Hemorrhagic Infarction Research Articles

Clinical Management and Surgical Outcomes of Wandering Spleen with Splenic Torsion in Pediatric Patients: A Case Report

Introduction: Wandering Spleen is a rare condition in which the splenic ligaments are abnormally loose or absent. This makes the Spleen more mobile and increases the risk of torsion. This case report outlines the clinical presentation and management of a 10-year-old female patient who presented at our clinic with acute abdominal pain, vomiting episodes, and a severe fever. Imaging tests, such as abdominal ultrasonography and computed tomography, confirmed the diagnosis of splenic torsion by showing a hemorrhagic infarction and a large spleen. We performed a splenectomy to remove the damaged organ, a partial omental resection to remove the dead tissue and removed the mesenteric lymph nodes for further pathological examination. After the surgical procedure, the intensive care unit carefully observed the patient and treated her with intravenous electrolyte replacement, broad-spectrum antibiotics, pain management, and measures to prevent thrombosis. This case highlights the critical need for early diagnosis and timely surgical intervention in cases of wandering Spleen to prevent serious complications, including splenic infarction. By presenting this case, we seek to elevate awareness of wandering Spleen among healthcare professionals, mainly within pediatric groups. We emphasize the importance of timely diagnosis and appropriate management to optimize patient outcomes. Conclusion: Early detection and prompt intervention are crucial in preventing severe complications in pediatric patients. This case emphasizes the necessity of rapid diagnosis and increased awareness in clinical practice. Due to the Spleen's impaired viability, a splenectomy was required. Following surgery, we provided comprehensive monitoring and pharmaceutical assistance to control pain, prevent infection, and maintain nutritional stability.

Deep learning of noncontrast CT for fast prediction of hemorrhagic transformation of acute ischemic stroke: a multicenter study

BackgroundHemorrhagic transformation (HT) is a complication of reperfusion therapy following acute ischemic stroke (AIS). We aimed to develop and validate a model for predicting HT and its subtypes with poor prognosis—parenchymal hemorrhage (PH), including PH-1 (hematoma within infarcted tissue, occupying < 30%) and PH-2 (hematoma occupying ≥ 30% of the infarcted tissue)—in AIS patients following intravenous thrombolysis (IVT) based on noncontrast computed tomography (NCCT) and clinical data.MethodsIn this six-center retrospective study, clinical and imaging data from 445 consecutive IVT-treated AIS patients were collected (01/2018–06/2023). The training cohort comprised 344 patients from five centers, and the test cohort included 101 patients from the sixth center. A clinical model was developed using eXtreme Gradient Boosting, an NCCT-based imaging model was created using deep learning, and an ensemble model integrated both models. Comparison with existing clinical scores (MSS, SEDAN, GRASPS) was performed using the DeLong test.ResultsOf the 445 individuals, 202 (45.4%) had HT, 79 (17.8%) had hemorrhagic infarction, and 123 (27.6%) had PH. In the test cohort, the area under the receiver operating characteristic curve (AUROC) of the clinical, imaging, and ensemble model for HT prediction was 0.877, 0.920, and 0.937, respectively. The ensemble model for HT prediction outperformed MSS, SEDAN, and GRASPS scores (p ≤ 0.023). The ensemble model predicted PH and PH-2 with AUROC of 0.858 and 0.806, respectively.ConclusionDeveloping and validating an integrated model that can predict HT and its subtypes in AIS patients following IVT based on NCCT and clinical data is feasible.Relevance statementThe clinical, imaging, and ensemble models based on noncontrast CT and clinical data outperformed existing clinical scores in predicting hemorrhagic transformation of AIS and its subtypes with poor prognosis, facilitating personalized treatment decisions.Key PointsThe models demonstrated the capability to predict hemorrhagic transformation of acute ischemic stroke quickly, accurately, and reliably.The proposed models outperformed existing clinical scores in predicting hemorrhagic transformation.The ensemble model provided risk assessment of parenchymal hemorrhage and parenchymal hemorrhage-2 outperforming existing clinical scores.Graphical

Magnitude and Time-Course of Dementia Risk in Stroke Survivors: A Population-Wide Matched Cohort Study.

