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1.
Turk J Med Sci ; 51(6): 3067-3072, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1737119

ABSTRACT

Background/aim: Plastic biliary stents that remain in situ for more than 12 months, called forgotten biliary stents (FBSs), can cause complications such as cholangitis, stent migration, stent occlusion, and perforation. Materials and methods: The medical records of patients who underwent ERCP procedures from December 2016 to December 2020 were analysed retrospectively. Data on patient characteristics, indications for ERCP and stenting, stent types, stenting duration, complications, and causes of FBSs were obtained from the hospital's database. Results: A total of 48 cases with FBSs were analysed. The mean age (SD) of the patients was 71.23 years (±12.165), the male-to-female ratio was 23/25 (0.92), and the mean stenting duration was 27.12 months (range: 12­84 months). The most common indication for biliary stenting was irretrievable choledochal stones (40/48). Stone formation (79%) and proximal stent migration (26.4%) were the most frequent complications. The patients in the FBS group were significantly older than those from whom stents were removed in a timely manner (71.23 vs. 62.43 years, p < 0.001). Endoscopic treatment was possible in all cases; surgery was not required in any case. The most common cause of FBSs cited by patients was not having been informed about the need for long-term management of their stents (n = 14, 29.2%) Conclusion: FBSs are potentially problematic particularly in elderly patients. Communication with the patient to remind them of the need for stent management is important for preventing FBSs.


Subject(s)
Biliary Tract Surgical Procedures/adverse effects , Cholelithiasis/surgery , Gallstones/surgery , Stents/adverse effects , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholelithiasis/diagnosis , Female , Foreign Bodies , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Treatment Outcome
2.
Viruses ; 14(2)2022 01 27.
Article in English | MEDLINE | ID: covidwho-1667341

ABSTRACT

Approximately 5 million percutaneous coronary interventions are performed worldwide annually. Therefore, stent-related complications pose a serious public health concern. Stent thrombosis, although rare, is usually catastrophic, often associated with extensive myocardial infarction or death. Because little progress has been made in outcomes following stent thrombosis, ongoing research is focusing on further understanding the predictors as well as frequency and timing in various patient subgroups. Coronavirus disease-2019 (COVID-19), a viral illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), activates inflammatory mechanisms that potentially create a prothrombotic environment and increases the risk of local micro thromboembolism and all types of stent thrombosis. In-stent thrombosis occurrence increased during the COVID-19 pandemic, however, there is still lack of comprehensive studies describing this population. This review and worldwide analysis of coronary stent thrombosis cases related to COVID-19 summarizes all available data.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Coronary Thrombosis/epidemiology , Coronary Thrombosis/virology , Global Health/statistics & numerical data , Stents/adverse effects , Adult , Aged , Aged, 80 and over , Case-Control Studies , Coronary Thrombosis/classification , Coronary Vessels/pathology , Humans , Male , Middle Aged , Percutaneous Coronary Intervention
3.
Catheter Cardiovasc Interv ; 99(2): 457-461, 2022 02.
Article in English | MEDLINE | ID: covidwho-1626918

ABSTRACT

We present a case of heavy lone coronary thrombosis in the setting of COVID-19 infection. We highlight the special angiographic, ultrasonographic, and histological features of this thrombus, and we describe the application of carotid stent retriever for its removal.


Subject(s)
COVID-19 , Coronary Thrombosis , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/etiology , Coronary Thrombosis/therapy , Coronary Vessels , Humans , SARS-CoV-2 , Stents , Thrombectomy , Treatment Outcome
4.
Medicine (Baltimore) ; 100(49): e28100, 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1566097

ABSTRACT

RATIONALE: Central vein thrombosis is an uncommon cause of chylothorax, usually secondary to central venous catheterization in association with prothrombotic state causes such as malignancies. In the following case, thrombosis was located in the left brachiocephalic vein and caused recurrent chylothorax resistant to the first line of treatment and successfully treated by percutaneous recanalization using a dual approach. PATIENT CONCERNS: A 52-year-old male patient with current follicular lymphoma undergoing treatment and recent history of COVID-19 pulmonary infection was hospitalized for dyspnea. A chest X-ray revealed extensive bilateral pleural effusion. Analysis of the pleural fluid was compatible with a chylothorax. Iodin injected thoracic computed tomography (CT) revealed a complete left brachiocephalic thrombosis extending to the left axillary vein, with no thoracic mass. DIAGNOSES: Chylothorax due to left brachiocephalic vein thrombosis. INTERVENTIONS: Following an unsuccessful first line of treatment consisting of a low-fat diet, somatostatins and anticoagulation medication, the patient was elected to undergo minimally invasive venous recanalization with stenting. After a first failed attempt of recanalization by femoral access, we successfully crossed the thrombus through brachial access and conducted a dilatation and stenting of the brachiocephalic vein by femoral access, using a "telepheric" method. OUTCOMES: During the 4-month follow up, PET-scanner and chest X-ray demonstrated a significant reduction of the pleural effusion, and the patient reported complete clinical recovery. LESSONS: Central vein thrombosis is an unusual cause of chylothorax. We report a case of chylothorax complicating a brachiocephalic vein thrombosis successfully treated by percutaneous recanalization and stenting using a dual brachial and femoral approach. No thoracic duct embolization or ligature was required.


