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1.
Stroke ; 51(6): 1743-1749, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375585

RESUMO

Background and Purpose- Embolic stroke of undetermined source (ESUS) constitutes a large proportion of acute ischemic stroke. It is crucial to identify possible stroke etiologies in this patient subgroup to individually tailor secondary stroke prevention strategies. This study aimed to assess the prevalence of carotid plaques causing <50% stenosis in ESUS patients on computed tomography angiography and the association of these plaques with ipsilateral strokes. Methods- Patients from INTERRSeCT-a multicenter prospective study of patients with acute ischemic stroke-were included in this study if their stroke etiology was not large artery atherosclerosis (>50% stenosis), and neck computed tomography angiography was obtained. Degree of stenosis (<30% versus 30%-50%), maximum plaque thickness, degree of plaque calcification (<50% versus ≥50%), plaque irregularity, ulceration, hypodensity, carotid web, and focal vessel outpouching were assessed for both carotid arteries on computed tomography angiography. Prevalence of carotid plaques with <50% stenosis (nonstenotic plaques), ipsilateral and contralateral to the stroke, in ESUS patients was determined and compared with non-ESUS patients. Features of these plaques with versus without ipsilateral stroke in ESUS patients were compared. Uni- and multivariable logistic regression was performed to determine associations between nonstenotic carotid plaque, plaque characteristics, and ipsilateral stroke in ESUS patients. Results- Four hundred forty-six patients were included in the study (median age, 73 years; 218 men), 138 of which were ESUS patients (median age, 70 years; 61 men). Nonstenotic carotid plaques (with <50% stenosis) were present in 54 of 138 (39.1%) ESUS patients. Twelve (8.7%) patients had bilateral carotid plaques. Forty (60.6%) of these plaques were ipsilateral and 26 (39.4%) contralateral to the side of the stroke (P=0.004). Nonstenotic carotid plaques were significantly associated with ipsilateral strokes (adjusted odds ratio, 1.83 [95% CI, 1.05-3.18]). Conclusions- In patients with ESUS, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential stroke etiology in patients in whom the ischemic stroke is classified currently as ESUS.


Assuntos
Isquemia Encefálica , Doenças das Artérias Carótidas , Angiografia por Tomografia Computadorizada , Embolia , Placa Aterosclerótica , Acidente Vascular Cerebral , Calcificação Vascular , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Embolia/diagnóstico por imagem , Embolia/epidemiologia , Embolia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/epidemiologia , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia
3.
Rinsho Shinkeigaku ; 60(6): 414-419, 2020 Jun 06.
Artigo em Japonês | MEDLINE | ID: mdl-32435046

RESUMO

A small centrum ovale infarct in the territory of the white matter medullary artery can be caused not only by embolism but also small-vessel disease. In our study, thorough screening for emboligenic diseases was performed, including the modality of transesophageal echocardiography (TEE), in patients with an acute, isolated, small (less than 1.5 cm) infarct in the centrum ovale. Of 79 patients enrolled in this study, 45 had emboligenic diseases, in whom a patent foramen ovale was detected in 29 patients, complicated aortic arch lesion in 15, atrial fibrillation in 6, occlusive carotid disease in 2, and others in 2. The majority (80%) of the emboligenic diseases were diagnosed by TEE. Therefore, TEE may be mandatory for the etiologic diagnosis of centrum ovale infarcts.


Assuntos
Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Ecocardiografia Transesofagiana , Embolia/complicações , Embolia/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/etiologia , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem
5.
Open Heart ; 7(1): e001176, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32257245

RESUMO

Objective: The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke. Methods: We retrospectively analysed TOE cases with confirmed ischaemic stroke at our centre between April 2015 and February 2017. We defined a change in management as the initiation of anticoagulation therapy, antibiotic therapy or patent foramen ovale closure as a direct result of TOE findings. Results: There were 185 patients included in this analysis; 19 (10%) experienced a change in management. However, only 7 of the 19 (4% of all subjects) experienced a change in management due to TOE findings. The remaining 12 were initiated on oral antigoagulation as a result of discoveries during routine workup, mainly atrial fibrillation on telemetry monitoring. Conclusions: This work suggests an overuse of TOE and provides support for the 2018 AHA/ASA stroke guidelines, which recommend against the routine use of echocardiography in the work up of cerebrovascular accident due to a cardioembolic source.


