Asunto(s)
Embolia , Humanos , Resultado del Tratamiento , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapia , Masculino , Cianoacrilatos/administración & dosificación , Cianoacrilatos/efectos adversos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Anciano , Femenino , Adhesivos Tisulares , Persona de Mediana EdadAsunto(s)
Prótesis Valvulares Cardíacas , Corazón Auxiliar , Humanos , Resultado del Tratamiento , Cateterismo Cardíaco/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Masculino , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapia , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Anciano , Femenino , EmbolectomíaRESUMEN
Ballistic embolism represents an unusual complication of vascular by a flying object injury. Because embolus is remote from injury site, the occurrence of missile embolus may be overlooked and lead to delay in diagnosis of significant ischemia or embolism. We herein report a successful surgical removal of a rare missile embolus from the upper arm in the right ventricle. A 44-year-old man visited our hospital because of pulsatile bleeding from the left upper arm due to injury by a flying metal fragment of a hammerhead. Chest roentgenogram and computed tomography (CT) scan 9 days after the injury demonstrated a missile embolus in the right ventricle, which was thought to be ballistic embolism of the metal fragment. We underwent surgical removal of the retained object under cardiopulmonary bypass uneventfully, and discharged home ten days later.
Asunto(s)
Embolia , Ventrículos Cardíacos , Humanos , Masculino , Adulto , Ventrículos Cardíacos/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Embolia/cirugía , Embolia/diagnóstico por imagen , Embolia/etiología , Tomografía Computarizada por Rayos X , Cuerpos Extraños/cirugía , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnóstico por imagenRESUMEN
We describe the case of a male heavy machinery operator who presented from work with a rapidly evolving spinal cord syndrome. Spinal MRI revealed thoracic vertebral body and cord infarction and evolving mild disc prolapse attributed to fibrocartilaginous disc embolism (FCDE). FCDE should be considered as one of the aetiological mechanisms of acute spinal cord infarction in pile-driver/heavy machinery operators, especially in association with adjacent vertebral body infarction and intervertebral disc prolapse. Magnetic resonance imaging (MRI) changes may evolve, warranting early follow-up MRI in appropriate cases.
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Embolia , Infarto , Imagen por Resonancia Magnética , Médula Espinal , Humanos , Masculino , Infarto/diagnóstico por imagen , Infarto/etiología , Embolia/diagnóstico por imagen , Embolia/diagnóstico , Embolia/etiología , Médula Espinal/diagnóstico por imagen , Médula Espinal/irrigación sanguínea , Médula Espinal/patología , Cuerpo Vertebral/diagnóstico por imagen , Adulto , Vértebras Torácicas/diagnóstico por imagen , Enfermedades de los Cartílagos/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/complicacionesAsunto(s)
Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Resultado del Tratamiento , Aortografía , Anciano de 80 o más Años , Masculino , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Angiografía por Tomografía Computarizada , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Anciano , Diseño de Prótesis , Dilatación Patológica , Femenino , Aorta/diagnóstico por imagen , Aorta/cirugía , Embolia/etiología , Embolia/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/etiologíaAsunto(s)
Estenosis de la Válvula Aórtica , Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Anciano de 80 o más Años , Femenino , Embolia/etiología , Embolia/diagnóstico por imagen , Prótesis Valvulares Cardíacas/efectos adversos , Masculino , AncianoRESUMEN
BACKGROUND: This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS: Between January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia were admitted to our center, including 11 cases of SMAE, 3 cases of superior mesenteric artery thrombosis, and 4 cases of superior mesenteric vein thrombosis. We retrospectively reviewed 8 patients (4 males and 4 females; range, 51-79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography. Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. RESULTS: The technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. One patient received an adjunctive catheter-directed thrombolysis due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. Two patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6-15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. Computed tomography angiography images showed good flow in the trunk and branches of the SMA in all patients. CONCLUSIONS: PMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.
