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1.
BMC Neurol ; 22(1): 22, 2022 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-35016635

RESUMO

INTRODUCTION: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.


Assuntos
COVID-19 , Procedimentos Endovasculares , Acidente Vascular Cerebral , Controle de Doenças Transmissíveis , Humanos , Países Baixos/epidemiologia , Pandemias , SARS-CoV-2 , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Resultado do Tratamento
2.
J Int Med Res ; 50(1): 3000605211072785, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35023389

RESUMO

Cases of patients complicated with dextrocardia who suffer from acute cerebral infarction with large vessel occlusion and receive emergency thrombectomy are particularly rare and have not been widely reported. This article aimed to increase the awareness and knowledge of these cases. We report the case of a patient with mirror-image dextrocardia who suffered from cerebral infarction with large vessel occlusion and received emergency thrombectomy. A male patient in his early 60s with dextrocardia had acute cerebral infarction with posterior circulation large vessel occlusion and underwent emergency thrombectomy. During the operation, the rapid confirmation of dextrocardia and use of flexible interventional instruments helped establish a pathway for blood flow. We used an intracranial thrombectomy stent and intracranial balloon dilation catheter to restore the cerebral blood supply. The Modified Rankin Scale score was 0 at 3 months after thrombectomy, indicating a good prognosis of the patient. Acute cerebral infarction with large vessel occlusion in patients with dextrocardia is extremely rare. Emergency thrombectomy is feasible to recanalize cerebral blood flow and give patients a chance to recover.


Assuntos
Transtornos Cerebrovasculares , Dextrocardia , Acidente Vascular Cerebral , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Dextrocardia/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Trombectomia , Resultado do Tratamento
3.
FP Essent ; 512: 18-23, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35006661

RESUMO

Ischemic stroke is an episode of neurologic dysfunction caused by focal cerebral, spinal, or retinal infarction. In patients with stroke symptoms, an urgent evaluation is advised. In the prehospital setting, early recognition of stroke signs allows appropriate triage of patients to hospitals that specialize in stroke management for thrombolysis or thrombectomy. In the hospital setting, evaluation of patients with suspected stroke includes clinical assessment, using the National Institutes of Health Stroke Scale (NIHSS), imaging of the head and blood vessels of the neck, and assessing for the cause of stroke. Evaluation for the etiology may include laboratory tests, cardiac imaging, and cardiac rhythm monitoring. Early measures for secondary stroke prevention can be initiated.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Humanos , Trombectomia , Triagem
4.
FP Essent ; 512: 24-30, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35006662

RESUMO

Urgent evaluation of patients with acute ischemic stroke allows for a comprehensive assessment of management options. These include thrombolysis and thrombectomy, depending on symptom onset and severity, the presumed location of the occlusion, and patient comorbidities and potential for improvement. For patients who present within 4.5 hours of onset of disabling symptoms consistent with acute ischemic stroke and with no contraindications, intravenous thrombolysis is indicated. Acute mechanical thrombectomy may be indicated for patients who present within 24 hours of symptom onset and have symptoms consistent with a large vessel occlusion. After reperfusion therapy, patients require close neurologic monitoring. Patients who receive reperfusion therapy tend to have better functional outcomes than patients who do not. Secondary prevention includes use of antithrombotics and glycemic control. Common issues in the acute setting include cerebral edema, hemorrhagic transformation, and symptomatic carotid disease.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Hospitais , Humanos , Reperfusão , Trombectomia
6.
Clin Imaging ; 81: 33-36, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34598001

RESUMO

In the U.S., pulmonary embolism (PE) is a common cause of cardiovascular death. Right heart thrombus (RHT) occurs in approximately 4% of patients with PE, and when concurrent is associated with increased 30-day PE-related and all-cause mortality. The consensus on optimal management of acute massive or high-risk PE is unclear, and even less so for concurrent RHT. In this report, we review a successful multidisciplinary coordination of vacuum-assisted thrombectomy (VAT) of a complex pacemaker lead-associated RHT in a patient with concurrent acute PE and significant comorbidities, using the AngioVac system (Vortex Medical, Norwell, MA). VAT is a reasonable treatment option that should be considered particularly for patients who are poor surgical or thrombolytic candidates. Procedural success and patient outcomes can be further optimized through multidisciplinary collaboration such as with the Pulmonary Embolism Response Team (PERT) model.


