P1426 Non-cardiac sourses of thromboembolic complications in atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Germanova ◽  
A Germanov
Keyword(s):  
Atrial Fibrillation ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Kinetic Parameters ◽  
Arterial Wall ◽  
Internal Carotid ◽  
Arterial Blood Flow ◽  
Thromboembolic Complications ◽  
Arterial Blood ◽  
Permanent Form

Abstract Background Thromboischemic stroke is a significant medical problem. The most dangerous arrhythmia that causes the thromboembolism is atrial fibrillation. The source of thrombus mostly located in left atrium appendage or apex of left ventricle. But there’re a lot of cases of thromboischemic stroke in patients with atrial fibrillation without any intra-heart thrombus. Purpose To study the possibility of thromboembolic complications in patients with permanent form of atrial fibrillation without intra-heart thrombus. Materials and methods We included 48 patients with permanent form of atrial fibrillation. Mediana age - 68 ± 4,6 y.o. 32 (66,7%) were men and 16 (33,3%) women. All patients were performed 24-hours ECG monitoring to verify the atrial fibrillation. 34 (70,8%) were regularly took warfarin or NOACs to prevent the thromboembolic complications. We used CHADS-2 scale to make the prognosis of 1-year thromboembolic complications. 0 points - 0 (0%) patients, 1 point - 1 (2,1%), 2 points - 2 (4,2%), 3 points - 8 (16,6%), 4 points - 7 (14,5%), 5 points - 18 (37,5%), 6 points - 12 (25,1%). All patients were made transesophageal echocardiography. Only 3 (6,2%) of them had intra-heart thrombus. Intra-arterial blood flow we measured with Doppler-ultrasound. Most of patients – 39 (81,3%) had atherosclerotic plaques of internal carotid artery on one or both sides. In 22 (45,8%) patients were the signs of non-stability of plaques (heterogenic structure, rough surface). We valued the arterial wall kinetic parameters with sphygmography: speed, acceleration, power, work. We analyzed these parameters in different cardiocycles. Results We observed the following patterns: 1. If longer was the pause between cardiocycles in atrial fibrillation then more increase of biomechanical and kinetic parameters was observed. 2. The secondary hemodynamic arterial hypertension at the moments after long pause between cardiocycles. The longest duration of it was observed in bradysystolic atrial fibrillation (up to 38% of time). 3. In patients with hemodynamically important stenosis (about 70%) of internal carotid artery the speed after the long pause in atrial fibrillation is rising up to 4-4,5 meters per second. In comparison with sinus rhythm it is about 2,3 meters per second. Such rising of speed can cause the plaque integrity damage of parietal thrombus fragmentation. 4. Increased arterial wall deformation. The increased biomechanical parameters cause the appearance of additional waves, stand waves that may cause non-stability of plaques with further thromboembolism. 5. During the 1-year observation thromboembolic comlications appeared in 11 (22,9%) patients. Conclusion The source of thromboembolic complications can be non-cardiac in patients with multi-focus atherosclerosis and non-stable plaques.

P1-322: Four-Dimensional Arterial Blood Flow Metrics in The Internal Carotid Artery Predict Cognitive Performance and are Associated with CSF Biomarkers in Patients with MCI

2016 ◽  
Vol 12 ◽  
pp. P548-P549
Author(s):  
Sara Elizabeth Berman ◽  
Leonardo A. Rivera ◽  
Annie M. Racine ◽  
Lindsay R. Clark ◽  
Christopher R. Nicholas ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cognitive Performance ◽  
Internal Carotid ◽  
Arterial Blood Flow ◽  
Csf Biomarkers ◽  
Arterial Blood

scholarly journals Investigation of Hemodynamic Receptors of the Internal Carotid Artery Segments

2021 ◽  
Author(s):  
Mehmet Deniz Yener ◽  
Tuncay Colak ◽  
Belgin Bamac ◽  
Ahmet Ozturk ◽  
Selenay Humeyra Rencber ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Outer Surface ◽  
Laser Scanning ◽  
Internal Carotid ◽  
Venous Blood ◽  
Cervical Region ◽  
Tunica Media ◽  
Arterial Blood ◽  
The Brain

