scholarly journals The use of a stent-retriever to cause mechanical dilatation of a vasospasm secondary to iatrogenic subarachnoid haemorrhage

2017 ◽  
Vol 23 (3) ◽  
pp. 330-335 ◽  
Author(s):  
Pervinder Bhogal ◽  
Dimitris Paraskevopoulos ◽  
Hegoda LD Makalanda
Keyword(s):  
Computed Tomography ◽  
Clinical Status ◽  
Stent Retriever ◽  
Post Procedure ◽  
Perfusion Scan ◽  
Stent Retrievers ◽  
Computed Tomography Angiogram ◽  
The Right ◽  
Postoperative Improvement ◽  
Dilatory Effect

Objective To report the use of a stent-retriever in the management of vasospasm secondary to craniopharyngioma resection. Postoperative improvement was seen both clinically and on perfusion imaging. Methods A patient was admitted for resection of a large craniopharygioma. On day 6 postoperatively the patient had an acute hemiparesis. A computed tomography angiogram and perfusion scan demonstrated acute right-sided cerebral vasospasm and a perfusion defect in the territory of the middle cerebral artery (MCA). Results A pREset 4 × 20 mm stent-retriever was used to dilate the M1 and proximal M2 segments of the right MCA mechanically. This resulted in immediate dilatation of the spastic segment and improvement in the transit time on the angiogram. There was an improvement in the clinical status post-procedure and a computed tomography perfusion performed 24 hours after the procedure showed symmetrical perfusion. A computed tomography angiogram and magnetic resonance imaging performed 1 week later showed a symmetrical appearance to the MCA and no evidence of restricted diffusion. Conclusion The use of commercially available stent-retrievers can cause mechanical dilatation of vasospastic vessels. The stents do not need to be deployed for a prolonged period nor do they need to be implanted to have a prolonged dilatory effect on the spastic vessels.

Endovascular Approach for Management of Bullet Embolization to the Heart

2018 ◽  
Vol 52 (4) ◽  
pp. 295-298 ◽  
Author(s):  
Alireza Mojtahedi ◽  
Sohail Contractor ◽  
Piotr S. Kisza
Keyword(s):  
Computed Tomography ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Hemodynamic Parameters ◽  
Viable Option ◽  
Right Heart ◽  
Technical Aspects ◽  
Computed Tomography Angiogram ◽  
Endovascular Approach ◽  
The Right

Bullet embolization to the right heart through the vasculature is seen infrequently in cases presenting with penetrating trauma. Patients with unstable hemodynamic status are managed operatively. For a patient with stable hemodynamic parameters, diagnostic evaluation such as computed tomography angiogram, echocardiogram, or angiography could be performed to select the best treatment option. Endovascular treatment is employed infrequently in these cases but can be a viable option for select patients. We present a case of a bullet embolus to the right ventricle treated successfully with endovascular approach and discuss the technical aspects of this approach.

scholarly journals Endovascular foreign body removal of a MynxGrip polyethylene glycol (PEG) sealant embolus using a cerebral stent retriever

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Mohammed Shamseldin ◽  
Hendrik Bergert ◽  
Axel Neumeister ◽  
Ralf Puls
Keyword(s):  
Polyethylene Glycol ◽  
Foreign Body ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Rare Complication ◽  
Stent Retriever ◽  
Closure Device ◽  
Vascular Closure Device ◽  
Stent Retrievers ◽  
The Right

Abstract Background This is a rare case of removing an intra-arterial foreign body represented by MynxGrip polyethylene glycol (PEG) sealant as a rare complication of using the MynxGrip™ Vascular Closure Device (AccessClosure, Inc., Mountain View, CA) using a pRESET stent retriever (Phenox, Bochum, Germany) which is utilized mainly for treatment of endovascular stroke. Case presentation A 60-year-old female patient suffering from intermittent claudication in the right lower limb (stage IIb according to Fontaine) due to a peripheral arterial occlusive disease was presented for an elective revascularization using balloon angioplasty of a short chronic occlusion of the right superficial femoral artery. After a successful revascularization of the right superficial femoral artery using a retrograde femoral access from the left common femoral artery, the patient suffered from an acute limb ischemia in the left foot with distal popliteal embolization with involvement of BTK (below the knee) trifurcation. This is believed to be due to an intra-arterial foreign body embolism of MynxGrip polyethylene glycol sealant as a rare complication of using the MynxGrip™ Vascular Closure Device. Conclusions Stent retrievers have been used previously in removing dislocated coils especially in the cerebral vessels. This case report however proves a high efficacy and safety of using stent retrievers in removing different and rather unusual intra-arterial foreign bodies such as MynxGrip polyethylene glycol sealant.

