Intraventricular Silicone Oil Migration Resembling Hemorrhagic Complication in a Patient with Ischemic Stroke Receiving Antithrombotic Therapy

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

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Intravitreal Silicone Oil Migration Into the Lateral Cerebral Ventricles

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419875298 ◽

2019 ◽

Vol 3 (6) ◽

pp. 466-473

Author(s):

Jessica L. Cao ◽

Andrew W. Browne ◽

Thomas Clifford ◽

Sumit Sharma ◽

Vivek Patel

Keyword(s):

Case Report ◽

Retinal Detachment ◽

Literature Review ◽

Current Literature ◽

Symptom Management ◽

Silicone Oil ◽

Cerebral Ventricles ◽

Oil Migration ◽

Intraocular Tamponade ◽

History Of

Purpose: Silicone oil (SO) is often used as an intraocular tamponade in repairs of retinal detachments. It may be associated with complications such as cataract, glaucoma, keratopathy, subretinal migration of oil, fibrous epiretinal and sub retinal proliferations, and oil emulsification. The purpose of this report is to describe a rare phenomenon of intraocular silicone oil migration into the cerebral ventricles, which may later be mistaken for intraventricular hemorrhages on neuroimaging. Methods: Case report with literature review. Results: A patient with a history of retinal detachment repair with intraocular SO presented with headaches. Neuroimaging revealed SO migration to the cerebral ventricles. The patient was treated conservatively with symptom management and headaches resolved. Conclusions: We present a case of intraocular SO migration to the cerebral ventricles and review the current literature. We also propose two mechanisms for this phenomenon.

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Silicone Oil Migration

10.1148/cases.20226014 ◽

2022 ◽

Author(s):

Sahithi Sharma ◽

Veena D. Sathyakumar, MBBS, MD

Keyword(s):

Silicone Oil ◽

Oil Migration

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Abstract P252: Discharge Antithrombotic Therapy for Ischemic Stroke Patients With Prior Aspirin Failure

Stroke ◽

10.1161/str.52.suppl_1.p252 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ying Xian ◽

Haolin Xu ◽

Deepak L Bhatt ◽

Gregg C Fonarow ◽

Eric E Smith ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Prevention ◽

Antithrombotic Therapy ◽

Recurrent Stroke ◽

Oral Anticoagulants ◽

The United States ◽

Future Research ◽

Large Artery ◽

Secondary Stroke Prevention ◽

Stroke Registry

Introduction: Aspirin is one of the most commonly used medications for cardiovascular disease and stroke prevention. Many older patients who present with a first or recurrent stroke are already on aspirin monotherapy, yet little evidence is available to guide antithrombotic strategies for these patients. Method: Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we described discharge antithrombotic treatment pattern among Medicare beneficiaries without atrial fibrillation who were discharged alive for acute ischemic stroke from 1734 hospitals in the United States between October 2012 and December 2017. Results: Of 261,634 ischemic stroke survivors, 100,016 (38.2%) were on prior aspirin monotherapy (median age 78 years; 53% women; 79.4% initial stroke and 20.6% recurrent stroke). The most common discharge antithrombotics (Figure) were 81 mg aspirin monotherapy (20.9%), 325 mg aspirin monotherapy (18.2%), clopidogrel monotherapy (17.8%), and dual antiplatelet therapy (DAPT) of 81 mg aspirin and clopidogrel (17.1%). Combined, aspirin monotherapy, clopidogrel monotherapy, and DAPT accounted for 86.8% of discharge antithrombotics. The rest of 13.2% were discharged on either aspirin/dipyridamole, warfarin or non-vitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotics at all. Among patients with documented stroke etiology (TOAST criteria), 81 mg aspirin monotherapy (21.2-24.0%) was the most commonly prescribed antithrombotic for secondary stroke prevention. The only exception was those with large-artery atherosclerosis, in which, 25.3% received DAPT of 81 mg aspirin and clopidogrel at discharge. Conclusion: Substantial variations exist in discharge antithrombotic therapy for secondary stroke prevention in ischemic stroke with prior aspirin failure. Future research is needed to identify best management strategies to care for this complex but common clinical scenario.