Survivors of stroke are at high risk of dementia, but it is unclear whether this elevated risk is due to other confounding factors. We sought to determine the magnitude and time course of dementia risk after stroke with robust comparison with matched nonstroke populations in an entire province. We conducted a population-wide analysis of over 15 million people in Ontario, Canada, between 2002 and 2022. Using linked administrative databases, we identified adults hospitalized for ischemic stroke, intracerebral hemorrhage, or acute myocardial infarction (AMI). We performed 1:1 matching of people with stroke to all residents of Ontario (reference population) without stroke and separately to those with AMI, on age, sex, rural residence, neighborhood deprivation, and vascular comorbidities. We calculated the incident rate per 100 person-years and hazard ratios (HRs) for all-cause dementia between 90 days after stroke and 1 year, 5 years, 10 years, and total follow-up and evaluated time-varying HRs. In sensitivity analyses, we adjusted for new stroke in follow-up and the cumulative number of health care encounters. Of 175,980 stroke survivors, 174,817 (99.3%) were successfully matched to people in the reference population and 151,673 (90%) were matched to those with AMI. Over a mean follow-up of 5.6 years (SD 4.71, maximum 20 years), a total of 32,621 (18.7%) were diagnosed with dementia after stroke compared with 21,929 (12.5%) in the Ontario reference population. The rate of dementia per 100 person-years over total follow-up time was higher after acute stroke compared with the reference population (3.34 vs 1.89) and the AMI cohort (3.19 vs 1.75). The HR of dementia was higher in those with stroke compared with the reference population (1.76, 95% CI 1.73-1.79) and the AMI cohort (1.82, 1.79-1.85). HRs varied across time, with over 2.5-fold increase in dementia risk within 1 year, decreasing to 1.5-fold at 5 years and 1.3-fold at 20 years after stroke. Estimates were similar in sensitivity analyses. Recurrent stroke was associated with 3-fold increased dementia risk. In this population-wide study, almost one-fifth of stroke survivors were diagnosed with dementia, with an 80% higher risk of dementia after robust matching to those without stroke. Targeted dementia prevention efforts in acute and chronic survivors of stroke are needed.

Congenital disorders of glycosylation type 1A associated with cerebral hemorrhagic infarction: illustrative case.

Cases of congenital disorders of glycosylation (CDGs) are rare, and the occurrence of hemorrhagic infarction is also rare. The etiology is unclear. A 3-year-old Asian boy with CDG type 1A was hospitalized with pneumonia. Consciousness disturbance and hemiplegia appeared after high fever and were associated with disseminated intravascular coagulation. Magnetic resonance (MR) images showed subcortical hemorrhagic infarction due to anterior superior sagittal sinus occlusion. Follow-up computed tomography revealed the enlargement of a right frontal lobe hematoma with a midline shift. The authors performed emergency craniotomy for hematoma evacuation. The postoperative course was favorable, with improvements in consciousness and hemiplegia. Patients with CDG type 1A have various types of coagulation disorders and sometimes develop several thrombotic and bleeding events; however, there has only been one reported case of CDG with concomitant intracranial hemorrhagic infarction. The authors detected sinus thrombosis on MR images for the first time in a patient with CDG. In patients with CDGs, abnormalities in the coagulation-fibrinolysis system can cause various neurological symptoms, such as intracranial bleeding, cerebral ischemia, and stroke-like episodes. In Asian infants with suspected cerebral venous sinus thrombosis, it is advisable to conduct examinations that include imaging modalities, such as MR venography and/or contrast-enhanced T1-weighted imaging, to confirm complications. https://thejns.org/doi/10.3171/CASE23729.

