scholarly journals 148 Acute Renal Infarcts from Spontaneous Intra-Renal Dissection

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Daga ◽  
B Chua ◽  
M Taneja
Keyword(s):  
Renal Artery ◽  
Fibromuscular Dysplasia ◽  
Visceral Artery ◽  
Artery Dissection ◽  
Endovascular Stents ◽  
Anti Platelet Therapy ◽  
Ct Angiogram ◽  
Procedural Complications ◽  
Male Patients

Abstract Spontaneous renal artery dissection and acute renal infarcts are rare occurrences and often misdiagnosed in clinical practice. We present four male patients, between 30-50 years of age, who have no underlying cardiac conditions, hypertension, or diabetes mellitus. They presented with abdominal/loin/flank pain due to spontaneous renal artery dissection and were all treated with endovascular stenting. Two patients had renal artery fibromuscular dysplasia, confirmed by CT angiogram, a rare pathology which is reported in literature to mostly affect women. All four patients recovered fully from the operation, with no post-operative complications noted. These patients were post-operatively managed medically with anti-platelet therapy for two years and did not experience any post-procedural complications at their 24-month follow up. Classically visceral artery dissection can be managed by anti-platelet therapy alone, however fibromuscular dysplasia can cause spontaneous dissection with renal infarcts and this requires urgent treatment with endovascular stents. Further research is needed on the post-procedural medical management guidelines.

Spontaneous renal artery dissection: an elusive diagnosis

2021 ◽  
Vol 14 (9) ◽  
pp. e245949
Author(s):  
Catherine Mary Henry ◽  
Peter MacEneaney ◽  
Gemma Browne
Keyword(s):  
Renal Artery ◽  
Antihypertensive Treatment ◽  
Rare Condition ◽  
Acute Onset ◽  
Flank Pain ◽  
Artery Dissection ◽  
Renal Infarction ◽  
Ct Angiogram ◽  
Systemic Anticoagulation ◽  
The Right

Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.

Symptomatic Carotid Stenosis: Stroke and Transient Ischemic Attack

2019 ◽  
Author(s):  
Kenneth R. Ziegler ◽  
Thomas C. Naslund
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Ct Scan ◽  
Hemorrhagic Stroke ◽  
Fibromuscular Dysplasia ◽  
The United States ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Ct Angiogram ◽  
Ischemic Attack

Nearly 800,000 strokes are reported in the United States annually, with an economic impact upward of $33 billion. Carotid artery disease, familiar to all vascular surgeons, accounts for just over one fifth of these strokes. However, these cases reflect an opportunity for the surgeon to intervene and mitigate the substantial burden of stroke. This review includes the epidemiology of stroke in the United States and the carotid artery and noncarotid etiologies of stroke, including atherosclerotic disease, fibromuscular dysplasia, carotid artery dissection, and cardioembolism. The clinical presentations of ischemic and hemorrhagic stroke and transient ischemia attacks are examined, as are the major findings expected in the patient history and physical examination. Strategies for further evaluation of the patient are discussed, including the use of sonographic imaging of the carotid artery and the relative advantages and disadvantages among the dominant modes of brain imaging. New updates to the review include interventional approaches toward the treatment of acute ischemic stroke, as well as the latest strategies regarding the timing of carotid endarterectomy after stroke and the utility of carotid artery stenting in these patients, with active areas of current research highlighted. Figures show a computed tomographic (CT) angiogram of fibromuscular dysplasia of an internal carotid artery, a CT angiogram of an internal carotid artery dissection showing a defect in the dissection, a CT scan demonstrating hemorrhagic conversion of cardioembolic stroke, a CT scan of acute thalamic hemorrhage, a CT scan of evolving ischemic stroke, a T2-weighted image demonstrating acute left frontal stroke and remote right frontal stroke, T1- and T2-weighted images of right parietal ischemic stroke, and M1 occlusion of a middle cerebral artery treated successfully with transcatheter thrombectomy. Tables list Society of Radiologists in Ultrasound and University of Washington criteria for duplex ultrasound diagnosis of carotid artery stenosis.   This review contains 8 figures, 8 tables, and 68 references. Keywords: Carotid stenosis, ischemic stroke, transient ischemic attack, endovascular therapy, thrombolysis, infarct, hemorrhagic stroke, atherosclerosis, embolism

