Abstract 1122‐000052: Endovascular Management of Infectious PICA Aneurysm in the Setting of Recent Dental Work

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Neeharika Krothapalli ◽  
Abner Gershon
Keyword(s):  
Aortic Valve ◽  
Posterior Inferior Cerebellar Artery ◽  
Inpatient Rehabilitation ◽  
Maximal Dimension ◽  
Anterior Circulation ◽  
Dental Procedures ◽  
History Of ◽  
Ct Head ◽  
Glue Embolization ◽  
Dental Work

Introduction : Infectious intracranial aneurysms (IIA) of the posterior inferior cerebellar artery (PICA) are exceedingly rare and have been infrequently reported. IIAs are typically distal and located in the anterior circulation, particularly the middle cerebral artery and its distal branches. Etiology is secondary to hematogenous spread of septic emboli from a proximal source such as infective endocarditis. Few cases have documented an association between IIA and dental disease or procedures. We describe a rare case of an infectious PICA aneurysm in the setting of recent dental work and successfully treated with endovascular intervention. Methods : An 88‐year‐old male with medical history of atrial fibrillation on anticoagulation presented with one month duration of recurrent falls and progressive generalized weakness. CT head demonstrated left cerebral hemorrhage with scattered subarachnoid hemorrhage. MRI brain noted a rounded enhancing intra‐axial lesion located at the left paramedian cerebellum measuring 7 mm in maximal dimension. Further investigation with cerebral angiography demonstrated an infectious intracranial aneurysm of the left PICA. He underwent workup with an echocardiogram that noted a mobile echo density on the aortic valve consistent with a vegetation. Blood cultures were positive for Streptococcus salivarius and viridans. Investigation revealed that he had recent dental work performed and missed taking his prophylactic amoxicillin. Infectious disease was consulted and etiology was determined to be seeding of aortic valve from recent dental procedure that ultimately led to IIA formation. Results : Patient was treated with 6‐week course of intravenous ceftriaxone and underwent glue embolization for his left PICA aneurysm. Post embolization angiogram did not reveal any evidence of contrast filling within the aneurysm. He tolerated the procedure well with no complications and was subsequently discharged to inpatient rehabilitation with a modified Rankin scale (mRS) score of 3. Conclusions : IIAs of PICA in the setting of recent dental procedures are exceptionally rare and challenging to diagnose. They may be clinically silent until rupture and are usually identified incidentally on imaging or during autopsy. Physicians should maintain vigilance for this unique entity as prompt recognition and timely intervention may prevent severe morbidity and mortality.

scholarly journals 1075. A Retrospective Comparison of Native Valve Endocarditis and Prosthetic Valve Endocarditis in a Large Tertiary Care Teaching Hospital From 2007 to 2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S322-S322
Author(s):  
Hoi Yee Annie Lo ◽  
Anahita Mostaghim ◽  
Nancy Khardori
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Aortic Valve ◽  
Teaching Hospital ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Native Valve ◽  
Prosthetic Valves ◽  
Dental Procedures ◽  
History Of