Abstract Objectives Internal carotid artery (ICA), the main artery of the brain, passes through the cavernous sinus (CS) which forms one of these venous pools. During this transition, while there is arterial blood in the lumen of ICA, its outer surface is in contact with venous blood from the brain. Herein, we aimed to detect the receptor differences of ICA in this highly specialized anatomical region of the skull base. Methods We performed the study on 10 human cadavers and searched CGRPR, TRP12, ASIC3 and ACTHR receptors via immunostaining using laser scanning confocal microscopy. Results We determined TRP12 receptor positive in the tunica media and tunica adventitia layers of the cavernous segment of ICA. We did not detect similar positivity in the cervical part of the ICA. In the receptor scan we made in terms of CGRPR, while we detected positivity in the tunica media layer of the cavernous segment, we found positivity in the tunica intima layer of the cervicalis segment of the ICA. We did not detect any positivity for ASIC3 and ACTHR receptors in both parts of the ICA. Conclusions As a result, we observed various differences in receptors between ICA segments. While the outer surface of the ICA in the cervical region did not show any receptor positivity, we detected TRP12 receptor positivity along the tissue contour of vessel in the CS. We assume that it may provide a new perspective on pathologies of the CS/ICA and preservation of brain hemodynamics for clinicians.

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 469-472 ◽  
Author(s):  
Yasutaka Kurokawa ◽  
Masahiko Wanibuchi ◽  
Masanori Ishiguro ◽  
Ken-ichi Inaba
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arterial Wall ◽  
Internal Carotid ◽  
Anterior Wall ◽  
Middle Part ◽  
Arterial Stenosis ◽  
Anterior Surface ◽  
Diagonal Part ◽  
Silicone Sheet

Abstract OBJECTIVE AND IMPORTANCE Aneurysms on the anterior surface of the internal carotid artery (ICA) have been shown to be somewhat different from ordinary berry aneurysms because they are rather small, grow rapidly in a short time, and easily lead to rupture, especially during surgery. The most difficult problem is that this type of aneurysm cannot be eliminated easily by an ordinary clipping procedure without causing apparent arterial stenosis or occlusion. CLINICAL PRESENTATION A 52-year-old man experienced a subarachnoid hemorrhage because of a ruptured aneurysm located on the anterior surface of the ICA. The tiny aneurysmal body, which was covered with a layer of brain tissue, was successfully exposed. The ICA seemed to be atherosclerotic, and the aneurysmal portion was solitary and had a reddish color. TECHNIQUE A large silicone sheet encircling clip (Vascwrap; Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) was selected for this patient. The proximal margin of the silicone sheet was incised with a V-shaped cut, and the middle part of the sheet, which covered the diagonal part of the ICA, was trimmed to make it shorter. The blade of the fenestrated clip was applied to obliterate the aneurysm and was attached to the normal arterial wall together with this modified Vascwrap sheet to create a small space between the normal arterial wall and the surrounding Vascwrap sheet. Then tiny pieces of Teflon fiber (E.I. duPont de Nemours and Co., Wilmington, DE) was inserted from both margins, and the whole Vascwrap sheet was sealed with fibrin glue to ensure good adhesion. CONCLUSION This method seemed adequate in treating this difficult aneurysm without causing postoperative regrowth or occlusion of the patient's ICA.

scholarly journals Simple aspiration with balloon catheter technique (simple ABC technique) against proximal internal carotid artery occlusion in cases of cardiogenic cerebral embolism

2018 ◽  
Vol 24 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Akitake Okamura ◽  
Kazuhiko Kuroki ◽  
Katsuhiro Shinagawa ◽  
Naoto Yamada
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Stent Retriever ◽  
Cervical Segment ◽  
Guiding Catheter

Background In cases of acute ischemic stroke, manual aspiration of the thrombus is commonly performed with a balloon guiding catheter placed in the cervical segment of the internal carotid artery (ICA). However, most manual aspirations using a balloon guiding catheter are combined with inner catheters, as in the direct aspiration first pass technique (ADAPT). We experienced some cases of acute ischemic stroke with proximal ICA occlusion due to cardiogenic thrombus where we obtained sufficient recanalization by simple manual aspiration from inflated Optimo 9F balloon catheters (Tokai Medical Products, Japan) placed in the origin of the cervical segment of the ICA without any inner catheter or stent retriever. We perform by preference this procedure, named the simple Aspiration with Balloon Catheter (simple ABC) technique. Herein, we report two recent cases and discuss this procedure. Case presentation Case 1: An 80-year-old man with paroxysmal atrial fibrillation developed left ICA occlusion. We performed the simple ABC technique and obtained a large amount of dark red and white thrombus. Puncture-to-reperfusion time was 14 minutes with Thrombolysis in Cerebral Infarction (TICI) grade 3. Case 2: A 69-year-old man with chronic atrial fibrillation developed left internal carotid occlusion. We performed the simple ABC technique and obtained a large amount of dark red thrombus. Puncture-to-reperfusion time was 15 minutes with TICI grade 2b. Conclusion The simple ABC technique is useful to deal with a large amount of thrombus, shortens procedure time, enables less invasive thrombectomy, and can shift immediately to subsequent procedures such as delivering a stent retriever or ADAPT.

