Simultaneous Occlusion Research Articles

Clinical Efficacy of Permanent Internal Mammary Artery Occlusion in Chronic Coronary Syndrome: A Double-Blind, Randomized, Sham-Controlled Trial

The CLIMACCS trial, a randomized, sham-controlled trial tested the CLinical efficacy of permanent internal mammary artery (IMA) device occlusion on symptoms in patients with chronic coronary syndrome (CCS), on coronary artery occlusive blood supply, and on myocardial ischemia. This was a prospective trial in 101 patients with CCS randomly allocated (1:1) to IMA device occlusion (verum group) or to IMA sham intervention (placebo group). The primary study endpoint was the change in treadmill exercise time (ΔET in seconds, s) at 6 weeks after trial intervention. Secondary study endpoints were the changes in collateral flow index (CFI), and angina pectoris during a simultaneous 1-minute proximal balloon occlusion of a coronary artery. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure. In the verum and placebo group, exercise time changed from 398±176s to 421±198s in the verum group (p=0.1745), and from 426±162s to 430±166s in the placebo group (p=0.55); DET amounted to +23±116s and +4±120s, respectively (p=0.44). CFI change during follow-up equalled +0.022±0.061 in the verum and-0.039±0.072 in the placebo group (p<0.0001). Angina pectoris at follow-up during the coronary balloon occlusion for CFI measurement had decreased or disappeared in 20/48 patients of the verum, and in 9/47 patients of the placebo group (p=0.0242). In conclusion, permanent IMA device occlusion tends to augment treadmill exercise time in response to heightened coronary artery occlusive blood supply, the fact of which is reflected by mitigated symptoms and signs of myocardial ischemia.

Non-routine thrombectomy in pediatric arterial ischemic stroke.

Unlike in adults, the indications and techniques for mechanical thrombectomy for arterial ischemic stroke (AIS) in children are not clearly established. The medical and interventional management of children with acute large vessel occlusion may entail the modification of the standardized management of this condition in adults. We present six cases of children who underwent non-routine thrombectomy for AIS. We retrospectively reviewed the records of children diagnosed with AIS between 2015 and 2023 and evaluated patient characteristics, procedural technical data, and final clinical outcomes. Procedures deviating from the current definition and indications for AIS treatment in adults as well as previously reported pediatric thrombectomy cases were defined as non-routine thrombectomy. Seven non-routine thrombectomy procedures in six children were included in the study. The National Institutes of Health Stroke Scale scores on admission ranged from 4 to 35; no procedure-related mortality or major neurologic morbidity occurred. One child died of causes related to the initial severe heart failure and stroke; otherwise, all the children had a modified Rankin scale score of 0 to 1 at follow-up. Unique clinical and procedural features in our case series included presentation with acute stent occlusion (two children), bilateral simultaneous internal carotid artery occlusions associated with a unilateral tandem middle cerebral artery (MCA) occlusion (one child), MCA occlusion caused by thromboembolism of the atrial myxoma (one child), and very distal (one child) or delayed thrombectomy (two children). Modifications to the standard medical and interventional algorithms may be required for mechanical thrombectomy in children. Referral centers specialized in pediatric neurology, pediatric anesthesia, and pediatric intervention are optimal for treating children using mechanical thrombectomy and for modifying the treatment, if required.

DOUBLE ST–ELEVATION, DOUBLE OCCLUSION?

Abstract Case Presentation A 71–year–old woman was referred to our outpatient clinic for two episodes of chest pain during last two days. Her past medical history was remarkable for arterial hypertension, obesity, diabetes mellitus type 2 treated by oral hypoglycaemic agents complicated by diabetic maculopathy. Diagnostic Work–Up At the presentation, the patient was symptomathic for chest pain, hemodynamically stable. The ECG showed synus rhythm, left–axis deviation, Q wave and ST–elevation from V2 to V5 and in DIII and ST–elevation in DII and aVF (FIGURE 1). Transthoracic echocardiography revealed concentric hypertrophy, mildly reduced LV ejection fraction (EF 45%) with akinesia of intreventricular septum and apex, without severe valvulopathies and no pericardial effusion. Given the clinical data the patient was addressed to urgent coronary angiography that showed LAD occlusion at the end of his proximal tract and right coronary artery occlusion at the beggining of his second tract (FIGURE 2); furthermore omo and etero–coronaric collaterals for right coronary artery area were detected. By using a workhorse guidewire flow was restored in both coronary arteries and PTCA was performed with 3 DES on LAD and other 2 DES on right coronary artery (FIGURE 3). The patient was transferred to our coronaric intensive unit care after the procedure; no complications were noticed during the hospitalization. A week after the patient was discharged in good general health. Conclusion Multiple simultaneous coronary occlusions are reported in literature, yet the accurate incidence and physiopathology of this occurrence is still uncertain. Probably the symphathetic system activation caused by first coronary occlusion could promote an increased basal platelets activation and then the second coronary occlusion. Our case shows that during coronary angiography identifying a culprit lesion may be delicate and cardiologists should be prepared to manage multiple coronary occlusions.