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Arteria Mesentérica Superior , Isquemia Mesentérica , Oclusión Vascular Mesentérica , Trombectomía , Humanos , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Anciano , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Arteria Mesentérica Superior/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/terapia , Oclusión Vascular Mesentérica/cirugía , Oclusión Vascular Mesentérica/mortalidad , Resultado del Tratamiento , Trombectomía/efectos adversos , Trombectomía/instrumentación , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/terapia , Isquemia Mesentérica/fisiopatología , Factores de Tiempo , Enfermedad Aguda , Embolia/etiología , Embolia/cirugía , Embolia/diagnóstico por imagen , Succión , Diseño de Equipo , ChinaRESUMEN
This case report documents the management of a 66-year old man with atrial fibrillation with recent placement of a WATCHMAN® Flex atrial appendage occlusion device. The patient presented with renal failure, abdominal pain, and difficulty walking 2 months after placement. The WATCHMAN® Flex device was found to have embolized to his abdominal aorta at the level of the renal arteries with associated thrombus. Extensive workup revealed reduced left ventricular cardiac function and decreased renal function, both of which were felt to be potentially reversible with device removal. The patient then underwent retrieval of the device and all associated thrombus via an open retroperitoneal approach. This case demonstrates a potential consequence of implanting devices such as an atrial appendage occlusion device and describes a technique for removal.
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Apéndice Atrial , Fibrilación Atrial , Remoción de Dispositivos , Migración de Cuerpo Extraño , Humanos , Anciano , Masculino , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Fibrilación Atrial/diagnóstico , Resultado del Tratamiento , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Diseño de Prótesis , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Trombosis/etiología , Trombosis/diagnóstico por imagen , Trombosis/terapia , Trombosis/fisiopatología , Aortografía , Angiografía por Tomografía Computarizada , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapiaRESUMEN
INTRODUCTION AND OBJECTIVES: Embolic phenomena frequently occur during hip joint replacement surgery, and may lead to haemodynamic instability in frail patients. Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres, and cannot be performed in awake patients under spinal anaesthesia. The main objectives of this prospective exploratory study were to determine the feasibility of using an alternative ultrasound approach to monitor the inferior vena cava during hip replacement surgery, and to determine the intra and interobserver reliability of the ultrasound findings. METHOD: We conducted a prospective exploratory study in 20 patients undergoing cemented hip arthroplasty in the supine position under spinal anaesthesia and sedation. The inferior vena cava was assessed through a subcostal window at 10 intraoperative time points, and the findings were rated on a qualitative embolism severity scale. The ultrasound images were evaluated by 2 independent observers. RESULTS: An adequate subcostal window was obtained in 90% of cases. Intra- and inter-observer reliability was high (kappa index >0.80, pâ¯<â¯0.001). Nearly all (95%) patients presented some degree of embolism, which was severe in 50% of cases. CONCLUSIONS: Our study suggests that ultrasound assessment of embolic phenomena in the inferior vena cava through a subcostal window is feasible in 90% of cases. The qualitative embolic severity rating scale is highly reproducible and has high intra- and inter-observer reliability.
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Artroplastia de Reemplazo de Cadera , Estudios de Factibilidad , Complicaciones Intraoperatorias , Vena Cava Inferior , Humanos , Vena Cava Inferior/diagnóstico por imagen , Estudios Prospectivos , Femenino , Masculino , Anciano , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Intraoperatorias/etiología , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Anciano de 80 o más Años , Ultrasonografía/métodos , Embolia/diagnóstico por imagen , Embolia/etiología , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Anestesia Raquidea/métodosRESUMEN
The use of left atrial appendage occlusion (LAAO) devices have gained prominence as an alternative to long-term anticoagulation therapy in patients with atrial fibrillation at risk of stroke and high risk of bleeding. While these devices have shown efficacy in reducing stroke risk, there have been reported cases of embolization of the Watchman device. There are very few cases of successful percutaneous retrieval of embolized Watchman devices from the left ventricle (LV), as many of these cases require open heart surgery for safe removal. We are presenting a case of an 80-year-old male whose Watchman device embolized to the LV and was entrapped on the LV papillary muscle that was then successfully retrieved via percutaneous methods, which shows the percutaneous options remain a viable strategy to retrieve LAAO devices from the LV.
