Thrombosis Of Branches Research Articles

Branch Thrombus after Endovascular Treatment with Arch Branched Devices for Aortic Arch Pathologies

The aim of this study was to describe the occurrence of branch thrombosis following endovascular treatment of aortic arch pathology using an arch branched device (ABD) and to determine whether this is influenced by clinical and geometric parameters. In this retrospective observational study of patients treated with an ABD in three centres, the primary endpoint was thrombus formation within a branch during follow up. Secondary endpoints were technical success, serious adverse events (SAEs), early and late death, stroke, and re-interventions. Geometric measurements (tortuosity index and curvature) were determined on pre-operative and post-operative computed tomography angiographies. Thirty nine patients were treated and 68 antegrade branches were analysed (innominate artery, n = 27; common carotid artery [CCA], n = 40; left subclavian artery [LSA], n = 1). Thrombus was identified within seven branches (10%) on surveillance imaging (innominate artery, n = 6; CCA, n = 1; LSA, n = 0; p = .021) and was associated with a wider distal bridging stent diameter (median 14.0 mm [interquartile range {IQR} 2.0] vs. 8.7 mm [IQR 5.9]; p = .026), a higher degree of reversed tapering (4.3 mm [IQR 1.4] vs. 1.2 mm [IQR 2.8]; p = .023), use of polyethylene terephthalate (Dacron) covered (vs. expanded polytetrafluoroethylene) bridging stents (23% vs. 2%; p = .011), and higher body mass index (BMI) (32.1 kg/m2 [IQR 7.5] vs. 25.7 kg/m2 [IQR 5.4]; p = .029), but not with pre-operative or post-operative tortuosity index or curvature or alterations. Regarding secondary outcomes, the technical success rate was 97%, SAEs occurred in 15 patients (38%), early and late death rates were 8% and 23%, respectively, and early and late stroke rates were 5% and 23%, respectively. The risk of developing branch thrombosis after endovascular intervention with an ABD is considerable, especially of innominate artery branches, characterised by Dacron covered large diameter bridging stents, and in patients with a high BMI. Large prospective studies are required to analyse factors associated with branch thrombosis.

Appropriate ischemic criteria for type 4a myocardial infarction: insights from the ALPHEUS trial

Abstract Background Different troponin thresholds have been proposed to define periprocedural myocardial injury based on post percutaneous coronary intervention (PCI) troponin increase only, whereas the definition of type 4a myocardial infarction (MI) needs the association of post procedural troponin and one ischemic criterion. These criteria which evolved from the 3rd to the 4th Universal Definition of Myocardial Infarction (UDMI) are frequently under-reported in studies on periprocedural MI. Purpose We aimed to describe rates of type 4a MI additional diagnostic criteria among the ranges of post PCI troponin elevation in the randomized ALPHEUS trial which compared ticagrelor to clopidogrel in high-risk elective PCI patients. Methods 1698 patients with normal pre-PCI troponin values and centralized core laboratory angiogram analyzes were divided into 4 groups according to maximal post PCI troponin elevations (≤ 1x upper reference limit (URL) for group 1; > 1xURL and ≤ 5xURL for group 2; > 5xURL and < 35xURL for group 3 and ≥ 35xURL for group 4). The type 4a MI additional criteria (ischaemic imaging changes, ischaemic ECG changes, chest pain and angiographic complications) as defined by the 3rd and 4th UDMI were reported and the different angiographic complications were detailed for each group. Results The most prevalent additional ischemic criterion was the presence of angiographic complications detected by the core laboratory. The rate of angiographic complications increased in a stepwise manner with higher post PCI troponin elevation (Figure). Interestingly, we found a similar rate of angiographic complications in patients without any increase in post PCI troponin and troponin elevations below the 5xURL threshold (8.4% and 9.9% respectively). Most angiographic complications were related to transient main branch dissection and/or thrombosis, and transient or permanent side branch occlusions (Table). ECG changes and chest pain ischemic criteria also increased in a stepwise manner and were rarely found below the 5-fold threshold increase, although they might be underreported. Conclusion When using a core laboratory, angiographic complications are found even in patients with no or minor troponin elevation. Above the 5 xURL threshold the rates of angiographic complications are 2 to 3-fold more frequent, and ECG changes and chest pain ischaemic criteria are likely to be present. Our findings support the use of angiographic core laboratory in clinical trial using periprocedural MI as an endpoint; similarly, chest pain -which disappeared from the 4th UDMI- should be reconsidered as a diagnostic ischemic criterion.

