE, 1989) JAYAKRISHNAN, A; THANOO, BC; RATHINAM, K; MANDALAM, KR; RAO, VRK; LAL, AV; MOHANTY, M
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    HYDROLYZED MICROSPHERES FROM CROSS-LINKED POLYMETHYL METHACRYLATE (HYDROGEL) - A NEW EMBOLIC MATERIAL FOR INTERVENTIONAL NEURORADIOLOGY
    (JOURNAL OF NEURORADIOLOGY, 1991)
    Highly hydrophilic, perfectly smooth and spherical microspheres have been synthetized. These non-biodegradable microspheres absorb water in varying degrees and can be injected easily through microcatheters due to their slippery and compressible characteristics. The material was successfully used of embolization of 4 vascular intracranial tumours and 2 spinal vascular lesions in the cervical region, by superselective delivery. Histopathology confirmed absolute inertness of the microspheres.
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    HYPERPERFUSION SYNDROME FOLLOWING BALLOON ANGIOPLASTY AND BYPASS-SURGERY OF AORTIC-ARCH VESSELS - A REPORT OF 3 CASES
    (CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 1992)
    Hyperperfusion syndrome is a rare complication following revascularization for severe cerebrovascular occlusive disease. We report 2 cases with milder manifestations of this syndrome in the form of unilateral headache following balloon angioplasty of brachiocephalic arteries, and 1 case with massive cerebral hemorrhage after aorto-carotid bypass surgery. The mechanism of autoregulation of cerebral blood flow and the pathophysiology of cerebral hyperperfusion are discussed. The importance of recognizing this phenomenon and possible means of preventing its occurrence are emphasized.
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    LEFT CERVICAL ARCH AND ASSOCIATED ABNORMALITIES
    (CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 1989)
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    MODIFIED CROSSOVER AND GUIDEWIRE LOOP TECHNIQUE FOR DOUBLE-BALLOON ANGIOPLASTY OF THE AORTIC BIFURCATION
    (CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 1994)
    A modified form of crossover railroad technique is described for iliac and aortic bifurcation obstructions in which the iliac occlusion is crossed from the opposite side by a guidewire which is brought out through the ipsilateral puncture site. After forming a loop in the abdominal aorta, dilatation with two balloons is performed. This procedure was successfully performed in 2 patients having iliac artery occlusions and aortic bifurcation obstruction.
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    MULTIPLE PULMONARY-ARTERY ANEURYSMS DUE TO MUCOID VASCULOPATHY - ANGIOGRAPHIC AND HISTOLOGICAL OBSERVATIONS
    (THORACIC AND CARDIOVASCULAR SURGEON, 1993)
    Multiple peripheral pulmonary artery aneurysms were diagnosed by Computed Tomography and confirmed angiographically in a 7-year-old boy. On histological examination unusual mucoid vasculopathic changes were noted in the pulmonary artery aneurysms and pulmonary vasculature as a part of systemic vascular involvement. This case demonstrates a new association between mucoid vasculopathic changes and pulmonary aneurysms. Mucoid vasculopathy could represent one more disorder having a causative role in the etiology of intrapulmonary arterial aneurysms.
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    NATURAL-HISTORY OF AORTOARTERITIS - AN ANGIOGRAPHIC STUDY IN 26 SURVIVORS
    (CLINICAL RADIOLOGY, 1994)
    The natural history of aortoarteritis was angiographically studied in 26 surviving patients (19 female; 7 male). The interval between the initial and current angiographic study was 38-228 months (mean - 84.46 months). All patients underwent panaortography during both studies and one patient also underwent pulmonary angiography. The lesions were extensive involving the ascending, arch and the descending thoracic and/or the abdominal aorta (Type III) in 15 patients; localized to the arch alone (Type I) in five patients and to the descending thoracic and/or abdominal aorta in five patients (Type II). Pulmonary angiography in the solitary patient with clinical features of pulmonary hypertension showed occlusion of the lower lobe branch of the right pulmonary artery. The lesions were occlusive in 19 patients, aneurysmal in one patient and mixed in six patients. While four patients developed fresh lesions in the follow-up period, two showed progression of existing lesions and one revealed partial thrombosis of an aneurysm. Persistently elevated erythrocytic sedimentation rate (>40 mm) was identified as a reliable indicator for activity of inflammatory process and disease progression. The stable nature of the lesions in 20 out of 26 patients in this study indicates a non-progressive course in the healed stage of aortoarteritis and suggests a conservative approach to the management of this disease in all patients except those with severe, life-threatening manifestations.
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    OBSTRUCTION OF THE INFRARENAL PORTION OF THE ABDOMINAL-AORTA - RESULTS OF TREATMENT WITH BALLOON ANGIOPLASTY
    (AMERICAN JOURNAL OF ROENTGENOLOGY, 1991)
    Our experience in the treatment of stenoses of the infrarenal portion of the abdominal aorta with balloon angioplasty in 27 patients is reported. Clinical findings were lower limb claudication (all patients), impotence (eight patients), and blue-toe syndrome (two patients). The underlying disease was atherosclerosis in 24 patients and nonspecific aortoarteritis in three patients. Dilatation was successful in all patients. Embolic occlusions of the left common iliac artery (one patient) and left superficial femoral artery (one patient) were the only major complications. Claudication in the affected limb continued in the first patient; the second died when diagnostic angiography, performed 3 months after angioplasty, caused a severe atheroembolus. Of the other 25 patients, nine of the 10 followed up for 13-48 months and all seven followed up for 3-8 months were free of symptoms. Six of eight patients with sexual dysfunction had normal function after angioplasty. Seven patients still awaited follow-up and one was lost to follow-up.Our experience suggests that balloon angioplasty is an effective treatment of stenoses of the infrarenal portion of the abdominal aorta.