A case of left ventricular apical thrombus induce embolic stroke in patient with stress cardiomyopathy

We report a case of left ventricular apical thrombus induce embolic stroke in patient with stress cardiomyopathy. In this case, although we initiated anticoagulant treatment after finding apical thrombus on time, stroke occurred. However, favorable clinical results were achieved with prompt percutaneous mechanical thrombectomy after early suspicion and accurate diagnosis. This case emphasized the need for a follow-up echocardiography during SCMP recovery period to evaluate possible complications such as LV thrombus.

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Direct Anticoagulants Versus Vitamin K Antagonists in Patients Aged 80 Years or Older With Atrial Fibrillation in a “Real-world” Nationwide Registry: Insights From the FANTASIIA Study

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248420916316 ◽

2020 ◽

Vol 25 (4) ◽

pp. 316-323

Author(s):

Martín Ruiz Ortiz ◽

Javier Muñiz ◽

María Asunción Esteve-Pastor ◽

Francisco Marín ◽

Inmaculada Roldán ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Real World ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Left Ventricular ◽

Anticoagulant Treatment ◽

Cancer History

Objective: To describe major events at follow up in octogenarian patients with atrial fibrillation (AF) according to anticoagulant treatment: direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs). Methods: A total of 578 anticoagulated patients aged ≥80 years with AF were included in a prospective, observational, multicenter study. Basal features, embolic events (stroke and systemic embolism), severe bleedings, and all-cause mortality at follow up were investigated according to the anticoagulant treatment received. Results: Mean age was 84.0 ± 3.4 years, 56% were women. Direct oral anticoagulants were prescribed to 123 (21.3%) patients. Compared with 455 (78.7%) patients treated with VKAs, those treated with DOACs presented a lower frequency of permanent AF (52.9% vs 61.6%, P = .01), cancer history (4.9% vs 10.9%, P = .046), renal failure (21.1% vs 32.2%, P = .02), and left ventricular dysfunction (2.4% vs 8.0%, P = .03); and higher frequency of previous stroke (26.0% vs 16.6%, P = .02) and previous major bleeding (8.1% vs 3.6%, P = .03). There were no significant differences in Charlson, CHA2DS2VASc, nor HAS-BLED scores. At 3-year follow up, rates of embolic events, severe bleedings, and all-cause death (per 100 patients-year) were similar in both groups (DOACs vs VKAs): 0.34 vs 1.35 ( P = .15), 3.45 vs 4.41 ( P = .48), and 8.2 vs 11.0 ( P = .18), respectively, without significant differences after multivariate analysis (hazard ratio [HR]: 0.25, 95% confidence interval [CI]: 0.03-1.93, P = .19; HR: 0.88, 95% CI: 0.44-1.76, P = .72 and HR: 0.84, 95% CI: 0.53-1.33, P = .46, respectively). Conclusion: In this “real-world” registry, the differences in major events rates in octogenarians with AF were not statistically significant in those treated with DOACs versus VKAs.

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Does Mechanical Thrombectomy in Acute Embolic Stroke Have Long-term Side Effects on Intracranial Vessels? An Angiographic Follow-up Study

CardioVascular and Interventional Radiology ◽

10.1007/s00270-012-0496-8 ◽

2012 ◽

Vol 36 (3) ◽

pp. 629-636 ◽

Cited By ~ 26

Author(s):

Wiebke Kurre ◽

Marta Aguilar Pérez ◽

Diana Horvath ◽

Elisabeth Schmid ◽

Hansjörg Bäzner ◽

...

Keyword(s):

Side Effects ◽

Mechanical Thrombectomy ◽

Embolic Stroke ◽

Follow Up Study

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Long-term injury after Takotsubo syndrome (stress cardiomyopathy)

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa065 ◽

2020 ◽

Vol 22 (Supplement_E) ◽

pp. E73-E78

Author(s):

Gloria Vassiliki’ Coutsoumbas ◽

Pamela Gallo ◽

Silvia Zagnoni ◽

Giuseppe Di Pasquale

Keyword(s):