A-8 | Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in Patients with Simultaneous Chronic Total Occlusion

A-8 | Propensity Matched In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in Patients with Simultaneous Chronic Total Occlusion

Lacrimal occlusion and anti-inflammation with dexamethasone microcrystals incorporated gelatin methacryloyl-based plugs for treatment of dry eye

Dry eye, a frequently encountered disease of the ophthalmic clinic, is characterized by tear deficiency and ocular surface inflammation. Tear preservation through lacrimal drainage system plugs and anti-inflammatory therapy with glucocorticoids are generally used separately to control the disease progression. However, inherent limitations of current available plugs have necessitated the pursuit of new materials for plug production. Meanwhile, the therapeutic effects of glucocorticoids have been compromised by frequent dosing which reduces patient compliance. To address this, our present study developed a dexamethasone eluting intracanalicular plug (DEX-Plug) with dexamethasone microcrystals (DEX MCs) and gelatin methacryloyl (GelMA), which treated dry eye by simultaneous lacrimal occlusion and anti-inflammation. The resultant plug was biodegradable, biocompatible, and swelled rapidly to adapt the irregular anatomical structure of lacrimal canaliculi. It can block the lacrimal drainage system while serving as a drug delivery vehicle for sustained release of dexamethasone. The dual-functional therapeutic effects of DEX-Plug were demonstrated in a rabbit dry eye model using lissamine green drainage rates, the Schirmer’s test, corneal fluorescein staining, and real-time PCR. The plug reported herein can also be harnessed to deliver drugs other than dexamethasone, thus providing a novel approach to improve the treatment of dry eye.

Cardiac vein retroinjections provide an efficient approach for global left ventricular gene transfer with adenovirus and adeno-associated virus

Heart failure (HF) is a major burden worldwide, and new therapies are urgently needed. Gene therapy is a promising new approach to treat myocardial diseases. However, current cardiac gene delivery methods for producing global myocardial effects have been inefficient. The aim of this study was to develop an endovascular, reproducible, and clinically applicable gene transfer method for global left ventricular (LV) transduction. Domestic pigs (n = 52) were used for the experiments. Global LV myocardium coverage was achieved by three retrograde injections into the three main LV vein branches. The distribution outcome was significantly improved by simultaneous transient occlusions of the corresponding coronary arteries and the main anastomotic veins of the retroinjected veins. The achieved cardiac distribution was visualized first by administering Indian Ink solution. Secondly, AdLacZ (2 × 1012vp) and AAV2-GFP (2 × 1013vg) gene transfers were performed to study gene transduction efficacy of the method. By retrograde injections with simultaneous coronary arterial occlusions, both adenovirus (Ad) and adeno-associated virus (AAV) vectors were shown to deliver an efficient transduction of the LV. We conclude that retrograde injections into the three main LV veins is a potential new approach for a global LV gene transfer.

Treatment of Meniere's disease with simultaneous triple semicircular canal occlusion and cochlear implantation.

Report three cases of simultaneous triple semicircular canal occlusion (TSCO) and cochlear implantation (CI) as the treatment of intractable Meniere's disease (MD). Patients with MD can present occasionally with intractable vertigo and profound sensorineural hearing loss (SNHL). TSCO and CI have been proposed to control vertigo and restore profound deafness in patients with MD separately. However, a few studies have reported simultaneous TSCO and CI in the same surgical procedure for the treatment of MD. In the present study, we described three patients with MD showing incapacitating vertigo and severe SNHL who underwent simultaneous TSCO and CI after examinations of auditory system, vestibular system, and imaging. Their symptoms were significantly alleviated during the follow-up period. The combined TSCO and CI remains a viable treatment option which is effective for the control of vertigo as well as the restoring of hearing in patients with MD.