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Changes in Antithrombotic Therapy of Atrial Fibrillation in the Hospital in 2011-2012 and 2016-2017 (Pharmacoepidemiological Analysis)

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2020-10-10 ◽

2020 ◽

Vol 16 (5) ◽

pp. 686-692

Author(s):

O. V. Reshetko ◽

A. V. Sokolov ◽

N. V. Furman ◽

V. V. Agapov

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

High Risk ◽

Antithrombotic Therapy ◽

Heart Defects ◽

Oral Anticoagulants ◽

Prosthetic Heart Valve ◽

Saratov Region ◽

Coronary Syndrome ◽

Risk Of Bleeding

Aim. To study the changes that have occurred in the pharmacotherapy of atrial fibrillation (AF) in the Saratov Region for 5 years by analyzing the antithrombotic therapy of patients who were admitted in a specialized department of the multidisciplinary hospital in Saratov in 2011-2012 and in 2016-2017.Material and methods. A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (Form 003/y) with the diagnosis “Atrial fibrillation” (ICD-X code I48), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from January 1, 2011 to December, 31, 2012 (n=211) and from January 1, 2016 to December, 31, 2017 (n=227). Criteria for inclusion in the study: patients over 18 years of age, established diagnosis of non-valvular AF of ischemic genesis. Exclusion criteria from the study: non-ischemic cardiomyopathy, thyrotoxicosis, congenital heart defects, rheumatic heart damage, acute coronary syndrome, endocarditis, myocarditis, pericarditis, pulmonary thromboembolism, the presence of prosthetic heart valve. Pharmacoepidemiological analysis was carried out for the drugs prescribed during hospitalization and given by doctors at discharge of patients from the hospital. The risk of ischemic stroke was assessed using the CHA2DS2-VASc score, and the risk of bleeding – according to the HAS-BLED score.Results. When analyzing the risk of ischemic stroke, it was found that 100% of patients in 2011-2012 years and 98.2% in 2016-2017 years had indications for the prescription of oral anticoagulants (OAСs). In 2011-2012 there were no patients with a low risk of stroke (CHA2DS2-VASc=0). High risk of bleeding (HAS-BLED≥3) occurred in 4.7% of patients in 2011-2012 and in 10.6% in 2016-2017, however, due to the high risk of stroke, the refusal to prescribe OAC in these patients was inappropriate in accordance with the recommendations for the treatment of AF. In the group of patients with CHA2DS2-VASc=0 in 2016-2017 antiplatelet therapy was prescribed in 100% at the hospital stage and at discharge, which contradicts the guidelines, according to which antithrombotic therapy is not recommended to patients with CHA2DS2-VASc=0. In patients with CHA2DS2-VASc=1, a low percentage of anticoagulants prescription was noted. In 2016-2017 OACs were prescribed only in 12.5% of patients at all stages of observation. In 2011-2012 OAC alone was prescribed only to 1 person (20%) at the hospital stage, which does not comply with modern guidelines for the treatment of patients with AF, according to which patients with a risk score CHA2DS2-VASc=1 are recommended to receive OACs in the absence of contraindications. OACs prescription in group CHA2DS2-VASc≥2 occurred only in 15% of patients in 2011-2012 and in a third of patients in 2016-2017 (p<0.05). The frequency of isolated use of OACs significantly increased in 2016-2017 compared to 2011-2012 mainly due to the increase in the spectrum of direct OACs (DOACs) (p<0.05).Conclusion. For 5 years there have been significant changes in the antithrombotic therapy of AF in the Saratov Region. The frequency of prescribing OACs according to indications has increased mainly due to the introduction of the DOACs into clinical practice. However, prevention of stroke remains insufficient.

