-
BMC Ophthalmology Jun 2017Embozene® is a new neuroembolizing microsphere used to reduce intraoperative bleeding for head and neck tumours. We report a case of iatrogenic ophthalmic artery...
BACKGROUND
Embozene® is a new neuroembolizing microsphere used to reduce intraoperative bleeding for head and neck tumours. We report a case of iatrogenic ophthalmic artery occlusion after Embozene® embolization of the external carotid artery (ECA).
CASE PRESENTATION
A 22-year-old African gentleman presented with left nasal obstruction and epistaxis for 2 years and was diagnosed with nasopharyngeal carcinoma. He subsequently underwent embolization of the maxillary branch of the left ECA using Embozene® Microspheres - 250 μm in size before endoscopic tumour excision to reduce intra-operative bleeding. He complained of sudden painless profound visual loss in the left eye (LE) two hours after embolization. Visual acuity in LE was no light perception. Fundus examination showed pale retina with no cherry red spot. Arterial narrowing and segmentation were seen in all quadrants. A diagnosis of left ophthalmic artery occlusion was made. Despite immediate management including ocular massage and lowering of intraocular pressure, the visual loss remained. Retrospective review of digital subtraction angiogram showed an anastomosis between the left ophthalmic artery and anterior deep temporal artery as a potential route for microspheres migration.
CONCLUSION
Pre-operative angio-architecture understanding and diligent selection of embolic material are helpful in preventing this adverse event. The use of newer agents for embolotherapy may cause migration of embolic material from the external to the internal carotid system leading to ophthalmic artery occlusion and blindness.
Topics: Arterial Occlusive Diseases; Carotid Artery, External; Cerebral Angiography; Embolization, Therapeutic; Humans; Male; Nasopharyngeal Neoplasms; Ophthalmic Artery; Young Adult
PubMed: 28619056
DOI: 10.1186/s12886-017-0490-7 -
The Journal of Medical Investigation :... 2019We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone... (Review)
Review
We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone endovascular therapy with self-expanding stents to both iliac arteries that had occluded soon after placement. After salvage bypass grafting, a diagnosis of intimal sarcoma with angiosarcoma phenotype from the iliac artery was made. Further bypass graft surgery relieved symptoms temporarily. However, the tumor progressed and the left limb became ischemic. The chemotherapy of eribulin did not prevent tumor progression. The patient died of the disease 20 months after the first surgery. J. Med. Invest. 66 : 205-208, February, 2019.
Topics: Aged, 80 and over; Arterial Occlusive Diseases; Humans; Iliac Artery; Male; Sarcoma
PubMed: 31064943
DOI: 10.2152/jmi.66.205 -
Experimental Biology and Medicine... Feb 2016Since Chungkookjang, a short-term fermented soybean, is known to improve glucose metabolism and antioxidant activity, it may prevent the neurological symptoms and...
Fermented soybeans, Chungkookjang, prevent hippocampal cell death and β-cell apoptosis by decreasing pro-inflammatory cytokines in gerbils with transient artery occlusion.
Since Chungkookjang, a short-term fermented soybean, is known to improve glucose metabolism and antioxidant activity, it may prevent the neurological symptoms and glucose disturbance induced by artery occlusion. We investigated the protective effects and mechanisms of traditional (TFC) and standardized Chungkookjang fermented with Bacillus licheniformis (BLFC) against ischemia/reperfusion damage in the hippocampal CA1 region and against hyperglycemia after transient cerebral ischemia in gerbils. Gerbils were subjected to either an occlusion of the bilateral common carotid arteries for 8 min to render them ischemic or a sham operation. Ischemic gerbils were fed either a 40% fat diet containing 10% of either cooked soybean (CSB), TFC, or BLFC for 28 days. Neuronal cell death and cytokine expression in the hippocampus, neurological deficit, serum cytokine levels, and glucose metabolism were measured. TFC and BLFC contained more isoflavonoid aglycones than CSB. Artery occlusion increased the expressions of IL-1β and TNF-α as well as cell death in the hippocampal CA1 region and induced severe neurological symptoms. CSB, TFC, and BLFC prevented the neuronal cell death and the symptoms such as dropped eyelid, bristling hair, reduced muscle tone and flexor reflex, and abnormal posture and walking patterns, and suppressed cytokine expressions. CSB was less effective than TFC and BLFC. Artery occlusion induced glucose intolerance due to decreased insulin secretion and β-cell mass. TFC and BLFC prevented the impairment of glucose metabolism by artery occlusion. Especially TFC and BLFC increased β-cell proliferation and suppressed the β-cell apoptosis by suppressing TNF-α and IL-1β which in turn decreased cleaved caspase-3 that caused apoptosis. In conclusion, TFC and BLFC may prevent and alleviate neuronal cell death in the hippocampal CA1 region and neurological symptoms and poststroke hyperglycemia in gerbils with artery occlusion. This might be associated with increased isoflavonoid aglycones.