Hemorrhagic Infarct as a Rare Presentation of Vascular Ehlers-Danlos Syndrome in a 40-Year-Old Female: A Case Report

Hemorrhagic Infarct as a Rare Presentation of Vascular Ehlers-Danlos Syndrome in a 40-Year-Old Female: A Case Report

Acute Myocardial and Hemorrhagic Cerebral Infarction Secondary to Non-bacterial Thrombotic Endocarditis in a Patient with Advanced Uterine and Ovarian Cancer.

Non-bacterial thrombotic endocarditis (NBTE) causes myocardial and cerebral infarctions and is associated with advanced stages of malignancy. However, only a few cases of myocardial and cerebral infarctions have been reported in the same patient. We herein report a 47-year-old woman with advanced uterine and ovarian cancer who experienced acute myocardial infarction (MI) after receiving chemotherapeutic intervention for the cancer and hemorrhagic cerebral infarction 1 month after admission for acute MI, attributable to NBTE of the aortic valve. NBTE should be considered in patients with malignancies and life-threatening thromboembolism of important organs.

Detecting Hemorrhagic Myocardial Infarction With 3.0-T CMR: Insights Into Spatial Manifestation, Time-Dependence, and Optimal Acquisitions.

Hemorrhagic myocardial infarction (hMI) can rapidly diminish the benefits of reperfusion therapy and direct the heart toward chronic heart failure. T2∗ cardiac magnetic resonance (CMR) is the reference standard for detecting hMI. However, the lack of clarity around the earliest time point for detection, time-dependent changes in hemorrhage volume, and the optimal methods for detection can limit the development of strategies to manage hMI. The authors investigated CMR signal characteristics of hMI through time-lapse multiparametric mapping using a clinically relevant animal model and evaluated the translatability in ST-segment elevation MI patients when possible. Canines (N=20) underwent 3.0-T CMR at baseline and various time points over the first week of reperfused MI. Time-dependent relationships between T1, T2, and T2∗ mapping of hMI, non-hMI, and remote territories were determined. Reperfused ST-segment elevation MI patients (N=50) were studied to establish clinically feasibility. Although hMI was evident<1 hour after reperfusion on histopathology, it was not reliably detected with T1, T2, or T2∗ CMR. However, 24 hours to 7days postreperfusion, hMI was detectable on T2∗ (27.0 ± 2.4ms [baseline] vs 11.7 ± 2.8ms [hMI]; P< 0.001), with stable volume and transmurality. In T2 maps, hMI was most visible 5 to 7days postreperfusion with an area under the curve of 0.98 (sensitivity and specificity≥0.95) relative to T2∗. However, this was not the case with T1 (sensitivity<0.8, across all time points). HMI cannot be reliably detected with T1, T2, or T2∗ on 3.0-T CMR immediately after reperfusion. However, T2∗ CMR can be used to diagnose hMI between 24 hours and 7days postreperfusion. T2 maps at 3.0-T are a strong alternative to T2∗ maps for diagnosing hMI, provided CMR is performed 5 to 7days postreperfusion. However, diagnosing hMI with T1 is significantly more challenging at 3.0-T compared with both T2∗ and T2.

Prognostic impact of intracranial arteriosclerosis subtype after endovascular treatment for acute ischaemic stroke.