Cardiovascular Events ◽

Recovery Period ◽

Physical Stress ◽

Left Ventricular ◽

Major Adverse Cardiovascular Events ◽

Takotsubo Syndrome ◽

Severe Left Ventricular Dysfunction ◽

Coronary Syndrome

Abstract Takotsubo syndrome is a clinical condition characterized by transient impairment of left ventricular contractility, in association with symptoms, increase in indices of myocardial necrosis, as well as electrocardiographic changes, but without a coronary culprit lesion, and often after a significant psychological or physical stress. Albeit very similar to acute coronary syndrome (ACS) as far as presentation and clinical course, Takotsubo syndrome was considered, up until recently, a condition with very favourable long-term prognosis, in view of the frequent complete functional recovery. More recently, several retrospective observational studies as well as registers, unexpectedly called attention to a significant incidence of major adverse cardiovascular events, not limited to the recovery period but also during the long-term follow-up, in a way very similar to the outcome of patients after ACS. Several negative prognostic factors have been isolated, such as physical stress as trigger of the condition, the presence of severe left ventricular dysfunction, and the consequent cardiogenic shock during the acute phase. These factors are able to classify better the patient’s prognosis, both in the short- and long-term, and identify patients requiring a more stringent clinical follow-up, considering the higher likelihood of adverse cardiovascular events.

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Endovascular management of massive pulmonary embolism with clot fragmentation and suction

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492013000100010 ◽

2013 ◽

Vol 12 (1) ◽

pp. 49-52

Author(s):

Sergio Quilici Belczak ◽

Igor Rafael Sincos ◽

Ricardo Aun ◽

Alex Lederman ◽

Boulanger Mioto Neto ◽

...

Keyword(s):

Pulmonary Embolism ◽

Mechanical Thrombectomy ◽

Imaging Study ◽

Right Ventricular Dysfunction ◽

Massive Pulmonary Embolism ◽

Sudden Onset ◽

Percutaneous Mechanical Thrombectomy ◽

Limb Edema ◽

To Receive

Massive pulmonary embolism with right ventricular dysfunction may be treated with thrombolysis, embolectomy, or percutaneous mechanical thrombectomy. This study describes our experience with two patients that had massive pulmonary embolism and were treated with percutaneous mechanical thrombectomy and reports on the mid-term results of this procedure. A 28-year-old man and a 70-year-old woman were diagnosed with deep venous thrombosis and massive pulmonary embolism. They first had lower limb edema followed by sudden onset of dyspnea. Their physical examination revealed edema, tachypnea, chest discomfort and jugular turgescence. Both needed to receive oxygen using a nasal cannula. Doppler ultrasound, echocardiography, and computed tomography angiography were used to establish the diagnoses. Patients underwent percutaneous mechanical thrombectomy using the Aspirex® system (Straub Medical), and their clinical condition and imaging study findings improved substantially. At mid-term follow-up, patient conditions were improving satisfactorily.

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Acute Superior Mesenteric Artery Embolism treated with Percutaneous Mechanical Thrombectomy: Preliminary application and Experience

10.21203/rs.3.rs-34349/v1 ◽

2020 ◽

Author(s):

Qiyang Xu ◽

Yi Wang ◽

Di Wang ◽

Bin Xu ◽

Leibo Yang ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mechanical Thrombectomy ◽

Clinical Symptoms ◽

Surgical Complication ◽

Intestinal Resection ◽

Promising Alternative ◽

Percutaneous Mechanical Thrombectomy ◽

Artery Embolism

Abstract Background:Acute superior mesenteric artery embolism is a life-threatening disease and the prognosis is very poor. Few reports have described the application of Percutaneous Mechanical Thrombectomy in Acute superior mesenteric artery embolism. In the article, we show a series of cases treated with Percutaneous Mechanical Thrombectomy and share our experience.Methods:Review and analyze seven patients with acute superior mesenteric artery embolism treated by Angiojet Ultra thrombectomy system in our institution. Based on the literature, we summarize the diagnosis, treatment and surgical experience of acute superior mesenteric artery embolism. Results:Percutaneous Mechanical Thrombectomy were achieved successfully in all the patients without surgical complication occurred. Five patients’ symptoms relieved significantly and smoothly discharged from the hospital. Two patients still complained of abdominal pain after operation. One patient underwent surgical laparotomy and intestinal resection and the other one abandoned surgical treatment. During the first six months of follow-up, six patients were free of any clinical symptoms or signs and one patient who refused laparotomy died two days later with septic shock.Conclusion:Percutaneous Mechanical Thrombectomy by Angiojet Ultra thrombectomy system is a safe, effective and minimally invasive method in the initial stage of acute superior mesenteric artery embolism. We believe Percutaneous Mechanical Thrombectomy could be a promising alternative in selected cases. Furthermore, large sample data and long term follow-up are needed to verify its effect.