Acute coronary syndrome with simultaneous two-vessel occlusion De Winter ST-segment depression or reciprocal change?

We discuss a case of acute coronary syndrome (ACS) with simultaneous two-vessel occlusions in a man in his 20s. The serial electrocardiograms (ECG) showed very early dynamic changes of ST-T configuration resulting from ischemic zone depth or area between anterior wall versus inferior wall. The upsloping ST depression along with tall tentorial T waves in the precordial leads, as shown in the index ECG, raises the possibilities of a de Winter pattern. The retrospective assessment of the index ECG identified prominent T waves and a mild degree of ST-segment elevations in the inferior leads, given the electrocardiographic findings previously recorded at his workplace medical examination obtained at a later date. If the subtle ST-segment elevations in leads II, III, and aVF and the tall T waves were not overlooked in the index ECG, the probability of reciprocal ST-segment depressions in the precordial leads should also be taken into account. We recognize our ECG findings as intriguing ST-T deviation patterns that can change depending on the time sequence and anatomical dominancy of two infarct-related arteries. We finally suggest physicians should bear in mind the possibility of simultaneous multiple vessel occlusions when they encounter ACS patients with hemodynamic instability as in this present case

“Double Myocardial Infarct Syndrome” resulting from Simultaneous Occlusion of Dual Coronary Arteries: A Double Jeopardy

Angiographic evidence of thrombosis in more than one coronary artery at the same time is uncommon in patients with acute myocardial infarction, and this is hard to identify with routine electrocardiography. Patients may manifest with high-degree atrioventricular block, cardiogenic shock, or sudden cardiac arrest, all of which are potentially fatal outcomes. This case study focuses on a patient who experienced cardiogenic shock, high-degree atrioventricular block secondary to acute anterior-inferior ST-segment elevation myocardial infarction. During the coronary angiogram, thrombotic occlusions of the left anterior descending and right coronary arteries were observed. A patient was salvaged by the use of mechanical circulatory assistance in conjunction with prompt percutaneous coronary intervention of both the culprit arteries. Our case report emphasizes the importance of completing revascularization as soon as possible by opening the culprit arteries and ensuring appropriate mechanical circulatory support to the patient.

Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature.

Bilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate. To assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke. We present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature. Two patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients. In patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.

Biofouling occlusion of ships’ internal seawater systems: operational, economic, and biosecurity consequences

Biofouling of ships’ internal seawater systems (ISS) can cause significant operational issues and is a potential transfer mechanism for marine nonindigenous species. This study used an engine room simulator and economic evaluation to quantify impacts on commercial ship performance of biofouling occlusion within various ISS nodes (sea chest, strainer, and heat exchangers). A characteristic hockey-stick relationship between occlusion and impact emerged, whereby engine room systems could tolerate up to 55% occlusion of a single node without operational impact, followed by rapid performance deterioration. The relative magnitude of impacts varied by ISS node and in response to changes in ambient seawater temperatures. System tolerance was much lower when simultaneous occlusion of multiple nodes was assessed. In economic terms, consequences included required freight rate increases of 1–26% prior to forced (automatic) slowdown of the ship and up to 82% increases if slowdown conditions were required.

Catheter-related venous thrombosis: Simultaneous occlusion of cephalic and external jugular veins due to abnormal venous drainage

Catheter-related venous thrombosis: Simultaneous occlusion of cephalic and external jugular veins due to abnormal venous drainage

476 Technical and Clinical Outcomes in Concurrent Multivessel Occlusions Treated With Mechanical Thrombectomy: Insights from the STAR Collaboration

