Abstract 1122‐000072: Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis in the setting of APL

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Aravind Reddy ◽  
Neil Suryadevara ◽  
Hesham Masoud ◽  
Amar Swarnkar
Keyword(s):  
Jugular Vein ◽  
Filling Defect ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Stent Retriever ◽  
Post Procedure ◽  
Patient Reported ◽  
Residual Thrombus ◽  
The Right

Introduction : 28 year‐old woman with newly diagnosed acute promyelocytic leukemia (APL) undergoing chemotherapy with tretinoin and arsenic trioxide developed new onset headache and binocular diplopia. Neurologic exam was significant for bilateral papilledema and bilateral abducens nerve palsies. MR venogram showed incomplete opacification of the right and left transverse sinuses consistent with thrombosis. Therapeutic dose enoxaparin was started and she was taken to the neuroangiography suite. Methods : The left internal jugular vein was catheterized, and the microcatheter was advanced to the opacified left sigmoid sinus. A stent retriever was then deployed and suction thrombectomy was performed, with improvement of the filling defect. Next, the right internal jugular vein was catheterized and the right sigmoid sinus was accessed. Suction thrombectomy was performed, but due to residual thrombus, a stent retriever was deployed in the right transverse sinus and suction thrombectomy was reattempted, with improved recanalization. Results : Patient returned to the unit and continued therapeutic enoxaparin. Three days post‐procedure, she developed worsening headache and syncope. She was again taken to neuroangiography suite and the RIJ vein was again catheterized. Venogram after advancing the catheter to the right sigmoid sinus showed multiple filling defects in the proximal right transverse sinus. The catheter was advanced to the sigmoid sinus and a stent retriever was introduced; multiple attempts were made to remove the thrombus. Follow‐up venogram showed significant improvement in recanalization. The LIJ vein was then catheterized and venogram was performed, showing worsening filling defect in the left sigmoid sinus. A stent retriever was deployed in the left transverse sinus and suction thrombectomy was performed, however there was still significant residual thrombus. Suction thrombectomy, another stent retriever attempt and finally balloon angioplasty were then performed with some improvement of patency.. Follow‐up CTV 5 days post‐procedure showed stable venous sinus filling defects. Patient reported gradual improvement of headaches and was transitioned to apixaban. On follow‐up evaluation 3 months post‐procedure, patient reported resolution of headaches and diplopia. Conclusions : CVST is generally treated with systemic anticoagulation based on data from two randomized trials, however, ISCVT showed that 13% still decline on anticoagulation. Data regarding the safety and efficacy of MT for CVST is lacking, as well as data regarding patient selection. Our initial decision to treat with MT was due to involvement of posterior fossa and signs of increased intracranial pressure, which are potential prognostic factors for clinical decline with anticoagulation alone from ISCVT. Our patient was initially treated with therapeutic enoxaparin, however developed neurologic deterioration, so she was taken back to the neuroangiography suite. This case report illustrates an example of successful utilization of endovascular therapy for CVST in a patient with acute neurologic deterioration, with good neurologic outcome following recanalization

scholarly journals Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

2021 ◽  
pp. bmjsrh-2020-200954
Author(s):  
Chelsey Porter Erlank ◽  
Jonathan Lord ◽  
Kathryn Church
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Abortion ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Post Procedure ◽  
High Satisfaction ◽  
First Choice ◽  
Patient Reported ◽  
At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report

2021 ◽  
pp. 197140092110415
Author(s):  
Takuya Osuki ◽  
Hiroyuki Ikeda ◽  
Tomoko Hayashi ◽  
Silsu Park ◽  
Minami Uezato ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Balloon Angioplasty ◽  
Dural Arteriovenous Fistula ◽  
Executive Dysfunction ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Shunt Flow ◽  
Symptomatic Epilepsy ◽  
The Right

Background There is no consensus as to whether balloon angioplasty alone or stent placement is effective for sinus occlusion associated with dural arteriovenous fistula (DAVF). Herein, we first report a case of transverse sinus occlusion associated with DAVF in which gradual sinus dilatation was observed after balloon angioplasty with embolization of the affected sinus with shunt flow. Case presentation A 69-year-old man presented with executive dysfunction. Magnetic resonance imaging revealed left transverse sinus–sigmoid sinus DAVF with occlusion of the left jugular vein and right transverse sinus. Before endovascular treatment, the patient had symptomatic epilepsy and subarachnoid hemorrhage. Retrograde leptomeningeal venous drainage disappeared with packing of the left transverse sinus–sigmoid sinus. Subsequently, balloon angioplasty of the right occluded transverse sinus was performed to maintain the normal venous drainage and remaining shunt outflow. Dilatation of the right transverse sinus was poor immediately after surgery. However, angiography after 10 days and 6 months revealed gradual dilatation of the right transverse sinus. Conclusion Sinus occlusion, which is thought to be caused by sinus hypertension associated with DAVF rather than chronic organized thrombosis or thrombophilia, may dilate over time after balloon angioplasty and shunt flow reduction if occluded sinus is necessary for facilitating normal venous drainage.