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Percutaneous mechanical thrombectomy of superior mesenteric artery embolism

Radiology and Oncology ◽

10.2478/raon-2013-0029 ◽

2013 ◽

Vol 47 (3) ◽

pp. 239-243 ◽

Cited By ~ 12

Author(s):

Dimitrij Kuhelj ◽

Pavel Kavcic ◽

Peter Popovic

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mechanical Thrombectomy ◽

Long Term Results ◽

Successful Outcome ◽

Bowel Infarction ◽

Intestinal Infarction ◽

Percutaneous Mechanical Thrombectomy ◽

Artery Embolism

Abstract Background. The present series present three consecutive cases of successful percutaneous mechanical embolectomy in acute superior mesenteric artery ischemia. Superior mesenteric artery embolism is a rare abdominal emergency that commonly leads to bowel infarction and has a very high mortality rate. Prompt recognition and treatment are crucial for successful outcome. Endovascular therapeutic approach in patients with acute SMA embolism in median portion of its stem is proposed. Case reports. Three male patients had experienced a sudden abdominal pain and acute superior mesenteric artery embolism in median portion of its stem was revealed on computed tomography angiography. No signs of intestinal infarction were present. The decision for endovascular treatment was made in concordance with the surgeons. In one patient 6 French gauge Rotarex® device was used while in others 6 French gauge Aspirex® device were used. All patients experienced sudden relief of pain after the procedure with no signs of intestinal infarction. Minor procedural complication - rupture of a smaller branch of SMA during Aspirex® treatment was successfully managed by coiling while transient paralytic ileus presented in one patient resolved spontaneously. All three patients remained symptom-free with patent superior mesenteric artery during the follow-up period. Conclusions. Percutaneous mechanical thrombectomy seems to be a rapid and effective treatment of acute superior mesenteric artery embolism in median portion of its stem in absence of bowel necrosis. Follow-up of our patients showed excellent short- and long-term results.

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Noncompaction of the left ventricle: a new cardiomyopathy is presented to the clinician

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000100007 ◽

2006 ◽

Vol 124 (1) ◽

pp. 31-35 ◽

Cited By ~ 10

Author(s):

Fábio Cañellas Moreira ◽

Marcelo Haertel Miglioransa ◽

Marcela Pozo Mautone ◽

Karen Reetz Müller ◽

Fernando Lucchese

Keyword(s):

Mortality Rate ◽

Left Ventricle ◽

Case Series ◽

Rare Condition ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Accurate Diagnosis ◽

Left Ventricular Myocardium ◽

Poor Knowledge

Noncompaction of the left ventricular myocardium is a morphogenetic abnormality involving loss of compaction of the myocardial fiber meshwork during intrauterine life. It is an extremely rare condition, accounting for only 0.05% of the cases evaluated in databanks. It has been described in both genders, in many ethnic groups and at different ages. Recently published studies of case series have shown a high mortality rate among these patients during follow-up of up to 48 months. Many cases have so far been misdiagnosed due to poor knowledge of the findings relating to this syndrome. There needs to be an attempt at early and accurate diagnosis, because of the need to investigate the patient’s family upon such diagnosis, and today this can be achieved using echocardiographic criteria.

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Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619893197 ◽

2019 ◽

Vol 7 ◽

pp. 232470961989319

Author(s):

Temidayo Abe ◽

Melvin Simien ◽

Hayes Dolphurs

Keyword(s):

Acute Pancreatitis ◽

Takotsubo Cardiomyopathy ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Regional Wall Motion ◽

Left Ventricular ◽

Stress Cardiomyopathy ◽

Regional Wall Motion Abnormalities ◽

Wall Motion Abnormalities

Takotsubo cardiomyopathy or stress cardiomyopathy is a transient reversible cardiomyopathy characterized by regional wall motion abnormalities that usually extend beyond a single epicardial vascular distribution. It is often precipitated by acute physical or emotional stressors. In this article, we present the case of a postmenopausal woman who was admitted for management of acute pancreatitis. On the second day of admission, she developed shortness of breath and electrocardiographic abnormalities. A transthoracic echocardiogram revealed left ventricular systolic dysfunction and apical akinesis, and coronary angiography revealed normal coronary arteries. She was diagnosed with takotsubo cardiomyopathy triggered by acute pancreatitis and started on guideline-directed heart failure medications. A follow-up echocardiogram 4 months later revealed persistent systolic dysfunction and apical akinesis.

