Acute Embolic Occlusion Research Articles

Differences between Acute Embolic and Atherosclerotic Middle Cerebral Artery Occlusion in Multiphase Arterial Spin-labeling Imaging.

Arterial spin-labeling magnetic resonance imaging (ASL-MRI) is widely used for evaluating collateral development in patients with acute ischemic stroke (AIS). This study aimed to characterize the findings of multiphase ASL-MRI between embolic and atherosclerotic large vessel occlusion (LVO) to aid in the differential diagnosis. Among 982 patients with AIS, 44 who were diagnosed with acute, symptomatic, and unilateral occlusion of the horizontal segment of the middle cerebral artery (MCA) were selected and categorized into embolic stroke (ES) and atherosclerosis (AT) groups. Using ASL-MRI (postlabeling delay [PLD] of 1.5, 2.0, and 2.5 s) at admission, the ipsilateral to contralateral ratio (ICR) of the signal intensity and its time-course increasing rate (from PLD 1.5 to 2.0 and 2.5, ΔICR) were measured and compared between the two groups. The mean ICR was significantly higher in the AT group than in the ES group (AT vs. ES: 0.49 vs. 0.27 for ICR1.5, 0.73 vs. 0.32 for ICR2.0, and 0.92 vs. 0.37 for ICR2.5). The ΔICR of PLD 1.5-2.0 (ΔICR2.0) and 2.5 (ΔICR2.5) were also significantly higher in the AT group than in the ES group (AT vs. ES: 50.9% vs. 26.3% for ΔICR2.0, and 92.6% vs. 42.9% for ΔICR2.5). Receiver operating characteristic curves showed moderate-to-strong discriminative abilities of each ASL-MRI parameter in predicting MCA occlusion etiology. In conclusion, multiphase ASL-MRI parameters may aid in differentiating intracranial LVO etiology during the acute phase. Thus, it is applicable to AIS management.

Retrograde thrombectomy of acute common carotid artery occlusion with mobile thrombus: illustrative cases.

Acute embolic occlusion of the common carotid artery (CCA) alone is rare. However, once it occurs, recanalization is challenging due to the large volume of the clot, larger diameter of the CCA, and risk of procedure-related distal embolism into the intracranial arteries. The authors report two cases of acute embolic occlusion of CCA alone, caused by a cardiac embolus trapped at the proximal end of a preexisting atherosclerotic plaque at the cervical carotid bifurcation. In both cases, the CCA was successfully recanalized using retrograde thrombectomy in a hybrid operating room. In case 1, a 78-year-old male with acute right CCA occlusion underwent retrograde thrombectomy, where the cervical carotid bifurcation was exposed and incised, and the entire embolus was retrieved with forceps. Despite successful revascularization, massive bleeding from the CCA just after the retrieval remained a concern. In case 2, a 79-year-old female with acute right CCA occlusion underwent retrograde thrombectomy in the same manner. Because manual retrieval failed, a Fogarty balloon catheter inserted from the arteriotomy successfully retrieved the entire thrombus with minimal blood loss. Retrograde thrombectomy through the arteriotomy of the cervical carotid bifurcation safely and effectively recanalizes acute embolic occlusion of the CCA alone.

Application of Sofia Plus catheter tip shaping in the treatment of acute middle cerebral artery occlusion: A case control study.

To explore the safety and efficacy of Sofia Plus distal access catheter tip shaping for treatment of acute middle cerebral artery embolism. This single-center retrospective study involved patients eligible for acute embolic middle cerebral artery occlusion from January 2020 to October 2021. They were divided into a shaping and non-shaping group according to whether the Sofia Plus catheter tip was shaped intraoperatively. Baseline data, preoperative Alberta Stroke Program Early Computed Tomography (ASPECT) score, National Institutes of Health Stroke Scale (NIHSS) score, onset-to-admission time, admission-to-puncture time, Sofia Plus-clot time, puncture-to-reperfusion time, surgical approach, and use of a stent for rescue thrombectomy were compared between the 2 groups. Postoperative symptomatic intracerebral hemorrhage and the modified Rankin scale score at the 90-day follow-up were observed. In total, 54 patients were enrolled in this study (shaping group, 26 patients; non-shaping group, 28 patients). Their mean age was 64.8 ± 14.6 years, and the proportion of men was 68.5% (37/54). Successful recanalization was achieved in all patients. There were no differences in the baseline data (age, sex, history, pre-admission ASPECT score, or NIHSS score) between the shaping and non-shaping groups. Patients treated with a shaped Sofia Plus catheter had a shorter Sofia Plus-clot time [median (25th, 75th percentile: 4 (4, 7) vs 10.5 (5.25, 14) min, P = .006] and puncture-to-reperfusion time [16.5 (12, 30.5) vs 26 (16.25, 38.25) min, P = .036]. There were significant differences in the surgical approaches between the 2 groups. The rates of a favorable outcome (57.7% vs 64.3%, P = .62) and postoperative symptomatic intracerebral hemorrhage (7.7% vs 3.6%, P = .60) were not significantly different between the groups. Sofia Plus catheter tip shaping improved catheter trafficability and reduced the operative time. It was safe and effective for treatment of acute middle cerebral artery thrombotic occlusion.