P373 IN SUPPORT OF THE NEED FOR P.E.R.T. (PULMONARY EMBOLISM RESPONSE TEAMS) IN PULMONARY EMBOLISM (PE)

Abstract Pulmonary embolism (PE) is one of the leading causes of cardiovascular death with a wide range of criticality and complex and varied pathogenesis. A rapid therapeutic decision reverses the rapid progression towards a fatal outcome. A 64 years old patient, obese and hypertensive, returning from an intercontinental flight, went to the emergency room because of worsening dyspnoea and chest pain, which he had been suffering for a week; he arrived tachycardic, tachypnoic and with 91% O2 saturation in ambient air. A CT angiography showed extensive thrombosis of both main branches of the pulmonary artery (PA). Echocardiography confirmed right ventricular involvement, which was already hypokinetic and with a RV/LV ratio double than normal, which corresponds to a progressive drop in pressure and for which he was transferred to the cardiac intensive unit. The patient‘s history, comorbidities, risk of haemorrhage, imaging and laboratory data were analysed, leading to an evaluation of high risk PE, hemodynamic instability and positive cardiac biomarkers. With the availability of on–site equipment and trained personnel, the patient underwent ultrasound–guided locoregional thrombolysis through the placement of dedicated catheters capable of infusing into each PA branch 1mg of rtPA/h for 12 hours and ultrasound throughout the course of the catheter to increase the penetrance of thrombolysis into old thrombi (Ultrasound Accelerated Thrombolysis). As early as 6 hours, at echocardiographic control, there was a reduction in the RV/LV ratio to below 1.5, corresponding to a restoration of pressor stability. PERT shortens the time of decision of the best medical approach, which is the most effective method available to deal with the emergency. But PERT is also useful in low–risk PE in patients with significant comorbidities that contraindicate anticoagulant therapy, or in PE that is an incidentalomas, according to the wisdom of the radiologists in the group who know how to identify inveterate thromboses or PA sarcoma occlusion which are otherwise treatable. Hence the need for a multidisciplinary team: a) able to assess the patient with PE and provide the correct treatment which includes a range of medical, surgical and endovascular therapies; b) skilled in ensuring the follow–up of the patient with PE (post–thromboembolic pulmonary hypertension; c) skilled in getting the components to communicate about the effectiveness of treatment in the individual patient.

Safety and Efficacy of a Hybrid Approach Combining a Paclitaxel-Coated Balloon With a New Generation Drug-Eluting Stent in Patients With De Novo True Coronary Bifurcation Lesions