The influence of intracranial arteriosclerosis (ICAR) on acute ischaemic stroke (AIS) prognosis is unclear. This study explored its impact, focusing on ICAR subtypes categorized by intracranial carotid artery calcification (ICAC) patterns: intimal or atherosclerotic versus internal elastic lamina calcification or non-atherosclerotic. The aim was to determine their effect on AIS prognosis in patients undergoing endovascular treatment (EVT). This prospective cohort study included consecutive AIS patients with anterior circulation large vessel occlusion undergoing EVT. ICAC, the hallmark of ICAR, was assessed using non-contrast computed tomography to quantify volume and establish the predominant ICAR subtype. The primary outcome was long-term functional outcome, measured by the 90-day modified Rankin Scale score. Secondary outcomes included first-pass effect, revascularization degree, symptomatic intracranial haemorrhage and 24-h infarct volume. Multivariate-adjusted linear and logistic regression models were used to assess the association of ICAC volume and subtype with these outcomes. From January 2021 to February 2022, 181 patients were included, of whom 172 (95%) had ICAC. Internal elastic lamina calcification was the predominant subtype in 103 (57%), intimal in 52 (29%) and mixed in 17 (9%). The intimal or atherosclerotic ICAC pattern was linked to poorer functional outcomes (adjusted odds ratio 2.12, 95% confidence interval [CI] 1.10-4.09), decreased first-pass effect probability (adjusted odds ratio 0.42, 95% CI 0.21-0.84) and higher infarct volume (adjusted β value 22.11, 95% CI 0.55-43.67). A predominant intimal ICAC subtype, linked to underlying atherosclerosis, correlated with larger infarct volume and poorer 90-day functional outcomes in EVT-treated AIS patients. Intracranial atherosclerosis appears to be a relevant factor hampering clinical benefits post-EVT.

A comparison of the effects of ticagrelor and clopidogrel in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis of randomized clinical trials

BackgroundRupture of unstable coronary atherosclerotic plaque leads to acute ST-segment elevation myocardial infarction (STEMI). Dual anti-platelet therapy is one of the main treatments, and the combination of Aspirin and Clopidogrel is recognized as the standard oral regimen in most cases. Ticagrelor is a new generation of P2Y12 receptor inhibitors. We aimed to compare the effect of Ticagrelor and Clopidogrel in the treatment of patients post-STEMI.MethodsThis study investigated Pub Med, Scopus, Google Scholar Web of Science, and Embase Cochrane Library clinical trials.gov databases. Heterogeneity between studies was assessed using the I2 index and the Q statistic. The random effects model was used to combine studies and the Funnel plot and Egger’s test were used to assess the publication bias.ResultsEleven studies were included in this meta-analysis. 5274 patients in the Ticagrelor and 5,295 patients in the Clopidogrel groups were examined. The mean age of the patients was 58.84 years (2.70) and 59.92 years (3.19) in the Ticagrelor and Clopidogrel groups, respectively. Based on the results of the meta-analysis, compared to Clopidogrel, Ticagrelor had decreased the outcomes of mortality, recurrent myocardial infarction, stroke, and Major Adverse Cardiovascular Events (MACE). However, the post-myocardial infarction bleeding according to Bleeding Academic Research Consortium (BARC) criteria and reperfusion state regarding thrombolysis in myocardial infarction (TIMI) Flow Grading system showed no differences in both groups. However, these effects were not statistically significant.ConclusionsTicagrelor decreased the chance of mortality, re-infarction, stroke, and MACE in post-STEMI patients compared to clopidogrel. But there was no difference in the chance of major bleedings (BARC ≥ 3) and improvement in TIMI grade flow between these two drugs. However, none of these findings were statistically significant, and more studies are needed to reach definitive results.

Comparison of safety and efficacy outcomes of intravenous thrombolysis in posterior vs. anterior circulation stroke

