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2.
Medicine (Baltimore) ; 99(2): e18665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914055

RESUMO

We assessed the value of fluid-attenuated inversion recovery vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch in predicting revascularization and functional outcome in stroke patients with large vessel occlusion (LVO) after endovascular thrombectomy (EVT).Seventy-two acute stroke patients within 6 hour of stroke onset who received EVT were enrolled. FVH-DWI mismatch, revascularization (mTICI score), functional outcome (mRS at 3 months) and other clinical data were collected. Statistical analysis was performed to predict revascularization and functional outcome after stroke.Twenty-nine patients (60.42%) had FVH-DWI mismatch in patients with complete revascularization and 8 patients (33.33%) had FVH-DWI mismatch in patients with no/partial revascularization, and there was significant difference in 2 groups (t = 4.698; P = .045). The good functional outcome group (37/72; 51.39%) had higher FVH score (4.38 ±â€Š1.53 vs 3.49 ±â€Š1.52; t = 2.478; P = .016), higher FVH-DWI mismatch ratio (81.25% vs 48.15%; t = 10.862; P = .002), higher complete revascularization ratio (83.78% vs 48.57%; t = 10.036; P = .002) than the poor functional outcome group (35/72; 48.61%). Spearman's rank correlation analysis revealed that FVH-DWI mismatch was positively correlated with complete revascularization (r = 0.255; P = .030) and good functional outcome (r = 0.417; P = .000). Multivariable logistic regression analysis demonstrated that FVH-DWI mismatch was independently associated with complete revascularization (OR, 0.328; 95% CI, 0.117-0.915; P = .033) and good functional outcome (OR, 0.169; 95% CI, 0.061-0.468; P = .001).Assessments of FVH-DWI mismatch before thrombectomy therapy might be useful for predicting revascularization and functional outcome in stroke patients with LVO.


Assuntos
Revascularização Cerebral/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Imagem de Difusão por Ressonância Magnética , Procedimentos Endovasculares/métodos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico
3.
World Neurosurg ; 133: e835-e841, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31614218

RESUMO

BACKGROUND: Several independent randomized controlled trials have shown superior efficacy of mechanical thrombectomy (MT) for management of acute ischemic stroke (AIS). However, elderly patients have been underrepresented or excluded in these trials. The aim of this study was to investigate the feasibility and safety of MT in patients with AIS ≥90 years old. METHODS: A retrospective review was performed of patients ≥90 years old presenting with AIS who underwent MT between 2010 and 2018. RESULTS: Of 453 patients with AIS, 5.74% (n = 26) were ≥90 years old, and 69.32% (n = 314) were 60-89 years old. Of baseline characteristics between both groups, there was a significant difference in age, sex, body mass index, smoking, hyperlipidemia, atrial fibrillation, and diabetes mellitus. Mean National Institutes of Health Stroke Scale score on admission was higher in the nonagenarians (17 vs. 15). Similar proportions of both groups received tissue plasminogen activator, 57.69% (n = 15) versus 42.68% (n = 134), P = 0.14). There was no difference in periprocedural and postprocedural complications, good Thrombolysis In Cerebral Infarction scores (88.46% [n = 23] vs. 87.58% [n = 275], P = 1.00), good modified Rankin Scale scores (34.62% [n = 4] vs. 49.36% [n = 155], P = 0.40), or mortality (11.54% [n = 3] vs. 13.06% [n = 41], P = 0.82). CONCLUSIONS: Age is a factor that affects functional outcome following MT. Advancements in catheter techniques, technical experience, and great outcomes with MT allow for pushing the boundaries to consider age as one factor, rather than an exclusion criterion. Our results show that MT is safe and feasible in nonagenarians.