BackgroundThe use of drug-coated balloon in the management of true bifurcation lesions appears to be an attractive option to reduce the rate of stent thrombosis and restenosis particularly at the level of the side branch ostium. We aim to assess the safety and the efficacy of a hybrid approach combining a drug-eluting stent in the main branch and a drug-coated balloon to treat the side branch ostium in patients with de novo true bifurcation. MethodsFrom September 2020 to March 2022, 45 patients with a de novo true bifurcation lesion Medina (1.1.1) or Medina (0.1.1) were enrolled. All patients underwent a percutaneous coronary intervention with the hybrid approach. Clinical assessment with functional stress imaging test was scheduled at 6 months. In case of documented ischemia, coronary angiography was performed. The primary endpoint was the composite of target lesion failure at 6 months including cardiac death, target vessel MI or ischemia-driven target lesion revascularization. The secondary endpoints were technical success, defined by performing the percutaneous coronary intervention without an additional drug-eluting stent at the level of the side branch ostium, and clinical success, defined by a technical success associated with the absence of severe complications during in-hospital phase. ResultsThe immediate results show a technical success of the procedure in the majority of cases (88.9 %) with a low rate of bailout side branch stenting (11.1 %). The clinical success was obtained in 86.7 % and only one patient experienced a severe in-hospital complication. A side branch ostial lesion length > 10 mm was the only independent predictor of clinical failure of the procedure (OR 12.49, 95 % CI 1.17–133.6; p = 0.037). At 6 months, the TLF was low and occurred in 1 patient (2.2 %). No cardiac death was observed. No TVMI was observed. Importantly, at 6 months, no side branch thrombosis was observed. ConclusionThe use of a hybrid approach combining a drug-eluting stent in the main branch and a drug-coated balloon in the side branch to treat true bifurcation lesions appears to be safe and efficient with few immediate complications and with satisfactory results at mid-term follow up.

Ограничения индекса PESI в определении оптимальной лечебной тактики при тромбоэмболии легочной артерии: данные российского регистра СИРЕНА

Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals. Design: Registry, multicentre, prospective observational study. Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class). Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%). Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT. Keywords: Pulmonary Embolism Severity Index, pulmonary embolism, SIRENA registry, thrombolysis.

A clinical case of pulmonary artery branch thrombosis and lung infarction after SARS-CoV-2 infection

A clinical case of pulmonary artery branch thrombosis and lung infarction after SARS-CoV-2 infection

THROMBOEMBOLIC COMPLICATIONS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

The aim is the analysis of clinical and anamnestic, biochemical and hemostasiological parameters in thromboembolic complications in patients with acute calculous cholecystitis (ACC).
 Materials and Methods. A retrospective analysis of clinical information was performed regarding 206 patients with a diagnosis of acute calculous cholecystitis, who were hospitalized in the Emergency Medical Care Hospital of Lviv (current name: St. Panteleimon Hospital of the First Territorial Medical Association of the City of Lviv) in the period from 2014 to 2018.
 Results and Discussion. It was established that 2.91% of patients with ACC had thromboembolic complications, which were manifested in the form of deep vein thrombosis and PE of small branches and were more often diagnosed in patients with significantly older age (on average, 72.67±11.13 years of age). Thromboembolic complications in patients with ACC developed reliably more often in people who had concomitant pathology (hypertensive disease, IHD, COPD, liver cirrhosis, stroke). Patients with a complicated thrombotic diagnosis were also diagnosed with final non-thrombotic complications: local and general peritonitis, perivesical abscess, perforation, abdominal sepsis and subhepatic abscess. The average duration of laparoscopic cholecystectomy (LCE) in patients without complications was 60.00 [45.0-70.0] minutes, in patients with non-thrombotic complications - 62.50 [38.5-85.0] minutes, and in patients with thrombotic complications it was significantly longer - 95.0 [95.0-95.0] minutes (p<0.05).
 Conclusions. In patients with complicated acute cholecystitis, thromboembolic complications with local and general peritonitis, perivesical abscess were diagnosed more often (p<0.05). Patients with complicated acute calculous cholecystitis underwent cholecystectomy (83.33% [46.48-99.96]) reliably more often than patients with uncomplicated acute cholecystitis, whereas LCE was performed only in 16.67% [0.04-53.52] of cases. Therefore, cholecystectomy lasted for more than 1 hour in 80% [38,45-99,94] of cases.