Assuntos
Marca-Passo Artificial , Embolia Pulmonar , Trombose , Ecocardiografia Transesofagiana , Humanos , Marca-Passo Artificial/efeitos adversos , Trombectomia , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento
7.
Vasc Endovascular Surg ; 56(1): 62-69, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34266315

RESUMO

Several treatment options exist for acute intra-abdominal arterial thromboembolic events, including systemic thrombolytics, endovascular therapy, and less commonly surgery. A novel alternative treatment intervention for acute intra-abdominal arterial thrombus is the use of stent retriever (SR) devices, tools traditionally applied for treatment of acute vascular thrombosis in stroke patients. This brief report presents two cases of acute intra-abdominal arterial thrombosis successfully managed by deployment of SRs. Furthermore, it details the history, device mechanism, and design of SRs and describes cases in literature involving effective extracranial SR application.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Procedimentos Endovasculares/efeitos adversos , Fibrinolíticos/uso terapêutico , Humanos , Stents , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Trombectomia , Resultado do Tratamento
8.
Eur Radiol ; 32(1): 432-441, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34327578

RESUMO

OBJECTIVES: To assess whether dual-energy computed tomography (DECT), using conventional computed tomography or magnetic resonance imaging as a reference standard, is sufficiently accurate to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. METHODS: On January 20, 2021, we searched the PubMed Medline, Embase, Web of Science, and Cochrane Library databases. QUADAS-2 was used to assess the risk of bias and applicability. Meta-analyses were performed using a bivariate random-effects model. To explore sources of heterogeneity, meta-regression analyses were performed. Deeks' funnel plot asymmetry test was used to assess publication bias. RESULTS: A total of 7 studies (269 patients, 269 focal areas) were included. The pooled mean sensitivity, specificity, and accuracy of DECT in identifying intracerebral hemorrhage from contrast extravasation after mechanical thrombectomy for acute ischemic stroke were 0.77 (95% confidence interval (CI) 0.29 to 0.96), 1 (95% CI 0.86 to 1), and 0.99 (95% CI 0.98 to 1), respectively. This evidence was of moderate certainty due to the risk of bias. Higgin's I-squared for study heterogeneity was observed for the pooled sensitivity (I2 = 78.88%) and pooled specificity (I2 = 82.12%). Moreover, Deeks' funnel plot asymmetry test revealed no publication bias (p = 0.38). CONCLUSION: DECT shows excellent accuracy and specificity in differentiating intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. Nevertheless, there was substantial and moderate heterogeneity among the studies. Future large-scale, prospective cohort studies are warranted to validate our findings. KEY POINTS: • Dual-energy computed tomography shows excellent accuracy and specificity in differentiating intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. • Via meta-regression analysis, we found various possible covariates, including the publication date, image analysis, index test time, time of follow-up imaging, and reference standard judgment, that had an important effect on the heterogeneity. • There were no concerns regarding applicability in any of the included studies.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Humanos , Imageamento por Ressonância Magnética , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia
9.
Eur J Neurol ; 29(1): 105-113, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34370900