Assuntos
Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
5.
World Neurosurg ; 133: 150-154, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589986

RESUMO

BACKGROUND: Pseudoaneurysm after mechanical thrombectomy (MT) is rare but is one of the potential complications associated with endovascular procedures. There is limited information regarding its mechanism of formation and the potential risk of delayed bleeding. CASE DESCRIPTION: An 84-year-old woman was admitted to our institution with right hemiplegia and global aphasia. Magnetic resonance imaging and angiography revealed occlusion of the M2 segment of the left middle cerebral artery with subtle acute ischemic change in this territory. After initiating intravenous thrombolysis, MT was performed for persistent occlusion of the M2. Successful revascularization was finally achieved with a single pass of a Trevo XP 3 mm × 20 mm stent retriever; significant deviation of the vessel occurred during withdrawal of the stent retriever. Anticoagulation was initiated after confirming resolution of a small amount of postprocedural subarachnoid hemorrhage 1 day after the procedure. However, 4 days after the procedure, computed tomography and angiography revealed a massive sylvian hematoma with de novo formation of a small pseudoaneurysm at the site where the stent retriever was deployed. Open surgery revealed a small artery avulsion at this site. The lesion was closed by microsurgical suturing. CONCLUSIONS: Angiographic and intraoperative findings showed that the mechanism of formation of the pseudoaneurysm was small artery avulsion resulting from deviation of the vessel during withdrawal of the stent retriever. When performing MT in a tortuous distal vessel, the possibility of small artery avulsion should be kept in mind to both prevent and manage critical hemorrhagic complications.


Assuntos
Falso Aneurisma/etiologia , Isquemia Encefálica/terapia , Revascularização Cerebral/efeitos adversos , Trombectomia/efeitos adversos , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Microcirurgia , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Stents , Resultado do Tratamento
6.
World Neurosurg ; 133: e576-e582, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31561042

RESUMO

OBJECTIVE: To investigate the factors associated with futile recanalization after stent retriever thrombectomy in patients with acute ischemic stroke due to large vessel occlusion. METHODS: We retrospectively analyzed the medical records of 56 patients with an acute anterior circulation macrovascular occlusion who underwent successful stent retriever thrombectomy. Patients were classified as successful recanalization or futile recanalization at the follow-up. Univariate analysis and binary logic regression analysis were used to explore the association between patients' demographic and clinical characteristics and futile recanalization. RESULTS: The rate of futile recanalization was significantly higher after stent retrieval thrombectomy in patients with an Alberta Stroke Program Early CT (ASPECT) score ≤7 points versus >7 points (P < 0.001), ≥5 passes with the stent retriever versus <5 passes with the stent retriever (P = 0.036), or a longer recanalization time (P = 0.008). The influence of number of stent retriever pass is foremost, followed by ASPECT and occurrence to recanalization. CONCLUSIONS: Improving technical expertise with mechanical thrombectomy and shortening the therapeutic time window may improve the prognosis of patients with acute ischemic stroke due to large vessel occlusion.


Assuntos
Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents
7.
Radiol Med ; 125(1): 57-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31473929

RESUMO

INTRODUCTION: A direct aspiration first pass technique (ADAPT) is an alternative technique as first-line thrombectomy for large vessel occlusion in acute ischemic stroke, still debated when compared to first-line stent retriever. To retrospectively evaluate technical and clinical outcomes of the ADAPT as first-line treatment for anterior circulation acute ischemic stroke with large-bore reperfusion catheters. METHODS: A multicentric data collection from 14 medical centers was retrospectively analyzed. Large-bore catheters had a distal diameter between 0.64 and 0.71 in; stent retriever was added when aspiration alone failed. Baseline characteristics, technical and clinical variables were collected, including NIHSS, thrombolysis in cerebral infarction (TICI), peri-procedural complications, 90-day mRS and 90-day mortality. RESULTS: Overall, 501 patients were treated. No statistically significant difference in terms of baseline features or tPA administration was recorded between patients treated with ADAPT and with additional stent retriever. ADAPT alone was successful in achieving TICI ≥ 2b in 71.8% with a median of 1.55 aspiration attempts. In terms of TICI ≥ 2b, ADAPT alone was better than additional stent retriever (p < 0.001), while no statistical difference was achieved from catheter diameter. Embolization to a new territory was less frequent in ADAPT group (5.2 vs 18%; p = 0.0026). Patients treated with ADAPT alone had better clinical outcomes in terms of mRS ≤ 2 (p < 0.001). CONCLUSIONS: ADAPT is a valid technique with respect to the rates of TICI 2b/3 recanalization and 90-day mRS scores. In this series, an attempt at recanalization with ADAPT with larger-bore reperfusion catheter may be warranted prior to stentriever thrombectomy.