Abstract TP92: Dynamic Digital Subtraction Angiography With Rotation of Head and Neck May Serve as Critical Imaging Modality and Temporary Use of Cervical Collar in Addition to Anti-Platelet Therapy May Prevent Stroke in Cases of Acute Cervical Vertebral Artery Dissection (CVAD)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Stanley H Kim ◽  
Kelsi Hernandez ◽  
Yesenia De La Torre ◽  
Nathan Dhablania
Keyword(s):  
Prospective Study ◽  
Head And Neck ◽  
Cervical Collar ◽  
Artery Dissection ◽  
Lateral Side ◽  
Neutral Position ◽  
Cerebral Angiogram ◽  
Anti Platelet Therapy ◽  
A Prospective Study

Introduction: The AHA/ASA have published a statement on the CVAD in 2014 in which a variety of imaging modalities that are performed with the head in neutral position are discussed and pharmacological and endovascular treatment of CVAD is reviewed. The authors have performed a prospective study of 12 patients with acute spontaneous CVAD from 2012 to 2019 who developed angiographic worsening stenosis or occlusion of the dissected VA associated with rotation of the head and cervical collar was added to the anti-platelet therapy. Methods: From 2012 to 2019, we performed a prospective study of 12 consecutive patients with spontaneous acute CVAD. We reviewed initial and follow-up clinical data and dynamic catheter cerebral angiogram with the patient’s head and neck in the straight neutral position and the head turned to the right and left beyond 60 degrees. Results: A total of 12 patients (Age 41.8 +/- 9.8; M=8, F=4) presented with acute stroke or TIA due to a total of 12 CVAD at the level of V1 (N=1), V2 (N=2), V3 (N=5), V4 (N= 2), V2-3 (N=2) segments diagnosed by cerebral angiogram. Initial mRS and NIHSS scores on admission were 3 +/-0.5 and 1.5 +/- 1.9, respectively. Dynamic cerebral angiogram performed with the patient’s head in neutral position showed average stenosis of 71.6 % +/- 18.9. Symptomatic occlusion or worsening stenosis of the dissected VA was observed on dynamic cerebral angiogram with rotation of the head to the contra-lateral side in 10 of 12 patients (83%). All patients were treated with daily Aspirin and Plavix for at least 3 months and placed on a cervical collar for 1 month. A follow-up dynamic cerebral angiogram at 1.8 +/- 1.4 months showed resolution of rotational occlusion or worsening stenosis of the VA. Clinical follow-up evaluation at 13.1+/- 10.9 months showed mRS score of 0.9+/- 1.0 and NIHSS score of 0.4 +/- 0.7 with no recurrent stroke. Conclusion: Dynamic cerebral angiogram may be critical in diagnosing rotational occlusion or stenosis of the dissected VA in patients with acute CVAD. Traditional imaging of the head and neck in neutral position may fail to diagnose adverse effect of rotation of the head and neck in these patients. Temporary use of cervical collar to prevent rotation of the head in the acute period of CVAD should be considered.

scholarly journals Spontaneous Renal Artery Dissection in a Man with Previous Spontaneous Superior Mesenteric Artery Dissection

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Yujiro Yokoyama ◽  
Masato Nakajima
Keyword(s):  
Renal Artery ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Rare Case ◽  
Visceral Artery ◽  
Artery Dissection ◽  
History Of ◽  
Natural Histories ◽  
Superior Mesenteric Artery Dissection ◽  
Device Technology

Both spontaneous superior mesenteric artery dissection (SMAD) and spontaneous renal artery dissection (SRAD) are very rare conditions. Their etiologies and natural histories are not precisely defined, but they are thought to be associated with underlying conditions. In this report, we describe an extremely rare case of SRAD in a man who had a history of spontaneous SMAD. We successfully treated SRAD with endovascular intervention. Isolated spontaneous SMAD and SRAD are both rare conditions. Their optimal treatment has not been established due to their rare entities, but endovascular treatment is a good option because it can prevent both advancement of infarction and renovascular hypertension, and it has become safer as device technology has improved. Patients with isolated visceral artery dissection should be carefully followed up.