Endovascular treatment of acute basilar artery occlusion caused by vertebral artery stump syndrome: A clinical analysis of 37 cases

IntroductionAcute basilar artery occlusion (ABAO) caused by vertebral artery stump syndrome (VASS) has a low incidence and is always underestimated. Due to the occlusion of the origin of the vertebral artery (VA), it is often combined with basilar artery (BA) endovascular diseases or non-dominant contralateral vertebral artery, making the endovascular treatment (EVT) challenging to implement. ObjectiveThis article focuses on whether EVT and two interventional route options could bring clinical benefits to this group of patients: basilar artery thrombectomy through the occluded lateral vertebral artery and implementing revascularization of the occluded vertebral artery (dirty-road-path); thrombectomy through the non-occluded lateral vertebral artery (clean-road-path). MethodsWe collected six cases of acute embolic basilar artery occlusion (ABAO) due to VASS from January 2020 to December 2021 at our hospital and retrospectively analyzed 31 patients previously reported in the literature and applied statistical analysis to investigate the treatment options and clinical prognosis of these patients. ResultsThe clean-road-path surgical protocol was applied in 4 of 37 patients, the dirty-road-path protocol was applied in 29 patients, and 4 patients did not recanalized the basilar artery. By statistical analysis we found that successful recanalization of the basilar artery was clinically significant in reducing the modified Rankin Scale (mRS) scores in these patients, the statistical difference in the benefit of the two surgical protocols was negative. There was a significant positive correlation between preoperative National Institute of Health Stroke Scale (NIHSS) and postoperative 90-day mRS scores. ConclusionEndovascular treatment can benefit patients with ABAO due to VASS, and patients with higher preoperative NIHSS scores are more vulnerable to getting a poor prognosis. Comparison between the two endovascular options did not yield statistically significant results, but the dirty-road-path option may be superior to using the clean-road-path.

Superior Mesenteric Artery Thrombosis While on Rivaroxaban in a Patient With COVID-19

A vaccinated 54 year old man who tested positive for SARS-CoV-2 11 days ago with respiratory symptoms, presented with abdominal pain. Despite being on 20 mg/day of rivaroxaban for atrial fibrillation and with therapeutic anti-factor Xa levels (26.47 ng/L), imaging revealed acute embolic occlusion (arrow) of the distal superior mesenteric and ileocolic artery on computed tomography angiography imaging (A). The patient had no symptoms of bowel ischaemia. He was treated conservatively with intravenous heparin for 14 days and converted to warfarin titrated to therapeutic levels. (B) Imaging at four weeks demonstrated recanalisation of the thrombosed arteries (arrow) with good distal opacification. The patient was symptom free and was feeding normally with no intestinal complications.Image 1

Delayed Development of Symptomatic Arterial Stenosis after a Mechanical Thrombectomy for an Acute Embolic Occlusion of the Middle Cerebral Artery

Delayed stenosis of the treated artery following mechanical thrombectomy is known to occur in approximately 10% of the patients after the procedure. It is usually asymptomatic, and was frequently found within 1 year after the procedure. Here we report a 58-year-old stroke patient who suffered from recurrent transient ischemic attacks due to a delayed stenosis of the middle cerebral artery 2 years after the mechanical thrombectomy for an abrupt embolic occlusion of the vessel.

Atypical presentation of fistula dysfunction due to brachial arterial embolization mimicking stroke.

