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https://www.readbyqxmd.com/read/29044010/-simple-mechanical-reperfusion-in-acute-myocardial-infarction-determinants-prognostic-implications-and-relation-with-thrombus-histology
#1
Jorge L Szarfer, Alejandro García-Escudero, Federico Blanco, Federico Albornoz, Analía Alonso, Andrea Zappi, Rodrigo Blanco, Gerardo Gigena, Juan Gagliardi
Simple mechanical reperfusion (SMR) is defined as reperfusion achieved after wire insertion at the occluded infarct-related artery in primary angioplasty. The determinants and prognostic implications of SMR and its relationship with the histopathology of the rescued thrombus were evaluated in 601 patients with acute myocardial infarction showing ST elevation and pre-procedural total occlusion of the infarct-related artery (TIMI flow 0). Two groups were considered according to the presence of SMR, defined as the visualization of contrast material after crossing the occlusion with the guide wire...
2017: Medicina
https://www.readbyqxmd.com/read/29043564/the-ucp2-866g-a-polymorphism-could-be-considered-as-a-genetic-marker-of-different-functional-prognosis-in-ischemic-stroke-after-recanalization
#2
I Díaz-Maroto Cicuéndez, E Fernández-Díaz, J García-García, J Jordán, I Fernández-Cadenas, J Montaner, G Serrano-Heras, T Segura
Recent studies based on experimental animal models of stroke have suggested that uncoupling protein 2 (UCP2), an inner mitochondrial membrane protein that is thought to regulate energy metabolism and reduce reactive oxygen species generation, provides protection against reperfusion damage. We aimed to investigate whether -866G/A polymorphism in the promoter of the UCP2 gene, which enhances its transcriptional activity, is associated with functional prognosis in patients with embolic ischemic stroke after early recanalization...
October 17, 2017: Neuromolecular Medicine
https://www.readbyqxmd.com/read/29042328/ruptured-persistent-trigeminal-artery-causing-direct-cavernous-sinus-fistula-treated-with-pipeline-embolization-and-minimal-coiling
#3
Nam K Yoon, Al-Wala Awad, James M Gee, Philipp Taussky
BACKGROUND: Rupture of a persistent trigeminal artery associated with development of a cavernous sinus fistula in a traumatic setting is rare. They are typically treated with coil embolization of the cavernous sinus. CASE DESCRIPTION: We present the case of a 42-year-old woman who developed a direct cavernous carotid fistula after a motor-vehicle accident. Angiographic imaging revealed a rupture point of a persistent trigeminal artery as it connected with the cavernous segment of the internal carotid artery (ICA), causing a cavernous sinus fistula...
October 14, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29040967/improvement-and-aggravation-of-spontaneous-unruptured-vertebral-artery-dissection
#4
Tomoya Shibahara, Masahiro Yasaka, Yoshiyuki Wakugawa, Koichiro Maeda, Takeshi Uwatoko, Takahiro Kuwashiro, Gregory Y H Lip, Yasushi Okada
BACKGROUND: Intracranial vertebral artery dissection (VAD) is a well-recognized cause of stroke in young and middle-aged individuals, especially in Asian populations. However, a long-term natural course remains unclear. We investigated the long-term time course of VAD using imaging findings to examine the rate and predisposing factors for improvement. METHODS: We registered 56 consecutive patients (40 males; mean age, 51.8 ± 10.7 years) with acute spontaneous VAD and retrospectively investigated neuroimaging and clinical course within 1 month and at 3 months ± 2 weeks, 6 months ± 2 weeks, and 12 months ± 2 weeks after onset to ascertain predisposing factors and time course for improvement...