scholarly journals Rare Loss-of-function Mutations of PTGIR Identified in Fibromuscular Dysplasia and Spontaneous Coronary Artery Dissection

2019 ◽  
Author(s):  
Adrien Georges ◽  
Juliette Albuisson ◽  
Takiy Berrandou ◽  
Délia Dupré ◽  
Aurélien Lorthioir ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fibromuscular Dysplasia ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Loss Of Function ◽  
Coronary Artery Dissection ◽  
Genetic Causes ◽  
Prostacyclin Receptor

AbstractBackgroundFibromuscular Dysplasia (FMD) and Spontaneous Coronary Artery Dissection (SCAD) are related, non-atherosclerotic arterial diseases mainly affecting middle-aged women. Little is known about their physiopathological mechanisms.ObjectivesWe aimed to identify rare genetic causes to elucidate molecular mechanisms implicated in FMD and SCAD.MethodsWe analyzed 29 exomes that included familial and sporadic FMD. Follow-up was conducted by targeted or Sanger sequencing (1,071 FMD and 365 SCAD patients) or lookups in exome (264 FMD) or genome sequences (488 SCAD), all independent and unrelated. We used TRAPD burden test to test for enrichment in patients compared to gnomAD controls. The biological effects of variants on receptor signaling and protein expression were characterized using transient overexpression in human cells.ResultsWe identified one rare loss-of-function variant (LoF) (MAFgnomAD=0.000075) shared by two FMD sisters in the prostaglandin I2 receptor (hIP) gene (PTGIR), a key player in vascular remodeling. Follow-up in >1,300 FMD patients revealed four additional LoF allele carriers and a putative enrichment in FMD (PTRAPD=8×10−4), in addition to several rare missense variants. We confirmed the LoFs (Q163X and P17RfsX6) and one missense (L67P) to severely impair hIP function in vitro. Genetic analyses of PTGIR in SCAD revealed one patient who carries Q163X, one with L67P and one carrying a rare splicing mutation (c.768+1C>G), but not a significant enrichment (PTRAPD=0.12) in SCAD.ConclusionsOur study shows that rare genetic mutations in PTGIR are enriched among FMD patients and found in SCAD patients, suggesting a role for prostacyclin signaling in non-atherosclerotic stenosis and dissection.Condensed abstractFibromuscular Dysplasia (FMD) and Spontaneous Coronary Artery Dissection (SCAD) are non-atherosclerotic arterial diseases predominantly affecting women. Their mechanisms and genetic causes are poorly understood. We identified rare loss-of-function mutations of the prostacyclin receptor gene (PTGIR) in several FMD and SCAD patients, including two affected sisters, and several unrelated patients. We also showed that a rare missense mutation of PTGIR severely impairs prostacyclin receptor function in vitro. Our data provide evidence for a role for prostacyclin signaling in the etiology of FMD and SCAD providing leads towards this mechanism.

Symptomatic Carotid Stenosis: Stroke and Transient Ischemic Attack

2020 ◽  
Author(s):  
Kenneth R. Ziegler ◽  
Thomas C. Naslund
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Ct Scan ◽  
Hemorrhagic Stroke ◽  
Fibromuscular Dysplasia ◽  
The United States ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Ct Angiogram ◽  
Ischemic Attack