Assuntos
Isquemia Encefálica/cirurgia , Cateteres , Reperfusão/instrumentação , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Reperfusão/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/métodos , Resultado do Tratamento , Adulto Jovem
8.
Vasc Endovascular Surg ; 54(1): 69-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31500525

RESUMO

Acute limb ischemia (ALI) is an abrupt decrease of blood flow to a limb, resulting in a potential threat to that body part. In ALI, which is commonly caused by embolism or traumatic occlusion, symptoms appear quickly due to a lack of collateral blood flow and extension of the thrombus to arterial outflow. In cases with ALI presentation, urgent evaluation and management are necessary. Here, we report 3 cases with ALI due to thromboembolism. Conventional open thromboembolectomy was performed with a femoral artery cutdown and antegrade passage of the embolectomy catheter. Further, distal access was created in the dorsalis pedis artery and/or posterior tibial artery at the ankle level. After the retrograde passage of the guidewire and antegrade insertion of the embolectomy catheter, the embolus was completely removed.


Assuntos
Embolectomia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Trombectomia , Tromboembolia/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Tromboembolia/diagnóstico por imagem , Tromboembolia/fisiopatologia , Resultado do Tratamento
9.
Int Braz J Urol ; 46(1): 92-100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851465

RESUMO

PURPOSE: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two offline readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. RESULTS: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was na indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. CONCLUSION: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Idoso , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Meios de Contraste , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Reprodutibilidade dos Testes , Estudos Retrospectivos , Trombectomia/métodos , Carga Tumoral , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/patologia , Trombose Venosa/cirurgia
10.
Ideggyogy Sz ; 72(11-12): 407-412, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31834684

RESUMO

Background and purpose: Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. Methods: We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centers before 31st August 2016. Results: Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. Conclusion: Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro-intervention capacity needing improvement.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Humanos , Hungria , Resultado do Tratamento
11.
Angiol Sosud Khir ; 25(4): 181-187, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855216

RESUMO

BACKGROUND: Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS: Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS: After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION: Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.


Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Embolia Pulmonar/prevenção & controle , Trombectomia/métodos , Trombose Venosa/cirurgia , Implante de Prótese Vascular , Humanos , Embolia Pulmonar/etiologia , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/complicações
12.
Medicine (Baltimore) ; 98(50): e18249, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852092

RESUMO

RATIONALE: Cancer and chemotherapy individually confer hypercoagulability and increased risks of thrombosis. Most thromboembolic complication after breast cancer chemotherapy was venous thrombosis after multiagent chemotherapy. Arterial thrombosis is extremely rare in early breast cancer patients receiving adjuvant chemotherapy. PRESENTING CONCERNS: A 55-year-old woman with right breast cancer presented to the emergency department with sudden pain, numbness, and swelling in her left hand. She underwent breast conserving surgery and sentinel lymph node biopsy 2 months before the visit. She received the second cycle of adjuvant Adriamycin-cyclophosphamide chemotherapy 5 days before. INTERVENTIONS: Computed tomography angiography revealed acute arterial thrombosis in the left brachial, radial, and ulnar arteries. Unfractionated heparin was initiated immediately, followed by brachial and radial-ulnar thrombectomy, restoring perfusion to the extremity. The postoperative course was uncomplicated; she was discharged on warfarin at a daily dose of 4 mg. OUTCOMES: Chemotherapy was discontinued. Anticoagulation with warfarin was continued. She subsequently received adjuvant endocrine therapy with an aromatase inhibitor and adjuvant radiotherapy. MAIN LESSONS: Despite the low risks of arterial thrombosis in breast cancer, it is a devastating complication with significant morbidity and mortality. Thromboprophylaxis should be considered in those at risk. Immediate anticoagulant therapy and surgical intervention should be considered in affected cases.


