Parent artery stenting as a rescue management for stretched coils during cerebral aneurysms embolization: Report of three cases and review of literature

Background Displacement of a stretched coil into the parent artery during intracranial aneurysm coiling is a challenging situation where the risk of acute intravascular thrombosis might be a life-threatening condition. The usual way of management is coil snaring, yet in some cases, it might not be feasible to retrieve the coil. Parent artery rescue stenting had already been described as a way of management in acutely thrombosed parent arteries during aneurysm coiling. Case reports We present three cases with an inadvertent displacement of the unraveled coils into the parent artery for which rescue stenting was carried out to crush the coil against the vessel wall aiming to eliminate its thrombogenic effect. Our preliminary experience is that rescue stenting of the parent artery for stretched coil could be a convenient effective option particularly in case of failed/risky snaring with no notable immediate or long-term complications. Review and discussion We review the reported cases of stretched coils with or without further unraveling and fracture and discuss the possible consequences, salvage methods, and clinical outcomes. Neurointerventionists should be aware of this complication and get acquainted with bailout strategies.

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Spontaneous liver rupture in a pregnant woman associated with HELLP syndrome

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.20193132-138 ◽

2019 ◽

Vol 24 (3) ◽

pp. 132-138

Author(s):

T. M. Bunyatov ◽

I. A. Kozlov ◽

B. N. Gurmikov ◽

Yu. A. Stepanova ◽

V. S. Shirokov ◽

...

Keyword(s):

Hellp Syndrome ◽

Similar Case ◽

Case Reports ◽

Endovascular Embolization ◽

Syndrome Patient ◽

Liver Rupture ◽

Right Hepatic Artery ◽

Appropriate Treatment ◽

Threatening Condition ◽

Life Threatening

Spontaneous liver rupture is rare and highly dangerous, life-threatening condition occurring in 1–2% of pregnant women with preeclampsia and eclampsia. There are more than 100 similar case reports in the literature. It is believed that liver rupture is caused by HELLP syndrome as one of the signs of preeclampsia. The results of surgical treatment is still unsatisfactory. Appropriate treatment strategy is absent because of rareness of this condition. It is presented case report of a woman with spontaneous liver rupture associated with HELLP syndrome. Patient underwent perihepatic tamponade, endovascular embolization of right hepatic artery followed by right-sided hemihepatectomy.

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Treatment of Cerebral Aneurysms With Flow Divertors: Long Term Results in an In Vivo Model

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-176277 ◽

2007 ◽

Author(s):

Chander Sadasivan ◽

Baruch B. Lieber ◽

Liliana Cesar ◽

Jaehoon Seong ◽

Ajay K. Wakhloo

Keyword(s):

Thrombus Formation ◽

Cerebral Aneurysms ◽

Long Term Results ◽

In Vivo Model ◽

Parent Artery ◽

Momentum Exchange ◽

Aneurysm Neck ◽

Flow Stasis

Subarachnoid hemorrhagic stroke is a devastating illness with a 30-day mortality rate of 45% and is mostly caused due to the rupture of an intracranial aneurysm. Although these aneurysms are currently treated surgically by clipping, or, endovascularly by coiling and stent-assisted coiling, the feasibility of successfully treating aneurysms solely by the placement of an intravascular flow-diverting mesh across the aneurysm neck was established more than a decade ago [1]. Flow divertors disrupt the momentum exchange between the parent artery and aneurysm and significantly reduce intraaneurysmal hydrodynamic vorticity. The resultant flow stasis promotes thrombus formation within the aneurysm sac, which eventually matures into fibrotic tissue, leading to the exclusion of the aneurysm from the circulation. With the increased use of stents in the intracranial circulation, cases where coiling is not feasible, or is staged as a secondary procedure, are providing clinical evidence of the successful treatment of aneurysms with stents alone [2,3]. Such reports are sporadic and, moreover, the devices used are not designed to be flow divertors. Methodological evidence of the performance of appropriately designed flow divertors in treating cerebral aneurysms is currently unavailable.

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Cholesterol Embolism in Intensive Care Patients

Journal of Intensive Care Medicine ◽

10.1177/088506669300800205 ◽

1993 ◽

Vol 8 (2) ◽

pp. 91-102 ◽

Cited By ~ 1

Author(s):

Lisa L. Kirkland

Keyword(s):

Case Reports ◽

Supportive Therapy ◽

Hemodynamic Instability ◽

Cholesterol Embolism ◽

Intensive Care Patients ◽

Major Organ ◽

Life Threatening ◽

Perineal Gangrene ◽

Long Term Prognosis

Four case reports are presented, followed by a discussion of the acute, potentially life-threatening manifestations of the cholesterol embolism syndromes. Every major organ system except the lungs may be directly affected by cholesterol emboli; devastating consequences encompass cerebral, myocardial, spinal cord, intestinal, renal, and other visceral organ infarction, as well as peripheral and perineal gangrene. Additional complications include severe hypertension, gastrointestinal bleeding, and hemodynamic instability. Anticoagulants and thrombolytic therapy may exacerbate atheromatous embolism and are relatively contraindicated. Aggressive supportive therapy may improve chances of survival, but long-term prognosis is poor. Prevention remains the most important aspect in this devastating disorder.