Nearly 800,000 strokes are reported in the United States annually, with an economic impact upward of $33 billion. Carotid artery disease, familiar to all vascular surgeons, accounts for just over one fifth of these strokes. However, these cases reflect an opportunity for the surgeon to intervene and mitigate the substantial burden of stroke. This review includes the epidemiology of stroke in the United States and the carotid artery and noncarotid etiologies of stroke, including atherosclerotic disease, fibromuscular dysplasia, carotid artery dissection, and cardioembolism. The clinical presentations of ischemic and hemorrhagic stroke and transient ischemia attacks are examined, as are the major findings expected in the patient history and physical examination. Strategies for further evaluation of the patient are discussed, including the use of sonographic imaging of the carotid artery and the relative advantages and disadvantages among the dominant modes of brain imaging. New updates to the review include interventional approaches toward the treatment of acute ischemic stroke, as well as the latest strategies regarding the timing of carotid endarterectomy after stroke and the utility of carotid artery stenting in these patients, with active areas of current research highlighted. Figures show a computed tomographic (CT) angiogram of fibromuscular dysplasia of an internal carotid artery, a CT angiogram of an internal carotid artery dissection showing a defect in the dissection, a CT scan demonstrating hemorrhagic conversion of cardioembolic stroke, a CT scan of acute thalamic hemorrhage, a CT scan of evolving ischemic stroke, a T2-weighted image demonstrating acute left frontal stroke and remote right frontal stroke, T1- and T2-weighted images of right parietal ischemic stroke, and M1 occlusion of a middle cerebral artery treated successfully with transcatheter thrombectomy. Tables list Society of Radiologists in Ultrasound and University of Washington criteria for duplex ultrasound diagnosis of carotid artery stenosis.   This review contains 8 figures, 8 tables, and 68 references. Keywords: Carotid stenosis, ischemic stroke, transient ischemic attack, endovascular therapy, thrombolysis, infarct, hemorrhagic stroke, atherosclerosis, embolism

Symptomatic Carotid Stenosis: Stroke and Transient Ischemic Attack

2020 ◽  
Author(s):  
Kenneth R. Ziegler ◽  
Thomas C. Naslund
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Ct Scan ◽  
Hemorrhagic Stroke ◽  
Fibromuscular Dysplasia ◽  
The United States ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Ct Angiogram ◽  
Ischemic Attack

Nearly 800,000 strokes are reported in the United States annually, with an economic impact upward of $33 billion. Carotid artery disease, familiar to all vascular surgeons, accounts for just over one fifth of these strokes. However, these cases reflect an opportunity for the surgeon to intervene and mitigate the substantial burden of stroke. This review includes the epidemiology of stroke in the United States and the carotid artery and noncarotid etiologies of stroke, including atherosclerotic disease, fibromuscular dysplasia, carotid artery dissection, and cardioembolism. The clinical presentations of ischemic and hemorrhagic stroke and transient ischemia attacks are examined, as are the major findings expected in the patient history and physical examination. Strategies for further evaluation of the patient are discussed, including the use of sonographic imaging of the carotid artery and the relative advantages and disadvantages among the dominant modes of brain imaging. New updates to the review include interventional approaches toward the treatment of acute ischemic stroke, as well as the latest strategies regarding the timing of carotid endarterectomy after stroke and the utility of carotid artery stenting in these patients, with active areas of current research highlighted. Figures show a computed tomographic (CT) angiogram of fibromuscular dysplasia of an internal carotid artery, a CT angiogram of an internal carotid artery dissection showing a defect in the dissection, a CT scan demonstrating hemorrhagic conversion of cardioembolic stroke, a CT scan of acute thalamic hemorrhage, a CT scan of evolving ischemic stroke, a T2-weighted image demonstrating acute left frontal stroke and remote right frontal stroke, T1- and T2-weighted images of right parietal ischemic stroke, and M1 occlusion of a middle cerebral artery treated successfully with transcatheter thrombectomy. Tables list Society of Radiologists in Ultrasound and University of Washington criteria for duplex ultrasound diagnosis of carotid artery stenosis.   This review contains 8 figures, 8 tables, and 68 references. Keywords: Carotid stenosis, ischemic stroke, transient ischemic attack, endovascular therapy, thrombolysis, infarct, hemorrhagic stroke, atherosclerosis, embolism

Natural History of Cervical Artery Fibromuscular Dysplasia and Associated Neurovascular Events

