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3.
Vasc Endovascular Surg ; 54(6): 519-524, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32372691

RESUMO

Iliac artery aneurysms can rarely present with rupture into adjacent iliac vein resulting in arteriovenous fistula leading to acute cardiac failure or multi-organ failure. End-organ damage can be reversed with timely diagnosis and intervention. Endovascular therapy is an attractive option to treat this pathology besides allowing for a quick recovery and mitigating the risk of mortality associated with open surgical treatment options. We report treatment of this pathology with Endovascular repair with preservation of ipsilateral hypogastric artery flow using an iliac branch graft device. The postoperative course was complicated by type 3 endoleak due to the separation of components between iliac branch graft and aortic stent graft with resultant recurrence of the fistula. Additional endovascular techniques, including placement of a venous stent and stent grafts to bridge the components, was used to treat the endoleak. We present this report due to the unique nature of the recurrent arteriovenous fistula, technical complexity, and resultant multi-organ dysfunction.


Assuntos
Aneurisma Roto/cirurgia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Insuficiência de Múltiplos Órgãos/etiologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Recidiva , Stents , Resultado do Tratamento
4.
Ann Vasc Surg ; 66: 24-27, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32422287

RESUMO

We herein report a rare case of the ruptured popliteal artery aneurysm in an 89-year-old man, whose recovery after surgical treatment was complicated with acute respiratory distress syndrome secondary to confirmed infection with SARS-CoV-2. Presenting symptoms, patient's comorbidities, and postoperative course complicated with cardiac and respiratory failure leading to adverse outcome are discussed in this case report.


Assuntos
Aneurisma Roto/diagnóstico , Aneurisma Roto/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Artéria Poplítea , Síndrome do Desconforto Respiratório do Adulto/etiologia , Idoso de 80 Anos ou mais , Humanos , Masculino , Pandemias
5.
Am J Emerg Med ; 38(7): 1543.e3-1543.e5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305158

RESUMO

Patients with neurofibromatosis type 1 (NF1) can develop both benign and malignant tumors throughout their lives. A 49-year-old man was transferred to the emergency department with complaints of sudden right dorsal pain and respiratory discomfort. He was in shock on arrival. On finding significantly decreased permeability of the left lung field in chest X-ray, drainage was immediately performed. Subsequent computed tomography (CT; Lammert et al., 2005) angiography revealed the extravasation of contrast media from the deep carotid artery, a branch of subclavian artery. It suggested rupture of an aneurysm located at a rare site; the ruptured aneurysm penetrated the pleura, causing shock. The patient was resuscitated. Transcatheter arterial embolization (TAE; Evans et al., 2010) was successfully performed. Immediate drainage, resuscitation, and TAE 2 improved his condition. Most NF1 patients have café-au-lait macules; café-au-lait macules tend to fade with age. Importantly, café-au-lait macules, neurofibromas, and Lisch nodules were noticed at admission. NF1 patients are likely to have a malignant neoplasm when they are young. The patient had been diagnosed with thyroid cancer when he was young. As his deceased mother was an NF1 patient, we diagnosed him with NF1. Detailed patient history and early-stage examination led to the early diagnosis. NF1 should be considered as an early differential diagnosis to improve the outcome of patients in such cases.


Assuntos
Aneurisma Roto/etiologia , Artérias Carótidas/diagnóstico por imagem , Hemotórax/etiologia , Neurofibromatose 1/diagnóstico , Choque/etiologia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade
6.
BMC Neurol ; 20(1): 94, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171270

RESUMO

BACKGROUND: Infectious basilar artery (BA) aneurysm has been occasionally reported to be generated from meningitis following transcranial operation. However, infectious BA aneurysm formed by intracranial infection after endoscopic endonasal operation has never been reported. CASE PRESENTATION: A 53-year-old man who was diagnosed with suprasellar region meningioma received tumor removal via endoscopic endonasal approach. After operation he developed cerebrospinal fluid (CSF) leak and intracranial infection. The patient ultimately recovered from infection after anti-infective therapy, but a large fusiform BA aneurysm was still formed and ruptured in a short time. Interventional and surgical measures were impossible due to the complicated shape and location of aneurysm and state of his endangerment, therefore, conservative anti-infective therapy was adopted as the only feasible method. Unfortunately, the aneurysm did not disappear and the patient finally died from repeating subarachnoid hemorrhage (SAH). CONCLUSION: Though extremely rare, it was emphasized that infectious aneurysm can be formed at any stage after transnasal surgery, even when the meningitis is cured. Because of the treatment difficulty and poor prognosis, it was recommended that thorough examination should be timely performed for suspicious patient to make correct diagnosis and avoid fatal SAH.