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Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

Interventional Neuroradiology ◽

10.1177/1591019918824866 ◽

2019 ◽

Vol 25 (4) ◽

pp. 454-459

Author(s):

Changchun Jiang ◽

Wei Wang ◽

Baojun Wang ◽

Yuechun Li ◽

Guorong Liu ◽

...

Keyword(s):

Cerebral Aneurysm ◽

Coil Embolization ◽

Case Reports ◽

Balloon Catheter ◽

Treatment Strategies ◽

Cerebral Aneurysms ◽

Interventional Therapy ◽

Parent Artery ◽

Clinical Practices ◽

Detachable Coils

Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

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Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

Ear Nose & Throat Journal ◽

10.1177/0145561320952506 ◽

2020 ◽

Vol 100 (1) ◽

pp. 19-25

Author(s):

Sarina K. Mueller ◽

Maximilian Traxdorf ◽

Konstantinos Mantsopoulos ◽

Antoniu-Oreste Gostian ◽

Matti Sievert ◽

...

Keyword(s):

Quality Of Life ◽

Emergency Surgery ◽

Transmission Rate ◽

Medical Personnel ◽

Human Beings ◽

Threatening Condition ◽

Long Time ◽

Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

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Mucormycosis coinfection associated with global COVID-19: a case series from India

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211574 ◽

2021 ◽

Vol 7 (5) ◽

pp. 815

Author(s):

Deepthi Satish ◽

Divya Joy ◽

Anita Ross ◽

Balasubramanya .

Keyword(s):

Fungal Infection ◽

Fungal Infections ◽

Case Reports ◽

Case Series ◽

Retrospective Case ◽

High Dependency ◽

Life Threatening ◽

Immunocompromised Status ◽

Retrospective Case Study

Background: Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. There has been increasing number of mucormycosis cases during COVID-19 pandemic and also as post COVID-19 sequelae. Our study aimed at scrutinizing a possible coinfection of invasive mycoses and COVID-19 and also its managementMethods: We did a retrospective case study of 25 patients presenting as invasive fungal infection from March -December 2020. Majority of patients were immunocompromised, since they presented during the pandemic, all patients were subjected to rapid antigen and RT -PCR testing for COVID-19.Results: 11 patients tested COVID-19 positive out of 25. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. COVID-19 positive patients were managed in the high dependency units and COVID-19 wards. Severe COVID-19 positive patients were empirically started on IV Amphotericin based on clinical suspicion of mucormycosis and were taken up for debridement once stable. Negative patients underwent surgical debridement and were started on IV Amphotericin postoperatively.Conclusions: There have been lot of case reports from India showing COVID-19 recovered patients presenting with invasive fungal infections, this could be because of their immunocompromised status and long-term corticosteroid use. In our case series we had three patients with post COVID-19 mucormycosis. There was a surge in COVID-19 positive mucor cases during August and September which also coincided with the maximum peak of cases in India, thereafter, there has been a declining trend. There have been significant challenges in treatment modality and outcome due to the pandemic.

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Življenje ogrožajoč angioedem po zaviralcu angiotenzinove konvertaze: prikaz dveh primerov Life-threatening angioedema induced by angiotensin-converting enzyme inhibitor: two case reports

Slovenian Medical Journal ◽

10.6016/zdravvestn.1349 ◽

2016 ◽

Vol 84 (12) ◽

Author(s):

Erik Rupnik ◽

Stojan Kariž ◽

Črtomir Iglič ◽

Mihaela Zidarn

Keyword(s):

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Enzyme Inhibitor ◽

Case Reports ◽

Angiotensin Converting Enzyme Inhibitors ◽

Converting Enzyme ◽

Converting Enzyme Inhibitors ◽

Key Enzyme ◽

Life Threatening

Background. Angioedema is a rare but potentially very serious complication of treatment with angiotensin converting enzyme inhibitors (ACEI). Angioedema is due to the accumulation of bradykinin, because angiotensin converting enzyme is the key enzyme for its degradation.Case reports. We present two patients with life-threatening angioedema while taking ACEI. Both patients had already had episodes of angioedema. Angioedema didn't respond to adrenaline. In both patients intubation was difficult.Conclusion. In the acute phase of angioedema due to ACEI it is necessary to protect the airways. Bradykinin receptor inhibitors shorten the duration of episodes of angioedema. In the long term it is essential to permanently avoid ACEI.