INTRODUCTION: Endovascular thrombectomy(EVT) has become the mainstay treatment of large vessel occlusion, however its role in the treatment of patients with simultaneous multi-territory occlusions(MVOs) has not been established. METHODS: We reviewed the STAR registry and included patient data from 35 stroke centers for EVT performed to treat bilateral anterior or concurrent anterior and posterior circulation occlusions from 2017-2020. RESULTS: We included a total of 7723 patients who underwent EVT for acute ischemic stroke. 54 patients (0.7%) underwent EVT for MVOs (mean age 69 ± 12.5; Female 50%). 28% had bilateral and 72% had concurrent anterior and posterior circulations occlusions. We used propensity score matching to match patients with MVOs to another group with single vessels occlusions by age, gender, race, admission NIHSS, baseline mRS score, onset to groin, use of IV-tPA. The rate of recanalization (TICI2B/3), complications, modified Rankin score at 90 days, and mortality was not significantly different between the 2 groups. Multivariate analysis confirmed that MVOs was not a predictor of poor functional outcome, increased symptomatic hemorrhage, or longer procedure time. CONCLUSIONS: Compared to single vessel occlusions, EVT in appropriately selected MVOs has similar efficacy and safety profile.

Взаимосвязь амилоидогенеза и таупатии с клиническими исходами ишемии головного мозга. Экспериментальное исследование

Currently, it has been established that increased formation of β-amyloid and tau protein play a significant role in the pathogenesis of cerebral ischemia. At the same time, these molecules can act as prognostic markers of the severity of cerebral ischemia. The aim of the study. To evaluate the peculiarities of changes in the concentration of β-amyloid and tau protein in blood serum and cerebrospinal fluid in rats with experimental subtotal cerebral ischemia, as well as to establish their relationship with the severity of post-ischemic clinical changes. Materials and methods. Subtotal cerebral ischemia was modeled by simultaneous occlusion of common carotid arteries in Wistar rats. The study assessed changes in neurological, sensorimotor and cognitive deficits. The content of β-amyloid and tau protein was assessed in blood serum and cerebrospinal fluid on the 1st, 3rd, 5th and 7th days of ischemia. During the analysis, species-specific kits for solid-phase enzyme immunoassay were used. Results. It was found that in animals with subtotal cerebral ischemia, as the duration of the ischemic period increases from day 1 to day 7, the concentration of β-amyloid and tau protein in both blood serum and cerebrospinal fluid progressively increases. It is worth noting that these changes strongly correlated with changes in the clinical manifestations of cerebral ischemia — neurological, sensorimotor and cognitive deficits.

Simultaneous total occlusion due to spasm of 2 main coronary arteries: A case report.

Coronary artery spasm (CAS) defined by severe reversible focal or diffuse vasoconstriction, plays an essential role in the pathophysiology of acute coronary syndrome but is not very common in the clinic. Due to its transience, it is difficult to diagnose CAS directly, many patients are diagnosed by clinical experience. Here, we report the diagnosis and treatment of a rare case of simultaneous total occlusion due to spasm of the two main coronary arteries by coronary angiography (CAG). A 47-year-old man with no medical history was admitted to our emergency room complaining of sudden-onset chest pain lasting 3 hours. Emergency CAG showed total occlusion of the proximal left anterior descending artery and right coronary artery. Acute myocardial infarction caused by CAS was diagnosed, according to CAG findings and test results. Intracoronary injection of nitroglycerin and anti-spasm medication. The patient was discharged on the 8th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 27 months. This case highlights the significance of identifying CAS in patients with acute myocardial infarction and avoiding blind interventional stent therapy, which requires closer attention from clinicians.

A Case of Acute Myocardial Infarction due to Simultaneous Occlusion of Two Vessels Caused by Delayed-Onset Heparin-Induced Thrombocytopenia

A Case of Acute Myocardial Infarction due to Simultaneous Occlusion of Two Vessels Caused by Delayed-Onset Heparin-Induced Thrombocytopenia

Simultaneous bilateral central retinal artery occlusion in a patient with dilated cardiomyopathy.

Simultaneous bilateral central retinal artery occlusion in a patient with dilated cardiomyopathy.

Monitoring kidney size to interpret MRI-based assessment of renal oxygenation in acute pathophysiological scenarios.

