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Thrombus burden

Zuoyan Wang, Na Liu, Lihui Ren, Licheng Lei, Huiming Ye, Jianjun Peng
BACKGROUND: The intracoronary high-thrombus burden during the primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI) can lead to poor outcomes. Monocytes have been described to play an important role in thrombotic disorders. OBJECTIVES: This study aimed to investigate the relationship between admission monocyte count and angiographic intracoronary thrombus burden in patients receiving primary percutaneous coronary intervention (PPCI)...
March 12, 2018: Arquivos Brasileiros de Cardiologia
Ali Abdul Jabaar, J Stephen Jenkins
BACKGROUND: Beyond medical therapy, the role of endovascular approach for the management of chronic Venous Thromboembolic (VTE) disease is yet to be defined. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage this chronic condition. This paper represents the first systematic review of published reports on the use of vacuum-assisted thrombectomy (AngioVac) in treating chronic VTE disease. METHODS: A systematic review of published case-series, individual case-reports, and review articles in MEDLINE, PubMed, and Google Scholar was conducted...
February 15, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Sourabh Aggarwal, Feng Xie, Robin High, Gregory Pavlides, Thomas R Porter
BACKGROUND: Although microvascular flow abnormalities have been observed following epicardial recanalization in acute ST-segment elevation myocardial infarction (STEMI), the prevalence and severity of these abnormalities in the current era of rapid percutaneous coronary intervention (PCI) has not been evaluated. The objective of this study was to assess microvascular perfusion (MVP) following successful primary PCI in patients with STEMI and how it affects clinical outcome. METHODS: In this single-center, retrospective study, 170 patients who successfully underwent emergent PCI for STEMI were assessed using real-time myocardial contrast echocardiography using a continuous infusion of intravenous commercial microbubbles (3% Definity)...
March 7, 2018: Journal of the American Society of Echocardiography
Albeir Y Mousa, Mike Broce, David De Wit, Mina Baskarioun, Shadi AbuHalema, Michael Yacoub, Mark C Bates
BACKGROUND: The D-Dimer (DD) level combined with the pretest Wells criteria probability (WCP) score can safely exclude Deep Venous Thrombosis (DVT). The objective for this study was to examine the correlation between DD results alongside WCP score with findings on venous duplex ultrasound (VDU). The hypothesis is that VDU remains over utilized in low-risk patients with negative DD and that higher DD levels may correlate with thrombus burden and location. METHODS: Patients who presented to a high volume tertiary care center with lower limb swelling with or without associated pain were retrospectively examined through June and July for four consecutive years (2012 to 2015)...
March 1, 2018: Annals of Vascular Surgery
Bernardino C Branco, Miguel F Montero-Baker, Eduardo Espinoza, Maria Gamero, Rodrigo Zea-Vera, Nicos Labropoulos, Luis R Leon
Objective Inferior vena cava occlusion is a potentially life-threatening complication related to caval filters. We present our experience with filter-induced inferior vena cava occlusion in order to assess the feasibility, safety, and effectiveness of endovascular management. Methods A retrospective review of all patients undergoing inferior vena cava filter placement over a 60-month study period was performed. From this cohort, a total of 10 cases of inferior vena cava occlusion after filter placement were identified...
January 1, 2018: Vascular
Tomoyo Sugiyama, Lei Xing, Erika Yamamoto, Francesco Fracassi, Hang Lee, Bo Yu, Ik-Kyung Jang
OBJECTIVE: Recent studies suggest that conservative management with antithrombotic therapy without stenting may be an option in selected patients with acute coronary syndrome (ACS). We evaluated whether a glycoprotein IIb/IIIa inhibitor, tirofiban, would offer additional benefit in patients with plaque erosion presenting with ACS who were treated with antiplatelet therapy without stenting. PATIENTS AND METHODS: Forty-nine patients who completed 1-year follow-up optical coherence tomography imaging in the EROSION study were divided into two groups: tirofiban (n=32) versus no tirofiban (n=17)...