scholarly journals Results of an Interim Analysis of a Prospective Multicenter Study Assessing Radiographic and Patient Outcomes Following Triplanar Tarsometatarsal Arthrodesis with Early Weightbearing

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Dane K. Wukich ◽  
Robert D. Santrock ◽  
Daniel C. Farber ◽  
Abdi Raissi ◽  
Avneesh Chhabra ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Multicenter Study ◽  
Patient Reported Outcomes ◽  
Metatarsal Osteotomy ◽  
Recurrence Rates ◽  
Prospective Multicenter Study ◽  
Post Procedure ◽  
Patient Reported ◽  
The Mean

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The majority of hallux valgus corrections are performed via a uniplanar metatarsal osteotomy approach in which the metatarsal is cut and shifted over in the transverse plane. This approach has demonstrated high long-term recurrence rates. Recent research demonstrates that 87% of hallux valgus deformities are three-dimensional with abnormal frontal-plane rotation of the metatarsal, which cannot be fully addressed with a uniplanar metatarsal osteotomy. While correction at the 1st tarsometatarsal (TMT) joint may provide the optimal surgical approach for 3D anatomic restoration at the apex of the deformity, 1st TMT fusion has historically involved an extended period of non-weightbearing. This study evaluates the clinical, radiographic, and patient-reported outcomes in patients undergoing instrumented triplanar 1st TMT arthrodesis (TTA) with a biplanar plating system and protected near-immediate weightbearing. Methods: This is a prospective multicenter study that will continue for 60 months post-operatively. Patients between 14-58 years old with symptomatic hallux valgus (intermetatarsal and hallux valgus angles between 10.0-22.0° and 16.0-40.0°, respectively) and no prior hallux valgus surgery on the operative foot are eligible for this study. Patients are treated with an TTA procedure using a biplanar plating system with protected near-immediate weightbearing. Outcomes (radiographic, range of motion (ROM), pain measured by visual analog scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ), return to weightbearing and activities) are evaluated post-operatively. Two independent musculoskeletal radiologists reviewed radiographic data. These interim results are limited to patients completing at least 6 weeks of follow-up. Results: At time of data cut-off, 74 patients had undergone TTA with at least 6 weeks follow-up. The majority of patients were women (95%) with mean age 41.7 years. The mean (95% confidence interval) time to protected weightbearing in CAM boot was 8.0 (6.4, 9.7) days, return to work was 19.0 (13.6, 24.4) days, and return to full work was 31.5 (22.7, 40.2) days. There was a significant change in radiographic measures pre vs. post procedure and changes were maintained over time (Table). VAS pain score decreased 4 and 6 months post-procedure by 3.9 (3.2, 4.6) and 4.2 (3.5, 5.0), respectively. The mean MOxFQ Index Score pre-procedure was 53.3 (49.5, 57.1) and at month 6 had decreased to 18.6 (12.9, 24.2). Conclusion: These interim findings support that TTA with biplanar plating is successful in correcting the 3D hallux valgus deformity with early return to weightbearing and demonstrated favorable clinical and patient-reported outcomes. Patients were able to return to full, unrestricted work and activities within just a few months and had meaningful pain reduction after surgery. Patients will continue to be followed for up to 60 months. Clinical/radiographic healing at 12 months and recurrence rates at 24 months, as well as complications and patient satisfaction, will be evaluated. [Table: see text]

scholarly journals A Case Study of Deep Vein Thrombosis of the Right Internal Jugular Vein in a Healthy 21-Year-Old Male

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Javier Corral ◽  
Geri Villanueva
Keyword(s):  
Deep Vein Thrombosis ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Significant Past Medical History ◽  
Vein Thrombosis ◽  
The Right ◽  
Deep Vein ◽  
Work Up