Глазные осложнения после перенесенного коронавируса

Purpose. Identification of complications in patients in the post-reconvalescence period after suffering COVID-19 and proof of the relationship of these complications with the SARS-CoV-2 virus. Material and methods. We recruited and studied patients in the amount of 68 people of different age categories, from 20 to 65 years old with confirmed COVID-19 cases. For the subjects, we performed basic ophthalmic examinations, as well as ultrasound, pupillography, Worth's test, four-point test, cover test, and determination of the Hirschberg angle of strabismus. Results. We identified patients with uveitis (36 %), heterotropia (13 %), of which 3 subjects were diagnosed with ptosis and anisocoria (4 %), thrombosis of the CVS branches (7 %), partial hemophthalmos (12 %). In the remaining cases (32 %), no ocular manifestations were found. Conclusions. The virus is really capable of infecting the organ of vision. After the studies, we consider the nervous tissue of the eye and its vessels to be the main targets of the coronavirus. Of greatest interest is the possibility of its neurotropicity, since some subjects suffer from deep innervation of the cranial nerves. This, in turn, gives us a platform for further study of the coronavirus, its capabilities and the impact of its nonnervous tissue of the visual analyzer. Keywords: coronavirus, ocular complications, uveitis, iridocyclitis, heterotropia, ptosis, anisocoria, CVD branch thrombosis, hemophthalmos

Fighting SARS-CoV-2 infection: experience and prospects

BACKGROUND: COVID-19 is an international emergency. The Military Medical Academy, including the Department and Clinic of Infectious Diseases (with a course in medical parasitology and tropical diseases) are actively involved in the fight against the COVID-19 pandemic, and are also studying the pathogenesis, diagnosis and treatment of this disease.
 AIM: to systematize the work done at the Military Medical Academy in relation to the fight against a new coronavirus infection.
 MATERIALS AND METHODS: This article provides a brief description of the studies conducted in relation to COVID-19.
 RESULTS: The departments view of the infection caused by SARS-CoV-2 is presented, the main indicators of the work of the clinic of infectious diseases in the fight against COVID-19 are briefly reflected, and their own research in the field of this infectious disease is demonstrated.
 CONCLUSION: Based on our scientific work, our experience in treating patients with a new coronavirus infection, the main conclusions and recommendations are formulated:
 
 It is necessary to take into account the clinical feature of COVID-19 a long initial period (up to 8 days), which creates the illusion of imaginary well-being and contributes to late hospitalization.
 PCR is not an ideal diagnostic method, which creates the possibility of obtaining a false negative result. In this regard, clinical, epidemiological and radiological diagnostics are decisive.
 The organization of early active detection of patients with all clinical forms of infection caused by SARS-CoV-2, and their timely hospitalization helps to reduce the risk of developing a severe course, complications and epidemiological danger of patients.
 Complex antiviral and anticoagulant therapy should be early (up to 5 days from the clinical manifestation), proactive, aimed at reducing the likelihood of developing pneumonia with respiratory failure and thrombosis of the LA branches.
 Anti-inflammatory therapy increases the survival of patients with severe COVID-19 and should be administered as early as possible with a preventive goal at the first minimal clinical and laboratory signs of a hyperinflammatory response.

Surgical Resection of a Recurrent Hepatocellular Carcinoma with Portal Vein Thrombosis: Is It a Good Treatment Option? A Case Report and Systematic Review of the Literature.