Background &amp; Objectives: Most previous large clinical studies of intravenous thrombolysis (IVT) focused on anterior circulation stroke (ACS). However, the results from ACS studies cannot fully represent posterior circulation stroke (PCS) patients due to their differences in symptoms, signs and etiologies. This study aimed to compare whether there are differences in thrombolysis outcomes between ACS and PCS patients who underwent IVT alone, and to explore predictors of outcomes in PCS after IVT. Methods: We included acute ischemic stroke (AIS) patients who underwent IVT and divided them into ACS and PCS groups according to clinical symptoms and neuroimaging examinations. A series of baseline data were collected while symptomatic intracranial hemorrhage (sICH), hemorrhagic cerebral infarction (HI), parenchymal hemorrhage (PH), all intracranial hemorrhage (aICH), mortality and the modified Rankin Scale (mRS) score were employed to assess thrombolysis outcomes. Results: Among 321 IVT-treated AIS patients, 87 had PCS. The incidence of sICH (1.1% vs. 9.8%, p=0.007), PH (1.1% vs. 9.8%, p=0.007), and aICH (4.6% vs. 15.8%, p=0.008) were lower in PCS than in ACS. A higher proportion of PCS achieved an excellent recovery (56.3% vs. 43.6%, p=0.042) and functional independence (66.7% vs. 53.8%, p=0.039) at 3 months poststroke. Logistic regression analysis identified the National Institutes of Health Stroke Scale (NIHSS) score (p&lt;0.001) and pre-event antiplatelet therapy (p=0.005) as significant predictors of excellent recovery and the NIHSS score (p&lt;0.001) as a unique predictor of functional independence at 90 days in PCS. Conclusions: PCS patients had a lower risk of intracranial hemorrhage complications and better functional outcomes after IVT alone.

Coagulum in Quadri-Cardiac chambers in a patient with Right Parieto-occipital Temporal Hemorrhagic infarct following Antero-septal myocardial infarction

Coagulum in Quadri-Cardiac chambers in a patient with Right Parieto-occipital Temporal Hemorrhagic infarct following Antero-septal myocardial infarction

A multicenter trial on the predictors of different subtypes of hemorrhagic infarction after thrombolysis

Worldwide, stroke is a leading cause of long-term disability in adults. Alteplase is the only approved treatment for acute ischemic stroke (AIS) and results in an improvement in a third of treated patients. Most studies evaluated the post-alteplase haemorrhagic transformation of brain infarction as a homogeneous entity but we evaluated the predictors of each subtype of haemorrhagic transformation of brain infarction. Our trial included 616 AIS alteplase-treated patients. We evaluated the ability of different risk factors, clinical presentation, and imaging features to predict different haemorrhagic transformation (HT) subtypes. HT was seen in 152 patients (24.7%), higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction, in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 (odds ratio [OR], 11.04; 95% CI, 9.81 to 12.70; P-value > 0.001) and type2 (OR, 11.89; 95% CI, 9.79 to 14.44; P-value > 0.001), while older age was also an independent predictor of parenchymal hematoma type1 (OR, 1.312; 95% CI, 1.245 to 1.912; P-value 0.02). In AIS patients treated with alteplase in Egypt and Saudi Arabia, higher NIHSS, cardioembolic stroke and atrial fibrillation were independent predictors of all ECASS-based subtypes of hemorrhagic infarction; in addition, anterior-circulation stroke was an independent predictor of hemorrhagic infarction type 1 and 2, while older age was also an independent predictor of parenchymal hematoma type1. Trial registration: (clinicaltrials.gov NCT06337175), retrospectively registered on 29/03/2024.

The clinical value of fibrosis indices for predicting the hemorrhagic transformation in patients with acute ischemic stroke after intravenous thrombolysis.