February 28, 2018: Coronary Artery Disease
Anton A Khilchuk, Sergey V Vlasenko, Sergey G Scherbak, Andrey M Sarana, Vitaliy V Popov
Acute thrombotic occlusions of the large vessels, such as internal carotid artery, arms and legs arteries, and intracranial vessels, frequently require multiple techniques such as selective thrombolysis, manual aspiration, and stent retrievers for mechanical thrombectomy with combination of the mentioned techniques. Because of the massive thrombotic burden associated with these conditions, the response to systemic intravenous thrombolysis is poor. We present a case of a successful massive thrombi aspiration in a single attempt using an 8Fr guide catheter with aspiration syringe, subsequent ipsilateral middle cerebral artery mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke, right arm critical ischemia, and persistent atrial fibrillation...
February 2018: Radiology Case Reports
Mark D Balceniuk, Lauren E Trakimas, Claudia Aghaie, Doran Mix, Khurram Rasheed, Jennifer Ellis, Roan Glocker, Adam Doyle, Michael C Stoner
Introduction Formation and renewal of intramural thrombus is associated with inflammation, and contributes to the complexity of aneurysm repair. Current cardiovascular pharmacotherapy includes several inflammatory modulators such as aspirin, statins, clopidogrel, and angiotensin-converting enzyme inhibitors. The purpose of our study was to investigate the effect of these inflammatory modulators on radiographically-determined thrombus sac volume. Methods Pre-operative computed tomography scans were reviewed in patients who underwent elective infrarenal aortic aneurysm repair...
January 1, 2018: Vascular
Gianpiero D'Amico, Marco Basile, Giuseppe Tarantini, Alfredo Marchese
Acute ST-segment elevation myocardial infarction (STEMI) typically arises from total occlusion of an epicardial coronary artery, most often due to atherosclerotic plaque rupture/erosion and subsequent thrombus formation. Granted this, important angiographic information for patients presenting with STEMI is not only about the status of infarct-related artery (IRA) but also about the atherosclerotic disease burden and disease severity of non-IRA vessels. Previous studies have reported that multivessel (MV) coronary artery disease (CAD) is found in approximately 50% of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) [1,2]...
February 19, 2018: Minerva Cardioangiologica
Laura Petruescu, Fabien Picard, Alain Cariou, Olivier Varenne
A 63-year-old man presented with an out-of-hospital cardiac arrest. The coronary angiogram with intravascular imaging was performed and showed a mid-left anterior descending artery atherosclerotic cap rupture with thrombus burden treated with drug-eluting stent (DES) implantation. During the hospitalisation in the intensive care unit, the patient experienced recurrent ventricular fibrillations and asystole with transient ST-segment elevation in the inferior leads with normal coronary angiography. A methylergonovine provocative test was therefore performed and showed an occlusive right coronary artery (RCA) spasm...
February 8, 2018: BMJ Case Reports
Haihua Yang, Ning Ma, Lian Liu, Feng Gao, Dapeng Mo, Zhongrong Miao
BACKGROUND: Recently, the Basilar Artery on Computed Tomography Angiography (BATMAN) score predicts clinical outcome of acute basilar artery occlusion (BAO), yet there is no extensive external validation. The purpose of this study was to validate the prognostic value of BATMAN scoring system for the prediction of clinical outcome in patients with acute BAO treated with endovascular mechanical thrombectomy by using cerebral digital subtraction angiography (DSA). METHODS: We analyzed the clinical and angiographic data of consecutive patients with acute BAO from March 2012 to November 2016...
February 5, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Istvan Hizoh, Gyongyver Banhegyi, Dominika Domokos, Zalan Gulyas, Laszlo Major, Robert Gabor Kiss
Although routine aspiration thrombectomy (AT) is not recommended by the current American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guideline, for selected cases, a class IIb indication is given because of lack of data. We studied the impact of selective AT on mortality in patients with ST-segment elevation myocardial infarction using a prospective registry. We analyzed data of 1,255 patients, of whom 535 underwent AT based on operator's decision...
January 10, 2018: American Journal of Cardiology
Mun Hee Choi, Geun Hwa Park, Jin Soo Lee, Sung Eun Lee, Seong-Joon Lee, Jang-Hee Kim, Ji Man Hong
BACKGROUND AND PURPOSE: Recent advent of endovascular thrombectomy (EVT) enables us to provide a new perspective on the use of tPA (tissue-type plasminogen activator) through histological analysis of retrieved thrombus. We investigated the responsiveness of intravenous thrombolysis (IVT) according to the thrombus composition in EVT-attempted patients with acute ischemic stroke. METHODS: We reviewed 92 consecutive patients with anterior circulation stroke who received combined IVT and EVT for 2 years...