Background: Hepatocellular carcinoma (HCC) is the sixth most frequent diagnosed tumor worldwide and the third leading cause of cancer related death. According to the EASL Guidelines, HCC with portal vein tumor thrombosis (PVTT) is classified as an advanced stage (BCLC stage C) and the only curative option is represented by systemic therapy. Therefore, treatment of HCC patients with PVTT remains controversial and debated. In this paper, we describe the case of a 66-year-old man with a recurrent HCC with PVTT who underwent surgical resection. A systematic review of the literature, comparing surgical resection with other choices of treatment in HCC patients with PVTT, is reported. Methods: A systematic review of the literature regarding all prospective and retrospective studies comparing the survival outcomes of HCC patients with PVTT treated with surgical resections (SRs) or other non-surgical treatments (n-SRs) has been conducted. Case presentation: A 66-year-old Caucasian man with a history of Hepatitis C Virus (HCV) related liver cirrhosis and previous hepatocellular carcinoma of the VI segment treated with percutaneous ethanol infusion (PEI) seven years before presented to our clinics. A new nodular hypoechoic lesion in the VI hepatic segment was demonstrated on follow-up ultrasound examination. A hepatospecific magnetic resonance imaging (MRI) scan confirmed also the presence of a 18 × 13 mm nodular lesion in the V hepatic segment with satellite micronodules associated with V–VIII sectoral portal branch thrombosis. The case was then discussed at the multidisciplinary team meeting, and it was decided to perform a right hepatectomy. The postoperative course was regular and uneventful, and the discharge occurred seven days after the surgery. At eight-month follow-up, there was no clinical nor radiological evidence of neoplastic recurrence, with well-preserved liver function (Child-Pugh A5). Results: Nine studies were included in the review. Median Overall Survaival (OS) ranged from 8.2 to 30 months for SRs patients and from 7 to 13.3 for n-SRs patients. In SR patients, one-year survival ranged from 22.7% to 100%, two-year survival from 9.8% to 100%, and three-year survival from 0% to 71%. In n-SRs patients, one-year survival ranged from 11.8% to 77.6%, two-year survival from 0% to 47.8%, and three-year survival from 0% to 20.9%. Conclusion: The present systematic literature review and the case presented demonstrated the efficacy of surgery as a first-line treatment in well-selected HCC patients with PVTT limited or more distal to the right and left portal branches. However, further studies, particularly randomized trials, need to be conducted in future to better define the surgical indications.

Risks and possible complications in maxillofacial surgery patients during or after coronavirus infection

This review/prognostic article briefly shows the pandemic features of COVID-19, morphological changes in blood vessels in COVID-19, mainly related to endotheliitis and thrombosis of small vessel branches. Cases of COVID-19 complications occurring in the practice of maxillofacial surgeons are given. Regarding possible complications during invasive interventions on the head and neck, we believe it is possible to consider COVID-19 in the anamnesis of patients in the departments of maxillofacial surgery as a new risk factor, and in case of severe course and prognosis of possible complications, as a contraindication for manipulations in the head and neck area.

ПРИНЦИПЫ ВЕДЕНИЯ БЕРЕМЕННЫХ С ОСТРЫМ ВАРИКОТРОМБОФЛЕБИТОМ

Thrombophlebitis of the subcutaneous veins of the lower extremities, also called superficial thrombophlebitis (ST), is a well-known and common disease often occurring in pregnant women with varicose veins (VV). As a rule, ST is considered as a disease with an uncomplicated and mild course, which is usually not life-threatening. However, in the case of appearance of concomitant deep vein thrombosis and/or pulmonary embolism, ST can cause severe complications. The article presents a clinical case of treatment of a pregnant woman (28 weeks of gestational age) with acute ascending varicothrombophlebitis in the system of the great saphenous vein (GSV). According to ultrasound data, the patient was found to have insufficiency of the sapheno-femoral junction and occlusive thrombosis of the lateral branches and the trunk of GSV, extending to the middle third of the left thigh. Taking into account the obstetric history, clinical and ultrasound picture of the disease, and the risk of perioperative complications, it was decided to prescribe prolonged anticoagulation with low-molecular-weight heparin(LMWH) and perform phlebocentesis of thrombosed GSV segments. The basic component of symptomatic treatment of ST was elastic compression. The chosen option for managing gestational varicotrombophlebitis allowed improving the patient’s overall health, as well as to quickly (within 2-3 days) arrest local inflammation and significantly reduce local edema and pain. The case presented highlights the possibility of successful and safe use of needle aspiration thrombectomy and anticoagulation with LMWH in pregnant women with ascending subcutaneous venous thrombosis.