The Impact of Systemic Vasoconstrictors on the Cerebral Circulation of Anesthetized Patients 

1998 ◽  
Vol 89 (1) ◽  
pp. 67-72 ◽  
Author(s):  
Stephan P. Strebel ◽  
Christoph Kindler ◽  
Bruno Bissonnette ◽  
Gabriela Tschaler ◽  
Dubravka Deanovic
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Arterial Blood Pressure ◽  
Cerebral Artery ◽  
Mean Arterial Blood Pressure ◽  
Cerebral Circulation ◽  
Internal Carotid ◽  
Arterial Blood

Unlabelled BACKGROUND. The effect of vasoconstrictors on intracerebral hemodynamics in anesthetized patients is controversial. The influence of phenylephrine and norepinephrine on the cerebral circulation was investigated in isoflurane- or propofol-anesthetized patients using transcranial Doppler ultrasonography. Methods Forty patients were randomly assigned to have vasoconstrictor tests with norepinephrine or phenylephrine during either isoflurane or propofol anesthesia. Blood flow velocities were simultaneously measured in the middle cerebral artery and ipsilateral extracranial internal carotid artery. Baseline recordings were done during stable anesthesia in a supine position (test 0). A second series of measurements were performed after norepinephrine or phenylephrine had increased mean arterial blood pressure by about 20% (test 1). With maintained norepinephrine or phenylephrine infusion, a final series of results were obtained after the increased mean arterial blood pressure was counteracted by a slightly head-up patient position (test 2). Results Both vasoconstrictors significantly increased mean flow velocities in the middle cerebral artery (norepinephrine: 43 +/- 11 cm/s to 49 +/- 11 cm/s; phenylephrine: 43 +/- 8 cm/s to 48 +/- 9 cm/s; +/- SD) and internal carotid artery (norepinephrine: 27 +/- 7 cm/s to 31 +/- 8 cm/s; phenylephrine: 27 +/- 9 cm/s to 31 +/- 10 cm/s) in the isoflurane-but not in the propofol-anesthetized patients. In the head-up position, only small and insignificant flow velocity changes were observed in both cerebral arteries independent of the vasoconstrictor or background anesthetic. Conclusions The results of the present study indicate that norepinephrine and phenylephrine do not directly affect intracranial hemodynamics in anesthetized patients, but rather that hemodynamic changes observed with vasoconstrictors reflect the effect of the background anesthetic agents on cerebral pressure autoregulation.

scholarly journals Vorapaxar as an Alternative for Ticagrelor Resistance in Neuroendovascular Intervention

2021 ◽  
Author(s):  
James C. Mamaril‐Davis ◽  
Pedro Aguilar‐Salinas ◽  
Leonardo B. Brasiliense ◽  
Richard Cosgrove ◽  
Judy Dawod ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Antiplatelet Therapy ◽  
Internal Carotid ◽  
Dual Antiplatelet Therapy ◽  
Flow Diversion ◽  
Left Internal Carotid Artery ◽  
Thromboembolic Complications ◽  
Promising Alternative ◽  
Adp Receptor Antagonists

Abstract BACKGROUND Perioperative dual‐antiplatelet therapy for flow diversion limits thromboembolic complications. However, resistance to dual‐antiplatelet therapy medications remains a concern for neuroendovascular intervention. To date, there is no standardized approach for resistance to ADP receptor antagonists. METHODS We report a case of ticagrelor resistance for flow diversion of an intracranial aneurysm treated with vorapaxar, as well as a narrative review of the literature for previous cases of ticagrelor resistance. RESULTS Flow diversion with the Pipeline embolization device was deployed for a left internal carotid artery blister aneurysm and bilateral internal carotid artery dissecting pseudoaneurysms. The patient had 3 thromboembolic complications while on dual‐antiplatelet therapy with ticagrelor or prasugrel, leading to transition of antiplatelet therapy to vorapaxar. At 84 days follow‐up, the patient was fully recovered with complete occlusion of the aneurysms. CONCLUSION Our case suggests that vorapaxar is a promising alternative for patients with ticagrelor resistance in flow diversion–treated intracranial aneurysms. High‐quality randomized controlled trials are needed to elucidate the safety and efficacy of vorapaxar in neuroendovascular procedures.

Sign in / Sign up

Export Citation Format

Share Document