October 17, 2017: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/29040040/prevalence-of-carotid-web-in-patients-with-acute-intracranial-stroke-due-to-intracranial-large-vessel-occlusion
#5
Kars C J Compagne, Ad C G M van Es, Olvert A Berkhemer, Jordi Borst, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Charles B L M Majoie, Henk A Marquering, Diederik W J Dippel, Aad van der Lugt, Bart J Emmer
Purpose To investigate the prevalence of symptomatic carotid web in patients with acute ischemic stroke due to intracranial large vessel occlusion, to determine the clinical and imaging profile of patients with carotid web as well as their association with ischemic stroke, and to determine the interobserver agreement in the assessment of carotid webs. Materials and Methods All patients (n = 500) of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) in whom the carotid bifurcation could be assessed (n = 443) were included...
October 16, 2017: Radiology
https://www.readbyqxmd.com/read/29038080/a-stent-retrieving-into-an-aspiration-catheter-with-proximal-balloon-asap-technique-a-technique-of-mechanical-thrombectomy
#6
Shunsaku Goto, Tomotaka Ohshima, Kojiro Ishikawa, Taiki Yamamoto, Shinji Shimato, Toshihisa Nishizawa, Kyozo Kato
PURPOSE: The best technique for the first attempt at mechanical thrombectomy for acute ischemic stroke is a still matter of debate. In this study, we evaluated the efficacy of a stent-retrieving into an aspiration catheter with proximal balloon (ASAP) technique that employs a series of thrombus extraction by withdrawing the stent retriever into the aspiration catheter, and continuous aspiration from the aspiration catheter in the first attempt. METHODS: We performed a retrospective analysis of 42 consecutive patients with acute ischemic stroke caused by occlusions in the anterior circulation, who were treated with the ASAP technique at our institution...
October 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29037581/pulmonary-embolism-due-to-exogenous-estrogen-intoxication
#7
Caner Çelik, Murat Carus, Fatih Büyükcam
OBJECTIVE: Pulmonary embolism is a relatively common clinical presentation of venous thromboembolism, which develops in relation to acute pulmonary arterial occlusion mostly caused by thrombi of the lower limbs. CASE REPORT: 29year old female admitted to emergency department with pulmonary thromboembolism due to an ingestion of 17 Diana 35 pills (2 mg cyproterone acetate and 0.035mg ethinyl estradiol) in a suicide attempt without any previously known predisposing factors...
August 18, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29037436/which-imaging-before-reperfusion-strategy
#8
REVIEW
J M Olivot
The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4...
October 13, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29035192/bacillus-cereus-bacteremia-with-central-nervous-system-involvement-a-neuropathological-study
#9
Jean Philippe Brouland, Nathalie Sala, Selin Tusgul, Caterina Rebecchini, Enikö Kovari
Bacillus cereus is a widely-distributed, gram-positive or variable, rod-shaped bacterium frequently considered a contaminant in clinical specimens. It is recognized as a potential pathogen inducing self-limiting emetic or diarrheal food poisoning or localized infection in immunocompetent patients. True B. cereus bacteremia is uncommon and mainly observed in fragile patients, notably in immunocompromised individuals. We report clinical, radiological, and pathological findings of a 64-year-old patient with a history of acute myeloid leukemia who initially presented a fever while neutropenic after the induction of a second cycle of chemotherapy...
October 16, 2017: Clinical Neuropathology
https://www.readbyqxmd.com/read/29034035/surgical-embolectomy-for-acute-pulmonary-thromboembolism
#10
REVIEW
Ikuo Fukuda, Kazuyuki Daitoku
Acute pulmonary thromboembolism is a catastrophic event, especially for hospitalized patients. The prognosis of pulmonary thromboembolism depends on the degree of pulmonary arterial occlusion. The mortality of massive pulmonary embolism is reportedly as high as 25% without cardiopulmonary arrest and 65% with cardiopulmonary arrest. In patients with unstable hemodynamics due to pulmonary thromboembolism, surgical pulmonary embolectomy is indicated for patients with a contraindication to thrombolysis, failed catheter therapy, or failed thrombolysis...
