Spontaneous Recanalization Research Articles

Computed Tomography Perfusion Imaging in Acute Ischemic Stroke: Accurate Interpretation Matters.

Computed Tomography Perfusion Imaging in Acute Ischemic Stroke: Accurate Interpretation Matters.

Abstract WP9: Number Needed To Treat With Intravenous Tenecteplase To Reduce The Need For Mechanical Thrombectomy In Large Vessel Occlusion Acute Ischemic Stroke Patients: Real-world Experience Data.

Objective: We sought to describe short term outcomes in patients with large vessel occlusion acute ischemic stroke (LVOAIS) who were treated with intravenous tenecteplase (TNK) as compared to alteplase, focusing on reduction in the need for mechanical thrombectomy (MT). Background: In LVOAIS, TNK has shown improved reperfusion and outcomes with a similar safety profile to alteplase. Ultra-early reperfusion has been described with TNK which would prevent the need for MT. We analyze the magnitude of this effect in a “real-world” setting. Design/Methods: In this retrospective study, demographic, clinical, and imaging information from patients with LVOAIS treated with intravenous thrombolysis was collected. Data was compared between the group treated with TNK and alteplase. Results: One hundred eighty-six patients met the criteria for the study (LVOAIS and candidates for IV thrombolysis and MT). Of these, 144 patients received tPA and 42 received TNK. Nine had clinical improvement prior to groin puncture and did not require angiography. This phenomenon occurred in 2.1% who received IV tPA and 14.3% who received TNK (p=0.005). For 8.2 patients treated with TNK rather than tPA, one catheter angiography would be prevented. When combining the number of patients who had recanalization on angiography before MT, and those who had clinical improvement prior to angiography, there were a total of 23 patients. This was noted in 9.7% of patients who received tPA, and 21.4% of those who received TNK (p=0.043). For 8.5 patients treated with TNK rather than tPA, one patient will have spontaneous recanalization either angiographically or with clinical improvement, preventing the need for MT. Conclusions: Intravenous TNK in patients with LVOAIS reduces the need for catheter angiography and mechanical thrombectomy.

Abstract WP134: Long-Term Spontaneous Recanalization Rates Of Symptomatic Cervical Carotid Artery Occlusions

Background: Long-term rates of spontaneous recanalization of a previously acutely symptomatic cervical internal carotid artery occlusion (ICAO) have not been well characterized. The purpose of this study was to determine the rate of ICAO recanalization after index transient ischemic attack (TIA)/stroke in patients with serial vessel imaging, and the clinical factors associated with recanalization. Methods: This was a single-center, retrospective analysis from 2012-2020 of patients presenting with TIA/stroke due to an acute cervical ICAO. Patients were included if follow-up neck vessel imaging (CTA, MRA or ultrasound) was performed after index TIA/stroke. Recanalization was classified as the presence of continuous flow within the cervical carotid artery on repeat imaging. Patients were excluded if they received catheterization of the occluded artery during index admission or if the occlusion was previously documented (i.e., chronic). Results: Fifty-five patients were included in this study (mean age 61 ± 12 years, 27% female). The most common etiology for cervical ICAO was atherosclerosis (71%), followed by dissection (22%). Twelve patients (22%) demonstrated recanalization on follow-up imaging at a median of 125 days from index TIA/stroke (range 2-1072 days). Three patients with recanalization underwent carotid revascularization with endarterectomy or stenting. The administration of intravenous alteplase during index stroke admission was associated with recanalization (p=0.008). However, discharge antithrombotic regimen (antiplatelet or anticoagulation) or the etiology of the occlusion were not associated with recanalization (p=0.48 and p=0.73, respectively). There was no difference in 6-month recurrent TIA/stroke rates between those with recanalization (1 patient, 8.3%) and those without recanalization (4 patients, 9.3%), p=1.0. Conclusion: Cervical ICAO recanalization occurred in 12 (22%) patients in our cohort at follow-up and allowed for carotid revascularization procedures in 3 (25%) of these patients. Outpatient follow-up cervical vessel imaging should be considered after symptomatic cervical ICAO, as identifying spontaneous recanalization can alter management.