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Fibrilación Atrial , Cateterismo Cardíaco , Remoción de Dispositivos , Migración de Cuerpo Extraño , Músculos Papilares , Humanos , Masculino , Anciano de 80 o más Años , Resultado del Tratamiento , Fibrilación Atrial/terapia , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Migración de Cuerpo Extraño/terapia , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Músculos Papilares/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Embolia/etiología , Embolia/diagnóstico por imagen , Embolia/terapia , Embolia/diagnóstico , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Ecocardiografía TransesofágicaRESUMEN
PURPOSE: The purpose of this study was to assess the type and prevalence of stroke and non-stroke-related findings diagnosed on early cardiac computed tomography (CT) in patients with suspected stroke. The secondary objective was to assess the clinical consequences on the management of patients with non-stroke-related conditions identified by early cardiac CT. MATERIALS AND METHODS: This single-center, retrospective, observational study included 1111 consecutive patients with suspected ischemic stroke between November 2018 and March 2020 who underwent cardiac CT examination in addition to the usual brain CT protocol (i.e., non-enhanced brain CT, perfusion brain CT when needed, aortic arch and supra-aortic CT angiography, and post contrast brain CT). There were 562 women and 549 men with a median age of 74 years (range: 60-85 years). Of these, 415 (415/1111; 37.4%) patients had ischemic stroke and 692 (692/1111; 62.3%) had no stroke. Cardiac CT examinations were retrospectively reviewed for cardiac CT findings at high embolic risk and clinically significant extracardiac incidental findings. RESULTS: Among 1111 included patients, 89 (89/1111; 8.0%) had a stroke-related condition identified on early cardiac CT. This was significantly more frequent in patients with ischemic stroke (66/415; 15.9%) by comparison with those without ischemic stroke (23/696; 3.3%) (P < 0.001), with 41 patients (41/415; 9.9%) diagnosed with left atrial thrombus. Cardiac CT revealed a clinically significant non-stroke-related finding in 173 patients (173/1111; 15.6%), including 17 pulmonary embolisms (1.5%), seven suspicious pulmonary lesions (0.6%), and three breast lesions suspected to be malignant (0.3%). Twenty out of 173 patients (20/173; 11.5%) with incidental findings on early cardiac CT had a change in their management. CONCLUSION: This study shows that adding early cardiac CT to brain CT during the acute phase of an ischemic stroke leads to a higher rate of etiological diagnoses and highlights the major interest of looking at the bigger picture.
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Hallazgos Incidentales , Accidente Cerebrovascular Isquémico , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Persona de Mediana Edad , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Prevalencia , Embolia/diagnóstico por imagenRESUMEN
OBJECTIVE: Atrial fibrillation (AF) detected after insular stroke might arise from autonomic and inflammatory mechanisms triggered by insular damage, and be associated with a low embolic risk. We assessed the association of the timing of AF detection and insular involvement with the risk of embolic events after acute ischemic stroke. METHODS: Acute ischemic stroke patients with AF who underwent brain magnetic resonance imaging at baseline were enrolled. Patients were classified according to the timing of AF detection (AF detected after stroke [AFDAS] or known AF [KAF]) and insular involvement. The primary outcome was embolic events defined as recurrent ischemic stroke, transient ischemic attack, and systemic embolism within 90 days. RESULTS: Of 1,548 patients, 360 had AFDAS with insular cortex lesions (+I), 409 had AFDAS without insular cortex lesions (-I), 349 had KAF+I, and 430 had KAF-I. Cumulative incidence rates of embolic events at 90 days in patients with AFDAS+I, AFDAS-I, KAF+I, and KAF-I were 0.8%, 3.5%, 4.9%, and 3.3%, respectively. Patients with AFDAS-I (adjusted hazard ratio 5.04, 95% confidence interval 1.43-17.75), KAF+I (6.18, 1.78-21.46), and KAF-I (5.26, 1.48-18.69) had a significantly higher risk of embolic events than those with AFDAS+I. INTERPRETATION: Acute ischemic stroke patients with AFDAS and insular cortex lesions had a lower risk of embolic events than those who had AFDAS without insular cortex lesions or those with KAF, regardless of insular involvement. ANN NEUROL 2024;95:338-346.
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Fibrilación Atrial , Isquemia Encefálica , Embolia , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular Isquémico/complicaciones , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Embolia/complicaciones , Embolia/diagnóstico por imagen , Factores de RiesgoAsunto(s)
Embolia , Enfermedades Gastrointestinales , Oclusión Vascular Mesentérica , Humanos , Arteria Mesentérica Superior/diagnóstico por imagen , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/terapia , Embolectomía , Catéteres , Enfermedad Iatrogénica , Oclusión Vascular Mesentérica/cirugíaRESUMEN
Bullet vascular embolism is a rare complication of gunshot wounds with risk of dire consequences and even death. Bullet embolism of internal carotid artery is extremely rare. Therefore, there is no uniform approach to the treatment of these patients. Nevertheless, removal of embolus through available surgical approach and arterial reconstruction with restoration of blood flow seems optimal. The authors present a 14-year-old patient with a wound to the left half of the chest from pneumatic gun complicated by bullet migration to the right ICA. Surgical intervention made it possible to remove the bullet from the artery and eliminate the risk of thrombosis and embolism. This case demonstrates the possibilities of open reconstructive surgery of supra-aortic vessels.