We are reporting a case of a healthy 21-year-old male, with no significant past medical history, who was found to have an incidental nonocclusive deep vein thrombosis in the right internal jugular vein detected on a head MRI previously ordered for work-up of headaches. A follow-up upper extremity venous Doppler ultrasound confirmed the presence of a partially occlusive deep vein thrombosis in the right jugular vein. The case presented is unique for the reason that the patient is young and has no prior risk factor, personal or familial, for venous thrombosis except for associated polycythemia on clinical presentation.

scholarly journals Intractable Trigeminal Neuralgia Secondary to Osteoma of the Clivus: A Case Report and Literature Review

2022 ◽  
Author(s):  
Ebtesam Abdulla ◽  
Krishna Das ◽  
Joseph Ravindra ◽  
Tejal Shah ◽  
Sara George
Keyword(s):  
Trigeminal Neuralgia ◽  
Pressure Effect ◽  
Benign Tumors ◽  
Radiographic Images ◽  
Patient Reported ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Slow Growing ◽  
Serial Observation

AbstractSkull base osteomas (SBOs) are benign tumors that are frequently detected on radiographic images by coincidence. They are known for being slow-growing tumors and rarely symptomatic. The therapeutic approach for SBOs can differ substantially. Depending on the symptoms, size, and location of the tumor, this can range from serial observation to vigorous surgical extirpation. Clival osteoma is extremely rare. We report a case of clival osteoma, causing intractable trigeminal neuralgia due to the pressure effect on the trigeminal nerve at Meckel's cave. We also provide a review of pertinent literature. A 37-year-old woman presented with intractable trigeminal neuralgia. Cranial magnetic resonance imaging (MRI) demonstrated a large, lobulated, extra-axial lesion involving the right cerebellopontine angle and epicentering the clivus. Pathologically, the specimen was proven to be osteoma. The patient reported complete symptom resolution over a 4-year follow-up period. To the best of the authors' knowledge, this is the first clinical case of intractable trigeminal neuralgia due to clival osteoma.

scholarly journals Neck Swelling in A Child: Now You See it, Now You Don’t?

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ikram Hakim ◽  
Goh Bee See ◽  
Hamzaini Abd Hamid
Keyword(s):  
Early Diagnosis ◽  
Doppler Ultrasonography ◽  
Jugular Vein ◽  
Valsalva Maneuver ◽  
Focal Lesion ◽  
Neck Swelling ◽  
Left Internal Jugular Vein ◽  
History Of ◽  
The Right

Jugular Ectasia is a rare benign swelling due to dilatation of jugular vein, which can occur in the internal, external or an anterior jugular vein. It is characterized by painless, soft, compressible unilateral swelling appeared on Valsalva maneuver. A 3-year-old boy presented with 2 months history of prominent mass over the right side of the neck on Valsalva maneuver is subjected to Doppler ultrasonography (USG) of the neck. Doppler Ultrasonography (USG) of the neck revealed prominent right jugular dilatation during Valsalva without any focal lesion with the normal caliber of the left internal jugular vein. Jugular ectasia should be included in the differentials of a benign neck swelling in children despite infrequently encountered. Dilated jugular vein on ultrasound Doppler on Valsalva maneuver is pathognomic of jugular ectasia. Early diagnosis with serial follow up can reduce parent’s anxiety and will reduce complications.

Glomus Jugulare Tumor Presenting as Deep Vein Thrombosis

2018 ◽  
Vol 1 ◽  
pp. 11
Author(s):  
Maria Zambrano ◽  
Yoon Ko ◽  
Vikram S Dogra
Keyword(s):  
Deep Vein Thrombosis ◽  
Jugular Vein ◽  
Filling Defect ◽  
Review Of The Literature ◽  
Primary Tumors ◽  
Glomus Jugulare Tumor ◽  
Vein Thrombosis ◽  
Glomus Jugulare ◽  
The Right ◽  
Deep Vein

Intraluminal filling defect and non-compressibility of the vein are diagnostic of a deep vein thrombosis (DVT). However, other etiologies can present with features similar to DVTs; these include tumors extending into the vein and primary tumors arising from the vein such as leiomyosarcoma and hemangioendothelioma. Here, we present a case of an 80-year-old female with a right glomus jugulare tumor (GJT) with extension into the right internal jugular vein mimicking a DVT. This case report presents the sonographic features of GJT presenting as DVT and review of the literature of other tumors that can present in a similar fashion.

