Successful treatment of thromboses of major arteries after ChAdOx1 nCov-19 vaccination

The ChAdOx1 nCoV-19 adenoviral vector vaccine to prevent contracting Covid-19 caused by infection with SARS-CoV-2 has been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT) primarily leading to venous thromboses. Here, we report two cases of major arterial occlusions after ChAdOx1 nCov-19 vaccination, comprising a 42-year-old woman with thrombotic occlusion of the left carotid artery, and a 62-year-old man with occlusion of distal aorta and iliac arteries. Both were successfully treated with intravenous immunoglobulins and non-heparin anticoagulant agents leading to a beneficial short-term outcome of 6 weeks in case 1 and four months in case 2.

Paroxysmal hemicrania associated to carotid artery dissection: a case report

There are numerous case reports relating trigeminal autonomic cephalalgias to structural injuries. However there is no description of the association between paroxysmal hemicrania and carotid artery dissection. We describe a previously healthy 63-year-old male presented with the onset of severe, throbbing pain in the right frontal region, lasting between 10 and 30 minutes, with a frequency of approximately two to three attacks per day, which began two days before seeking medical care. Pain was associated with ipsilateral tearing, semiptosis and nasal congestion. A cervical arterial magnetic resonance angiography demonstrated left carotid artery dissection in the C1/C2 segment of the left internal carotid artery. The patient became asymptomatic after indomethacin use. We conclude that the possibility of investigating carotid dissection should be considered in patients with paroxysmal hemicrania.

A New Aortic Arch Dissection Classification: The Fuwai Classification

Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications.Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation.Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p < 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19).Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.

Brain noise in a quadriplegic tumor. Fedorova (Journal of Psychol. Neurol. & Psychiatry, 1922)

The author observed a case of incessant noise in the head, which disappeared on pressing the left carotid artery. The cause of this phenomenon, according to the author, was a tumor in the quadriplegic region.

The relation of SYNTAX score with Carotid Plaque Morphology in Patients who Undergoing Coronary By-pass Surgery

Objectives: Although there are many studies assessing the relationship between carotid artery ultrasound findings and coronary artery disease, the relationship between carotid plaque types and the complexity of coronary lesions is not assessed. We aimed to examine the relationship between the SYNTAX score and carotid plaque morphology. Patients and Methods: We retrospectively screened patients who underwent carotid Ultrasound before the coronary artery bypass graft operation between 2015 and 2020. Syntax score was calculated by two independent interventional cardiologists with online SYNTAX score calculator (www.syntaxscore.com). The lesions of carotid arteries by ultrasound were classified as fibrous, calcific and mixed plaques. Results: A total of 407 patients were enrolled. Median age was 65 (58-71) years and 81.6% of patients were male. We used multinomial logistic regression to test the association between plaque types and syntax score. The syntax score was associated with calcified plaque both in right (odds ratio 1.04, 95% CI 1.01-1.07, p=0.006) and left internal carotid artery (odds ratio 1.04, 95% CI 1.02-1.06, p=0.004). However, the syntax score was not associated with fibrous (odds ratio 0.97, 95% CI 0.94-1.01, p=0.155 for right and odds ratio 0.99, 95% CI 0.96-1.02, p=0.759 for left carotid artery) and mixed plaque types (odds ratio 1.02, 95% CI 0.98-1.06, p=0.168 for right and odds ratio 1.00, 95% CI 0.96-1.04, p=0.791 for left carotid artery). Conclusion: Syntax score may provide an idea for carotid plaque morphology prediction. Especially higher SYNTAX score may be a predictor of calcific carotid plaque.