The incidence of stroke in China is approximately 343 per 100,000 people each year, the highest rate worldwide. Hemorrhagic transformation (HT), particularly symptomatic intracerebral hemorrhage (sICH) following acute ischemic stroke (AIS) with or without intravenous thrombolysis (IVT), can lead to rapid neurological deterioration, poor prognosis, and even death. Non-alcoholic fatty liver disease (NAFLD) has been identified as a risk factor for stroke occurrence and associated with poor long-term functional outcomes. Nonetheless, no studies have examined the association between liver fibrosis and HT in AIS patients who underwent IVT. A total of 826 patients with AIS who underwent IVT were included in this study. We calculated nine validated liver fibrosis indices to assess the extent of liver fibrosis. HT was detected by follow-up cranial CT/MRI within 24 h post-IVT and was classified as either hemorrhagic infarction (HI) or parenchymal hematoma (PH). Symptomatic intracranial hemorrhage was defined as a sudden symptomatic neurological deterioration, indicated by an increase in (National Institutes of Health Stroke Scale) NIHSS score of 4 points or more. The median values of fibrosis-4 (FIB-4), modified FIB-4 (mFIB-4), aspartate aminotransferase (AST)-platelet ratio index (APRI), Forns index, alanine aminotransferase (ALT)/AST (ARR), AST/ALT ratio-platelet ratio index (AARPRI), fibrosis quotient (FibroQ), and Fibrosis Index were significantly higher, while the fibrosis-5 (FIB-5) was significantly lower in the HT and sICH groups (all P < 0.001). After adjusting for potential confounders, all nine liver fibrosis indices remained associated with HT and sICH. Receiver operating characteristic (ROC) curve analysis revealed that the FibroQ score had the best predictive ability for HT (AUC = 0.707, CI = 0.652-0.762, P < 0.001), while FIB-4 had the best predictive ability for sICH (AUC = 0.802, CI = 0.711-0.892, P < 0.001). Liver fibrosis, as validated by FIB-4, mFIB-4, FIB-5, APRI, Forns index, ARR, AARPRI, FibroQ, and Fibrosis Index, was associated with HT and sICH in AIS patients after IVT.

Oral anticoagulants-induced intracranial hemorrhage: a real-world pharmacovigilance study over 2008-2024

ABSTRACT Background This study aims to review and describe the national post-market cases of Oral anticoagulants (OACs)-induced intracranial hemorrhage (ICH) to enhance patient safety. Research design and methods All ICH cases of OACs as primary suspected medicines were extracted from the FAERS. The disproportionality analysis was utilized to signal detection. Subgroup analyses and logistic regression were conducted according to age, sex, weight, hypertension status, concomitant antiplatelet drugs and indications. Stratification analysis was performed according to ICH locations. Results In total 11,201 cases of OACs-induced ICH were identified from 2008Q1 to 2024Q1. The median time-to-onset (TTO) and median age for OACs-induced ICH was 181 days and 75 years, respectively. Most potent positive signal was subdural hemorrhage in rivaroxaban and vitamin K antagonists (VKAs), spinal cord hemorrhage in apixaban, hemorrhagic cerebellar infarction in edoxaban and extra-axial hemorrhage in dabigatran (IC025: 4.04, 5.00, 3.45, 6.09 and 3.51, respectively). After adjusting for confounding factors, lower ICH risks were observed in direct oral anticoagulants (DOACs), compared to VKAs. Conclusion DOACs demonstrated a robust lower risk of ICH compared with VKAs. Different OACs exhibited distinct risk profiles at different ICH sites. The majority of DOACs-induced ICH occurred within 5 months and in elderly patients.

A case of hemorrhagic pulmonary infarction accompanied by hemothorax

A case of hemorrhagic pulmonary infarction accompanied by hemothorax

Isolated Sixth Cranial Nerve Palsy in Patients with Pituitary Apoplexy.

Pituitary apoplexy is an acute clinical syndrome constituted by headache, visual impairment, ophthalmoplegia, and altered mental status. Abducens nerve palsy due to pituitary apoplexy is a significant clinical manifestation in pituitary apoplexy cases.This study aims to investigate the rare occurrence of isolated sixth cranial nerve palsy in patients with pituitary apoplexy, a condition characterized by sudden hemorrhagic or ischemic infarction of the pituitary gland. A search was conducted on major databases, including PubMed, Web of Science, and ScienceDirect, to identify cases of isolated sixth cranial nerve palsy in patients with pituitary apoplexy. Only six cases were found in the available literature. Descriptive statistics were used to summarize the data, and relevant clinical features were compared between the cases. Among the six identified cases, isolated sixth cranial nerve palsy in patients with pituitary apoplexy predominantly affected middle-aged adults, with a prominent male preponderance. Clinical manifestations included acute-onset diplopia and headache, with the most common radiologic finding being pituitary gland enlargement or hemorrhage. Laboratory investigations revealed hormonal dysregulation in some cases. Treatment approaches varied and included conservative management and surgical intervention. Outcomes were generally favorable, with most patients experiencing partial or complete resolution of their cranial nerve palsy. Isolated sixth cranial nerve palsy in patients in the context of pituitary apoplexy is an exceptionally rare occurrence, with only six documented cases in the available literature. Further research and case reporting are essential to better understand this rare clinical entity and guide optimal management strategies.