RECONSTRUCTIVE TREATMENT USING A STENT GRAFT FOR A DURAL ARTERIOVENOUS FISTULA OF THE TRANSVERSE SINUS IN THE CASE OF HYPOPLASIA OF THE CONTRALATERAL VENOUS SINUSES

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E994-E996 ◽  
Author(s):  
Beom Jin Choi ◽  
Tae Hong Lee ◽  
Chang Won Kim ◽  
Chang Hwa Choi
Keyword(s):  
Stent Graft ◽  
Coil Embolization ◽  
Transarterial Embolization ◽  
Transverse Sinus ◽  
Balloon Occlusion ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Venous Sinuses ◽  
Balloon Occlusion Test ◽  
The Right

Abstract OBJECTIVE Transvenous coil embolization for transverse sinus (TS) and sigmoid sinus dural arteriovenous fistulae (DAVFs) is now recognized as one of the most effective treatment modalities. However, in the case of hypoplasia of the contralateral venous sinuses and internal jugular vein, complete occlusion of the ipsilateral sinus may cause fatal consequences. We describe a case of combined intravenous graft stent placement and transarterial coil embolization for DAVFs that involved the dominant right TS in a patient with hypoplasia of the contralateral venous sinuses. CLINICAL PRESENTATION A 50-year-old man presented with headache, left hand tremor, and pulsatile right tinnitus. A cerebral angiogram demonstrated a right TS DAVF that was supplied by tentorial branches of both internal carotid arteries, multiple branches of the right external carotid artery, and branches of the left occipital artery. Unfortunately, left TS and sigmoid sinus hypoplasia were observed. INTERVENTION A right TS balloon occlusion test revealed contrast stagnation of the cortical veins and of the right TS and superior sagittal sinus. In this case, the use of transvenous stent graft placement with or without transarterial embolization is safer and more effective than sacrifice of the right TS. We therefore performed balloon-expandable stent graft deployment at the right TS, and the remnant DAVF flow between the stent graft and venous sinus was treated with transarterial coil embolization. Postprocedural angiograms showed patent right TS outflow with disappearance of retrograde cortical venous drainage as well as complete eradication of the fistulous connections. CONCLUSION In a DAVF involving the dominant TS or sigmoid sinus in a patient with hypoplasia of the contralateral venous sinuses and an intolerable balloon occlusion test for the ipsilateral venous sinuses, the complete occlusion of the diseased venous sinus may cause hazardous consequences. In this situation, the use of a stent graft with or without transarterial embolization to preserve venous sinus flow can be an effective treatment.

scholarly journals Cranial venous sinus dominance: what to expect? Analysis of 100 cerebral angiographies

2017 ◽  
Vol 75 (5) ◽  
pp. 295-300 ◽  
Author(s):  
Matheus Augusto Pinto Kitamura ◽  
Leonardo Ferraz Costa ◽  
Danilo Otávio de Araújo Silva ◽  
Laécio Leitão Batista ◽  
Maurus Marques de Almeida Holanda ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Sagittal Sinus ◽  
Jugular Vein ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Venous Sinuses ◽  
Sagittal Sinus ◽  
Cranial Venous Sinuses ◽  
And Gender ◽  
Dominance Pattern

ABSTRACT We report an analysis of the cranial venous sinuses circulation, emphasizing morphological and angiographic characteristics. Methods Data of 100 cerebral angiographies were retrospectively analyzed (p = 0.05). Results Mean age was 56.3 years, 62% female and 38% male. Measurements and dominance are shown in the Tables. There was no association between age or gender and dominance. Right parasagittal division of the superior sagittal sinus was associated with right dominance of the transverse sinus, sigmoid sinus and internal jugular vein; and left parasagittal division of the superior sagittal sinus was associated with left dominance of the transverse sinus, sigmoid sinus and internal jugular vein. Conclusion A dominance pattern of cranial venous sinuses was found. Age and gender did not influence this pattern. Angiographic findings, such as division of the superior sagittal sinus, were associated with a pattern of cranial venous dominance. We hope this article can add information and assist in preoperative venous analysis for neurosurgeons and neuroradiologists.

scholarly journals Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula

2020 ◽  
pp. 159101992093896
Author(s):  
Wen-Tao Yan ◽  
Xiu-Zhen Li ◽  
Chang-Xiang Yan ◽  
Jia-Chun Liu
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Computer Tomography ◽  
Sigmoid Sinus ◽  
Subdural Effusion ◽  
Severe Stenosis ◽  
History Of ◽  
Pial Arteriovenous Fistula ◽  
The Right

Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively.

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