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Identification of patients with embolic stroke of undetermined source and low risk of new incident atrial fibrillation: The AF-ESUS score

International Journal of Stroke ◽

10.1177/1747493020925281 ◽

2020 ◽

pp. 174749302092528 ◽

Cited By ~ 1

Author(s):

George Ntaios ◽

Kalliopi Perlepe ◽

Dimitris Lambrou ◽

Gaia Sirimarco ◽

Davide Strambo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Negative Predictive Value ◽

Predictive Value ◽

Left Ventricular ◽

Embolic Stroke ◽

Cardiac Monitoring ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Low Probability

Background and aims Only a minority of patients with Embolic Stroke of Undetermined Source (ESUS) receive prolonged cardiac monitoring despite current recommendations. The identification of ESUS patients who have low probability of new diagnosis of atrial fibrillation (AF) could potentially support a strategy of more individualized allocation of available resources and hence, increase their diagnostic yield. We aimed to develop a tool that can identify ESUS patients who have low probability of new incident AF. Methods We performed multivariate stepwise regression in a pooled dataset of consecutive ESUS patients from three prospective stroke registries to identify predictors of new incident AF. The coefficient of each independent covariate of the fitted multivariable model was used to generate an integer-based point scoring system. Results Among 839 patients (43.1% women, median age 67.0 years) followed-up for a median of 24.3 months (2999 patient-years), 125 (14.9%) had new incident AF. The proposed score assigns 3 points for age ≥ 60 years; 2 points for hypertension; −1 point for left ventricular hypertrophy reported at echocardiography; 2 points for left atrial diameter >40 mm; −3 points for left ventricular ejection fraction <35%; 1 point for the presence of any supraventricular extrasystole recorded during all available 12-lead standard electrocardiograms performed during hospitalization for the ESUS; −2 points for subcortical infarct; −3 points for the presence of non-stenotic carotid plaques. The rate of new incident AF during follow-up was 1.97% among the 42.3% of the cohort who had a score of ≤0, compared to 26.9% in patients with > 0 (relative risk: 13.7, 95%CI: 5.9--31.5). The area under the curve of the score was 84.8% (95%CI: 79.9--86.9%). The sensitivity and negative predictive value of a score of ≤0 for new incident AF during follow-up were 94.9% (95%CI: 89.3--98.1%) and 98.0% (95%CI: 95.8--99.3%), respectively. Conclusions The proposed AF-ESUS score has high sensitivity and high negative predictive value to identify ESUS patients who have low probability of new incident AF. Patients with a score of 1 or more may be better candidates for prolonged automated cardiac monitoring. Clinical trial registration URL: https://www.clinicaltrials.gov / Unique identifier: NCT02766205.

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Acute Superior Mesenteric Artery Embolism treated with Percutaneous Mechanical Thrombectomy: Preliminary application and Experience

10.21203/rs.3.rs-19786/v1 ◽

2020 ◽

Author(s):

Qiyang Xu ◽

Yi Wang ◽

Di Wang ◽

Songjie Hu ◽

Bin Xu ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mechanical Thrombectomy ◽

Clinical Symptoms ◽

Surgical Complication ◽

Intestinal Resection ◽

Promising Alternative ◽

Percutaneous Mechanical Thrombectomy ◽

Artery Embolism

Abstract Background: Acute superior mesenteric artery embolism is a life-threatening disease and the prognosis is very poor. Few reports have described the application of Percutaneous Mechanical Thrombectomy in Acute superior mesenteric artery embolism. In the article, we show a series of cases treated with Percutaneous Mechanical Thrombectomy and share our experience. Methods: Review and analyze seven patients with acute superior mesenteric artery embolism treated by Angiojet Ultra thrombectomy system in our institution. Based on the literature, we summarize the diagnosis, treatment and surgical experience of acute superior mesenteric artery embolism. Results: Percutaneous Mechanical Thrombectomy were achieved successfully in all the patients without surgical complication occurred. Five patients’ symptoms relieved significantly and smoothly discharged from the hospital. Two patients still complained of abdominal pain after operation. One patient underwent surgical laparotomy and intestinal resection and the other one abandoned surgical treatment. During the first six months of follow-up, six patients were free of any clinical symptoms or signs and one patient who refused laparotomy died two days later with septic shock. Conclusion: Percutaneous Mechanical Thrombectomy by Angiojet Ultra thrombectomy system is a safe, effective and minimally invasive method in the initial stage of acute superior mesenteric artery embolism. We believe Percutaneous Mechanical Thrombectomy could be a promising alternative in selected cases. Furthermore, large sample data and long term follow-up are needed to verify its effect.

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