Review of vasocutaneous fistulas and other rare complications after vasectomy.

Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy. A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy. Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications. Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.

Recanalization of an occluded artery of Percheron causing acute bilateral thalamic infarction

An 87-year-old woman was admitted with acute onset of disturbed consciousness. On neurological examination, both pupils were dilated and non-reactive to light. Decerebrate rigidity was present. Babinski testing was positive. CTA suggested an isolated left P1 segment occlusion. The P2 segment was supplied from the left internal carotid artery via the posterior communicating artery. MRI showed bilateral paramedian thalamic infarctions. Because occlusion of the artery of Percheron was suspected, intravenous thrombolysis was performed. Digital subtraction angiography (DSA) revealed occlusion of the left P1 segment and spontaneous recanalization before endovascular treatment. Her consciousness improved immediately. When acute bilateral thalamic infarction suggests top of the basilar artery syndrome but no basilar artery occlusion is found, occlusion of the artery of Percheron should be considered. Thrombectomy of the affected P1 segment may be needed.

CASE SERIES: HUMAN ERRORS AND TUBECTOMY FAILURE- REPORT OF FIVE CASES

Female sterilization is the most common permanent method of contraception in India. Most of those procedures are performed in various levels of public health facilities. Tubectomy failures due to spontaneous tubo-pertineal stula formation and recanalization is known in the literature. The human errors are also reported. However, the nature and frequency of human errors leading to failure are addressed in very few reports. This case series addressed the issues of preventable human errors, which helps physicians to revisit the procedure to prevent litigations.

Tenecteplase versus alteplase before mechanical thrombectomy: experience from a US healthcare system undergoing a system-wide transition of primary thrombolytic

BackgroundTenecteplase (TNK) is a genetically modified variant of alteplase (TPA) and has been established as a non-inferior alternative to TPA in acute ischemic stroke (AIS). Whether TNK exerts distinct benefits...

Thromboembolism from Carotid Web.

HomeRadiologyVol. 306, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyThromboembolism from Carotid WebNoel F. Fanning , Brian J. ManningNoel F. Fanning , Brian J. ManningAuthor AffiliationsFrom the Departments of Neuroradiology (N.F.F.) and Vascular Surgery (B.J.M.), Cork University Hospital, Wilton, Cork, Ireland.Address correspondence to N.F.F. (email: [email protected]).Noel F. Fanning Brian J. ManningPublished Online:Nov 15 2022https://doi.org/10.1148/radiol.221504MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 26-year-old woman presented with 5 hours of acute right neck pain and left arm weakness after exercising. At examination, her National Institutes of Health Stroke Scale score was 3, indicating mild deficits. MRI scans showed a right middle cerebral artery (MCA) infarct (Figure, A), and CT head angiogram showed a right MCA occlusion (not shown in Figure). The patient did not receive thrombolytic therapy due to time from symptom onset. She was transferred to a comprehensive stroke center for further management. Subsequent CT head angiogram showed spontaneous recanalization of the right MCA occlusion (not shown in Figure). CT carotid angiogram revealed shelf-like protrusion from the dorsal aspect of the internal carotid artery just beyond the bifurcation, diagnostic of a carotid web (Figure, B). A carotid endarterectomy (CEA) was performed, showing a firm pale protrusive web from the dorsal internal carotid artery (Figure, C) matching the CT angiogram appearance. Histologic findings showed spindle cells and myxoid degeneration (Figure, D) and no features of atherosclerotic plaque.Images in a 26-year-old woman with acute stroke symptoms. (A) Axial diffusion-weighted MRI scan shows an acute right middle cerebral artery territory infarct. (B) Sagittal CT right carotid angiogram shows a shelf-like protrusion from the dorsal aspect of the internal carotid artery (ICA) just beyond the bifurcation (arrow), diagnostic of a carotid web. (C) Intraoperative photograph shows the opened right ICA with a firm pale protrusive web from the dorsal ICA (arrow) matching the CT angiogram appearance. The asterisks in B and C indicate the external carotid artery for orientation. (D) Hematoxylin and eosin stain of the web show myxoid degeneration (arrow) and no features of atherosclerotic plaque.Download as PowerPointOpen in Image Viewer This patient example illustrates the appearance of carotid webs, an underrecognized cause of stroke. Carotid webs represent an intimal variant of fibromuscular dysplasia. In patients presenting with large vessel occlusions, carotid webs are seen in 1% of cases ipsilateral to the index ischemic stroke. Recurrent stroke occurs in 17% of patients with symptomatic carotid webs within 2 years, despite medical management, compared with 3% recurrence rate without carotid webs (1). Optimal management strategies for carotid webs are yet to be defined. Medical management, carotid endarterectomy, or carotid stenting should be considered as part of a multidisciplinary discussion. The patient has remained well 8 months after CEA, with no residual deficits or recurrent stroke symptoms.Disclosures of conflicts of interest: N.F.F. No relevant relationships. B.J.M. No relevant relationships.