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Aspirin Versus Low-Dose Low-Molecular-Weight Heparin: Antithrombotic Therapy in Pediatric Ischemic Stroke Patients: A Prospective Follow-Up Study

Stroke ◽

10.1161/hs1101.097379 ◽

2001 ◽

Vol 32 (11) ◽

pp. 2554-2558 ◽

Cited By ~ 72

Author(s):

R. Strater ◽

K. Kurnik ◽

C. Heller ◽

R. Schobess ◽

P. Luigs ◽

...

Keyword(s):

Molecular Weight ◽

Ischemic Stroke ◽

Antithrombotic Therapy ◽

Low Molecular Weight Heparin ◽

Low Dose ◽

Low Molecular Weight ◽

Stroke Patients ◽

Follow Up Study

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Abstract WP411: Asymptomatic Hemorrhage Predicts Delayed Symptomatic Hemorrhage After Alteplase in Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp411 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Katarina Dakay ◽

Brittany Ricci ◽

Andrew D Chang ◽

Shawna Cutting ◽

Brian Mac Grory ◽

...

Keyword(s):

Ischemic Stroke ◽

Brain Imaging ◽

Median Time ◽

Antithrombotic Therapy ◽

Strong Predictor ◽

Antithrombotic Treatment ◽

Code Status ◽

Blood Brain Barrier Disruption ◽

Brain Barrier Disruption ◽

Comprehensive Stroke Center

Background: Predictors of alteplase associated symptomatic intracranial hemorrhage (sICH) have been identified but there are very limited data on predictors of delayed sICH (> 24 hours from infusion). We hypothesize that asymptomatic hemorrhage on 24 hour brain imaging predicts delayed sICH and that delaying antithrombotic treatment in these patients reduces this risk. Methods: This is a retrospective analysis of a prospective quality improvement database of a comprehensive stroke center. We included all patients with a discharge diagnosis of ischemic stroke who received alteplase. Patients with sICH occurring within 24 hours from alteplase and those whose code status was changed to comfort measures only were excluded. Delayed sICH was defined as any hemorrhage causing neurological deterioration. We compared baseline characteristics, asymptomatic hemorrhage on 24 hour brain imaging, and median time to initiating antithrombotic therapy between patients with and without delayed sICH. Results: Among 606 patients who met our inclusion criteria; mean age was 70 years and 52% were men; 23.8% had asymptomatic hemorrhage on 24 hour brain imaging (CT or MRI) and 12 patients (2%) had delayed sICH. Aspirin was the most common initial antithrombotic (91.2%) followed by plavix (2.6%), and others (3.8%). After adjusting for confounders, asymptomatic hemorrhage on 24 hour brain imaging was associated with increased odds of delayed sICH (OR 5.5, 95% CI 1.52 - 19.87, p = 0.009) but the median time (days) to starting antithrombotic therapy did not differ between those with asymptomatic hemorrhage who developed delayed sICH vs. those who did not [2 (3) vs. 3 (5), p = 0.447). Conclusion: Delayed sICH in patients receiving alteplase is uncommon and asymptomatic hemorrhage is a strong predictor. Delaying initiation of antithrombotic treatment in patients with asymptomatic hemorrhage on 24 hour imaging was not associated with reduced delayed sICH risk. It is possible that other factors such as reperfusion and blood brain barrier disruption are more important determinants of delayed sICH risk as opposed to timing of antithrombotic therapy initiation.

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Migration of Silicone Oil into the Orbit and Eyelid as a Cyst

Case Reports in Ophthalmology ◽

10.1159/000507608 ◽

2020 ◽

Vol 11 (2) ◽

pp. 217-221

Author(s):

Mohammad Sharifi ◽

Mohammad Reza Ansari Astaneh

Keyword(s):

Silicone Oil ◽

Excisional Biopsy ◽

Upper Eyelid ◽

Oil Migration ◽

Eyelid Swelling ◽

Mobile Mass ◽

History Of ◽

Pars Plana ◽

Computed Topography ◽

Oil Injection

A 7-year-old female presented with left upper eyelid swelling following pars plana deep vitrectomy and silicone oil injection 1 year before admission. The left upper eyelid had mechanical ptosis and on palpation there was a lobulated mobile mass in the lateral portion of eyelid. Computed topography scan showed multiple isodense masses with silicone oil in vitreous in the eyelid and orbit; histopathology after excisional biopsy proved the silicone oil migration. Silicone oil migration followed by vitrectomy may be due to leakage from the site of initial wounds or vitrectomy ports. It is important to suspect extraocular silicone oil migration in patients who presented with eyelid mass-like lesions with a history of silicone oil injection following pars plana deep vitrectomy.