Abstract Background Studies comparing native valve and prosthetic valve endocarditis (NVE and PVE) have mixed findings on the risk factors and outcomes between the two cohorts. This retrospective review of infective endocarditis (IE) at a teaching hospital in the United States aims to compare the clinical and microbiological features between NVE and PVE. Methods Patients were retrospectively identified from 2007 to 2015 using appropriate IE-related ICD-9 codes. Cases that met definite Modified Duke Criteria for IE were further classified as either PVE or NVE, and were reviewed for epidemiology, causative organism(s), affected valves and associations, risk factors, dental procedures in the past 6 months, and 30-day mortality. Results A total of 363 admissions met criteria for definite endocarditis, with 261 NVE cases and 59 PVE cases. Forty-three cases that were either associated with an infection involving both native and prosthetic valves or intracardiac devices were omitted from this study. Most risk factors, such as hemodialysis and intravenous drug use, did not show any significant difference amongst the two groups. IE involving the aortic valve as well as a previous history of IE were more likely to be seen in PVE (both P < 0.0001). Dental procedures done in the preceding 6 months before IE admission were more likely to be associated with PVE than NVE (P = 0.0043). PVE showed a higher likelihood of 30-day mortality compared with NVE (P = 0.067). The causative organisms of PVE were more likely to be caused by common gut pathogens such as Klebsiella and Enterobacter species. Conclusion PVE cases had a significantly higher chance of involving the aortic valve as well as having a history of IE. PVE cases were also significantly more likely to be associated with a dental procedure done in the preceding 6 months than with the NVE cases. This implies that patients with prosthetic valves, who are currently covered under the 2007 AHA guidelines to receive prophylaxis prior to dental procedures, are still at a high risk of developing PVE. It may be prudent to reconsider adding a post-procedure dose of antibiotics, instead of a single preprocedure dose, to extend the protection of this high-risk population with prosthetic valves. Furthermore, PVE cases showed higher rates of 30-day mortality compared with NVE with near significance, which is likely multifactorial. Disclosures All authors: No reported disclosures.

Case of maxillary avascular necrosis due to oral bisphosphonates, presenting with signs of malignancy

2010 ◽  
Vol 124 (12) ◽  
pp. 1318-1320 ◽  
Author(s):  
R Green ◽  
K Blackmore ◽  
A Robson
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
World Literature ◽  
Unusual Case ◽  
Bisphosphonate Therapy ◽  
Oral Bisphosphonates ◽  
Dental Procedures ◽  
History Of ◽  
Intravenous Bisphosphonates ◽  
Dental Work

AbstractObjective:We report a rare case of avascular necrosis of the maxilla secondary to oral bisphosphonates.Methods:Case report and review of the world literature concerning avascular necrosis as a result of bisphosphonate therapy.Case report:A 62-year-old woman presented with unilateral nasal obstruction, swelling of the cheek and an ulcerating lesion of the upper alveolus. She had a past medical history of osteoporosis, for which she took oral bisphosphonates. Investigation revealed necrosis of the maxilla, and avascular necrosis secondary to oral bisphosphonates was diagnosed.Conclusion:There have been several documented cases of avascular necrosis of the mandible and maxilla following intravenous bisphosphonates or dental procedures. In our case, bisphosphonates were only taken orally and no dental work had been undertaken. This patient's clinical presentation was highly suggestive of malignancy, and we would like to communicate this unusual case to other otolaryngologists.

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

Temporal trends in utilization of transcatheter aortic valve implantation and patient characteristics – a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.E Strange ◽  
C Sindet-Pedersen ◽  
G Gislason ◽  
C Torp-Pedersen ◽  
E.L Fosboel ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
P Value ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
First Time

Abstract Introduction In recent years, there has been a surge in the utilization of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis. Randomized controlled trials have compared TAVI to surgical aortic valve replacement (SAVR) in patients at high-, intermediate-, and low perioperative risk. As TAVI continues to be utilized in patients with lower risk profiles, it is important to investigate the temporal trends in “real-world” patients undergoing TAVI. Purpose To investigate temporal trends in the utilization of TAVI and examine changes in patient characteristics of patients undergoing first-time TAVI. Methods Using complete Danish nationwide registries, we included all patients undergoing first-time TAVI between 2008 and 2017. To compare patient characteristics, the study population was stratified according to calendar year in the following groups: 2008–2009, 2010–2011, 2012–2013, 2014–2015, and 2016–2017. Results We identified 3,534 patients undergoing first-time TAVI. In 2008–2009, 180 patients underwent first-time TAVI compared with 1,417 patients in 2016–2017, resulting in a 687% increase in TAVI procedures performed. During the study period, the median age remained stable (2008–2009: Median age 82 year [25th–75th percentile: 78–85] vs. 2016–2017: Median age 81 years [25th–75th percentile: 76–85]; P-value: 0.06). The proportion of men undergoing first-time TAVI increased over the years (2008–2009: 49.4% vs 2016–2017: 54.9%; P-value for trend: &lt;0.05), also the proportion with diabetes increased (2008–2009: 12.2% vs. 2016–2017: 19.3%; P-value for trend: &lt;0.05). The proportion of patients with a history of stroke decreased over the years (2008–2009: 13.9% vs. 2016–2017: 12.1%; P-value for trend: &lt;0.05). The same trend was seen in patients with a history of myocardial infarction (2008–2009: 24.4% vs. 2016–2017: 11.9%; P-value for trend: &lt;0.05), ischaemic heart disease (2008–2009: 71.7% vs. 2016–2017: 29.4%; P-value for trend: &lt;0.05), and heart failure (2008–2009: 45.6% vs. 2016–2017: 29.4%; P-value for trend: &lt;0.05). Conclusions In this nationwide study, there was a marked increase in the utilization of TAVI in the years 2008–2017. Patients undergoing first-time TAVI had a decreasing comorbidity burden, while the age of the patients at first-time TAVI remained stable. Funding Acknowledgement Type of funding source: None

Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

2021 ◽  
pp. neurintsurg-2020-017193
Author(s):  
Ching-Jen Chen ◽  
Reda Chalhoub ◽  
Dale Ding ◽  
Jeyan S Kumar ◽  
Natasha Ironside ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage ◽  
History Of ◽  
Multivariable Models ◽  
Secondary Outcomes

BackgroundThe benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.MethodsThis is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.ResultsThe unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041).ConclusionsComplete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.

Abstract P686: Ischemic Stroke in Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aayushi Garg ◽  
Amjad Elmashala ◽  
Santiago Ortega
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Survey Design ◽  
Inpatient Rehabilitation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Hospital Charges ◽  
Multivariable Logistic Regression Analysis ◽  
Cerebral Vasoconstriction ◽  
History Of

Introduction: Ischemic stroke is the cause for major morbidity and mortality in reversible cerebral vasoconstriction syndrome (RCVS). While there is evidence to suggest that ischemic stroke in RCVS is associated with proximal vasoconstriction, it is still unclear why some patients develop ischemic lesions. The aim of this study was to evaluate the risk factors and outcomes of ischemic stroke in RCVS. Methods: We utilized the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations with the discharge diagnosis of RCVS. Occurrence of acute ischemic stroke was identified. Hospitalizations with the diagnosis of hemorrhagic stroke were excluded. Survey design methods were used to generate national estimates. Independent predictors of ischemic stroke were analyzed using multivariable logistic regression analysis with results expressed as odds ratio (OR) and 95% confidence intervals (CI). Results: Among the total 1,065 hospitalizations for RCVS during the study period (mean±SD age: 49.0±16.7 years, female 69.7%), 267 (25.1%) had occurrence of acute ischemic stroke. Patients with ischemic stroke were more likely to have history of hypertension (OR 2.33, 95% CI 1.51-3.60), diabetes (OR 1.81, 95% CI 1.11-2.98), and tobacco use (OR 1.64, 95% CI 1.16-2.33) and less likely to have a history of migraine (OR 0.56, 95% CI 0.35-0.90). Patients with stroke were more likely to develop cerebral edema. They also had longer hospital stay, higher hospital charges, and lower likelihood of being discharged to home or inpatient rehabilitation facility. They had higher in-hospital mortality rate, the difference was however not statistically significant. Conclusion: In conclusion, ischemic stroke affects nearly 25% of patients with RCVS and is associated with an increased rate of other neurologic complications and worse functional outcomes. Patients with traditional cerebrovascular risk factors might have a higher predisposition for developing the ischemic lesions.