Vascular access thrombosis is an important complication with great impact on access patency and, consequently, on a patient's quality of life and survival. We report the case of a 73-year-old woman with chronic kidney disease on hemodialysis with a radiocephalic arteriovenous fistula on the right arm that was brought to the emergency department with decreased strength in her right arm, ipsilateral hypoesthesia and facial hemi-hypoesthesia. The patient was given a brain computed tomographic scan that did not confirm suspicion of stroke. On re-examination, the patient had new-onset pain at arteriovenous fistula level, and her right arm was cold and pale. The nephrology department was called for arteriovenous fistula evaluation. On physical examination, her forearm fistula had a decreased thrill and arm elevation exacerbated its paleness. A bedside ultrasound was performed for arteriovenous fistula assessment. Doppler ultrasound revealed: partial thrombosis at brachial bifurcation, a flow of 80-105 mL/min at brachial artery level and a radial artery with a damped waveform. Anastomosis and draining vein were permeable. In this case, the diagnosis of acute embolic brachial artery occlusion was made by a fast bedside ultrasound evaluation. The patient underwent thromboembolectomy with Fogarty technique, recovering fistula thrill, radial and cubital pulses. Thromboembolism of the fistula feeding artery is a rare cause of vascular access thrombosis and it is rarely mentioned in the literature. In this report, failure to recognize the upper limb ischemia would have led to delayed treatment, potentially resulting in the fistula's complete thrombosis and further limb ischemia. We highlight the importance of a diagnosis method like Doppler ultrasound, which allows for rapid evaluation at the patient's bedside.

Acute Lower Limb Arterial Embolic Occlusion Due to Thrombus in the Wall of an Abdominal Aortic Aneurysm Which Developed as a Result of Blunt Abdominal Trauma: A Case Report

Acute Lower Limb Arterial Embolic Occlusion Due to Thrombus in the Wall of an Abdominal Aortic Aneurysm Which Developed as a Result of Blunt Abdominal Trauma: A Case Report

Mechanical revascularization using Solitaire AB device for acute limb ischemia secondary to popliteal and infrapopliteal embolic occlusion.

ObjectiveAcute limb ischemia is one of the most common arterial emergencies. The data of mechanical revascularization using Solitaire AB device coupled with thromboaspiration for the treatment of popliteal and infrapopliteal acute limb ischemia are limited. The aim of this study was to review the preliminary safety and effectiveness.MethodsWe performed a single-center retrospective review of patients with popliteal and infrapopliteal acute limb ischemia treated with Solitaire AB device coupled with thromboaspiration from February 2019 to May 2020. Adjunctive balloon angioplasty was performed to correct coexisting atherosclerotic stenosis. Technical success was defined as successful deployment of the Solitaire AB device across the occlusive segment and successful retrieval without the use of adjunctive catheter-directed thrombolysis or balloon angioplasty. Clinical success was defined as the relief of symptoms related to acute limb ischemia. Follow-up outcomes were also reviewed.ResultsThere were 15 consecutive patients who underwent 16 Solitaire AB devices. Technical success was achieved in 11 (73.3%) patients. Of the unsuccessful patients, double-stent retrievers were employed in 1 (6.7%) patient. Two patients who encountered residual clots in distal small arteries underwent adjunctive catheter-directed thrombolysis. An adjunctive balloon angioplasty was required in 1 (6.7%) patient. All patients had notable acute limb ischemia symptom relief after the procedures. Clinical success was achieved in 14 (93.3%) patients. Besides one patient encountered minor amputation, the major amputation was prevented in all patients. No device-related complications or distal embolization events were recorded during the procedures. At the follow-up of 12 months, all surviving patients remained symptom-free, the patency was achieved in 12 (80%) patients and the limb salvage was 100%.ConclusionsPreliminary outcomes suggest that mechanical revascularization using Solitaire AB device coupled with manual thromboaspiration appears to be a rapid, safe, and effective modality that appears to reduce the requirement for catheter-directed thrombolysis.Advances in knowledgeThese findings may add a promising recanalization therapy for acute embolic occlusion of the acute limb ischemia secondary to popliteal and infrapopliteal arteries.

Acute myocardial infarction secondary to left main coronary embolization after the conversion of an unwanted atrial fibrillation to the sinus rhythm

Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy and it represents the most frequent cause of coronary artery embolism.We describe a male patient with hypertrophic cardiomyopathy with persistent AF, for which he consumed rivaroxaban. The patient received implantable cardioverter-defibrillator shocks for ventricular tachycardia, but he developed acute embolic occlusion in the left main coronary artery (LMCA) following the conversion of the AF rhythm into the sinus rhythm.

Reduced Leukoaraiosis, Noncardiac Embolic Stroke Etiology, and Shorter Thrombus Length Indicate Good Leptomeningeal Collateral Flow in Embolic Large-Vessel Occlusion.