March 2018: Stroke; a Journal of Cerebral Circulation
Karsten Keller, Johannes Beule, Jörn Oliver Balzer, Wolfgang Dippold
BACKGROUND: Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients. METHODS: Overall, 161 PE patients were analyzed retrospectively, classified in 5 subgroups of thrombus burden according to clinical indications and compared regarding D-Dimer-levels...
January 17, 2018: American Journal of Emergency Medicine
Claire E Raphael, John A Heit, Guy S Reeder, Melanie C Bois, Joseph J Maleszewski, R Thomas Tilbury, David R Holmes
Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation...
January 22, 2018: JACC. Cardiovascular Interventions
Udaya Tantry, Eliano P Navarese, Aung Myat, Paul Gurbel
The P2Y12 receptor plays a critical role in the amplification of platelet aggregation in response to various agonists and stable thrombus generation at the site of vascular injury leading to deleterious ischemic complications. Therefore, treatment with a P2Y12 receptor blocker is a major effective strategy to prevent ischemic complications in high -risk patients with acute coronary syndrome (ACS) and patients undergoing percutaneous coronary intervention (PCI). The determination of optimal platelet inhibition is based on maximizing antithrombotic properties while minimizing bleeding risk and is critically dependent on individual patient's propensity for thrombotic and bleeding risks...
January 12, 2018: Progress in Cardiovascular Diseases
Behnood Bikdeli, Babak Sharif-Kashani, Bavand Bikdeli, Reina Valle, Conxita Falga, Antoni Riera-Mestre, Lucia Mazzolai, Peter Verhamme, Philip S Wells, Juan Francisco Sánchez Muñoz Torrero, Luciano Lopez-Jiménez, Manuel Monreal
Small studies have suggested differences in demographics and outcomes between left- and right-sided deep vein thrombosis (DVT), and also unilateral versus bilateral DVT. We investigated the clinical presentation and outcomes of patients with DVT based on thrombus sidedness. The authors used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) database (2001-2016) to identify patients with symptomatic proximal lower-extremity DVT. Main outcomes included cumulative 90-day symptomatic pulmonary embolism (PE) and 1-year mortality...
January 12, 2018: Seminars in Thrombosis and Hemostasis
Heitor C Alves, Kilian M Treurniet, Bruna G Dutra, Ivo G H Jansen, Anna M M Boers, Emilie M M Santos, Olvert A Berkhemer, Diederik W J Dippel, Aad van der Lugt, Wim H van Zwam, Robert J van Oostenbrugge, Hester F Lingsma, Yvo B W E M Roos, Albert J Yoo, Henk A Marquering, Charles B L M Majoie
BACKGROUND AND PURPOSE: Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome. METHODS: Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195)...
February 2018: Stroke; a Journal of Cerebral Circulation
Wi-Sun Ryu, Eun-Kee Bae, Soo-Hyun Park, Sang-Wuk Jeong, Dawid Schellingerhout, Matthias Nahrendorf, Dong-Eog Kim
BACKGROUND: We investigated whether left ventricular filling pressure is associated with arterial occlusion in patients with ischemic stroke related to atrial fibrillation (AF). METHODS: Ninety-nine patients with AF-related stroke were included. Left ventricular filling pressure was assessed by E (early mitral inflow velocity)/e' (early diastolic velocity of the mitral valve annulus velocity) ratio based on tissue Doppler echocardiography. Arterial occlusion was evaluated by computed tomography or magnetic resonance angiography...
January 5, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Luis Pablo Roldan, Chris Rowan, Mark Sheldon, Carlos A Roldan
The benefit of intracoronary thrombolytics in ST-elevation myocardial infarction (STEMI) is not well established. Mainstays of STEMI management include intravenous thrombolytics, percutaneous coronary interventions and surgical revascularisation. However, in cases of STEMI secondary to coronary artery aneurysmal disease (CAAD), standard treatment options may not be suitable due to high thrombus burden, perioperative risk and factors unique to each patient. Thus, STEMI management in CAAD can represent a therapeutically challenging clinical scenario...
December 15, 2017: BMJ Case Reports
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