2018 ◽  
Vol 46 (1-2) ◽  
pp. 33-39 ◽  
Author(s):  
Daniella Kadian-Dodov ◽  
Judith Z. Goldfinger ◽  
Susan Gustavson ◽  
Jeffrey W. Olin
Keyword(s):  
Fibromuscular Dysplasia ◽  
Medical Center ◽  
Imaging Study ◽  
Duplex Ultrasound ◽  
Complete Information ◽  
The United States ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Cervical Artery

Background and Purpose: Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy most often affecting the carotid and renal arteries. In the United States Registry for FMD, 41.7% of patients experienced an aneurysm and/or dissection by the time of entry into the Registry. We sought to determine the occurrence of neurovascular events after FMD diagnosis and any changes on cervical artery imaging that may be attributable to FMD. Methods: Patients followed at the Mount Sinai Medical Center (US Registry for FMD enrollment center) with confirmed FMD and > 1 cervical artery imaging study (at least ± 6 months from the baseline carotid duplex ultrasound [CDU]) between the years 2003 and 2015 were included. Medical records and cervical artery imaging ([CDU], magnetic resonance angiogram [MRA], and computed tomography angiogram [CTA]) were reviewed. New arterial dissection, aneurysm, transient ischemic attack, stroke, or new FMD findings were recorded. Results: Among 146 FMD patients with complete information, 52 (35.6%) had an aneurysm and 52 (35.6%) had a dissection. Mean clinical follow-up was 35.3 ± 25.3 months (range 5–153 months); patients underwent 4 ± 2.7 CDU (range 1–17); 86.3% had ≥1 neck MRA or CTA. After FMD diagnosis, 3 patients (2%) experienced a new carotid artery dissection; 1 patient experienced a stroke due to concomitant atherosclerosis. No new aneurysms occurred. In patients with cervical artery FMD, imaging findings remained stable throughout follow-up. No patient developed new cervical artery FMD findings on follow-up imaging. Conclusions: No new cervical artery FMD or aneurysm was observed on subsequent imaging. New carotid dissection was uncommon over a mean follow-up period of 35.3 ± 25.3 months and was the only non-atherosclerotic vascular event observed after FMD diagnosis.

Abstract 14194: Triple Vessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Franz Schweis ◽  
Ara Rostomian ◽  
Derek Phan ◽  
Mingsum Lee ◽  
Anne Ichiuji ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Renal Artery ◽  
Fibromuscular Dysplasia ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Management Approach ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Angiogram ◽  
Coronary Artery Dissection

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare albeit well-established etiology of myocardial infarction and most commonly involves a single coronary vessel. We present a unique case of a patient presenting with chest pain and found to have triple vessel SCAD with associated findings suggestive of coronary artery fibromuscular dysplasia (FMD). Case Presentation: A 53 year-old woman with a past medical history of hypertension and chronic headaches presented with intermittent exertional substernal chest pain for two days. Labs were significant for an elevated Troponin-I of 0.12 ng/mL (normal < 0.04 ng/mL). Coronary angiogram revealed tortuous vessels with evidence of SCAD in multiple coronary arteries including the left anterior descending artery (LAD), posterior descending artery (PDA), and posterior left ventricular artery (PLV) (Figure A, B). Intracoronary nitroglycerin was administered during the procedure to ensure the findings were not due to coronary vasospasm. Due to the known association of SCAD and FMD, a renal angiogram was performed, which demonstrated a “beading” appearance of the right renal artery consistent with renal artery FMD. She was conservatively managed with medical therapy.A head computed tomography angiogram (CTA) was performed, which showed evidence of FMD of the bilateral vertebral arteries. A repeat coronary angiogram was performed six weeks after discharge. She was found to have complete resolution of SCAD in the LAD and PLV (Figure C, D). Interestingly, the PDA displayed a “string of beads” appearance concerning for intracoronary artery FMD (Figure D). Conclusion: Our case demonstrates evidence that coronary artery FMD may contribute to the underlying etiology of the coronary artery dissection. A conservative management approach resulted in a favorable outcome and the patient was able to avoid unnecessary intervention and potential related complications.

Sign in / Sign up

Export Citation Format

Share Document