Assuntos
Isquemia Encefálica/etiologia , Ecocardiografia Transesofagiana , Embolia/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Idoso , Antibacterianos/administração & dosagem , Anticoagulantes/administração & dosagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/prevenção & controle , Tomada de Decisão Clínica , Bases de Dados Factuais , Embolia/complicações , Embolia/terapia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/terapia , Cardiopatias/complicações , Cardiopatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/prevenção & controle
6.
Medicine (Baltimore) ; 99(11): e19354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176057

RESUMO

RATIONALE: Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart. PATIENT CONCERNS: A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty. DIAGNOSES: Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found. INTERVENTIONS: The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve. OUTCOMES: The postoperative course was uneventful and the patient was discharged on the 13th day after surgery. LESSONS: If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia/etiologia , Embolia/cirurgia , Corpos Estranhos/diagnóstico por imagem , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Ecocardiografia/métodos , Embolia/diagnóstico por imagem , Feminino , Fluoroscopia/métodos , Seguimentos , Corpos Estranhos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 29(4): 104604, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31932211

RESUMO

BACKGROUND AND PURPOSE: While studies have stratified cardioembolic (CE) stroke risk by qualitative left atrial appendage (LAA) morphology and biomarkers of atrial dysfunction, the quantitative properties that underlie these observations are not well established. Accordingly, we hypothesized that LAA volume and contrast density (attenuation) on computerized tomography (CT) may capture the structural and hemodynamic processes that underlie CE stroke risk. METHODS: Data were collected from a single center prospective ischemic stroke database over 18 months and included all patients with ischemic stroke who previously underwent routine, nongated, contrast enhanced thin-slice (≤2.5 mm) chest CT. Stroke subtype was determined based on the inpatient diagnostic evaluation. LAA volume and attenuation were determined from CT studies performed for various clinically appropriate indications. Univariate and multivariable analyses were performed to determine factors associated with ischemic stroke subtype, including known risk factors and biomarkers, as well as LAA density and morphologic measures. RESULTS: We identified 311 patients with a qualifying chest CT (119 CE subtype, 109 Embolic Stroke of Undetermined Source (ESUS), and 83 non-CE). In unadjusted models, there was an association between CE (versus non-CE) stroke subtype and LAA volume (OR per mL increase 1.15, 95% CI 1.07-1.24, P < .001) and LAA density (4th quartile versus 1st quartile; OR 2.95, 95% CI 1.28-6.80, P = .011), but not with ESUS (versus non-CE) subtype. In adjusted models, only the association between LAA density and CE stroke subtype persisted (adjusted OR 3.71, 95% CI 1.37-10.08, P = .010). CONCLUSION: The LAA volume and density values on chest CT are associated with CE stroke subtype but not ESUS subtype. Patients with ESUS and increased LAA volume or attenuation may be a subgroup where the mechanism is CE and anticoagulation can be tested for secondary stroke prevention.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Embolia/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/fisiopatologia , Bases de Dados Factuais , Embolia/complicações , Embolia/fisiopatologia , Feminino , Cardiopatias/complicações , Cardiopatias/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
8.
Stroke ; 51(1): 154-161, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31795906

RESUMO

Background and Purpose- We aimed to determine if microemboli after endovascular thrombectomy correlate with unfavorable outcomes despite successful recanalization. Methods- This is a prospective multicenter study of consecutive patients with ischemic stroke and occlusion of anterior circulation vessels (terminal internal carotid or main trunk of the middle cerebral artery/first-order branch of the main trunk of the middle cerebral artery segments of middle cerebral artery) after successful thrombectomy (modified Treatment In Cerebral Ischemia grades 2b-3). Microembolic signals (MES) were assessed by 30 minutes of transcranial Doppler monitoring within 72 hours of the last-seen-well time. Major outcomes included modified Rankin Scale at 90 days and infarct volume on head computed tomography at 24 hours. We also assessed early outcomes based on National Institutes of Health Stroke Scale variation and recurrence of stroke, transient ischemic attack, or systemic embolism within 90 days. Results- Among 111 patients, MES were detected in 43 (39%), with a median rate of 4 counts/h (interquartile range 2-12). The occurrence of MES was not associated with a significant difference in modified Rankin Scale (ordinal shift analysis, adjusted odds ratio, 1.06 [95% CI, 0.48-2.34] P=0.85) nor in functional independence (modified Rankin Scale, 0-2: adjusted odds ratio, 0.52 [95% CI, 0.19-1.39] P=0.19). Patients with and without MES had similar infarct volumes (adjusted beta, 11.2 [95% CI, -46.6 to +22.9] P=0.51) on 24-hour computed tomography. MES did predict new embolic events (adjusted Cox hazard ratio, 6.78 [95% CI, 1.63-27.8] P=0.01). Conclusions- MES detected by transcranial Doppler following endovascular treatment of anterior circulation occlusions do not predict clinical or radiological outcome. However, such emboli are an independent marker of recurrent embolic events within 90 days.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias , Acidente Vascular Cerebral , Trombectomia/efeitos adversos , Ultrassonografia Doppler Transcraniana , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/cirurgia , Embolia/diagnóstico por imagem , Embolia/epidemiologia , Embolia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/cirurgia
9.
Plast Reconstr Surg ; 145(1): 42e-50e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881603