Acute leptomeningeal collateral flow is vital for maintaining perfusion to penumbral tissue in acute ischemic stroke caused by large-vessel occlusion. In this study, we aimed to investigate the clinically available indicators of leptomeningeal collateral variability in embolic large-vessel occlusion. Among prospectively registered consecutive patients with acute embolic anterior circulation large-vessel occlusion treated with thrombectomy, we analyzed 108 patients admitted from January 2015 to December 2019 who underwent evaluation of leptomeningeal collateral status on pretreatment CTA. Clinical characteristics, extent of leukoaraiosis on MR imaging, embolic stroke subtype, time of imaging, occlusive thrombus characteristics, presenting stroke severity, and clinical outcome were collected. The clinical indicators of good collateral status (>50% collateral filling of the occluded territory) were analyzed using multivariate logistic regression analysis. Good collateral status was present in 67 patients (62%) and associated with independent functional outcomes at 3 months. Reduced leukoaraiosis (total Fazekas score, 0-2) was positively related to good collateral status (OR, 9.57; 95% CI, 2.49-47.75), while the cardioembolic stroke mechanism was inversely related to good collateral status (OR, 0.17; 95% CI, 0.02-0.87). In 82 patients with cardioembolic stroke, shorter thrombus length (OR, 0.91 per millimeter increase; 95% CI, 0.82-0.99) and reduced leukoaraiosis (OR, 5.79; 95% CI, 1.40-29.61) were independently related to good collateral status. Among patients with embolic large-vessel occlusion, reduced leukoaraiosis, noncardiac embolism mechanisms including embolisms of arterial or undetermined origin, and shorter thrombus length in cardioembolism are indicators of good collateral flow.

Acute and Massive Aortic Thrombosis and Embolic Occlusion in a Patient with COVID-19: A Case Report

: A 73-year-old man with a history of COVID-19 infection from two weeks ago was referred to the Emergency Department with a complaint of colicky and generalized abdominal pain in addition to prior respiratory symptoms. High-resolution Computed Tomography (HRCT) displayed the typical signs of COVID-19 pneumonia. Initially, laboratory tests showed increased C-reactive protein and severe leukocytosis. Because of generalized abdominal pain, spiral abdominal and pelvic CT scans were done, which showed massive irregular and free-floating aortic thrombosis from the carina site to the Superior Mesenteric Artery (SMA) detachment, indicative of acute and life-threatening thrombosis. Filling defects were seen in the middle and distal part of the splenic artery, indicating the embolic occlusion of the splenic artery. The patient was admitted to the Intensive Care Unit (ICU), and he became a candidate for conservative treatment because of the wide extension of thrombosis. Therefore, we should pay more attention to the indirect signs of thrombosis in patients with COVID-19 infection with gastrointestinal symptoms and consider anticoagulant therapy for high-risk patients with COVID-19. The unique feature of our case was acute and extensive arterial thrombosis.

Heterogeneity between proximal and distal aspects of occlusive thrombi on pretreatment imaging in acute ischemic stroke.

The potential heterogeneity in occlusive thrombi caused by in situ propagation by secondary thrombosis after embolic occlusion could obscure the characteristics of original thrombi, preventing the clarification of a specific thrombus signature for the etiology of ischemic stroke. We aimed to investigate the heterogeneity of occlusive thrombi by pretreatment imaging. Among consecutive stroke patients with acute embolic anterior circulation large vessel occlusion treated with thrombectomy, we retrospectively reviewed 104 patients with visible occlusive thrombi on pretreatment non-contrast computed tomography admitted from January 2015 to December 2018. A region of interest was set on the whole thrombus on non-contrast computed tomography under the guidance of computed tomography angiography. The region of interest was divided equally into the proximal and distal segments and the difference in Hounsfield unit densities between the two segments was calculated. Hounsfield unit density in the proximal segment was higher than that in the distal segment (mean difference 4.45; p < 0.001), regardless of stroke subtypes. On multivariate analysis, thrombus length was positively correlated (β = 0.25; p < 0.001) and time from last-known-well to imaging was inversely correlated (β = -0.0041; p = 0.002) with the difference in Hounsfield unit densities between the proximal and distal segments. The difference in density between the proximal and distal segments increased as thrombi became longer and decreased as thrombi became older after embolic occlusion. This time/length-dependent thrombus heterogeneity between the two segments is suggestive of secondary thrombosis initially occurring on the proximal side of the occlusion.