Assuntos
Aneurisma Roto/etiologia , Aneurisma Intracraniano/etiologia , Meningite/complicações , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Subaracnóidea/etiologia , Antibacterianos/uso terapêutico , Artéria Basilar , Endoscopia , Evolução Fatal , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Meningite/tratamento farmacológico , Pessoa de Meia-Idade , Neoplasias da Base do Crânio/cirurgia
7.
World Neurosurg ; 137: 173, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32001410

RESUMO

This case Video 1 demonstrates a microsurgical technique for trapping and excision of 2 ruptured mycotic aneurysms. The patient was a 64-year-old man with severe mitral regurgitation and valvular vegetations suggestive of endocarditis. On examination, the patient presented with speech difficulty. Preoperative imaging showed a large left temporoparietal intracerebral hemorrhage and associated sulcal subarachnoid hemorrhage from 2 distal aneurysms of the left middle cerebral artery. In the presence of ruptured aneurysms in a patient who requires anticoagulation for valve replacement, endovascular options are limited. For aneurysms located in an eloquent area in the left hemisphere, microsurgical treatment with small corridors can facilitate excision and minimize damage to the surrounding tissue. As such, the patient was treated with microsurgical trapping and excision of the aneurysms followed by evacuation of intraparenchymal hemorrhage using stereotactic navigation. Intraoperative neurophysiologic monitoring was used to prepare for a potential bypass in the event of inadequate collaterals or changes in neurophysiologic potentials. Postoperatively, the patient remained symmetric in his motor strength and had improved speech deficits, indicative of an uneventful recovery. The patient was cleared for full anticoagulation and valve replacement on postoperative day 10. The patient underwent intravenous antibiotic therapy with ceftriaxone before undergoing mitral valve replacement by cardiac surgery.


Assuntos
Aneurisma Roto/cirurgia , Hemorragia Cerebral/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Aneurisma Roto/etiologia , Anticoagulantes/uso terapêutico , Hemorragia Cerebral/etiologia , Endocardite/complicações , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Aneurisma Intracraniano/etiologia , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Técnicas Estereotáxicas
8.
J Neurol Surg A Cent Eur Neurosurg ; 81(2): 177-184, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31935782

RESUMO

BACKGROUND: Advances in the endovascular armamentarium, such as flow diversion and stenting devices, provide treatment options for posterior circulation intracranial aneurysms (IAs) with complex angioarchitecture. Delayed IA rupture following flow diversion is a rare but often fatal complication. Giant IAs likely pose a higher risk because of the extensive clot formation and its suspected detrimental effect on the aneurysmal wall. However, mechanisms that lead to delayed rupture are poorly understood, and few cases provide thorough documentation of macroscopic and histologic findings. CLINICAL PRESENTATION: After our 60-year-old patient with a giant basilar aneurysm underwent treatment with a LEO stent, the postoperative clinical course remained uneventful until day 4 when he suffered an unexpected fatal subarachnoid hemorrhage (SAH). Autopsy demonstrated extensive hemorrhage, large intraluminal thrombus, and ruptured IA wall. The aneurysm, which ruptured linearly, was completely filled with a clot that seemed to have outgrown the thin aneurysm wall. Histologic specimens revealed thinning and degenerative changes of the aneurysm's wall, and sparse neutrophilic and histiocytic inflammatory infiltrate adjacent to the rupture site, a finding consistent with recently published cases of IA rupture. CONCLUSIONS: Our case report highlighting the clinical course and autopsy findings of a fatal SAH shortly after stenting this giant basilar artery aneurysm adds to the few previously reported fatal cases of IA rupture after endovascular treatment. Our macroscopic and histologic findings suggested that multimodal changes of inflammation, wall sheer tress (mechanical), and recanalization were involved.