The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology

:Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.

Suture approximation of esophageal atresia leads to esophageal recanalization

Esophageal atresia is a congenital pathology in 1:4000 live newborns, which can occur isolated, associated with tracheoesophageal fistula or long gap (>2 vertebral bodies); the surgical objective is the ligation of the fistula and the esophageal anastomosis in the same surgery. However, this may not be possible in all cases [1]. The staged approach initially begins with the ligation of the tracheoesophageal fistula and gastrostomy, and definitive surgery focuses on the esophageal anastomosis. It is performed when the patient presents adequate clinical and anatomical conditions. Spontaneous recanalization of esophageal atresia is rare. The exact mechanism by which it occurs is unknown. Gastric reflux, being in contact with the esophageal distal end, generates inflammation and erosion of the wall, producing communication between the esophageal segments. We propose approximating the proximal and distal esophageal segments utilizing sutures produces an inflammatory process due to a foreign body generating a fistulous tract between the two esophageal components and esophageal recanalization [2]. We present two cases of esophageal recanalization to describe the clinical presentation, diagnostic and therapeutic approaches through imaging tests and endoscopy, contributing to the management of this unusual condition. • Esophageal atresia is a challenge; it presents variations in the location of the tracheoesophageal fistula and the length of the esophageal ends. It occurs isolated or associated with malformations. The pediatric surgeon must individualize treatment for each patient. • In all cases, extreme premature patients have hemodynamic alterations and fragile esophageal tissue, which do not allow performing a primary esophageal anastomosis. • Upper gastrointestinal endoscopy is a diagnostic and therapeutic resource in patients with spontaneous esophageal recanalization or the presence of a recurrent tracheoesophageal fistula.

Establishment of the reproducible branch retinal artery occlusion mouse model and intravital longitudinal imaging of the retinal CX3CR1-GFP+ cells after spontaneous arterial recanalization.

