metrizamide and Carotid-Artery-Diseases

In vitro work with detachable latex balloons confirms that long term balloon inflation can be achieved. The short term osmotic effects of hypertonic and nearly isotonic radiographic contrast materials filling the balloons are negligible. Long term osmotic effects may be operative. The discrepancy between in vitro prolonged inflation and in vivo deflation cannot be due to the osmolarity of the balloon contents.

Topics: Aged; Arteriovenous Fistula; Carotid Artery Diseases; Carotid Artery, Internal; Cavernous Sinus; Embolization, Therapeutic; Female; Humans; Iothalamate Meglumine; Latex; Metrizamide; Neurosurgery; Osmolar Concentration

Four carotid-ophthalmic aneurysms were treated through a contralateral pterional approach. Three of these aneurysms were clipped successfully. Because awareness of the size and shape of the optic chiasm is crucial for the success of this approach, we used metrizamide or blood cisternography with a high resolution computed tomographic scanner. With this technique, the shape of the optic chiasm was delineated before operation to make certain that the prechiasmatic space was large enough for the aneurysm to be approached.

Topics: Adult; Blood; Carotid Artery Diseases; Carotid Artery, Internal; Female; Humans; Intracranial Aneurysm; Metrizamide; Middle Aged; Ophthalmic Artery; Optic Chiasm; Subarachnoid Space; Tomography, X-Ray Computed

A carotid-cavernous fistula was occluded by a detachable latex balloon. Because of technical problems, the contrast-filled balloon was left in a precarious position in the ostium of the fistula. Premature deflation of the balloon would have resulted in intra-arterial migration of the device. Approximately 1 week is required for the balloon to become secured in place by fibrous attachment to the vascular wall. For success, if the ligature is adequate, a detachable Debrun balloon should remain inflated for this period of time. The deflation process was monitored radiographically in this patient. The balloon remained inflated for at least 2 weeks. A short summary of the experience with deflation of various contrast-containing balloon devices in the treatment of carotid-cavernous fistulas is given. Metrizamide may be the best contrast agent for use in these devices.

Topics: Adult; Angioplasty, Balloon; Arteriovenous Fistula; Carotid Artery Diseases; Cavernous Sinus; Humans; Intraoperative Period; Male; Metrizamide; Monitoring, Physiologic; Radiography