RESUMO

BACKGROUND: With an increase in recent years in the number of people receiving cosmetic facial injection treatments of hyaluronic acid, the incidence of hyaluronic acid embolism has also increased commensurately. Hyaluronic acid embolism leads to serious complications, including blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment for hyaluronic acid embolism by intraarterial thrombolysis therapy. METHODS: This study included 24 patients with a decrease in visual acuity and other complications induced by facial hyaluronic acid injection. Patients underwent emergency intraarterial thrombolysis therapy by injection of hyaluronidase (500 to 1500 units) alone or hyaluronidase (750 to 1500 units) combined with urokinase (100,000 to 250,000 units), followed in both cases by a general symptomatic treatment and nutritional therapy. RESULTS: Ten (42 percent) of 24 patients ultimately had improvements to visual acuity, even when the clinical application of the thrombolytic treatments had passed the recommended window for optimal treatment. In all cases, patients' facial skin necrosis was restored to nearly normal appearance. In addition, the authors found that hyaluronidase combined with urokinase was a more effective therapy than hyaluronidase alone. CONCLUSIONS: The authors' results indicate that intraarterial thrombolysis therapy is beneficial to patients suffering from blindness induced by hyaluronic acid embolism. The therapy was shown to be worthy of clinical application because it alleviated the impairment to patients' vision and was also beneficial in the recovery from other serious complications, including eye movement disorder, eye edema, headaches, and skin necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Cegueira/tratamento farmacológico , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Embolia/tratamento farmacológico , Artéria Oftálmica/patologia , Terapia Trombolítica/métodos , Adulto , Angiografia Digital , Cegueira/etiologia , Preenchedores Dérmicos/administração & dosagem , Quimioterapia Combinada/métodos , Embolia/diagnóstico por imagem , Embolia/etiologia , Embolia/patologia , Olho/irrigação sanguínea , Feminino , Seguimentos , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase/uso terapêutico , Injeções Intra-Arteriais , Injeções Subcutâneas/efeitos adversos , Masculino , Artéria Oftálmica/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Acuidade Visual
11.
J Radiol Case Rep ; 13(2): 9-14, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31565167

RESUMO

A 73-year old man presented with a posterolateral ST-elevated myocardial infarction 9 months after biological aortic valve replacement for aortic valve stenosis. Invasive coronary angiography showed a filling defect across the left main coronary artery bifurcation extending into the left anterior descending artery and the ramus circumflex. Transthoracic echocardiography revealed a thickened prosthesis leaflet with signs of slight stenosis. Cardiac computed tomography angiography showed a mass on the left coronary cusp of the valve prosthesis, suggestive for vegetation or thrombus. The scan also revealed central luminal filling defects, indicative for thrombus or septic emboli. Blood cultures proved positive for Propionibacterium acnes, therefore the patient was treated for prosthetic valve endocarditis. Computed tomography angiography offers high diagnostic accuracy for detecting infective endocarditis and renders complementary information about valvular anatomy, coronary artery disease and the extension of infections.


Assuntos
Valva Aórtica , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico por imagem , Embolia/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Idoso , Angiografia Coronária , Ecocardiografia , Embolia/microbiologia , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Propionibacterium acnes , Tomografia Computadorizada por Raios X
14.
Cardiovasc Eng Technol ; 10(4): 648-659, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31529410

RESUMO

PURPOSE: There has been interest in recent work in using computational fluid dynamics with Lagrangian analysis to calculate the trajectory of emboli-like particles in the vasculature. While previous studies have provided an understanding of the hemodynamic factors determining the fates of such particles and their relationship to risk of stroke, most analyses have relied on a particle equation of motion that assumes the particle is "small" e.g., much less than the diameter of the vessel. This work quantifies the limit when a particle can no longer be considered "small". METHODS: The motion of embolus-like particles are simulated using an overset mesh technique. This allows the fluid stresses on the particle surface to be fully resolved. Consequently, the particles can be of arbitrary size or shape. The trajectory of resolved particles and "small" particles are simulated through a patient-specific carotid artery bifurcation model with particles 500, 1000, and 2000 µm in diameter. The proportions of particles entering the internal carotid artery are treated as the outcome of the particle fate, and statistical comparisons are made to ascertain the importance of non-small particle effects. RESULTS: For the 2000 µm embolus, the proportion of particles traveling to the internal carotid artery is 74.7 ± 1.3% (mean ± 95% confidence margin) for the "small" particle model and is 85.7 ± 5.4% for a resolved particle model. The difference is statistically significant, [Formula: see text], based on the binomial test for the particle outcomes. No statistically discernible differences are found for the smaller diameter particles. CONCLUSIONS: Quantitative differences are observable for the 2000 µm trajectories between the "small" and resolved particle models which is a particle diameter 27% relative to the common carotid artery diameter. A fully resolved particle model ought to be considered for emboli trajectory simulations when the particle size ratio is ≳ 20%.