Abstract 457: Utilizing the Comaneci Device for Dural Venous Sinus Thrombectomy

Purpose: The treatment of dural venous sinus (DVS) thrombosis is anticoagulation. In select patients, thrombectomy or thrombolysis can be considered based on clinical status. The following case demonstrates the potential benefits of an off‐label application of the Comaneci device for DVS thrombectomy. Case: A 47‐year‐old female patient presented with right‐sided weakness, nausea, and vomiting. Imaging revealed thrombosis of the superior sagittal sinus (SSS) extending to the torcula, right transverse sinus (TS), and right sigmoid sinus (SS) with a hemorrhagic venous infarct in the left parietal lobe. The patient was started on anticoagulation. However, her symptoms worsened with repeat imaging showing a new left frontal lobe hemorrhagic infarct. The decision was made to proceed with mechanical thrombectomy. Arterial and venous access was obtained in the right groin. Angiography showed venous sinus thrombosis of most of the SSS and torcula with focal occlusion of the right TS. A Zoom 71TM catheter was advanced into the anterior SSS. Pharmacomechanical thrombolysis was performed using a Scepter balloon that was intermittently inflated along the SSS while 5 mg tPA was infused. This yielded minimal improvement. Therefore a combination of mechanical thrombectomy using a Comaneci 21 device and aspiration thrombectomy using a Zoom 88TM catheter was performed in the SSS torcula, and right TS. The rapid inflation‐deflation (RID) technique of fast cycling the expansion and closure of the Comaneci over a period of time allowed for dislodgment of hard thrombus while concurrent aspiration of dislodged thrombus into the Zoom 71 intermediate and Zoom 88 guide catheters was employed. Post‐treatment angiogram confirmed resolution of occlusive thrombus with improved rate of angiographic arterial to capillary phase transgression. Only small volume non‐occlusive thrombus in the SSS, right TS, and right SS remained. Result: The patient was continued on therapeutic systemic anticoagulation post‐procedure. Follow‐up imaging showed stable left parietal and frontal lobe infarcts with stable hemorrhage and near‐complete resolution of prior DVS thrombus. She was discharged on hospital day 6. Conclusion Multiple endovascular techniques for DVS thrombosis have been described, which include aspiration, angioplasty, and lysis. To our knowledge, this is the first reported use of the Comaneci device for the treatment of DVS thrombosis. Following suboptimal results from balloon‐assisted thrombolysis, we used the Comaneci device and RID technique to actively macerate hard thrombus and allow for more effective aspiration. The Comaneci device is typically utilized with cerebral aneurysm coiling interventions or treatment of intracranial arterial vasospasm. Our case demonstrates a novel approach of rapid inflation‐deflation utilizing the Comaneci device for a successful DVS thrombectomy.