Assuntos
Aneurisma Intracraniano/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Stents/efeitos adversos , Aneurisma Roto/etiologia , Aneurisma Roto/patologia , Autopsia , Evolução Fatal , Humanos , Aneurisma Intracraniano/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Hemorragia Subaracnóidea/etiologia
9.
Neurol Neurochir Pol ; 54(1): 47-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967317

RESUMO

BACKGROUND: In patients with SAH and multiple aneurysms, the ruptured lesion must be identified to prevent recurrent bleeding. AIM OF THE STUDY: To assess the diagnostic value of non-enhanced computed tomography (NECT) in identifying the rupture site in patients with subarachnoid haemorrhage (SAH) and multiple aneurysms. MATERIAL AND METHODS: We included patients with SAH revealed by NECT and multiple aneurysms detected on computed tomography angiography (CTA) in whom a ruptured aneurysm was identified during neurosurgery. Two radiologists predicted the location of the ruptured aneurysm based on the distribution of the SAH and location of intracerebral haematoma (ICH) by NECT. RESULTS: Eighty-three patients with a mean age of 55.7 ± 14.4 years were included. Ruptured aneurysms were significantly larger (mean size 7.7 ± 4.7 mm) than unruptured aneurysms (mean size 5.9 ± 4.5 mm; p = 0.014). Interobserver agreement was 0.86 (p < 0.001). Overall sensitivity and specificity of radiological prediction were 78.3% (95% CI, 68.6%-87.1%) and 96.4% (95% CI, 94.3%-97.8%) respectively. Overall PPV and NPV were 78.3% (95% CI, 67.6%-86.3%) and 96.8% (95% CI, 94.8%-98.1%) respectively. The sensitivity and PPV for aneurysms in the anterior communicating, anterior, and middle cerebral arteries appeared to be significantly higher than in other locations (p = 0.015 and 0.019 respectively). Analysis of independent predictive factors of correct radiological location revealed that ICH predisposes to a correct radiological diagnosis with an odds ratio of 8.57 (95% CI, 1.07-68.99; p = 0.03). CONCLUSIONS: NECT has a high diagnostic value in identifying the source of bleeding in patients with multiple aneurysms for anterior circulation aneurysms, especially with coexisting ICH. For other locations, NECT is not reliable enough to base treatment decisions upon.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X
10.
World Neurosurg ; 133: e89-e96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479795

RESUMO

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artéria Radial/transplante , Artérias Temporais/cirurgia , Adulto , Idoso , Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Circulação Cerebrovascular , Transtornos Cognitivos/etiologia , Estudos de Viabilidade , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/etiologia , Adulto Jovem
11.
World Neurosurg ; 134: e289-e297, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629140

RESUMO

BACKGROUND: The long-term outcomes of patients with intraprocedural aneurysm rupture (IPR) during endovascular coiling of unruptured intracranial aneurysms (UIAs) remain unclear. We investigated the long-term outcomes and predictors of neurological outcomes in patients who sustained IPR during coil embolization of UIAs. METHODS: We retrospectively analyzed the medical record of 312 untreated UIAs in 284 patients who underwent endovascular coiling between April 2013 and July 2018. RESULTS: The mean follow-up period for the entire cohort was 25.6 months. Twelve patients (3.8%) experienced IPR. The mean aneurysm size in the IPR cohort was significantly smaller than that in the no-IPR cohort (P = 0.045). The IPR cohort had a higher percentage of earlier subarachnoid hemorrhage from another aneurysm (P = 0.019), anterior communicating artery (AComA) aneurysm (P < 0.001), and basilar artery (BA) aneurysm (P = 0.022) than the no-IPR cohort. Neurologic deterioration was observed in 3 patients. The morbidity and mortality rates of the IPR cohort were 25% and 8.3%, respectively. Patients with IPR during coil embolization for AComA aneurysm did not develop neurological deterioration. Two of the 3 patients (66.7%) with a BA aneurysm had neurological deterioration. The proportion of patients with an mRS score of 0-2 at the last follow-up did not differ between the 2 cohorts (P = 0.608). CONCLUSIONS: The proportion of functionally independent patients did not differ between patients with and without IPR. Patients with BA aneurysms who developed an IPR tended to exhibit more unfavorable clinical courses than patients with AcomA aneurysms.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Embolização Terapêutica/tendências , Procedimentos Endovasculares/tendências , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/etiologia , Estudos de Coortes , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
World Neurosurg ; 135: 2-6, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31734428