Assuntos
Artéria Braquial , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Doxorrubicina/efeitos adversos , Artéria Radial , Trombose/induzido quimicamente , Artéria Ulnar , Doença Aguda , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante/efeitos adversos , Angiografia por Tomografia Computadorizada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Trombectomia/métodos , Trombose/diagnóstico , Trombose/cirurgia , Ultrassonografia Doppler
13.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 385-390, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185135

RESUMO

Objetivos. El tiempo es un factor clave en el tratamiento y pronóstico del ictus. Nuestro centro ha implementado un protocolo de Actuación Rápida Puerta Aguja (ARPA) para optimizar los tiempos de reperfusión. Este protocolo intrahospitalario consiste en tratar a los pacientes derivados por código ictus (CI) directamente en el escáner o en la sala de angiografía movilizando al equipo de ictus. Los objetivos son evaluar el impacto del protocolo ARPA en los tiempos de reperfusión, y valorar la viabilidad y seguridad de incorporar un enfermero de la unidad de ictus (UI) al equipo de ictus para la asistencia a pacientes CI, así como la satisfacción de los profesionales. Método. Estudio descriptivo de pacientes atendidos en el circuito CI entre marzo 2015 y marzo 2018. Se compararon con el periodo previo entre febrero 2014 y febrero 2015. Resultados. Se atendieron 903 pacientes con el protocolo ARPA y recibieron tratamiento de reperfusión 502 pacientes (55,6%). La mediana de tiempo puerta-aguja para fibrinolisis fue de 24 (18-33) minutos y puerta-punción para trombectomía 39 (20-75) minutos, ambos inferiores (p < 0,001) al periodo anterior, que tuvo unos tiempos de 43 (31-66) y 93 (60-150) minutos, respectivamente. El enfermero atendió los CI durante 25 (20-32) minutos, y no se encontraron problemas graves de seguridad o viabilidad. Veinte profesionales (95%) refirieron que el protocolo ARPA aumentaba su carga de trabajo pero consideraron que se debía seguir aplicando. Conclusiones. El tratamiento de pacientes CI directamente en el escáner o en la sala de angiografía incorporando un enfermero de la UI reduce, de forma segura, los tiempos de reperfusión


Background and objectives. The timing of treatment is a key prognostic factor in stroke. Our hospital implemented a rapid-action time-to-intervention protocol to optimize reperfusion times. The protocol consisted of direct transfer of stroke-code patients to the scanner or angiosuite and mobilization of the stroke team. Our aim was to assess the impact of the protocol on times to reperfusion. We also sought to evaluate the feasibility and safety of including a stroke-team nurse and assess staff satisfaction with the protocol. Methods. Descriptive study of patients attended by the hospital stroke team between March 2015 and March 2018. Outcomes were compared to those for the previous period (February 2014 to February 2015). Results. Nine hundred three patients were attended under the rapid-action protocol; 502 of them (55.6%) underwent reperfusion. The median (interquartile range) door-to-needle or groin access times were 24 (18-33) minutes for fibrinolysis and 39 (20-75) minutes for thrombectomy. Both times were significantly shorter than in the earlier period (43 [31-66] and 93 [60-150] minutes, respectively; P<.001). Median duration of nurse attendance was 25 (20-32) minutes during the implementation period, and no problems of feasibility or safety appeared during nurse attendance. Twenty staff members (95%) reported that the rapid-action protocol increased their workload but they felt it warranted continued application. Conclusion. Direct transfer of stroke patients for scanning or to the angiography suite, with nurse attendance, safely reduced reperfusion times


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fatores de Tempo , Acidente Vascular Cerebral/diagnóstico , Reperfusão/métodos , Protocolos Clínicos , Cuidados de Enfermagem , Estudos Transversais , Inquéritos e Questionários , Relações Enfermeiro-Paciente , Monitorização Hemodinâmica , Trombectomia , Fibrinólise , Acidente Vascular Cerebral/classificação , Recursos Humanos de Enfermagem/estatística & dados numéricos
14.
No Shinkei Geka ; 47(11): 1143-1149, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31761775