RESUMO

BACKGROUND AND PURPOSE: Many countries worldwide, including Germany, reported that the first wave of the coronavirus disease 2019 (COVID-19) pandemic in early 2020 influenced the care of acute ischemic stroke (AIS) patients, but data are lacking for further pandemic wave periods. METHODS: We conducted a nationwide, retrospective, cross-sectional study of all hospitalized patients with the main diagnosis of AIS in 2019 and 2020. Primary outcomes were the number of hospitalizations for AIS, the application of stroke unit care, intravenous thrombolysis (IVT), and mechanical thrombectomy (MT), as well as the in-hospital mortality during the different pandemic periods in 2020 compared to the corresponding periods in 2019. Secondarily, we analyzed differences in outcomes between patients with and without concurrent COVID-19. RESULTS: We included 429,841 cases with AIS, of which 1268 had concurrent COVID-19. Hospitalizations for AIS declined during both pandemic wave periods in 2020 (first wave: -10.9%, second wave: -4.6%). MT rates were consistently higher throughout 2020 compared to 2019, whereas the IVT rate dropped during the second wave period (16.0% vs. 17.0%, p < 0.001). AIS patients with concurrent COVID-19 frequently received recanalization treatments, with an overall MT rate of 8.4% and IVT rate of 15.9%. The in-hospital mortality was high (22.8% vs. 7.5% in noninfected AIS patients, p < 0.001). CONCLUSIONS: These findings demonstrate a smaller decline in hospitalizations for AIS in the more severe second wave of the COVID-19 pandemic. AIS patients with and without concurrent COVID-19 who did seek acute care continued to receive recanalization treatments in Germany.


Assuntos
Isquemia Encefálica , COVID-19 , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Estudos Transversais , Alemanha/epidemiologia , Humanos , Pandemias , Assistência ao Paciente , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Resultado do Tratamento
13.
Rev Assoc Med Bras (1992) ; 67(11): 1564-1569, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34909879

RESUMO

OBJECTIVE: The aim of this study was to analyze the effect of tirofiban on new cerebral microhemorrhage after mechanical thrombectomy in patients with acute ischemic stroke. METHODS: In total, 203 patients with acute ischemic stroke treated by mechanical thrombectomy in our department of neurology were enrolled as the research objects. The patients were divided into two groups: the patients who used tirofiban within 24 h after surgery were assigned to the study group (78 subjects), while patients who did not use tirofiban were assigned to the conventional group (125 subjects). Magnetic resonance imaging was used to detect new-onset cerebral microbleeds in patients with stroke after surgery. The National Institute of Health Stroke Scale, modified ranking scale, and activity of daily living scale were used to assess the prognosis of patients, and the general data and the occurrence of adverse effects between two groups were compared to comprehensively evaluate the efficacy and safety of tirofiban. RESULTS: The proportion of atrial fibrillation in the research group was significantly lower than that in the conventional group. The research group had a much lower rate of new-onset cerebral microbleeds than the conventional group (p<0.001). There was no significant difference in the proportion of adverse reactions between the two groups (p>0.05). CONCLUSION: The application of tirofiban in mechanical thrombectomy of patients with acute ischemic stroke has high safety, effectively reduces the occurrence of new cerebral microhemorrhage, and provides a guarantee for patient safety.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Hemorragia Cerebral/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Humanos , Acidente Vascular Cerebral/tratamento farmacológico , Trombectomia , Tirofibana , Resultado do Tratamento
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(6): 1159-1162, 2021 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-34916698