RESUMO

BACKGROUND: Intracranial aneurysm formation after Gamma Knife radiosurgery (GKRS) is a rare complication that has only recently been reported in the literature. We report the case of a fatal distal superior cerebellar artery (SCA) aneurysm rupture in a woman treated twice with GKRS for trigeminal neuralgia along with a review of the literature regarding radiation-induced aneurysms. CASE DESCRIPTION: A 77-year-old white woman with a history of refractory right-sided trigeminal neuralgia treated with GKRS in 2001, and again in 2006 after a relapse, presented to our emergency department with complaints of a sudden-onset severe headache associated with vomiting, right eye vision loss, left-sided facial droop, and left-sided weakness with no history of hypertension or smoking prior to presentation. Initial head computed tomography scan without contrast demonstrated an intraparenchymal hemorrhage centered in the right middle cerebellar peduncle with subarachnoid hemorrhage in the basal cisterns and extension into the fourth ventricle causing early hydrocephalus. Head computed tomography angiography (CTA) demonstrated a distal right SCA aneurysm adjacent to the hemorrhage. The patient's mental status deteriorated into coma after suspected rerupture during the CTA requiring immediate intubation, external ventricular drain placement, and emergent cerebral angiogram with coil embolization. Ultimately, the patient never recovered despite medical and surgical management; therefore, care was withdrawn in accordance with her known wishes. CONCLUSIONS: The pathophysiologic association of aneurysm formation after GKRS remains to be elucidated, but given the potentially fatal consequences of aneurysm rupture, we advocate for further research and propose serial vascular imaging during the postradiosurgery follow-up period for iatrogenic aneurysm formation surveillance.


Assuntos
Aneurisma Roto/etiologia , Aneurisma Intracraniano/etiologia , Radiocirurgia/efeitos adversos , Neuralgia do Trigêmeo/cirurgia , Idoso , Aneurisma Roto/diagnóstico por imagem , Angiografia Cerebral , Doença Crônica , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neuralgia do Trigêmeo/diagnóstico por imagem
13.
Surg Today ; 50(1): 38-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31620866

RESUMO

Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.


Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Vísceras/irrigação sanguínea , Aneurisma/etiologia , Aneurisma/patologia , Aneurisma Roto/etiologia , Aneurisma Roto/prevenção & controle , Artéria Celíaca , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/tendências , Humanos , Laparoscopia/métodos , Laparoscopia/tendências , Artéria Mesentérica Inferior , Artéria Mesentérica Superior
14.
World Neurosurg ; 134: 79-85, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669242

RESUMO

BACKGROUND: Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, noninflammatory vascular disease, characterized by mediolysis. We report an extremely rare case of subarachnoid hemorrhage (SAH) due to a ruptured blood blister-like aneurysm (BBA) of the internal carotid artery associated with SAM-related arteriopathy. CASE DESCRIPTION: We experienced a case of SAH followed by intraperitoneal hemorrhage that occurred 12 days after the SAH onset. SAH was caused by a ruptured BBA of the internal carotid artery, which was treated by trapping with high-flow bypass. Intraperitoneal hemorrhage was caused by a rupture of a posterior inferior pancreaticoduodenal artery (PIPDA) aneurysm, which induced hypovolemic shock resulting in death in spite of endovascular internal trapping. Postmortem pathologic examination revealed that the PIPDA pseudoaneurysm was due to SAM. CONCLUSIONS: We should pay attention to the association of SAM, which is a potentially life-threatening pathology when treating cerebral BBAs.


Assuntos
Aneurisma Roto/patologia , Artéria Carótida Interna/patologia , Artéria Mesentérica Superior/patologia , Túnica Média/patologia , Doenças Vasculares/patologia , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/patologia , Aneurisma Roto/etiologia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/complicações
15.
World Neurosurg ; 134: 123-127, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31689569

RESUMO

BACKGROUND: The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children. CASE DESCRIPTION: We herein report the first case, to our knowledge, of an extremely rare subarachnoid hemorrhage presentation of a child with a ruptured anterior cerebral artery dissecting aneurysm secondary to a newly discovered, unilateral Moyamoya-like pathology. CONCLUSIONS: MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic stress.


Assuntos
Doenças Arteriais Cerebrais/etiologia , Aneurisma Intracraniano/etiologia , Doença de Moyamoya/complicações , Hemorragia Subaracnóidea/etiologia , Adolescente , Aneurisma Roto/etiologia , Feminino , Humanos
17.
Am J Case Rep ; 20: 1892-1895, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31848328

RESUMO

BACKGROUND Coronary-to-pulmonary artery fistulas are congenital coronary anomalies that are often incidentally found and no hemodynamic significance. They are abnormal vessels originating from the coronary artery and terminating into the pulmonary artery, with a tortuous pathway. However, coronary-pulmonary artery fistula associated with coronary artery aneurysm is a rare condition that can cause cardiac death. CASE REPORT A 55-year-old Thai woman diagnosed with traumatic aortic injury after being gored by a buffalo was incidentally found by computed tomography (CT) to have a coronary arteriovenous fistula with large aneurysm. One week after urgent thoracic endovascular aortic repair (TEVAR), she had a cardiac tamponade. Median sternotomy was performed for diagnosis and treatment. The final diagnosis was rupture of a large aneurysm of the coronary-pulmonary artery fistula (CPAF). No complications were found and the patient was discharged 2 weeks after surgery. CONCLUSIONS CPAF associated with rupture of a giant coronary aneurysm is a rare and life-threatening condition. Prompt diagnosis and emergency surgery are essential to treatment of these patients.