Carotid Artery Dissection Following Neck Cannulation for Extracorporeal Life Support

2016 ◽  
Vol 8 (3) ◽  
pp. 414-416 ◽  
Author(s):  
Lindsay M. Ryerson ◽  
Carlos Sanchez-Glanville ◽  
Christa Huberdeau ◽  
Mohammed Al Aklabi
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Common Carotid Artery ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
False Lumen ◽  
Artery Dissection ◽  
Transverse Arch ◽  
Computed Tomography Angiogram ◽  
The Right

A term neonate was cannulated for venoarterial extracorporeal life support (ECLS) via the right neck for non-postoperative junctional ectopic tachycardia. Initial echocardiogram demonstrated an echogenic strand in the transverse arch. Computed tomography angiogram confirmed arterial dissection of the right common carotid artery that extended into the proximal transverse arch. Dissection flap was repaired at the time of ECLS decannulation without cardiopulmonary bypass. Follow-up computed tomography angiogram revealed a segment of narrowing of approximately 50% of the right common carotid artery without false lumen or aneurysm.

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 Delayed manifestation of COVID-19 presenting as lower extremity multilevel arterial thrombosis: a case report

2020 ◽  
Author(s):  
Cecilia Schweblin ◽  
Anne Lise Hachulla ◽  
Marco Roffi ◽  
Frédéric Glauser
Keyword(s):  
Computed Tomography ◽  
Arterial Thrombosis ◽  
Thrombotic Event ◽  
Common Femoral Artery ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Antibody Testing ◽  
Internal Iliac ◽  
Computed Tomography Angiogram ◽  
The Right

Abstract Background Venous thrombo-embolic events have been described in hospitalized patients with coronavirus disease 2019 (COVID-19), suggesting the presence of coagulopathy induced by the viral infection. To date, only rare cases of arterial thrombosis related to COVID-19 have been reported. Case summary A 54-year-old patient with an influenza-like illness 15 days earlier, which resolved, and no known cardiovascular risk factor presented with acute right lower limb ischaemia. A computed tomography angiogram of the abdominal aorta and lower extremities showed, in the absence of vascular disease, a subocclusive thrombosis of the right common iliac artery and an occlusion of the right internal iliac, profunda femoral, and popliteal arteries. On the left side, the computed tomography angiogram demonstrated a non-occlusive thrombosis of the common femoral artery. The patient underwent emergency surgical thrombectomy as well as endovascular revascularization on the right side followed by therapeutic anticoagulation, with normalization of the limb perfusion. A nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcription–PCR (rRT–PCR) was negative three times. Haemostasis analysis showed a mild hyperfibrinogenaemia and a shortening of the activated partial thromboplastin time. An extensive screening for cardio-embolism was negative. As the thrombotic event was unexplained, antibody testing for SARS-CoV-2 was performed and the result was positive. Discussion Venous thrombosis and pulmonary embolisms have been observed in COVID-19. As in our case, the first reports on COVID-19-associated arterial thrombotic events have emerged. A better understanding of the coagulopathy in COVID-19 is essential to guide prevention and treatment of venous as well as arterial thrombo-embolic events.

Coronariaeredési anomáliák kardio-CT-vizsgálatok során

2020 ◽  
Vol 161 (47) ◽  
pp. 1995-1999
Author(s):  
László Barna ◽  
Zsuzsanna Takács-Szabó ◽  
László Kostyál
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Sinus Of Valsalva ◽  
Coronary Anomalies ◽  
Coronary Computed Tomography ◽  
Left Circumflex Artery ◽  
The Right ◽  
Left Sinus Of Valsalva