June 25, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29033725/assessment-of-patient-controlled-analgesia-versus-intermittent-opioid-therapy-to-manage-sickle-cell-disease-vaso-occlusive-crisis-in-adult-patients
#11
Alaa Al-Anazi, Lowloa Al-Swaidan, Maha Al-Ammari, Tariq Al-Debasi, Abdulmalik M Alkatheri, Shmeylan Al-Harbi, Aiman A Obaidat, Abdulkareem M Al-Bekairy
BACKGROUND: Vaso-occlusive crisis (VOC) is one of the acute complications of sickle-cell disease (SCD). Treatment mainly relies on hydration and pain control by analgesics. The specific aim of this study was to assess potential health outcomes within the first 72 h of admission between intermittent and patient-controlled analgesia (PCA) by opioids among VOC patients. METHODS: A retrospective chart review study was conducted to determine SCD patients with VOC. Using the hospital electronic system, the following data were collected: patient's age, gender, blood pressure, heart rate, respiratory rate, oxygen saturation, and pain score on admission and daily for 3 days as well as the cumulative opioid analgesic dose for 72 h which is reported as morphine equivalent...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29033516/primary-endovascular-intervention-for-acute-mesenteric-ischemia-performed-by-interventional-cardiologists-a-single-center-experience
#12
Tsung-Yan Chen, Chih-Horng Wu, Wen-Feng Hsu, Lin Lin, Ren-Huei Wang, Chao-Lun Lai, Kuei-Chin Tsai, Li-Ta Keng, Chih-Cheng Wu, Mu-Yang Hsieh
The current standard care for acute mesenteric ischemia (AMEI) involves urgent revascularization and resection of the necrotic bowel. Since 2012, we have used an AMEI protocol of our own design, which focused on early treatment and allowed interventional cardiologists to become involved when interventional radiologist was not available. A total of 8 patients were treated, and two interventional cardiologists performed all the stenting procedures. The procedure success rate was 100% in patients with non-calcified lesions (6/8)...
July 2017: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/29033392/mechanical-recanalization-in-ischemic-anterior-circulation-stroke-within-an-8-hour-time-window-a-real-world-experience
#13
Dagmar Krajíčková, Antonín Krajina, Roman Herzig, Miroslav Lojík, Vendelín Chovanec, Jan Raupach, Eva Vítková, Jan Waishaupt, Oldřich Vyšata, Martin Vališ
PURPOSE: We aimed to assess the safety and effectiveness of mechanical recanalization in patients with ischemic stroke in the anterior circulation within 8 h since symptoms onset and with unknown onset time. We compared time intervals <6 h vs. 6-8 h/unknown onset time, as only limited data are available for a time window beyond 6 h. METHODS: Our cohort included 110 consecutive patients (44 males; mean age, 73.0±11.5 years) with ischemic stroke in the anterior circulation due to the acute occlusion of a large intracranial artery who underwent mechanical recanalization within an 8-hour time window or with unknown onset time...
October 16, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/29033031/the-next-challenges-for-optimal-reperfusion-in-the-era-of-mechanical-thrombectomy
#14
REVIEW
M Mazighi
The therapeutic management of acute ischemic stroke has changed tremendously over the past few years. Mechanical thrombectomy in addition to intravenous tissue plasminogen activator (t-PA) is currently the standard of care for patients experiencing acute ischemic stroke as a consequence of large vessel occlusion of the anterior circulation. Yet, despite strong evidence supporting such a therapeutic approach, several issues remain a source of debate, such as the need for intravenous t-PA, the optimal target for blood pressure levels and the opportunity for additional antithrombotic therapies to improve reperfusion...
October 12, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29032862/endovascular-treatment-of-acute-tandem-occlusion-strokes-and-stenting-first-experience
#15
Süha Akpınar, Pınar Gelener
This study demonstrates the radiologic and clinical findings, etiologies and intervention strategy in 8 acute ischemic stroke patients with tandem occlusions. The mean age was 57 and mean NIHSS score was 19. Stent-assisted thrombectomy (SAT) was performed on all of the patients. Additionally, 6 patients underwent carotid artery stenting before SAT. Recanalization with TICI≥2b was attained in 7/8 patients. The 90thday median mRS was 2 and mortality was 1/8. The etiologies of the tandem occlusions were either extracranial high grade ICA stenosis/occlusion or cervical ICA dissection...