RESUMO

OBJECTIVE: To evaluate the effectiveness and safety of Rotarex mechanical thrombectomy system in treating acute lower limb ischemia. METHODS: From December 2017 to December 2019, the clinical data of 23 acute lower limb ischemia cases treated with Rotarex mechanical thrombectomy system were retrospectively analyzed. There were 14 males and 9 females from 53- to 84-year-old patients and the mean age was (69.1±9.1) years. Duration of symptoms was 6 hours to 14 days (median time 7 days). In the study, 8 acute thromboembolism cases and 15 acute thrombosis cases were included (In which, there was one thromboangiitis obliterans case and two in-stent restenosis cases). In 5 cases, the lesions were located above the groin; in 16 cases, the lesions were located below the groin, and in the other 2 cases, the lesions were located both above and below the groin. All the cases were treated with Rotarex mechanical thrombectomy system. When residual stenosis was greater than 50%, percutaneous transluminal angioplasty (PTA) was used, and stent was used only when it was necessary. Heparin was used 24 h after the procedure, and after that, antiplatelet agents were used in acute thrombosis cases, and oral anti-coagulants were used in acute thromboembolism cases. Doppler ultrasonography was taken during the follow-up. RESULTS: In all the 23 cases, there were 22 successful cases and 1 unsuccessful case, the mean procedure time was (68.2±15.6) min. Percutaneous transluminal angioplasty was used in 18 cases, 7 of which were implanted stents (3 stents were implanted in iliac artery and 4 in superficial femoral artery). There were 3 procedure related complications. The first one was arterial wall injury which resulted in contrast medium extravazation, and in this case, we solved it with prolonged balloon inflation. The second one was distal embolism. We took out the thrombus with guiding catheter. The last one was acute occlusion in a stent, and thrombectomy was applied urgently, and the result was good. Mean hospital stay were (3.6±1.7) days. The ankle brachial index (ABI) increased from 0.25±0.10 to 0.85±0.16 after treatment (t=12.901, P < 0.001). All the patients were followed up for 4.0-28.0 months, and the median time was 12.0 months. One patient stopped antiplatelet agents, which resulted in acute thrombosis 2 months later. Another percutaneous mechanical thrombectomy and PTA were taken. In the failed case, the patient suffered amputation above the knee 3 months later and in another case, the patient died of heart failure 8 months after the procedure. Two target lesion restenosis occurred during the follow-up. Because the patients' symptom was not sever, no procedure was taken. CONCLUSION: Percutaneous mechanical thrombectomy using Rotarex catheter is safe and effective in treating acute lower limb ischemia. For one side, it can restore blood flow to the affected limbs quickly, and for the other, it has the characteristics of minimally invasive and good repeatability. So it should be considered that this me-thod can be widely used for acute lower limb ischemia.


Assuntos
Isquemia , Trombectomia , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Multimedia | Recursos Multimídia | ID: multimedia-9399

RESUMO

Priscilla Souza, CGPClin, sobre uso de Evidências em Saúde sobre o uso de Trombectomia em casos de AVC.


Assuntos
Trombectomia/normas , Acidente Vascular Cerebral/terapia , Política Informada por Evidências
16.
BMJ Case Rep ; 14(11)2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34785513

RESUMO

Hypercoagulable and proinflammatory states induced by the novel coronavirus (SARS-CoV-2) lead to thrombotic and embolic events. In this case report, the authors describe how they successfully managed acute critical limb ischaemia in a patient of COVID-19 illness with severe pulmonary disease and high thrombus burden in the infrapopliteal arteries.


Assuntos
Arteriopatias Oclusivas , COVID-19 , Humanos , Isquemia/etiologia , Isquemia/cirurgia , SARS-CoV-2 , Trombectomia
17.
Medicina (Kaunas) ; 57(11)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34833394

RESUMO

We present the case of a 50-year-old male, with no cardiovascular risk factors other than smoking, that presented with acute chest pain, revealed to be an acute myocardial infarction with a large thrombus located in the ascending aorta. Such findings are rare in a patient with no other afflictions, such as atherosclerosis, aortic aneurysm, or aortic wall injury (surgical or traumatic). There is no specific pathway regarding the management of ascending aorta thrombus in such a patient; therapeutic options include surgical, interventional, or medical methods. Surgical thrombectomy was performed in this case, considering the high risk of systemic embolism and stroke and the hemodynamic stability of the patient.