Axillary pullout syndrome: A novel approach to managing a devastating complication

Vascular ◽  
2021 ◽  
pp. 170853812110489
Author(s):  
Nathan W Kugler ◽  
Brian D Lewis ◽  
Michael Malinowski
Keyword(s):  
Stent Graft ◽  
Effective Means ◽  
Bypass Graft ◽  
Hybrid Approach ◽  
Inpatient Rehabilitation ◽  
Anastomotic Dehiscence ◽  
Open Approach ◽  
Novel Approach ◽  
Life Threatening ◽  
History Of

Objectives Axillary pullout syndrome is a complex, potentially fatal complication following axillary-femoral bypass graft creation. The re-operative nature, in addition to ongoing hemorrhage, makes for a complicated and potentially morbid repair. Methods We present the case of a 57-year-old man with history of a previous left axillary-femoral-femoral bypass who presented with acute limb-threatening ischemia as a result of bypass thrombosis managed with a right axillary-femoral bypass for limb salvage. His postoperative course was complicated by an axillary anastomotic dehiscence while recovering in inpatient rehabilitation resulting in acute, life-threatening hemorrhage. He was managed utilizing a novel hybrid approach in which a retrograde stent graft was initially placed across the anastomotic dehiscence for control of hemorrhage. He then underwent exploration, decompression, and interposition graft repair utilizing the newly placed stent graft to reinforce the redo axillary anastomosis. Results and Conclusion Compared with a traditional operative approach, the hybrid endovascular and open approach limited ongoing hemorrhage while providing a more stable platform for repair and graft revascularization. A hybrid approach to the management of axillary pullout syndrome provides a safe, effective means to the management of axillary anastomotic dehiscence while minimizing the morbidity of ongoing hemorrhage.

scholarly journals Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

2020 ◽  
pp. 159101992095953
Author(s):  
Dylan Noblett ◽  
Lotfi Hacein-Bey ◽  
Ben Waldau ◽  
Jordan Ziegler ◽  
Brian Dahlin ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Methamphetamine Use ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

Prognostic importance of CT ASPECTS and CT perfusion measures of infarction in anterior emergent large vessel occlusions

2018 ◽  
Vol 11 (7) ◽  
pp. 670-674 ◽  
Author(s):  
Syed Ali Raza ◽  
Clara M Barreira ◽  
Gabriel M Rodrigues ◽  
Michael R Frankel ◽  
Diogo C Haussen ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Area Under The Curve ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Median Baseline ◽  
Ct Head ◽  
Prognostic Importance ◽  
Contrast Ct

BackgroundAge, neurologic deficits, core volume (CV), and clinical core or radiographic mismatch are considered in selection for endovascular therapy (ET) in anterior circulation emergent large vessel occlusion (aELVO). Semiquantitative CV estimation by Alberta Stroke Programme Early CT Score (CT ASPECTS) and quantitative CV estimation by CT perfusion (CTP) are both used in selection paradigms.ObjectiveTo compare the prognostic value of CTP CV with CT ASPECTS in aELVO.MethodsPatients in an institutional endovascular registry who had aELVO, pre-ET National Institutes of Health Stroke Scale (NIHSS) score, non-contrast CT head and CTP imaging, and prospectively collected 3-month modified Rankin Scale (mRS) score were included. Age- and NIHSS-adjusted models, including either CT ASPECTS or CTP volumes (relative cerebral blood flow <30% of normal tissue, total hypoperfusion, and radiographic mismatch), were compared using receiver operator characteristic analyses.ResultsWe included 508 patients with aELVO (60.8% M1 middle cerebral artery, 34% internal carotid artery, mean age 64.1±15.3 years, median baseline NIHSS score 16 (12–20), median baseline CT ASPECTS 8 (7–9), mean CV 16.7±24.8 mL). Age, pre-ET NIHSS, CT ASPECTS, CV, hypoperfusion, and perfusion imaging mismatch volumes were predictors of good outcome (mRS score 0–2). There were no differences in prognostic accuracies between reference (age, baseline NIHSS, CT ASPECTS; area under the curve (AUC)=0.76) and additional models incorporating combinations of age, NIHSS, and CTP metrics including CV, total hypoperfusion or mismatch volume (AUCs 0.72–0.75). Predicted outcomes from CT ASPECTS or CTP CV-based models had excellent agreement (R2=0.84, p<0.001).ConclusionsIncorporating CTP measures of core or penumbral volume, instead of CT ASPECTS, did not improve prognostication of 3-month outcomes, suggesting prognostic equivalence of CT ASPECTS and CTP CV.

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