Past COVID-19 infection and feasibility of transcatheter aortic valve replacement in a patient with severe aortic stenosis (a clinical case study)

A fatal case of severe stenosis of the aortic orifice in a patient with not diagnosed in time, long-term persistent covid infection is presented. The patient was hospitalized to resolve the issue of surgical correction of the aortic stenosis. On admission, there were symptoms of circulatory failure at the level of 3–4 functional class according to NYHA and angina pectoris clinic. A detailed collection of anamnesis about the epidemiological environment and symptoms of pneumonia suffered in the fall of 2020 raised suspicions of its covid genesis. Subsequently, this assumption was confirmed by the data of laboratory, instrumental studies, as well as the results of the pathological and anatomical autopsy. The study of microslides showed signs of extensive vasculitis with thrombosis of small branches of the pulmonary artery and foci of pneumofibrosis of various degrees of prescription, which also testified in favor of the transferred covid infection. Taking into account the severity of the patient’s condition upon admission, it was not possible to perform emergency intervention on the aortic valve. After stabilization of the state and regression of the phenomena of circulatory failure, it was planned to simultaneously perform endovascular revascularization of the coronary valve bed and transcatheter aortic valve replacement. The planned surgical intervention failed. The immunosuppressive effect of the SARS-CoV-2 virus, apparently, led to the activation of autoflora and an increase in inflammation for nosocomial infection. Bilateral polysegmental bacterial pneumonia that joined during hospitalization, against the background of postcoid changes in the lung parenchyma, contributed to the development of acute coronary syndrome with ventricular arrhythmias. The patient died from acute cardiopulmonary failure. The article also presents ideas about the operational tactics of managing patients with aortic stenosis in a pandemic.

Aortic arch debranching in hybrid thoracic aortic replacement

To analyze the outcomes of aortic arch debranching in hybrid thoracic aortic replacement. There were 107 patients who underwent hybrid thoracic aortic repair with debranching of supra-aortic vessels between 2015 and 2021. Patients underwent total and partial debranching (subtotal debranching and subclavian-carotid anastomosis/bypass). Debranching was performed in patients with type 3 dissection, type B aneurysms, post-traumatic aortic isthmus and arch aneurysms, thoracoabdominal aneurysms type A and DeBakey type 1 dissections. One patient (0.9%) died from thoracic aorta rupture after retrograde dissection. There was a moderate decrease of blood flow velocity through the left vertebral artery after subtotal debranching without severe hemodynamic disorders. Despite mild surgical trauma, subtotal and especially total debranching are characterized by higher risk of thrombosis of branches with potential fatal outcomes. In young patients requiring subtotal aortic arch debranching, open reconstruction or repair with fenestrated stents is preferred. We recommend a Bavaria type II hybrid procedure for patients with high surgical risk. In our opinion, more physiological hybrid interventions with anatomical arrangement of supra-aortic vessels such as Elephant Trunk and Frozen Elephant Trunk procedures are preferred.

A rational approach to the prevention ofthromboembolic complications in the surgical treatment of complicated forms ofcholelithiasis in patients with liver cirrhosis

Background. It is known from scientific sources that a significant proportion of complications of liver cirrhosis is associated with negative impact of this pathology on the coagulation system. According to many scientists, liver cirrhosis in most cases poses a risk of developing both thrombotic and hemorrhagic complications. Objective: to identify a rational approach to the prevention of thromboembolic complications in the surgical treatment of complicated forms of cholelithiasis in patients with cirrhosis. Materials and methods. We retrospectively analyzed the hospital records of 62 patients who were treated for complicated forms of cholelithiasis with verified liver cirrhosis for the period from 2005 to 2018. The distribution of patients by nosology was as follows: acute calculous cholecystitis— 48 patients, Mirizzi syndrome— 7, choledocholithiasis— 7. Results. Based on a comparative analysis of two groups, the risk of intraoperative bleeding in patients with preoperative prophylaxis was higher (3cases— 8.1 %), with a blood loss of more than 400 ml. Hematomas of postoperative wounds were observed in 5 cases in group 1 and in one case in group 2. In the group of preoperative prophylaxis, portal vein thrombosis (n = 1), thrombosis of small branches of the pulmonary artery (n = 1), and deep vein thrombosis of the leg (n = 1) developed. No such complications were observed in the group with postoperative prophylaxis. Conclusions. The decision on the prevention of thromboembolic complications in this category of patients should be balanced and include an assessment of the risks of developing both hemorrhagic disorders and complications associated with thrombosis.