Animal models of retinal artery occlusion (RAO) have been widely used in many studies. However, most of these studies prefer using a central retinal artery occlusion (CRAO) which is a typical global ischemia model of the retina, due to the technical limitation of producing single vessel targeted modeling with real-time imaging. A focal ischemia model, such as branch retinal artery occlusion (BRAO), is also needed for explaining interactions, including the immunological reaction between the ischemic retina and adjacent healthy retina. Accordingly, a relevant model for clinical RAO patients has been demanded to understand the pathophysiology of the RAO disease. Herein, we establish a convenient BRAO mouse model to research the focal reaction of the retina. As a photo-thrombotic agent, Rose bengal was intravenously injected into 7 week-old transgenic mice (CX3CR1-GFP) for making embolism occlusion, which causes pathology similarly to clinical cases. In an optimized condition, a 561 nm laser (13.1 mw) was projected to a targeted vessel to induce photo-thrombosis for 27 s by custom-built retinal confocal microscopy. Compared to previous BRAO models, the procedures of thrombosis generation were naturally and minimal invasively generated with real-time retinal imaging. In addition, by utilizing the self-remission characteristics of Rose bengal thrombus, a reflow of the BRAO with immunological reactions of the CX3CR1-GFP+ inflammatory cells such as the retinal microglia and monocytes was monitored and analyzed. In this models, reperfusion began on day 3 after modeling. Simultaneously, the activation of CX3CR1-GFP+ inflammatory cells, including the increase of activation marker and morphologic change, was confirmed by immunohistochemical (IHC) staining and quantitative real-time PCR. CD86 and Nox2 were prominently expressed on day 3 after the modeling. At day 7, blood flow was almost restored in the large vessels. CX3CR1-GFP+ populations in both superficial and deep layers of the retina also increased around even in the BRAO peri-ischemic area. In summary, this study successfully establishes a reproducible BRAO modeling method with convenient capabilities of easily controllable time points and selection of a specific single vessel. It can be a useful tool to analyze the behavior of inflammatory cell after spontaneous arterial recanalization in BRAO and further investigate the pathophysiology of BRAO.

Reversal of a Large Ischemic Lesion with Low Apparent Diffusion Coefficient Value by Rapid Spontaneous Recanalization

Cytotoxic edema at the site of a lesion following cerebral infarction is shown as a high signal on diffusion-weighted imaging, with a corresponding decreased apparent diffusion coefficient value on magnetic resonance imaging. These imaging findings have been used clinically as imaging markers of the infarction core, implying irreversible ischemic damage. However, reversal of diffusion lesions has been reported in patients with small lesions, relatively higher values of the apparent diffusion coefficient, or rapid endovascular reperfusion. Herein, we report a case of reversal of a large ischemic lesion on diffusion-weighted imaging with corresponding low apparent diffusion coefficient values in an acute middle cerebral artery infarction after immediate spontaneous recanalization. This case suggests that large ischemic lesions revealed by diffusion-weighted imaging may be reversed upon timely reperfusion, and could be considered as therapeutic targets.

Prognostic impact of pre-interventional culprit artery thrombolysis in myocardial infarction (TIMI) flow in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

BackgroundPrimary percutaneous coronary intervention (PCI) is considered the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). However, the prognostic role of spontaneous re-canalization in STEMI patients is still not clear. The purpose of this study is to evaluate the impact of pre-procedural TIMI flow grade in the culprit coronary artery on the short and long term prognosis in Egyptian patients presented with STEMI and treated with primary PCI.ResultsA dual center, prospective observational study that was conducted in the period from January 2019 till June 2020 and enrolled 150 STEMI patients presented within 24 h from onset of chest pain. Initial angiography was done with analysis of TIMI flow grade in the infarct related artery. Of the 150 enrolled patients; 93 patients (62%) were found to have initial TIMI flow grade 0 (group A) and 57 patients (38%) had initial TIMI flow grade I–III (group B). There was a strong association between cardiac mortality and pre-procedural TIMI flow grade. 12 mortalities (8% of total study population) were recorded during our study period; in-hospital mortality was reported in 7 patients in group A, yet no mortalities were recorded in-hospital in group B (P value = 0.033). At 1 year follow up; 5 mortalities were recorded in group A with no mortalities at all in group B (P value = 0.005). There was a trend towards an increase in acute heart failure incidence in group A yet no statistically significant value was achieved (P value = 0.112). Target lesion revascularization was reported in 8 patients in group A and in only 3 patients in group B (P value 0.446).ConclusionsDespite the evolution in primary PCI strategies and the continuous advancement in anti-thrombotic treatment; pre-interventional infarct related artery TIMI flow grade I–III is associated with better in hospital and 1 year outcome, specifically significantly lower cardiac mortality compared to patients who had TIMI flow grade 0 at initial angiography.