RESUMO

OBJECTIVE: The purpose of this study was to investigate the current status of thrombectomy calls for acute ischemic stroke for a single neurointerventionist in a regional hospital. METHODS: We retrospectively evaluated patients with thrombectomy calls for a neurointerventionist from January to November 2016 in our hospital, where a single board-certified neurointerventionist conducts endovascular interventions. Number, frequency, and time of thrombectomy calls were analyzed. Patients ineligible for revascularization were still used in analysis even though the neurointerventionist did not perform thrombectomy. RESULTS: Over 11 months(334 days), there were 105 calls, of which 48 were during duty hours and 57 during off-duty hours. The neurointerventionist was called once every 3.2 days in total, once every 4.7 days during duty hours, once every 5.7 days during off-duty hours of working days, and once every 6.2 days during holidays. Thrombectomies were performed in 37 cases(35%). Thrombectomies were performed once every 9.1 days and once every 2.8 calls. Twenty-four patients presented with ischemic stroke with large vessel occlusion, but they were determined to be ineligible for thrombectomy because of progressed ischemia in 7 patients, poor clinical condition in 7, or symptom recovery or recanalization in 10. Diagnoses of 42 patients who were not indicated for thrombectomy included ischemic stroke without major artery occlusion in 24 patients and intracerebral hemorrhage in 14. CONCLUSION: In a regional hospital with a single neurointerventionist, the frequency of thrombectomy calls was about once in every 3 days, and approximately half of them occurred during off-duty hours. A thrombectomy was performed about once every 9 days and about once every 3 thrombectomy-calls. Measures should be taken to reduce the burden on neurointerventionists in stroke centers, especially in understaffed institutes.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Isquemia Encefálica/cirurgia , Hemorragia Cerebral , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
15.
No Shinkei Geka ; 47(11): 1157-1163, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31761777

RESUMO

A 76-year-old man underwent a left upper lobectomy due to lung cancer. On postoperative day 3, he developed a cerebral infarction(NIHSS:17). MR and right carotid angiography demonstrated a right internal carotid artery occlusion. The patient underwent an endovascular thrombectomy without intravenous administration of recombinant tissue plasminogen activator. Complete recanalization was achieved and the symptoms almost disappeared except for a slight dysarthria. The patient subsequently continued cancer treatment by administration of edoxaban. Reports of cerebral emboli due to a thrombus migrating from the stump of the pulmonary vein after a left upper lobectomy are increasing. Several reports indicate that left upper lobectomy carries a high risk of thromboembolism. The current prospective study demonstrates that a mechanical thrombectomy can significantly improve both neurological and cognitive functions of patients after acute ischemic stroke. Endovascular neurosurgeons should prepare for and await an opportunity for thrombectomy for patients undergoing pulmonary resection.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Neoplasias Pulmonares , Acidente Vascular Cerebral , Trombectomia , Tromboembolia , Idoso , Artéria Carótida Interna , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pneumonectomia , Estudos Prospectivos , Ativador de Plasminogênio Tecidual , Resultado do Tratamento
16.
No Shinkei Geka ; 47(11): 1165-1171, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31761778

RESUMO

The accessory middle cerebral artery(AMCA)is an anatomical variant of the MCA. It originates from the anterior cerebral artery, reaches the sylvian fissure, and supplies the territory of the middle cerebral artery. We report a case of embolic infarction associated with the AMCA that was treated using mechanical thrombectomy. An 82-year-old man with chronic atrial fibrillation experienced a sudden onset of left hemiparesis and was brought to our hospital. Magnetic resonance imaging showed a right temporal lobe, parietal lobe, and basal ganglion infarction, and indicated right internal carotid artery(ICA)occlusion. Mechanical thrombectomy using a Penumbra system was performed with complete recanalization. Final angiography revealed the existence of the AMCA, and the thrombus was located at the right ICA C2 portion to the main MCA. There have been twelve reported cases of ischemic stroke associated with the AMCA, including the present case. We summarized the data from the reported cases of ischemic stroke with an AMCA and evaluated their clinical characteristics and the pitfalls of endovascular treatment. These cases suggest that the AMCA may play a role in collateral flow around the main MCA occlusion, but provides insufficient collateral blood supply. Owing to the anatomical characteristics of the AMCA, we should pay attention to possible complications of endovascular treatment.