Assuntos
Artéria Carótida Interna/fisiopatologia , Embolia/fisiopatologia , Hemodinâmica , Modelos Cardiovasculares , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/diagnóstico por imagem , Embolia/diagnóstico por imagem , Humanos , Tamanho da Partícula , Fluxo Sanguíneo Regional , Propriedades de Superfície , Fatores de Tempo
15.
J Pak Med Assoc ; 69(8): 1216-1218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431784

RESUMO

Peripartum cardiomyopathy (PPCM) is a condition of unknown etiology that presents as heart failure due to left ventricular systolic dysfunction in the last of month of pregnancy and up to six months after giving birth. PPCM predisposes towards thrombo-embolism and an acute limb ischaemia can be a manifestation of this disease. We present a case of a 23-year-old lady presenting an acute lower limb ischaemia four months post-partum. Doppler ultrasound showed bilateral femoral emboli and cardiac ECHO showed a 24% ejection fraction. Amputation was performed on both limbs, below her right knee and above her left knee. The patient was started on heart failure medication and her symptoms improved with diuretic therapy, confirming the diagnoses of PPCM. It is important to recognise acute limb ischaemia as a rare manifestation of PPCM, as a timely diagnosis and effective treatment of the disease can improve the prognosis. We believe this is the first case to be reported in medical literature from Pakistan of a patient presenting PPCM with bilateral acute limb ischaemia and gangrene.


Assuntos
Cardiomiopatias/complicações , Embolia/etiologia , Artéria Femoral/diagnóstico por imagem , Gangrena/etiologia , Isquemia/etiologia , Transtornos Puerperais/diagnóstico por imagem , Amputação , Cardiomiopatias/diagnóstico por imagem , Ecocardiografia , Embolectomia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Gangrena/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Extremidade Inferior , Volume Sistólico , Falha de Tratamento , Ultrassonografia Doppler , Adulto Jovem
16.
BMJ Case Rep ; 12(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31375507

RESUMO

A 46-year-old man with a medical history of rheumatic valve disease underwent mitral and aortic valve replacements with On-X and CarboMedics Top Hat supra-annular mechanical valves, respectively. Seven months after the valve replacement surgery, the patient presented with dizziness. A CT scan of the brain was done as part of a thorough workup of dizziness. The CT scan revealed a small metallic density in the M2 branch of the right middle cerebral artery. The metallic density was believed to be a metallic embolus that originated from the mechanical valves or the suturing material, that is, Cor-Knot fastener. Although in our case, the dizziness was believed to be the result of benign paroxysmal positional vertigo, through this case, we aim to highlight this extremely rare structural complication of mechanical valves. This complication can have serious and potentially fatal consequences such as embolic component-related stroke or another organ infarction.


Assuntos
Encéfalo/diagnóstico por imagem , Embolia/diagnóstico por imagem , Embolia/terapia , Próteses Valvulares Cardíacas/efeitos adversos , Encéfalo/patologia , Tontura/etiologia , Embolia/etiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Suturas/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Angiol. (Barcelona) ; 71(4): 167-169, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-190301

RESUMO

Las variaciones anatómicas en la vascularización arterial renal son altamente prevalentes y su conocimiento es de especial interés clínico. Nuestro objetivo es describir una variante anatómica de las arterias renales poco conocida en la literatura actual


The anatomical variations in renal arterial vascularization are highly prevalent and their knowledge is of special clinical interest. Our aim is to describe an anatomical variant of the renal arteries little known in current literatura


Assuntos
Humanos , Feminino , Idoso , Embolia/diagnóstico por imagem , Embolia/cirurgia , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia
18.
Clin Nucl Med ; 44(8): 655-656, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274615

RESUMO

We report a case of a transient focal MIBI uptake in the late, 90 minutes postinjection phase of a parathyroid scintigraphy in which SPECT/CT imaging proved valuable in delineating the nature of this incidental finding.


Assuntos
Embolia/diagnóstico por imagem , Hiperparatireoidismo/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Feminino , Humanos , Hiperparatireoidismo/patologia , Achados Incidentais , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi
19.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
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