Abstract TP73: Heterogeneity of Occlusive Thrombus Investigated on Pretreatment Imaging in Acute Ischemic Stroke

Background and Purpose: Investigation of occlusive thrombus in ischemic stroke is expected to clarify the etiology and mechanism of stroke fueling an optimal treatment strategy. However, in situ propagation due to secondary thrombosis after initial embolic occlusion could obscure the characteristics of initial emboli. Differentiation of the initial embolus and secondary thrombosis using retrieved specimens might be difficult due to fragmentation of whole thrombi. We aimed to investigate the heterogeneity of occlusive thrombi using pretreatment imaging of ischemic stroke. Methods: Among consecutive stroke patients with acute embolic occlusion of the anterior circulation eligible for endovascular reperfusion therapy, we retrospectively reviewed 81 patients who underwent both brain non-contrast CT (NCCT) and CT angiography (CTA) on admission from June 2015 to May 2018. Region of interest (ROI) was set on the whole thrombus on NCCT, which was identified referring to the filling defect on CTA, and the size of thrombus was measured. ROI was then divided equally into proximal and distal segments and Hounsfield Unit (HU) densities of those segments were measured respectively. Difference of HU between proximal and distal segments (ΔHU; HU in proximal segment - HU in distal segment) was calculated and analyzed. Results: HU density on NCCT in proximal segment was higher than in distal segment (mean difference: 3.75, 95% CI: 2.69-4.80, p&lt;0.01). ΔHU was correlated positively with the length of thrombus (ρ=0.32, p&lt;0.01), and correlated inversely with the time from last-known-well (LKW) to imaging (ρ=-0.29, p=0.01) and blood platelet level (ρ=-0.27, p=0.02). Stroke subtype and vascular risk factors had no significant correlation with ΔHU. On multivariate regression analysis, the length of thrombus (β=0.31, p=0.01) and the time from LKW to imaging (β=-0.30, p=0.01) were associated with ΔHU. Conclusions: Density of occlusive thrombi in the proximal segment is higher than in the distal segment. This difference increases as thrombi grow longer and decreases as thrombi get older after embolic occlusion. This time/length-dependent thrombus heterogeneity is suggestive of secondary thrombosis, occurring initially at the proximal side of occlusion.

A thread of hope for successful revascularization for acute embolic basilar artery occlusion due to miserable vertebral artery stump syndrome. A technical report

Acute basilar artery occlusion (BAO) is associated with major morbidities and a high mortality rate. The prevalence of acute BAO is 10.4% among patients treated with thrombectomy for acute large vessel occlusion. Vertebral artery stump syndrome (VASS) reportedly causes ischemic stroke with tandem occlusions as vertebral artery (VA) origin occlusion and BAO. The pathogenesis of ischemic stroke due to VASS can be attributed to thrombi or emboli. Acute embolic BAO due to VASS accounted for 2 of 25 cases (8.0%) of BAO treated using thrombectomy between April 2014 and May 2019 in our registry. VASS must be considered as one cause of BAO. With the initial Magnetic resonance angiography on arrival, it is difficult to distinguish between BAO due to simple cardiogenic embolus and due to embolus caused by VASS rapidly. In patients suffering from acute embolic BAO due to VASS, the presence of VA origin occlusion makes endovascular therapy (EVT) difficult to perform. Here, we report consecutive cases of thrombectomy for acute embolic BAO due to VASS, showing markedly different outcomes. VA origin occlusion severely limits the technical options for EVT. Visualization or conjecture of the origin of both or dominant VAs conceivably offers the possibility of successful EVT and may allow good outcomes.

A case report of atrial myxoma presenting with systemic embolization and myocardial infarction