An elderly woman presents with a “Transient Ischemic Attack”: A curable cause

We report a 78-year-old female who presented to the Emergency department after a 10-minute episode of transient ischemic attack (TIA)-like symptoms of right side sensorimotor deficit, presumably due to a left carotid artery ischemia syndrome, only to be found surprisingly to have bilateral multifocal acute infarcts of cardioembolic pattern by brain magnetic resonance imaging, and, even more surprisingly, to have a rare, but curable embolic source from a large left atrial myxoma. This case report emphasizes the importance of following existing guidelines to timely and thoroughly investigate the potential management-changing causes for all TIA patients. Rare but curable causes of stroke or TIA in young adults such as cardiac myxoma can also occur in the elderly patient population.

Analysis of MicroRNAs Associated With Carotid Atherosclerotic Plaque Rupture With Thrombosis

Atherosclerosis is a progressive vascular wall inflammatory disease, and the rupture of atherosclerotic vulnerable plaques is the leading cause of morbidity and mortality worldwide. This study intended to explore the potential mechanisms behind plaque rupture and thrombosis in ApoE knockout mice. The spontaneous plaque rupture models were established, and left carotid artery tissues at different time points (1-, 2-, 4-, 6-, 8-, 12-, and 16-week post-surgery) were collected. By the extent of plaque rupture, plaque was defined as (1) control groups, (2) atherosclerotic plaque group, and (3) plaque rupture group. Macrophage (CD68), MMP-8, and MMP-13 activities were measured by immunofluorescence. Cytokines and inflammatory markers were measured by ELISA. The left carotid artery sample tissue was collected to evaluate the miRNAs expression level by miRNA-microarray. Bioinformatic analyses were conducted at three levels: (2) vs. (1), (3) vs. (2), and again in seven time series analysis. The plaque rupture with thrombus and intraplaque hemorrhage results peaked at 8 weeks and decreased thereafter. Similar trends were seen in the number of plaque macrophages and lipids, the expression of matrix metalloproteinase, and the atherosclerotic and plasma cytokine levels. MiRNA-microarray showed that miR-322-5p and miR-206-3p were specifically upregulated in the atherosclerotic plaque group compared with those in the control group. Meanwhile, miR-466h-5p was specifically upregulated in the plaque rupture group compared with the atherosclerotic plaque group. The highest incidence of plaque rupture and thrombosis occurred at 8 weeks post-surgery. miR-322-5p and miR-206-3p may be associated with the formation of atherosclerotic plaques. miR-466h-5p may promote atherosclerotic plaque rupture via apoptosis-related pathways.

Diagnosis Under Pressure

A 75-year-old man with a history of BPH and squamous cell carcinoma of the tongue, presented to hospital with a one-month history of recurrent falls associated with orthostatic lightheadedness. On initial examination he had a blood pressure (BP) of 132/75 and heart rate (HR) 86 while supine and BP 101/54, HR 88 while standing. Physical exam revealed a left neck mass, and computed tomography confirmed a large left nodal mass with encapsulation of the left carotid artery. He was not a surgical candidate and had symptomatic improvement with midodrine and fludrocortisone. This case highlights a unique cause of orthostatic hypotension due to mechanical disruption of blood supply and autonomic innervation, and exemplifies the lack of compensatory tachycardia with autonomic dysregulation. RESUMEUn homme de 75 ans ayant des antécédents d’HBP et de ysregula spinocellulaire de la langue s’est présenté à l’hôpital avec des antécédents d’un mois de chutes récurrentes associées à des vertiges orthostatiques. Lors de l’examen initial, il avait une tension artérielle (BP) de 132/75 et un rythme cardiaque (HR) de 86 en position couchée et une BP de 101/54, HR 88 en position debout. En évaluant les causes communes, une tomographie informatisée de la tête/cou a révélé une grande masse nodale gauche avec encapsulation de l’artère ysregu gauche. Il n’était pas un candidat à la chirurgie et présentait une ysregulatio symptomatique grâce à la midodrine et à la fludrocortisone. Ce cas met en ysregul une cause unique d’hypotension orthostatique due à une perturbation mécanique de l’approvisionnement en sang et à une innervation autonome, et illustre l’absence de tachycardie compensatoire avec ysregulation autonome.