Assuntos
Artéria Cerebral Média , Acidente Vascular Cerebral , Idoso de 80 Anos ou mais , Artéria Carótida Interna , Angiografia Cerebral , Humanos , Infarto da Artéria Cerebral Média , Masculino , Artéria Cerebral Média/cirurgia , Trombectomia , Resultado do Tratamento
17.
No Shinkei Geka ; 47(10): 1093-1100, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31666427

RESUMO

INTRODUCTION: We report a case of embolic stroke with an atypical course after endovascular therapy performed during the subacute stage of progressive stroke, where symptom relapse could not be controlled despite medical treatment. CASE PRESENTATION: An 81-year-old woman developed slight weakness in her left leg and was hospitalized three days after the onset of symptoms. On admission, her consciousness was almost clear and she exhibited left hemiparesis. The computed tomography(CT)and magnetic resonance imaging(MRI)revealed a cerebral infarction in the right caudate head and corona radiata, and CT perfusion showed no difference in the cerebral blood flow. However, three-dimensional computed tomography angiography showed right M1 occlusion. Considering the clinical course of the leg weakness without atrial fibrillation, antiplatelet therapy for atherosclerotic cerebral infarction was administered. Five days after the symptom onset, the left hemiparesis deteriorated. CT and diffusion-weighted MRI showed increasing edema associated with the cerebral infarction, and CTP showed decreased cerebral blood flow in the right middle cerebral artery region. Because angiography revealed an obstruction involving a long lesion with loss of contrast, we suspected an embolic stroke. Endovascular surgery was performed successfully using the Penumbra system. Postoperatively, the hemiparesis resolved and the patient was transferred to the rehabilitation hospital. CONCLUSION: In rare cases, patients with an embolic stroke develop gradual progression of symptoms. To differentiate between cardioembolic stroke and atherosclerotic cerebral infarction in such patients, a follow-up examination of the brain blood flow must be performed, especially when there is a change in symptoms. This may provide useful information for intravascular treatment even in the subacute period.


Assuntos
Fibrilação Atrial , Infarto Cerebral , Embolia Intracraniana , Idoso de 80 Anos ou mais , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Trombectomia
19.
Hinyokika Kiyo ; 65(10): 397-402, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31697884

RESUMO

A 36-year-old female was referred to our hospital for a giant abdominal mass found by ultrasound examination. A computed tomographic scan showed a large retroperitoneal mass measuring 11 cm in diameter suspected to be liver invasion,a right atrial and inferior vena cava (IVC) tumor thrombus with obstruction of hepatic vein junction of IVC,and small lung metastases. She was diagnosed with cT4N0M1 adrenocortical carcinoma (ACC) by a needle biopsy and radiographic examination. Right adrenalectomy and thrombectomy were successfully performed without cardiac arrest and without liver dissection. The operative time was 485 minutes,and the estimated blood loss was 7,533 ml. No major peri- or postoperative complications were observed. For the residual lung mass,a first line combination chemotherapy with etoposide,doxorubicin,cisplatin and mitotane followed by a second line chemotherapy with gemcitabine and capecitabine were administered. She has been alive with disease for 45 months under mitotane treatment against residual lung metastases. In conclusion,extended surgery could be successfully performed for advanced ACC with right atrium and IVC tumor thrombus. Although careful planning is needed for successful surgery,combination therapy with extended surgery and subsequent systematic chemotherapy may provide a substantial benefit in patients with advanced ACC.


Assuntos
Neoplasias do Córtex Suprarrenal , Carcinoma Adrenocortical , Trombose , Neoplasias do Córtex Suprarrenal/complicações , Adrenalectomia , Carcinoma Adrenocortical/complicações , Adulto , Feminino , Humanos , Trombectomia , Trombose/etiologia , Veia Cava Inferior
20.
Tex Heart Inst J ; 46(3): 172-174, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708697

RESUMO

Treatments for pulmonary embolism are numerous and often complex. Current data on surgical thrombectomy are important but are not readily available. We studied the National Inpatient Sample to evaluate trends in the performance rates and outcomes of surgical thrombectomy in the United States from 2003 through 2014. We think that our findings have meaningful application to the triage and risk stratification of patients who have hemodynamically significant pulmonary embolism.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Embolia Pulmonar/cirurgia , Trombectomia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
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