Thrombosis of the pulmonary arteries branches as a complication of COVID-19 pneumonia (a case report)

The article presents a rare case of thrombosis of the pulmonary arteries branches, which developed in a patient two months after infection with the SARS-CoV-2 virus, that caused bilateral polysegmental pneumonia. The thrombosis was suspected because of a high plasma D-dimer level. Contrast-enhanced chest CT was performed to make a definitive diagnosis. The absence of blood clots in the veins of the lower extremities and pelvis allowed us to conclude that the patient did not have thromboembolism, but rather a pulmonary thrombosis in situ. Such possible causes of venousthromboembolic complications as tumors, systemic diseases of the connective tissue, and antiphospholipid syndrome were excluded based on negative tests for tumor and autoimmune diseases markers. The long-stay in the hospital was associated with the inability of the patient to maintain the normal level of blood oxygen saturation independently due to the large area of the lung damage associated with COVID-19 pneumonia and ischemia caused by thrombosis of the branches of the pulmonary arteries.

Our experience of rare otolaryngological complications of coronavirus infection

Introduction: COVID-19 disease can lead to serious complications of the ENT organs. Among them are the developments of aseptic thrombosis of the arteries of the ENT organs and face, as well as auditory dysfunction. Purpose: to investigate changes in auditory function and blood supply to the ENT organs of patients which underwent coronavirus COVID-19. Materials and methods: examination and treatment of patients with complications of coronavirus infection: facial soft tissue thrombosis (2) and auditory dysfunction (38). The results obtained: Coronavirus infection in two patients resulted in thrombosis of the soft branches of the internal and external carotid arteries with the development of necrosis of the mucous membrane of the lateral wall of the nose, nasal sinuses, septum and palate, which required surgical treatment. Acute sensorineural hearing loss with an increase in thresholds of sound perception to 40 dB was observed in 23 (60.5%) patients, and most of them (19 people) suffered from severe coronavirus infection and received comprehensive treatment (hormones, anticoagulants, etc.). Hearing loss with an increase in the threshold of sound perception to 40-60 dB was determined in 15 (39.5%) patients, of whom only 5 underwent severe COVID-19. Conclusions: Patients who have undergone a coronavirus infection caused by the SARS-CoV-2 virus may develop otolaryngological complications in the form of auditory dysfunction or arterial thrombosis. More severe bilateral damage to the auditory analyzer occurs in patients who underwent mild COVID-19 and did not receive anti-inflammatory therapy. The use of glucocorticoids and anticoagulants for the treatment of coronavirus infection on time prevents the development of complications from the auditory analyzer and blood coagulation system.

Cause of death based on systematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic.

ImportanceAssessment of the causative association between the COVID‐19 and cause of death has been hampered by limited availability of systematically performed autopsies. We aimed to present autopsy‐confirmed causes of death in patients who died with COVID‐19 and to assess the association between thrombosis and diffuse alveolar damage consistent with COVID‐19 (DAD).MethodsConsecutive forensic (n = 60) and clinical (n = 42) autopsies with positive post‐mortem SARS‐CoV‐2 PCR in lungs (age 73 ± 14 years, 50% men) were included. The cause of death analysis was based on a review of medical records and histological reports. Thrombotic phenomena in lungs were defined as pulmonary thromboembolism (PE), thrombosis in pulmonary artery branches or microangiopathy in capillary vessels.ResultsCOVID‐19 caused or contributed to death in 71% of clinical and 83% of forensic autopsies, in whom significant DAD was observed. Of the patients with COVID‐19 as the primary cause of death, only 19% had no thrombotic phenomena in the lungs, as opposed to 38% amongst those with COVID‐19 as a contributing cause of death and 54% amongst patients whose death was not related to COVID‐19 (p = 0.002). PE was observed in 5 patients. Two patients fulfilled the criteria for lymphocyte myocarditis.ConclusionsVast majority of all PCR‐positive fatalities, including out‐of‐hospital deaths, during the SARS‐CoV‐2 pandemic were related to DAD caused by COVID‐19. Pulmonary artery thrombosis and microangiopathy in pulmonary tissue were common and associated with the presence of DAD, whilst venous PE was rarely observed. Histology‐confirmed lymphocyte myocarditis was a rare finding.