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Long-term efficacy of lipoprotein apheresis and lomitapide in the treatment of homozygous familial hypercholesterolemia (HoFH): a cross-national retrospective survey

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01999-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Laura D’Erasmo ◽

Antonio Gallo ◽

Angelo Baldassare Cefalù ◽

Alessia Di Costanzo ◽

Samir Saheb ◽

...

Keyword(s):

Familial Hypercholesterolemia ◽

Treatment Algorithm ◽

Lipid Lowering ◽

Homozygous Familial Hypercholesterolemia ◽

Lipoprotein Apheresis ◽

Term Efficacy ◽

Threatening Condition ◽

Life Threatening

Abstract Background Homozygous familial hypercholesterolemia (HoFH) is a rare life-threatening condition that represents a therapeutic challenge. The vast majority of HoFH patients fail to achieve LDL-C targets when treated with the standard protocol, which associates maximally tolerated dose of lipid-lowering medications with lipoprotein apheresis (LA). Lomitapide is an emerging therapy in HoFH, but its place in the treatment algorithm is disputed because a comparison of its long-term efficacy versus LA in reducing LDL-C burden is not available. We assessed changes in long-term LDL-C burden and goals achievement in two independent HoFH patients’ cohorts, one treated with lomitapide in Italy (n = 30) and the other with LA in France (n = 29). Results The two cohorts differed significantly for genotype (p = 0.004), baseline lipid profile (p < 0.001), age of treatment initiation (p < 0.001), occurrence of cardiovascular disease (p = 0.003) as well as follow-up duration (p < 0.001). The adjunct of lomitapide to conventional lipid-lowering therapies determined an additional 58.0% reduction of last visit LDL-C levels, compared to 37.1% when LA was added (padj = 0.004). Yearly on-treatment LDL-C < 70 mg/dl and < 55 mg/dl goals were only achieved in 45.5% and 13.5% of HoFH patients treated with lomitapide. The long-term exposure to LDL-C burden was found to be higher in LA than in Lomitapide cohort (13,236.1 ± 5492.1 vs. 11,656.6 ± 4730.9 mg/dL-year respectively, padj = 0.002). A trend towards fewer total cardiovascular events was observed in the Lomitapide than in the LA cohort. Conclusions In comparison with LA, lomitapide appears to provide a better control of LDL-C in HoFH. Further studies are needed to confirm this data and establish whether this translates into a reduction of cardiovascular risk.

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Hereditary angioedema: Long-term prophylactic treatment

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200092 ◽

2020 ◽

Vol 41 (6) ◽

pp. S35-S37

Author(s):

Huamin Henry Li

Keyword(s):

Disease Management ◽

Hereditary Angioedema ◽

Clinical Investigation ◽

Limiting Factors ◽

Plasma Kallikrein ◽

Therapeutic Drugs ◽

Threatening Condition ◽

Life Threatening ◽

Risk And Benefit

Hereditary Angioedema (HAE) is a potentially life-threatening condition. With episodic, unpredictable swelling, HAE negatively affect the quality of life for those affected individuals. To reduce the morbidity and mortality of HAE are the primary goal for the disease management. In addition to have access to therapeutic drugs for their acute HAE attacks, many patients require long term prophylaxis (LTP) to reduce their attack frequency and severity. Preventing HAE attack by regular administration of medicine has become an important part of HAE disease management. Over the past few years, growing number of therapeutic options for the HAE LTP have made it possible for physicians to choose the most appropriate and effective treatment for individual patients. C1 INH concentrate and plasma kallikrein inhibitors (IV or SC) have largely replaced the oder modality of treatment consisting different androgen derivatives or antifibrinolytics. Additional options, such as oral kallikrein inhibitor, antisense RNA/plasma kallikrein, anti-Factor 12a, bradykinin receptor blocker or future gene therapy are under clinical investigation. The significant cost and the uncertainty of its long term safety may be the primary limiting factors for its clinical application. The limited data for young children and pregnant women pose additional challenge for physicians to assess the risk and benefit when considering LTP treatment.

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Liver Disease Secondary to Intestinal Failure

BioMed Research International ◽

10.1155/2014/968357 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Bassam Abu-Wasel ◽

Michele Molinari

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Multidisciplinary Approach ◽

Intestinal Failure ◽

Term Survival ◽

Early Referral ◽

Long Term Survival ◽

Threatening Condition ◽

Life Threatening

IFALD is a common and potentially life-threatening condition for patients with SBS requiring long-term PN. There exists the potential for decreasing its incidence by optimizing the composition and the rate of infusion of parenteral solutions, by advocating a multidisciplinary approach, and by early referral for intestinal-liver transplantation to ensure long-term survival of patients with SBS.

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