October 9, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29032219/emergency-extracranial-intracranial-bypass-to-revascularize-salvageable-brain-tissue-in-acute-ischemic-stroke-patients
#16
Jan-Karl Burkhardt, Sebastian Winklhofer, Jorn Fierstra, Susanne Wegener, Giuseppe Esposito, Andreas Luft, Oliver Bozinov, Luca Regli
INTRODUCTION: To present an algorithm based on clinical and radiological factors including MR perfusion/diffusion mismatch (MR-PDM) for the indication of urgent cerebral bypass in patients with acute ischemic stroke METHODS: Analysis of clinical and radiological data on eight consecutive patients undergoing urgent cerebral revascularization for acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery between 2012 and 2015. All patients were either not eligible or failed first line treatment with emergent endovascular revascularization...
October 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29030500/prolapsed-antrochoanal-polyp-an-unusual-cause-of-acute-adult-respiratory-distress
#17
Thomas Terence Whittle, Stuart Benzie, Daniel Graham
Here we describe an adult male who presented with acute dyspnoea and airway occlusion. Nasoendoscopy revealed a large antrochoanal polyp extending from his maxillary sinus to the level of the epiglottis. The patient underwent a successful semi-emergency polypectomy following initial stabilisation with medication.
October 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29030498/late-recanalization-of-basilar-artery-occlusion-in-a-previously-healthy-17-month-old-child
#18
D Andrew Wilkinson, Aditya S Pandey, Hugh J Garton, Luis Savastano, Julius Griauzde, Neeraj Chaudhary, Joseph J Gemmete
Endovascular treatment of acute ischemic stroke in children is increasingly being reported, although the time window for intervention is unclear. We describe a previously healthy 17-month-old child who presented with vertebral artery thrombosis and cerebellar stroke requiring posterior fossa decompression. She later progressed to basilar artery thrombosis treated with mechanical thrombectomy 50 hours after clinical decline. At 3 month follow-up, the patient had a modified Rankin Scale score of 0.
October 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29030377/spontaneous-closure-of-ventricular-septal-perforation-following-percutaneous-coronary-intervention-for-acute-myocardial-infarction
#19
Tetsuo Yamanaka, Toru Fukatsu, Yoshimaro Ichinohe, Yasunobu Hirata
We report on an 84-year-old woman with anteroseptal acute myocardial infarction. Emergency coronary angiography revealed the occlusion of proximal left anterior descending artery without collateral circulation, and percutaneous coronary intervention was performed. Two drug eluting stents were implanted, and the procedure was concluded with thrombolysis in myocardial infarction grade 3 without complications. Postoperatively, no murmur was audible on auscultation and no shunt flow was observed on transthoracic echocardiography (TTE), and normal blood pressure was maintained...
October 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29029774/immediate-coronary-angiography-in-survivors-of-out-of-hospital-cardiac-arrest-without-obvious-extracardiac-cause-who-benefits
#20
Z Moutacalli, J-L Georges, B Ajlani, G Cherif, E El Beainy, G Gibault-Genty, E Blicq, C Charbonnel, R Convers-Domart, F Boutot, J-M Caussanel, B Lemaire, S Legriel, B Livarek
BACKGROUND: Immediate coronary angiography (iCA) and primary percutaneous coronary angioplasty (pPCI) in patients successfully resuscitated after out-of-hospital cardiac arrest (OHCA) of suspected cardiac cause is controversial. Our aims were to assess the results of iCA, the prognostic impact of pPCI after OHCA, and to identify subgroups most likely to benefit from this strategy. METHODS: In this single-centre retrospective study, patients aged ≥18 years with sustained return of spontaneous circulation after OHCA and no evidence of a non-cardiac cause underwent routine iCA at admission, with pPCI if indicated...
October 10, 2017: Annales de Cardiologie et D'angéiologie
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