Опыт радиохирургического блокирования слезоотведения при недостатке слезопродукции

The purpose of the study was the effective assessment and safety of the lacrimal ducts obturation by using radio wave energy in patient with “dry eye” syndrome with sagnificant damage of the ocular surface. Materials and methods. A retrospective analysis of data as patients radiosurgical blocking of tear flow was performed was carried out. Occlusion of the lacrimal ducts was carried out according to the own method using “Surgitron™” devices. The radio wave low-temperature event leads to persistent closure of the lumen of the lacrimal ducts and blockage of the passage of the lacrimal fluid. Results and discussion. The study included 49 patients (79 eyes), of different age groups, with severe manifestations of the “dry eye” syndrome. All patients after the procedure observd an improvement in their condition, an objective examination showed an increase in tear production, tear test values and visual acuity compared to the initial state. Over the entire period of observation, spontaneous recanalization of the lacrimal ducts occurred only in 2 patients (4 %) (3 eyes), which is significantly less in detection with other surgical methods of occlusion of the lacrimal ducts. Conclusion. Radiosurgical lacrimal blockage is an alternative method of surgical treatment of patients with “dry eye” syndrome wich allows to achieve a good functional result. It is supposed to be clinically atraumatic, bloodless and aesthetic. A small percentage of spontaneous recanalization of open tracts of high efficiency and preservation of the result after radiosurgical blocking of lacrimal drainage. Keywords: “dry eye” syndrome, punctal occlusion surgery, radiosurgical occlusion of lacrimal passage, lacrimal punctum plug.

Risk Factors, Clinical Presentation, Diagnosis, and Treatment Outcomes of Portal Vein Thrombosis: A Five-Year Hospital-Based Study From Qatar.

BackgroundThere is a lack of robust epidemiological information on portal vein thrombosis (PVT) in Qatar. This study aimed to describe the risk factors, clinical presentation, diagnosis, and treatment outcomes of PVT in patients with and without liver cirrhosis admitted to Hamad General Hospital.MethodsThis retrospective observational study was conducted at Hamad General Hospital, Doha, Qatar. Consecutive patients with PVT between January 1, 2015 and December 31, 2019 were included in this study.ResultsWe included 363 cases representing 0.05% of all inpatients admitted to our hospital during the study period. Their mean age was 47.79 ± 14.48 years. There were 258 (71.1%) males and 105 (28.9%) females. Abdominal pain was the most common presenting symptom (160 (44.1%)), while splenomegaly was the most common presenting sign (158 (43.5%)). Liver cirrhosis was the most frequent risk factor for PVT (147 (40.5%)), while no risk factors were identified in 49 (13.5%) patients. Anticoagulant therapy was given to 171/207 (82.6%) patients with acute PVT and 19/156 (12.2%) patients with chronic PVT. The options used for anticoagulation treatment were: low molecular weight heparin (LMWH) or unfractionated heparin alone, LMWH/unfractionated heparin followed by warfarin, and direct-acting oral anticoagulants (rivaroxaban). Out of the 262 patients in whom PVT recanalization was assessed, 43.8% of the cases had recanalization after anticoagulation treatment, while 12.6% of them had spontaneous recanalization without such therapy. A comparison between different anticoagulants used in this study showed no significant difference in the effectiveness of the three regimens used. The 30-day mortality was recorded for 71 patients (19.5%). The major risk factors for 30-day mortality were: age over 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L.ConclusionPVT is a rare clinical entity in Qatar with liver cirrhosis being the most common risk factor. Early administration of anticoagulation therapy is associated with a significant recanalization, while age > 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L are independent risk factors for 30-day mortality.

Coronary Caverns: Spontaneous Recanalized Chronic Total Occlusion With Multiple Microchannels.

Spontaneous chronic total occlusion recanalization is rare. It has scarcely been described previously and with minimal visual detail. Optical coherence tomography permitted comprehensive visualization of the microchannels in this case, seldom seen previously. With Thrombolysis in Myocardial Infarction 3 flow in the affected vessel via these patent channels, optimal medical therapy may be an appropriate strategy.