BackgroundCardiac myxomas are the most common benign primary tumour of the heart. Clinical presentation is variable and ranges from constitutional symptoms to clinical features due to intracardiac obstruction, such as mitral stenosis, coronary embolization, or systemic embolization. Surgical resection is the only effective treatment to prevent its debilitating and catastrophic complication.Case summaryA 61-year-old woman presented with an-hour history of bilateral leg pain, numbness, lightheadedness, dyspnoea, and diaphoresis. Physical exam was remarkable for pale and cold lower extremities. Arterial pulse was not palpable in the right femoral, popliteal, and posterior tibial and dorsalis pedis arteries bilaterally. Electrocardiogram demonstrated normal sinus rhythm with T-wave inversion in lead I, V2, V3, and V4. Laboratory investigations were remarkable for leucocytosis and elevated troponin. Computed tomography angiogram showed emboli with acute infarcts involving the spleen and kidneys, acute embolic occlusion of right external and internal iliac arteries, and left distal common femoral artery. She underwent emergent bilateral cut-down and femoral artery thrombectomies. Transthoracic echocardiogram demonstrated wall motion abnormalities. Computed tomography angiography of the chest revealed an atrial mass and transoesophageal echocardiography was obtained which confirmed an atrial myxoma. Coronary angiography demonstrated no significant coronary artery disease, raising the possibility of myxoma embolization to the coronary arteries as the cause of her troponin elevation and wall motion abnormality. Subsequently she underwent successful resection of the atrial myxoma.DiscussionThe majority of cardiac myxomas are sporadic and arise from the left atrium as an isolated lesion in middle-aged women. Echocardiography is the diagnostic procedure of choice. The long-term survival after surgical resection is excellent and recurrence is rare.

Charakterystyka pacjentów z ostrym niedokrwieniem tętniczym — badanie retrospektywne, jednoośrodkowe

Introduction. Acute peripheral arterial occlusion is a serious medical condition that requires an immediate action. De- lays in diagnosis or treatment could lead to death or serious disability. The appropriate and early clinical evaluation of acute ischaemia is crucial. The goal of therapy for both acute embolic and thrombotic occlusion is reperfusion of the ischaemic organ. Materials and methods. The aim of this study was a retrospective analysis of the demographic and epidemiological data of patients admitted to Surgical Department of Mazovian Brodnowski Hospital in Warsaw from 2014 to 2018 due to displaying symptoms of acute peripheral arterial ischaemia. 208 patients were evaluated. Our analysis included anthro- pometric parameters, history of cardiovascular and other important chronic diseases, and addictions. The aetiology, localisation, and type of primary surgery were also assessed. Results. The analysed group contained 112 men (53.8%, average age: 67.9 years) and 96 women (46.2%, average age: 76.4). We find a statistically significant correlation was found between epidemiological factors [ i.e. age, hypertension, atrial fibrillation (AF), peripheral artery disease, myocardial infarction, and smoking] and gender. Embolic ischaemia occurred in 50.5% of cases. Thrombosis was diagnosed in the remaining 49.5%. Lower extremity ischaemia occurred most frequently (81.3%). Open embolectomy/thrombectomy was the primary surgery in 155 cases. We find significance of the aetiology in relation to the type of intervention and to the ischaemia localisation, but there was no significance in terms of mortality. The presence of ischaemic heart disease, atherosclerosis and tobacco smoking were relevant factors affecting the aetiology of acute ischaemia. Conclusion. Acute arterial ischaemia can occur regardless of gender. Embolic and thrombotic aetiologies occur with a very similar frequencies. Upper extremity arterial thrombosis occurs very rarely. An embolism is more often respon- sible for acute intestinal ischaemia. In patients with atherosclerosis and a history of previous vascular surgery, the presence of a vascular graft/stent graft is associated with a higher risk of arterial thrombosis. Among patients with AF and who were receiving vitamin K antagonists, the average level of international normalized ratio was non-therapeutic.

Microsurgical Embolectomy for Acute Embolic Occlusion of Intracranial Arteries: Forgettable Life-Saving Way for Endovascular Neurosurgeon

Microsurgical Embolectomy for Acute Embolic Occlusion of Intracranial Arteries: Forgettable Life-Saving Way for Endovascular Neurosurgeon

In Reply to ”Microsurgical Embolectomy for Acute Embolic Occlusion of Intracranial Arteries: Forgettable Life-Saving Way for Endovascular Neurosurgeon”

Cranial pneumatization in humans is normally confined to the paranasal sinuses and the petrous and mastoid parts of the temporal bones.We present a case of left-sided fractures of the occipital condyle and lateral mass of the atlas in the setting of extensive craniocervical pneumatization but in the absence of trauma, with a resulting unilateral hypoglossal nerve palsy.We discussed the possible etiology of this rare disease, its management, and prognosis.

Aspiration therapy for acute embolic occlusion of the superior mesenteric artery.

BACKGROUNDEmbolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.AIMTo evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.METHODSThis retrospective study reviewed eight patients (six males and two females) from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography (CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.RESULTSSix (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration).CONCLUSIONAspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients’ death, resolving thrombi, and improving symptoms.