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Embolia , Heridas por Arma de Fuego , Humanos , Adolescente , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/cirugíaAsunto(s)
Enfermedades de los Cartílagos , Embolia , Isquemia de la Médula Espinal , Humanos , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Enfermedades de los Cartílagos/complicaciones , Enfermedades de los Cartílagos/diagnóstico por imagen , Embolia/complicaciones , Embolia/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Infarto/diagnóstico por imagen , Infarto/etiologíaRESUMEN
Non-bacterial thrombotic endocarditis, characterised by sterile vegetations, is commonly caused by systemic lupus erythematosus and is known to be complicated with embolic cerebrovascular disease. Embolic myocardial infarction with non-bacterial thrombotic endocarditis is extremely rare. We report a case of ventricular fibrillation arrest from presumed coronary embolisation in non-bacterial thrombotic endocarditis. While there are no standardised guidelines on the management of embolic myocardial infarction in endocarditis, it requires a multidisciplinary approach unique for every encountered clinical scenario.
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Embolia , Endocarditis no Infecciosa , Endocarditis , Paro Cardíaco , Infarto del Miocardio , Humanos , Endocarditis no Infecciosa/diagnóstico , Endocarditis no Infecciosa/diagnóstico por imagen , Infarto del Miocardio/complicaciones , Endocarditis/complicaciones , Endocarditis/diagnóstico , Paro Cardíaco/complicaciones , Embolia/complicaciones , Embolia/diagnóstico por imagenRESUMEN
This study aimed to construct a large animal model of coronary microvascular embolism, and investigate whether it could mimic the clinical imaging phenotypes of myocardial hypoperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Nine minipigs underwent percutaneous coronary embolization with microspheres, followed by cardiac magnetic resonance (CMR) on week 1, 2 and 4 post operation. Microvascular obstruction (MVO) was defined as the isolated hypointense core within the enhanced area on late gadolinium enhancement images, which evolved during a 4-week follow-up. Fibrotic fraction of the segments was measured by Masson trichrome staining using a panoramic analysis software. Iron deposit and macrophage infiltration were quantified based on Perl's blue and anti-CD163 staining, respectively. Seven out of 9 (77.8%) minipigs survived and completed all of the imaging follow-ups. Four out of 7 (57.1%) minipigs were identified as transmural infarct with MVO. The systolic wall thickening (SWT) of MVO zone was similar to that of infarct zone (P = 0.762). Histopathology revealed transmural deposition of collagen, with microvessels obstructed by microspheres. The fibrotic fraction of infarct with MVO segments was similar to that of infarct without MVO segments (P = 0.954). The fraction of iron deposit in infarct with MVO segments was higher than that of infarct without MVO segments (P < 0.05), but the fraction of macrophage infiltration between these two segments did not show statistical difference (P = 0.723). Large animal model of coronary microvascular embolism could mimic most clinical imaging phenotypes of myocardial hypoperfusion in patients with STEMI, demonstrated by serial CMR and histopathology.
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Enfermedad de la Arteria Coronaria , Embolia , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Animales , Porcinos , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/cirugía , Medios de Contraste , Porcinos Enanos , Circulación Coronaria , Valor Predictivo de las Pruebas , Gadolinio , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Modelos Animales , Embolia/diagnóstico por imagen , Embolia/etiología , MicrocirculaciónRESUMEN
Ascending aorta thrombosis unaccompanied by an aneurysm or a primary hypercoagulable state is rare. We report a surgical case of ascending aorta thrombosis with multiple emboli. A 44-year-old woman visited the hospital for evaluation of dysarthria and was diagnosed with multiple cerebral infarcts. Contrast-enhanced computed tomography (CT) revealed a mass in the ascending aorta and the brachiocephalic artery. We performed emergency removal of the masses and endarterectomy with cardiopulmonary bypass under hypothermic circulatory arrest. Histopathological examination of the resected specimen showed thrombi. The patient had an uneventful recovery and was discharged 12 days postoperatively. No recurrent thrombus or hypercoagulable state was observed for 3 years postoperatively.