Topics: Animals; Apoptosis; Arterial Occlusive Diseases; Brain Diseases; Cell Death; Cytokines; Diet; Disease Models, Animal; Gerbillinae; Hippocampus; Immunologic Factors; Isoflavones; Soybean Proteins; Treatment Outcome
PubMed: 26468168
DOI: 10.1177/1535370215606811 -
Journal of the American College of... Mar 1984Percutaneous transluminal coronary angioplasty was attempted without streptokinase in 24 patients with total coronary artery occlusion but without acute transmural...
Percutaneous transluminal coronary angioplasty was attempted without streptokinase in 24 patients with total coronary artery occlusion but without acute transmural myocardial infarction. The maximal duration of occlusion was estimated to be 1 week or less in 10 patients, more than 1 to 4 weeks in 6, more than 4 to 12 weeks in 3 and more than 12 weeks in 5. Dilation of the occluded artery was attempted in the left anterior descending coronary artery in 17 patients, in the right coronary artery in 4 and in the circumflex coronary artery in 3. Angioplasty was successful in 13 patients (54%): left anterior descending coronary artery in 59%, right coronary artery in 50% and circumflex coronary artery in 33%. In patients with successful dilation, there was a mean decrease in coronary artery stenosis from 100 to 23%. In the 19 patients whose occlusion was estimated to be of 12 weeks' duration or less, angioplasty was successful in 68%. In the five patients whose occlusion was estimated to be of more than 12 weeks' duration, dilation was not successful in any (p = 0.006). It is concluded that in selected patients with symptomatic coronary artery disease and recent coronary artery occlusion without associated acute myocardial infarction, percutaneous transluminal coronary angioplasty alone may be effective in restoring patency.
Topics: Aged; Angioplasty, Balloon; Arterial Occlusive Diseases; Collateral Circulation; Constriction, Pathologic; Coronary Disease; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radiography
PubMed: 6229570
DOI: 10.1016/s0735-1097(84)80263-6 -
American Journal of Physiology. Heart... Nov 2010Acid-sensing ion channels (ASICs) in sensory nerves are responsive to increases in the levels of protons in the extracellular medium. Prior studies suggest that the...
Acid-sensing ion channels (ASICs) in sensory nerves are responsive to increases in the levels of protons in the extracellular medium. Prior studies suggest that the muscle metabolite, lactic acid, plays a role in reflex sympathetic and cardiovascular responses via stimulation of thin muscle afferent nerves. Also, femoral artery occlusion augments the reflex sympathetic nerve response in rats. ASIC3 is a main subtype to appear in sensory nerves in mediating the response induced by increases in protons in the interstitial space of contracting muscles. Thus, in this article, we hypothesized that femoral occlusion increases the expression of ASIC3 in primary afferent neurons innervating muscles, and this contributes to the exaggerated reflex sympathetic responses. Femoral occlusion/vascular insufficiency of the hindlimb muscles was induced by the femoral artery ligation in rats. First, Western blot analysis shows that 24-72 h of femoral artery ligation significantly increased the expression of ASIC3 protein in dorsal root ganglion (optical density, 1.0 ± 0.07 in control vs. 1.65 ± 0.1 after 24 h of occlusion, P < 0.05; n = 6 in each group). There were no significant differences for increases in ASIC3 24 and 72 h postocclusion. Second, experiments using fluorescent immunohistochemistry and retrograde-labeling technique show that a greater percentage of ASIC3 staining neurons are localized in muscle-innervating dorsal root ganglion neurons after the arterial occlusion (78 ± 3% in 24 h post occlusion vs. 59 ± 5% in control, P < 0.05; n = 6 in each group). Third, the reflex responses in renal sympathetic nerve and arterial blood pressure induced by the stimulation of ASIC were examined after an injection of lactic acid into the arterial blood supply of hindlimb muscles of control rats and ligated rats. The results demonstrate that the sympathetic and pressor responses to lactic acid were significantly augmented after femoral occlusion compared with those in the control group. The data of this study suggest that enhanced ASIC3 expression in muscle afferent nerves contributes to the exaggerated reflex sympathetic and pressor responses to lactic acid as seen in arterial occlusion.