Tissue hypoxia is an early key feature of acute kidney injury. Assessment of renal oxygenation using magnetic resonance imaging (MRI) markers T2 and T2 * enables insights into renal pathophysiology. This assessment can be confounded by changes in the blood and tubular volume fractions, occurring upon pathological insults. These changes are mirrored by changes in kidney size (KS). Here, we used dynamic MRI to monitor KS for physiological interpretation of T2 * and T2 changes in acute pathophysiological scenarios. KS was determined from T2 *, T2 mapping in rats. Six interventions that acutely alter renal tissue oxygenation were performed directly within the scanner, including interventions that change the blood and/or tubular volume. A biophysical model was used to estimate changes in O2 saturation of hemoglobin from changes in T2 * and KS. Upon aortic occlusion KS decreased; this correlated with a decrease in T2 *, T2 . Upon renal vein occlusion KS increased; this negatively correlated with a decrease in T2 *, T2 . Upon simultaneous occlusion of both vessels KS remained unchanged; there was no correlation with decreased T2 *, T2 . Hypoxemia induced mild reductions in KS and T2 *, T2 . Administration of an X-ray contrast medium induced sustained KS increase, with an initial increase in T2 *, T2 followed by a decrease. Furosemide caused T2 *, T2 elevation and a minor increase in KS. Model calculations yielded physiologically plausible calibration ratios for T2 *. Monitoring KS allows physiological interpretation of acute renal oxygenation changes obtained by T2 *, T2 . KS monitoring should accompany MRI-oximetry, for new insights into renal pathophysiology and swift translation into human studies.

Pharmacological characteristics of intranasal dosage forms containing Ginkgo biloba extracts

Background: This article reviews the pharmacological characteristics of developed dosage forms for intranasal administration. The influence of the type of dosage form on the efficacy of the drug is significant. Gel-like structures are interesting objects for research. Interest in understanding the nature and properties of such structures is due to the variety of effects observed when gels are used. The active ingredient in the studied forms is ginkgo biloba extract obtained by ultrasonic extraction followed by thickening. The object of comparison is standardized dried ginkgo biloba extract (EGB 76). The study of cerebrotropic activity of the developed gels was conducted on the model of bilateral occlusion of the common carotid arteries. The studied objects and the reference preparation were administered therapeutically after modeling cerebral ischemia once a day for 3 weeks. Aim of the study: To evaluate specific pharmacological activity of the developed dosage forms of ginkgo biloba. Materials and Methods: Studies were performed in an appropriate design by simulating cerebral ischaemia in rabbits using simultaneous bilateral occlusion of the common carotid arteries. Changes in cerebral blood flow velocity were performed by Doppler using an appropriate transducer and software package. The data obtained were statistically processed using an application software package. Results: Conducted investigations revealed that under conditions of experimental cerebral ischemia simulated by simultaneous occlusion of the common carotid arteries in large laboratory animals (rabbits), the use of the developed dosage forms promoted the reduction of the severity of neurological deficit, the restoration of cerebral hemodynamics and pro/antioxidant balance in the hippocampus. Conclusions: Developed nasal gels based on chitosan and sodium alginate are promising agents for chronic cerebrovascular accident with antioxidant mechanism of action and therapeutic potential similar to oral administration of standardized ginkgo biloba extract - EGB 761

Acute myocardial infarction with simultaneous total occlusion of the left anterior descending artery and right coronary artery successfully treated with percutaneous coronary intervention

BackgroundSimultaneous thrombosis in more than one coronary artery is an uncommon angiographic finding in patients with acute ST-segment elevation myocardial infarction. It is difficult to identify using 12-lead electrocardiography and usually leads to cardiogenic shock and fatal outcomes, including sudden cardiac death. Therefore, immediate revascularization and adequate mechanical circulatory support are required.Case presentationWe report the case of a 58-year-old man who presented with vomiting and chest pain complicated by cardiogenic shock and complete atrioventricular block. Electrocardiography revealed ST-segment elevation in leads II, III, aVF, and V1–V6. Emergency coronary angiography revealed total occlusion of the proximal left anterior descending artery and right coronary artery. The patient successfully underwent primary percutaneous coronary intervention with ballooning and stenting for both arteries. An Impella CP was inserted during the procedure. Fifty-seven days after admission, he had New York Heart Association class II heart failure and was transferred to a rehabilitation hospital.ConclusionsAcute double-vessel coronary thrombosis, a serious event with a high mortality rate, requires prompt diagnosis and management to prevent complications such as cardiogenic shock and ventricular arrhythmias. A combination of judicious medical treatment, efficient primary percutaneous coronary intervention, and early mechanical support device insertion is crucial to improve the survival rate of patients with this disease.