Assuntos
Aneurisma Roto/cirurgia , Fístula Arteriovenosa/cirurgia , Aneurisma Coronário/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Artéria Pulmonar/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Animais , Aorta/lesões , Fístula Arteriovenosa/diagnóstico por imagem , Búfalos , Aneurisma Coronário/diagnóstico por imagem , Ponte de Artéria Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Traumatismos Torácicos/complicações , Tomografia Computadorizada por Raios X , Ferimentos Penetrantes/complicações
18.
Medicine (Baltimore) ; 98(52): e18420, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876716

RESUMO

RATIONALE: The incidence of double aneurysms on the ophthalmic segment of the internal carotid artery (ICA) is very rare. Nevertheless, delayed rupture of a parent artery instead of the aneurysmal sac following pipeline embolization device (PLED) is unusual. PATIENT CONCERNS: We present a 72-year-old female who was admitted at our facility with gradual onset of nonspecific visual changes. DIAGNOSIS: Conventional angiography revealed 2 aneurysms located at the ophthalmic segment of the left ICA. INTERVENTIONS: Both aneurysms were successfully treated with PLED. OUTCOMES: Two months after discharge, the patient was rushed into the emergency with bilateral conjunctival congestion. Computed tomography revealed intracranial hemorrhage at left temporal lobe while digital subtraction angiography established a left direct carotid cavernous fistula. We utilized stent (Solitaire 6*30) assisted coils to occlude the fistula. The patient is well and go about her normal duties. LESSIONS: Manipulation of the tortuous parent artery resulted in a focal traumatic weakness in the artery and subsequently a delay tear. We are of the view that, endovascular surgeons should be on the lookout for this complication following flow deviation treatment modalities.


Assuntos
Aneurisma Roto/etiologia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/terapia , Idoso , Aneurisma Roto/diagnóstico por imagem , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Embolização Terapêutica/métodos , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem
19.
Neurol India ; 67(5): 1194-1199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31744943

RESUMO

Objective: Aneurysm rupture is often a fatal complication of giant intradural aneurysm (GIA) treatments. The purpose of this study was to review aneurysm rupture in GIA treatment. Materials and Methods: We performed a systematic review on aneurysm rupture related to GIA treatment. For each reported case, we collected the following information: aneurysm location, size and rupture status, the mode of treatment, timing of the hemorrhage, anatomical, and hemodynamic factors. Results: We identified 56 aneurysm ruptures related to treatment in 38 published studies. Of the nine intraoperative ruptures, eight occurred during endovascular procedures and one in surgical treatment. Of the 47 delayed ruptures, 72.3% occurred within 2 weeks. The prognosis of intraoperative and delayed ruptures was poor, with 83.9% experiencing death. Of these aneurysms, 75% were initially unruptured. Of the delayed ruptured aneurysms, 21.3% had prior surgical treatment, 74.4% had prior endovascular treatment, and 4.3% had prior combined surgical and endovascular treatments. Vertebrobasilar artery (VBA) location was significantly associated with aneurysm rupture after treatment, occurring at 57.2%. Flow diverter (FD) treatment seemed to elevate the delayed rupture proportion of giant paraclinoid internal carotid artery (ICA) aneurysms from 22.0% to 42.9%. FD treatment did not lower the rupture risk of giant VBA aneurysms and the corresponding death rate. Conclusion: Intraoperative and delayed aneurysm ruptures were the most challenging in endovascular treatment of GIAs. Giant VBA aneurysm had the highest rupture risk after treatment. FD seemed to elevate the delayed rupture proportion of giant paraclinoid aneurysms.


Assuntos
Aneurisma Roto/etiologia , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/terapia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos
20.
Medicine (Baltimore) ; 98(44): e17785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689850

RESUMO

INTRODUCTION: Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS: A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. DIAGNOSIS: Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. INTERVENTIONS: After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. OUTCOMES: Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. CONCLUSIONS: Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.


Assuntos
Aneurisma Roto/etiologia , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/etiologia
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