Topics: Acid Sensing Ion Channels; Animals; Arterial Occlusive Diseases; Blood Pressure; Femoral Artery; Ganglia, Spinal; Hindlimb; Lactic Acid; Male; Models, Animal; Muscle, Skeletal; Nerve Tissue Proteins; Neurons, Afferent; Rats; Rats, Sprague-Dawley; Regional Blood Flow; Sodium Channels; Sympathetic Nervous System
PubMed: 20852050
DOI: 10.1152/ajpheart.00612.2010 -
Medicine Nov 2021The best endovascular therapy revascularization strategies for acute ischemic stroke caused by vertebral artery dissection (VAD) are unclear. We describes a case of...
RATIONALE
The best endovascular therapy revascularization strategies for acute ischemic stroke caused by vertebral artery dissection (VAD) are unclear. We describes a case of basilar artery (BA) occlusion caused by extracranial VAD, in which we used a stent-retriever to achieve thrombectomy in the BA through the contralateral vertebral artery (VA).
PATIENT CONCERNS
A 32-year-old male presented with a sudden-onset headache accompanied by articulation disorder, left-sided weakness, and tinnitus in the left ear.
DIAGNOSIS
Digital subtraction angiography showed the V1 to V2 segment dissection of the left VA and occlusion of the BA.
INTERVENTIONS
Thrombectomy was performed through the thinner right VA with three passes of the Solitaire FR device 4 × 20 mm in the BA, and angiograms showed modified treatment in cerebral ischemia 3 reperfusion of BA and left VA V4 segment still occluded.
OUTCOMES
The patient had a modified Rankin Scale of 2 at 90 days, and re-established blood flow of the left VA and BA.
LESSONS
When extracranial VAD complicated with BA occlusion, choosing the clean-road path to perform a BA thrombectomy may be a fast and effective treatment strategy.
Topics: Adult; Angiography; Arterial Occlusive Diseases; Basilar Artery; Brain Ischemia; Endovascular Procedures; Humans; Male; Stents; Stroke; Thrombectomy; Vertebral Artery Dissection
PubMed: 34964795
DOI: 10.1097/MD.0000000000027995 -
Polski Przeglad Chirurgiczny Aug 2019Purpose The objective of the study was to evaluate the frequency and severity of atherosclerotic lesions in extracranial sections of carotid arteries and to determine...
Purpose The objective of the study was to evaluate the frequency and severity of atherosclerotic lesions in extracranial sections of carotid arteries and to determine the level of the correlation between these lesions and symptoms of cerebral ischemia. Secondly, to identify the most common risk factors of ischaemic stroke occurrence in population of patients of vascular outpatient clinic. Material and Methods Prospective study was conducted on a group of 1,000 people (217 women and 783 men), aged 50 to 86 years, the average age was 62 years (± 9.95). Results Atherosclerotic lesions of carotid arteries were observed in 670 examined people (67%). In 63 cases (6.3%) carotid artery occlusion was revealed. Patients with symptomatic carotid artery stenosis more frequently were addicted to cigarettes and suffered from hypertension in comparison to asymptomatic group. A statistically significant correlation between the TIA or ischemic stroke and smoking were noticed, as well as between TIA/ischemic stroke and hypertension Conclusions Among patients with atherosclerosis of peripheral arteries atherosclerotic lesions in the extracranial carotid sections occur with a high frequency. Statistically significant differences in the incidence and severity of atherosclerotic lesions in the carotid arteries were observed in this group. A statistically significant correlation was revealed between the prevalence and severity of atherosclerosis in the carotid arteries in symptomatic patients and smoking and hypertension. Performing screening in patients with atherosclerosis of the abdominal aorta and/or lower limb arteries may detect significant carotid artery stenosis, requiring surgical intervention.
Topics: Aged; Aged, 80 and over; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery, Internal; Carotid Stenosis; Female; Humans; Male; Middle Aged; Prospective Studies; Stroke; Ultrasonography, Doppler, Duplex
PubMed: 31702573
DOI: 10.5604/01.3001.0013.4520 -
Catheterization and Cardiovascular... Nov 2018During transradial (TR) access, it remains unclear whether differences in baseline patients characteristics and hemostasis care impact the rate of radial artery... (Comparative Study)
Comparative Study Randomized Controlled Trial
Impact of sheath size and hemostasis time on radial artery patency after transradial coronary angiography and intervention in Japanese and non-Japanese patients: A substudy from RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT) randomized multicenter trial.
BACKGROUND
During transradial (TR) access, it remains unclear whether differences in baseline patients characteristics and hemostasis care impact the rate of radial artery occlusion (RAO). We sought to compare the rate of RAO after TR access with the 6 French(Fr) Glidesheath Slender (GSS6Fr, Terumo, Japan) or a standard 5 Fr sheath in Japanese and non-Japanese patients.