66 Survival and school-age outcomes of extremely premature neonates with intraventricular hemorrhage

Abstract Background Extremely low gestational age (ELGA) neonates are at risk for intraventricular hemorrhage (IVH) and periventricular hemorrhagic infarction (PVHI). There is no clear consensus on the prognosis of these conditions. Objectives The aim of this study was to compare the survival, and the neurodevelopmental outcomes (NDO) at school-age for neonates with IVH and/or PVHI, to those without. Design/Methods This retrospective single-center study (2012-2017) included neonates less than 26 weeks gestational age (GA) who received resuscitation and early intensive care. Imaging data were collected from cranial US for the presence of IVH described by Papile grading. Survival was defined as survival to discharge. NDO were classified as no neurodevelopmental impairment (NDI), no NDI with multidisciplinary referrals, and the adverse outcome was defined as NDI at school-age. NDI included any diagnosis of cerebral palsy, global developmental delay, intellectual disability, visual or hearing impairment. Autism spectrum disorder (ASD) was included as an outcome of interest. Results 164 infants met inclusion criteria, of whom 156 survived resuscitation. Mean GA was 24 weeks and 6 days (SD 6 days) and mean birth weight 701g (SD 125g), grade I-II IVH was present in 43 (28%) infants, and grade III-IV IVH was present in 48 (31%) infants. Survival was 45% for those with bilateral grade III-IV IVH, 53% for unilateral grade III-IV IVH, 78% for bilateral grade I-II IVH, 80% for unilateral grade I-II IVH, and 81% for no IVH groups. 108 infants survived to discharge and 90 had complete follow up at school age. 30% of children had NDI and ASD was diagnosed in 12%. Logistic regression for adverse outcome demonstrated an adjusted odds-ratio (OR) 0.30 (95% CI 0.14, 0.56) for gestational age (p &amp;lt;0.001). The logistic regression resulted in adjusted OR 0.72 (95% CI 0.21, 2.37) for grade I-II IVH and OR 1.43 (95% CI 0.4, 5.03) for Grade III-IV IVH (p=0.63). Conclusion In neonates born ELGA, survival decreased with increasing severity of IVH. Decreasing GA, but not severity of IVH, was predictive of neurodevelopmental impairment. Extremely preterm infants born &amp;lt; 26 weeks are at high risk of NDI and of ASD.

Essential thrombocythemia complicated by multivessel intracranial dolichoectasia with subarachnoid hemorrhage and recurrent cerebral infarction

BackgroundPatients with essential thrombocythemia (ET) can develop systemic thrombotic and hemorrhagic vascular complications due to increased and dysfunctional platelets.Case presentationWe encountered a 49-year-old Japanese woman with a history of essential ET, cerebral infarction, hypertension, and hyperlipidemia. She had been taking anagrelide (2.5 mg/day) and aspirin (100 mg/day) and had vomited at home. At the time of admission to our hospital, she was in a deep stupor. We thought these symptoms were caused by intracranial hypertension. Head computed tomography showed severe subarachnoid hemorrhage (SAH) at the interhemispheric fissure, hematoma at the corpus callosum, and intraventricular hemorrhages. Digital subtraction angiography demonstrated multiple dilated, stenotic, tortuous intracranial arteries, and a dissecting aneurysm at the right anterior cerebral artery (ACA). The dissecting aneurysm measured 7.7 × 15.5 mm, and a bleb was observed. Our diagnosis was ruptured ACA dissecting aneurysm and diffuse intracranial arterial dolichoectasia (DIADE). We performed stent-assisted coil embolization of the aneurysm. She remained apathetic and manifested unilateral apraxia and alien limb syndrome due to a partial callosal disconnection. Two months thereafter her symptoms gradually improved, her consciousness level and limb function improved, and her modified Rankin scale (mRS) score was 2. However, when we tapered her antiplatelet therapy, she again developed an acute cerebral infarct.ConclusionsThis is the first presentation of a patient with ET complicated by DIADE, both of which can result in ischemic and hemorrhagic vascular complications including SAH. As antithrombotic therapy in patients with DIADE and ET may be associated with higher hemorrhage rates, its effects must be monitored carefully.

Association between basal ganglia infarction and hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke: insights from the DIRECT-MT trial

BackgroundAcute ischemic stroke (AIS) often leads to significant morbidity and mortality. Mechanical thrombectomy (MT) is an effective intervention for large vessel occlusion strokes. However, hemorrhagic transformation (HT) remains a critical...