COVID-19 and Stroke

Most patients with COVID-19 present with constitutional and respiratory symptoms and some with atypical gastrointestinal, cardiovascular, or neurological manifestations. Recent studies suggest that there are neurologic manifestations of COVID-19, including acute cerebrovascular disease (CVD). The aim of this study is to find out any evidence of COVID-19 related stroke. Radiologic studies of the patients admitted to the emergency department (ED) of our center from March 11 Th to June 10 Th 2020, with acute stroke symptoms and of whom the acute cerebrovascular disease is confirmed by Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) are searched retrospectively. CT Angiography (CTA) and MR Angiography (MRA) studies obtained for stroke management, searched for acute thromboembolism. We noticed some radiologic evidence of acute cerebrovascular disease in 56 patients of 528 patients admitted with immediate neurological symptoms. 11 (19.64 %) of these patients who were not diagnosed before, proved to be simultaneous COVID-19 infection with laboratory tests and/or thorax CT. It was noteworthy that these 11 patients presented with an acute cerebrovascular event supported by neurological and radiological findings instead of the well-known constitutional or respiratory symptoms of COVID 19 infection. 45 (80.35 %) patients were negative for COVID-19 infection. CT /or MR Angiography demonstrated carotid or intracranial major arterial thromboembolism in 5 (11.1 %) of the non-COVID-19 patients and 5 (45.4 %) of the simultaneous COVID-19 disease diagnosed ones. COVID19 positive 5 patients presented with acute internal carotid artery (ICA) or major ICA branch thrombosis at the first stage of COVID-19 infection, rather than a complication of the serious lung disease or a component of multiorgan disfunction related COVID-19. Acute cerebrovascular disease symptoms bringing patients to the ED instead of the respiratory symptoms, aroused high suspicion of the direct neuropathy and early coagulopathy effect of the virus. COVID- 19 disease, itself thought to be a great risk factor for stroke alone. Even in initial cases and in cases where COVID-19 infection do not show a severe and fatal course, stimulation in the coagulation cascade in the early stages, increased the risk of acute stroke.

Thrombodynamics as a tool for monitoring the effectiveness of anticoagulant therapy in patients with pulmonary embolism

Background . Monitoring of hemostasis in patients with pulmonary embolism (PE) to assess the efficacy and safety of anticoagulant therapy is one of the most emerging needs in clinical practice. Aim. To determine the factors associated with an insufficient decrease in the rate of fibrin clot formation in patients after pulmonary embolism receiving anticoagulation therapy. Methods. 33 patients were recruited in the study. To control plasma hemostasis, we measured coagulogram indices and performed dynamic thrombophotometry (T-2 Thrombodynamics Registrar, GemaCore, Russia). Results. The median rate of fibrin clot formation in the general sample of patients was within the normal range. However, 13 patients (39.4%) had these values higher than 29 pm/min. Patients with an insufficient decrease in the rate of fibrin clot formation were significantly younger (p = 0.045), more often had massive PE of the main branches of the pulmonary artery (p = 0.015), and high systolic pulmonary artery pressure (p = 0.043). Conclusion. Thrombodynamics allows identifying patients with PE and an increased thrombogenic potential under anticoagulation therapy by the end of the hospital stage. A high rate of fibrin clot formation by the end of the hospital period is observed in younger patients with thrombosis of the main branches of the pulmonary artery and high pulmonary hypertension.