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Antithrombotic therapy for atrial fibrillation in patients with acute ischemic stroke or transient ischemic attack

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.11.102 ◽

2015 ◽

Vol 179 ◽

pp. 288-291 ◽

Cited By ~ 2

Author(s):

Poh-Shiow Yeh ◽

Chun-Ming Yang ◽

Sheng-Hsiang Lin ◽

Wei-Ming Wang ◽

Po-Sheng Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Transient Ischemic Attack ◽

Antithrombotic Therapy ◽

Ischemic Attack

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Acute Treatments and Early Outcomes of Childhood Arterial Ischemic Stroke: First Analysis of the International Pediatric Stroke Study.

Blood ◽

10.1182/blood.v112.11.1978.1978 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1978-1978 ◽

Cited By ~ 2

Author(s):

Neil A Goldenberg ◽

Timothy J. Bernard ◽

Anne Gordon ◽

Heather J. Fullerton ◽

Gabrielle A. deVeber

Keyword(s):

Ischemic Stroke ◽

South America ◽

Antithrombotic Therapy ◽

Geographic Region ◽

Treatment Selection ◽

Pediatric Stroke ◽

Arterial Ischemic Stroke ◽

Antithrombotic Treatment ◽

Stroke Study ◽

International Pediatric

Abstract Background: In pediatric arterial ischemic stroke (AIS) clinical treatment trials are lacking and treatment practices variable. Factors determining treatment selection and outcomes are important to delineate. Objective: We aimed to (1) describe acute treatments and outcomes in childhood AIS, and (2) test putative variables for treatment selection, and outcome in a prospective-retrospective multicenter international study. Methods: We evaluated treatments and early outcomes of children enrolled in the International Pediatric Stroke Study with AIS diagnosed at >28 days and <18 years of age from 2003 to 2007. Putative predictor variables for antithrombotic treatment selection included age, clinical AIS subtypes, geographic region (Asia, Australia, Canada, Europe, South America, and U.S.), and diagnosis pre- versus post-2004 (when pediatric AIS guidelines published). Results: Among 676 children with acute AIS, anticonvulsants and antibiotics were administered acutely in 57% and 40%, respectively; use of each decreased with age (P<0.001). Acute anticoagulants (AAC; with/without concomitant anti-platelet therapy) were selected more frequently than either acute anti-platelet agents (AAP) alone or no acute antithrombotic treatment (NAAT) (43% AAC vs. 28% AAP alone and 29% NAAT). NAAT decreased with increasing age. AAC was most frequent in cerebral/cervical arterial dissection (n=52; 75% AAC vs. 6% AAP) and least frequent with moyamoya syndrome (n=72; 31% AC vs. 43% AAP). AAC was most common in Europe and Canada, AAC vs. AAP relatively balanced in the U.S., and AAP most common in Asia and South America. AAC use was similar pre- versus post-2004. At hospital discharge 71% had neurological deficits independent of age, subtype, or geographical region. Mortality at discharge was 3%. Conclusions: Acute anticoagulation is frequently but not uniformly employed in childhood AIS. With current treatment, the prevalence of neurological deficit at hospital discharge is high. These findings reflect disparity in published guidelines and highlight the need for clinical trials to reduce adverse outcomes. Figure 1. Acute antithrombotic therapy in childhood AIS, by geographic region. Figure 1. Acute antithrombotic therapy in childhood AIS, by geographic region.

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