INVOLVED CULPRIT ARTERIES AND PROPORTION OF SPONTANEOUS ARTERIAL RECANALIZATION IN ACUTE LATERAL WALL MYOCARDIAL INFARCTION ADULT PATIENTS IN PAKISTAN

Objectives: To elucidate the involved culprit arteries and proportion of spontaneous arterial recanalization (SAR) in acute lateral wall myocardial infarction (ALWMI) patients in Pakistan. Methodology: This cross-sectional study was conducted in the outpatient department (OPD) of a tertiary care cardiac center from February 2019 to July 2019. Patients meeting selection criteria of ALWMI were included. Key angiographic outcomes were recorded for each patient. Proportion of SAR in terms of involved culprit arteries was assessed. Results: One hundred fifty two (152) patients were included, out of which 81% (124) were males. Mean age was 54.73 ± 11.03 years. Most (46.4%) of the study patients presented with single vessel disease. Overall, 89 (59%) patients showed SAR with settled ECG changes. Of them 73 (66%), 8 (33%) and 8 (47%) patients had diagonal artery involvement, 1st obtuse marginal artery involvement and ramus intermedius artery involvement respectively. Statistical significance (p=0.006) is observed for relationship of involved culprit arteries and SAR in ALWMI patients. Conclusion: This cross-sectional study reports the proportion of arterial recanalization in terms of involved culprit arteries. Diagonal was the culprit artery (~ 73%) in most patients presented with ALWMI. SAR proportion is also highest in patients with diagonal artery involvement. This tendency of SAR was more in single vessel diseases patients compared to double vessel and triple vessel diseases patients.

Intracoronary Imaging of Recanalised Coronary Thrombus: A Report of Two Cases

Advances in intracoronary imaging – particularly optical coherence tomography (OCT) – facilitate the visualisation of detailed vessel anatomy and plaque morphology, which is essential in determining the optimum percutaneous coronary intervention (PCI) strategy. The authors present two cases of OCT-guided PCI in spontaneous recanalisation of coronary thrombus lesions. They emphasise the role of OCT in detecting spontaneous recanalisation of coronary thrombus lesions, allowing optimisation of the PCI strategy and stent deployment. The cases described also illustrate the procedural challenges that can be encountered when managing lesions of this type.

Optical Coherence Tomography-OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes.

Cardiovascular diseases are the main cause of death worldwide, with coronary artery disease being the predominant underlying etiology. The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases, but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma and spontaneous recanalization of coronary thrombus, which are less common, approximately 5% of cases, but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions. Optical coherence tomography (OCT) is an intracoronary imaging technique, developed in order to overcome the diagnostic limitations of a standard coronary angiography and has an extremely high resolution, similar to that of a usual histological evaluation of a biopsy sample, thus, OCT provides a histological-like information, but in a in vivo environment. The aim of this article is to review the current knowledge regarding non-atherosclerotic coronary lesions, with an emphasis on the importance of OCT for optimal identification, characterization of pathogenic mechanisms and optimal treatment selection.

Spontaneous early recanalization of an acute internal jugular vein thrombosis

Acute internal jugular vein thrombosis (IJVT) is a rare vascular disease that can cause lethal complications and manifests with varying neurological symptoms. A 42-year-old woman presented with a progressively worsening headache over the left temporal-occipital area and pain in the left posterior nuchal; ultrasonography and magnetic resonance venography (MRV) revealed a thrombosis with critical stenosis in the left internal jugular vein (IJV). Seven days after treatment with an anticoagulant, she exhibited considerable improvement. Follow-up ultrasonography and three-dimensional computed tomography angiography (CTA) indicated spontaneous IJV recanalization. To avoid implementing inappropriate treatments and prevent adverse outcomes, acute IJVT should be considered as a cause of secondary headaches. To determine the prognosis and secondary prophylaxis strategy (i.e., medical or surgical), recanalization should be detected using color-coded duplex ultrasonography and confirmed using MRV or CTA; these are all safe and minimally invasive procedures.