Összefoglaló. Bevezetés: Congenitalis coronariaanomáliának tekintik azokat a coronariamorfológiai rendellenességeket, melyek 1%-nál kisebb gyakorisággal fordulnak elő. Többségük nem jár tünettel, olykor azonban okozhatnak mellkasi fájdalmat, eszméletvesztést, és hirtelen halálhoz is vezethetnek. A coronariaanomáliák gyakoriságáról Magyarországon eddig csak invazív koronarográfiás adatok alapján jelent meg közlemény. Célkitűzés: Jelen vizsgálatunkban a coronariák eredési rendellenességeinek gyakoriságát mértük fel intézetünk coronaria-komputertomográfiás angiográfián átesett betegeinél. Módszer: A coronaria-komputertomográfiás vizsgálatra került betegek felvételeinek értékelésekor rögzítettük a coronariaanomália jelenlétét. A vizsgálat indikációja általában mellkasi fájdalom volt. 128 szeletes berendezést használtunk, a vizsgálatok során részben retrospektív, részben prospektív EKG-kapuzást alkalmaztunk. Eredmények: 1751 beteg komputertomográfiás angiográfiás felvételeit elemeztük. A betegek között a férfiak aránya 38,4%, a vizsgálatra kerülők életkorának átlaga pedig 58,07 ± 11,07 év volt. Eredési anomáliát 1,83%-ban találtunk, ezen belül a leggyakoribb volt a körbefutó ág (ramus circumflexus) és az elülső leszálló ág különálló eredése a bal Valsalva-sinusból (1%). A további rendellenességek a következők voltak: a jobb coronaria eredése magasan az aortából (0,34%), ramus circumflexus a jobb sinusból vagy a jobb coronariából (0,34%), jobb coronaria a bal Valsalva-sinusból (0,057%), elülső leszálló ág részben a bal Valsalva-sinusból a circumflexustól külön, részben a jobb coronariából (kettős elülső leszálló ág, 0,057%). Következtetés: Mindössze 0,057%-ban fordult elő potenciálisan tünetet okozó coronariaeredési rendellenesség (a bal sinusból eredő jobb coronaria). A komputertomográfiás angiográfia segítségével a coronariaeredés helye pontosan megállapítható, tisztázható az ér lefutása és ennek során viszonya a környező struktúrákhoz. Orv Hetil. 2020; 161(47): 1995–1999. Summary. Introduction: Congenital coronary artery anomaly is defined as a coronary morphology which occurs in less than 1% of the cases. Usually these anomalies do not result in symptoms but sometimes they can cause chest pain, syncope and sudden death. In Hungary, the prevalence of these abnormalities was published only from data of invasive coronary angiography. Objective: In this study, we evaluated the prevalence of the anomalies of coronary origin in the patients of our institution undergoing coronary computed tomography. Method: While reading the computed tomography angiograms of our patients, we registered the presence of coronary anomalies. In most of the cases, the indication of the coronary computed tomography was chest pain. A scanner with 128 detectors was used, scans were performed partly with prospective, partly with retrospective ECG gating. Results: We assessed 1751 patients. The ratio of males was 38.4%, while the average age of patients 58.07 ± 11.07 years. Anomaly of coronary origin was present in 1.83% of our patients, with the separate origin of left anterior descending and left circumflex artery being the most frequent (1%) among them. Other anomalies were as follows: high take-off of the right coronary artery from the ascending aorta (0.34%), left circumflex arising from the right sinus of Valsalva or from the right coronary (0.34%), right coronary artery from the left sinus of Valsalva (0.057%), left anterior descending arising partly from the left sinus of Valsalva, apart from the left circumflex, partly from the right coronary (dual left anterior descending artery, 0.057%). Conclusion: The prevalence of potentially symptomatic coronary anomalies was only 0.057% in our series (right coronary from the left sinus of Valsalva). The computed tomography angiography can precisely define the origin of the coronary artery, depict its run-off and its relationship to the neighbouring structures. Orv Hetil. 2020; 161(47): 1995–1999.

Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals

2019 ◽  
Vol 15 (10) ◽  
pp. 990-993 ◽  
Author(s):  
Elif Gündoğdu ◽  
Uğur Toprak
Keyword(s):  
Computed Tomography ◽  
Otitis Media ◽  
Middle Ear ◽  
Healthy Subjects ◽  
Normal Values ◽  
Chronic Otitis Media ◽  
Healthy Individuals ◽  
Inner Diameter ◽  
Male Patients ◽  
The Right

Background: The middle ear cavity is ventilated through the aditus ad antrum. Aditus blockage contributes to the pathology of otitis media. Objective: To determine the normal values of the aditus ad antrum diameter on computed tomography and to investigate its relationship with chronic otitis media and related pathologies (tympanosclerosis and myringosclerosis). Methods: The temporal CT images of 162 individuals were evaluated retrospectively. In the axial sections, the inner diameter of the aditus was measured at the narrowest point at the cortex. The differences in diameter were compared between diseased and healthy ears. Results: In healthy individuals, the diameter was narrower in women. There was no difference between the right and left ears in healthy subjects. No correlation was found between age and diameter. In male patients with myringosclerosis, the diameter was slightly narrower on both sides but more marked on the left. In female patients with myringosclerosis, the diameter in both ears was slightly narrower. In cases of otitis media and tympanosclerosis, the diameter was less than that of healthy individuals, despite the lack of statistically significant result in all cases. Conclusion: The aditus ad antrum was narrower in diseased ears, indicating that a blocked aditus may contribute to the development of otitis media, as well as mucosal diseases.

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

2021 ◽  
pp. 153857442110225
Author(s):  
Giuseppe S. Gallo ◽  
Roberto Miraglia ◽  
Luigi Maruzzelli ◽  
Francesca Crinò ◽  
Christine Cannataci ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatic Artery ◽  
Surgical Repair ◽  
Endovascular Embolization ◽  
Proper Hepatic Artery ◽  
Ultrasound Guided ◽  
Complete Occlusion ◽  
Right Hepatic Artery ◽  
Ultrasonographic Guidance ◽  
The Right

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.

scholarly journals Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 50
Author(s):  
Jun-Ho Ha ◽  
Byeong-Ho Jeong
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Chest Tube ◽  
Biopsy Forceps ◽  
Chest Computed Tomography ◽  
Contrast Enhanced ◽  
Lobar Bronchus ◽  
Green Pea ◽  
Airway Foreign Body ◽  
The Right

Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.

scholarly journals Aortic dissection during transoesophageal echocardiography: a case report

2020 ◽  
Author(s):  
Rin Hoshina ◽  
Hideyuki Kishima ◽  
Takanao Mine ◽  
Masaharu Ishihara
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Bypass Graft ◽  
Transoesophageal Echocardiography ◽  
Ascending Aorta ◽  
Maximum Diameter ◽  
Abnormal Finding ◽  
The Right

Abstract Background Transoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure. Case summary A 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery. Discussion Transoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk–benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.

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