Assuntos
Doenças da Aorta , Infarto do Miocárdio , Trombose , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia
18.
Am J Case Rep ; 22: e933225, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34822708

RESUMO

BACKGROUND COVID-19 caused by SARS-CoV-2 infection has been associated with a hypercoagulable state in which patients can be at risk for developing venous and arterial thromboembolic events at a rate as high as 31%. A free-floating aortic thrombus (FFT) is a rare life-threatening complication of a hypercoagulable state. These thrombi require medical, endovascular, or surgical treatment. The optimal treatment modality for FFT occurring in the setting of COVID-19 remains unknown. We present a patient with a COVID-19-associated free-floating descending aortic thrombus that was treated with percutaneous vacuum-assisted thrombectomy (angio-VAC). CASE REPORT A 61-year-old man presented to the hospital with dyspnea and hypoxia and was diagnosed with severe COVID-19 pneumonia. Initial chest computed tomography angiography (CTA) did not show pulmonary emboli or thrombi. Inflammatory markers (D-dimer, lactate dehydrogenase, ferritin, fibrinogen) were tracked every other day. After several measurements of decreasing D-dimer values, there was a noticeable increase in D-dimer level and continued dependence on high levels of supplemental oxygen. A repeat chest CTA showed an FFT, confirmed by transesophageal echocardiogram. Cardiothoracic surgery and interventional radiology teams performed successful angio-VAC percutaneous removal, confirmed with intravascular ultrasound. The patient was subsequently discharged with a 3-month supply of apixaban. CONCLUSIONS Minimally invasive endovascular removal of an FFT is a therapeutic option, as anticoagulation alone carries the risk of partial lysis and repeat embolization. Clinicians can consider this endovascular treatment option paired with therapeutic anticoagulation. Further guidelines on monitoring and treatment of possible COVID-19-associated thrombosis are needed, particularly when the risk of embolization is high.


Assuntos
COVID-19 , Trombose , Aorta , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Trombectomia
19.
Cardiovasc Intervent Radiol ; 44(12): 1954-1963, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34741196

RESUMO

PURPOSE: To evaluate the safety and efficacy of endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to intracranial atherosclerosis-related basilar artery occlusion (ICAS-related BAO) by comparison with embolic and tandem occlusion. METHODS: We retrospectively reviewed consecutive patients with AIS due to BAO who underwent EVT. Patients were assigned to the ICAS-related group and embolic group, and tandem group based on the etiology. Baseline data, procedural details, and clinical outcomes were compared between the three groups. RESULTS: A total of 100 patients (ICAS-related group: 31; embolic group: 41; tandem group: 28) were included. No significant difference was observed in the successful reperfusion (mTICI 2b or 3), but the procedural time differed significantly (60 min vs. 43 min vs. 60 min, P = 0.010). There were no differences in the different intracranial hemorrhage grades among the three groups (P = 0.134). After adjusting for baseline differences, there was no significant difference in pairwise comparisons regarding favorable outcome (mRS 0-2), moderate outcome (mRS 0-3), and mortality. CONCLUSIONS: Endovascular treatment for patients with acute ICAS-related BAO had equal efficacy and safety compared with embolic BAO and tandem BAO. Primary endovascular treatment and rescue modalities were effective treatments for acute ICAS-related BAO.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Artéria Basilar/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Trombectomia , Resultado do Tratamento
20.
Hinyokika Kiyo ; 67(10): 443-447, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34742168

RESUMO

A woman in her seventies complained of chest pain during exertion and visited a local hospital. Computed tomographic scan showed right renal cell carcinoma with inferior vena cava (IVC) tumor thrombus extending above the diaphragm, and the patient was referred to our hospital. She was diagnosed with right renal cell carcinoma cT3cN0M0, with level IV IVC thrombus by Mayo classification. Axitinib and pembrolizumab were administered against intractable advanced renal cell carcinoma. The dose of axitinib was reduced due to grade 3 liver dysfunction. Right nephrectomy together with IVC thrombectomy was performed because the primary lesion had shrunk, and the level of IVC thrombus had become level III. The pathological results were clear cell carcinoma, pT3c, G3, Fuhrman grade3, INFA, v1, and ly0. Axitinib and pembrolizumab might be a presurgical option against an intractable renal cell carcinoma with an IVC thrombus.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Axitinibe/uso terapêutico , Carcinoma de Células Renais , Neoplasias Renais , Trombose , Idoso , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Nefrectomia , Trombectomia , Trombose/tratamento farmacológico , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
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