METHODS AND RESULTS
The Radial Artery Patency and Bleeding, Efficacy, Adverse evenT (RAP and BEAT) trial randomized 1,836 patients undergoing TR coronary angiography and/or interventions to receive the GSS6Fr or the standard 5 Fr Glidesheath (GS5Fr, Terumo, Japan). Out of this study population, 1,087 were Japanese patients and 751 non-Japanese patients. The overall incidence of RAO was significantly higher in Japanese patients (3.6% vs. 1.2%, P = 0.002). Use of GSS6Fr was associated with higher rates of RAO than GS5Fr in Japanese patients (5% vs. 2.2%, P = 0.02) and with similar RAO rates in non-Japanese patients (1.3 vs. 1.1%, P = 1). The mean hemostasis time was significantly longer in Japanese patients (378 ± 253 vs. 159 ± 136 min, P < 0.001) and more Japanese patients had a hemostasis time of more than 6 hr (16.2% vs. 4.9%, P < 0.0001). Longer hemostasis time was an independent predictor of RAO (OR per additional hour 1.070, 95% CI 1.008-1.136, P = 0.03).
CONCLUSIONS
Use of GSS6Fr was associated with a higher rate of RAO than a standard 5 Fr sheath in Japanese patients but not in non-Japanese patients. Whether improvement in post-procedural care and reduced hemostasis time could impact the incidence of RAO in Japanese patients should be further assessed.
Topics: Aged; Aged, 80 and over; Arterial Occlusive Diseases; Asian People; Cardiac Catheters; Catheterization, Peripheral; Coronary Angiography; Coronary Artery Disease; Equipment Design; Female; Hemorrhage; Hemostasis; Humans; Incidence; Japan; Male; Middle Aged; Percutaneous Coronary Intervention; Prospective Studies; Radial Artery; Risk Factors; Single-Blind Method; Time Factors; Treatment Outcome; United States; Vascular Patency
PubMed: 29451949
DOI: 10.1002/ccd.27526 -
JACC. Cardiovascular Interventions Aug 2014
Topics: Arterial Occlusive Diseases; Constriction, Pathologic; Hand; Humans; Laser-Doppler Flowmetry; Perfusion Imaging; Predictive Value of Tests; Radial Artery; Regional Blood Flow; Ultrasonography, Doppler
PubMed: 25086840
DOI: 10.1016/j.jcin.2013.11.028 -
Medical Science Monitor : International... Jun 2018BACKGROUND MRI FLAIR hyperintense vessels sign (FHVs) is a special imaging marker that plays a key role in acute infarction imaging and diagnosis. However, FHVs have not...
BACKGROUND MRI FLAIR hyperintense vessels sign (FHVs) is a special imaging marker that plays a key role in acute infarction imaging and diagnosis. However, FHVs have not been studied in the context of progressive posterior circulation infarction (PPCI), and little is known about the association of hyperintense endo-vessels sign (HEVs) on transverse section MRI with infarction. Thus, our objective here was to investigate the clinical significance of transverse MRI T2 HEVs in patients with PPCI. MATERIAL AND METHODS In this retrospective, case-control study, we enrolled 100 consecutive posterior circulation infarction patients. All the patients underwent head MRI examinations on the onset day and the seventh day after admission. Neurologic deficits of the patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) scores upon admission and after 7 days. Infarction volume on DWI was compared. RESULTS HEVs were detected in 25 of 37 patients in the PPCI group (67.6%) and 22 of 63 patients in the NPPCI group (34.9%). Logistic regression analysis showed that the proportion of HEVs in the PPCI group was higher than in the NPPCI group (P=0.007). Among all the patients, HEVs were detected in 15 of 18 patients (83.3%) with occlusion of the vertebral artery or basilar artery, and 17 of 23 (73.9%) showed severe stenosis. The proportion of vertebrobasilar artery occlusions in the PPCI group was higher than in the NPPCI group (P<0.05). MRI DWI showed that 20 patients had cerebellum infarction among 23 vertebral artery HEVs patients, and 14 patients had brainstem infarction among 15 basilar artery HEVs patients. All of the 9 vertebral and basilar artery HEVs patients had brainstem infarction. The increase in NIHSS scores from baseline to 7 days was significantly greater in patients with HEVs than in patients without HEVs in the PPCI group (P=0.002). The expansion of the infarction size from baseline to 7 days was significantly larger in patients with HEVs than in patients without HEVs in the PPCI group (P=0.037). CONCLUSIONS HEVs are frequently detected in patients with vertebrobasilar artery territory infarction, and they can be considered as a special imaging marker for vertebral artery and basilar artery occlusion and severe stenosis. HEVs can indicate whether or not posterior circulation infarction progresses and they may be an independent risk factor of PPCI.
Topics: Aged; Arterial Occlusive Diseases; Brain Infarction; Female; Humans; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Vertebral Artery
PubMed: 29882523
DOI: 10.12659/MSM.908300