Subject(s)
Chylothorax , Stents , Venous Thrombosis , COVID-19 , Chylothorax/etiology , Chylothorax/therapy , Humans , Male , Middle Aged , Pleural Effusion , Venous Thrombosis/complications
7.
Rev Esp Cardiol (Engl Ed) ; 74(12): 1095-1105, 2021 12.
Article in English, Spanish | MEDLINE | ID: covidwho-1517450

ABSTRACT

INTRODUCTION AND OBJECTIVES: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2020, the year of the coronavirus disease (COVID-19) pandemic. METHODS: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. RESULTS: A total of 123 centers participated (4 more than 2019), of which 83 were public and 40 were private. Diagnostic coronary angiograms decreased by 9.4%, percutaneous coronary interventions by 10.1%, primary percutaneous coronary interventions by 4.1%, transcatheter aortic valve replacements by 0.9%, and left atrial appendage closure by 8.3%. The only procedures that increased with respect to previous years were edge-to-edge mitral valve repair (13.8%) and patent foramen ovale closure (19.4%). The use of pressure wire (5.5%), intravascular imaging devices and plaque preparation devices decreased (with the exception of lithotripsy, which increased by 62%). CONCLUSIONS: In the year of the COVID-19 pandemic, the registry showed a marked drop in activity in all procedures except for percutaneous mitral valve repair and patent foramen ovale closure. This decrease was less marked than previously described, suggesting a rebound in interventional activity after the first wave.


Subject(s)
COVID-19 , Cardiology , Percutaneous Coronary Intervention , Cardiac Catheterization , Humans , Pandemics , Registries , SARS-CoV-2 , Stents
8.
Int J Mol Sci ; 22(21)2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1512379

ABSTRACT

The research presented herein follows an urgent global need for the development of novel surface engineering techniques that would allow the fabrication of next-generation cardiovascular stents, which would drastically reduce cardiovascular diseases (CVD). The combination of hydrothermal treatment (HT) and treatment with highly reactive oxygen plasma (P) allowed for the formation of an oxygen-rich nanostructured surface. The morphology, surface roughness, chemical composition and wettability of the newly prepared oxide layer on the Ti substrate were characterized by scanning electron microscopy (SEM) with energy-dispersive X-ray analysis (EDX), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and water contact angle (WCA) analysis. The alteration of surface characteristics influenced the material's bio-performance; platelet aggregation and activation was reduced on surfaces treated by hydrothermal treatment, as well as after plasma treatment. Moreover, it was shown that surfaces treated by both treatment procedures (HT and P) promoted the adhesion and proliferation of vascular endothelial cells, while at the same time inhibiting the adhesion and proliferation of vascular smooth muscle cells. The combination of both techniques presents a novel approach for the fabrication of vascular implants, with superior characteristics.


Subject(s)
Endothelial Cells/cytology , Muscle, Smooth, Vascular/cytology , Plasma/chemistry , Titanium/chemistry , Cell Adhesion , Cell Line , Cell Proliferation , Humans , Microscopy, Atomic Force , Microscopy, Electron, Scanning , Nanostructures , Particle Size , Stents , Surface Properties , Wettability
9.
J Stroke Cerebrovasc Dis ; 30(12): 106152, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1506161

ABSTRACT

Cerebrovascular diseases attributed to coronavirus disease 2019 (COVID-19) are uncommon but can result in devastating outcomes. Pediatric acute ischemic strokes are themselves rare and with very few large vessel occlusion related acute ischemic strokes attributed to COVID-19 described in the literature as of date. COVID-19 pandemic has contributed to acute stroke care delays across the world and with pediatric endovascular therapy still in its infancy, it poses a great challenge in facilitating good outcomes in children presenting with acute ischemic strokes in the setting of COVID-19. We present a pediatric patient who underwent endovascular therapy for an internal carotid artery occlusion related acute ischemic stroke in the setting of active COVID-19 and had an excellent outcome thanks to a streamlined stroke pathway involving the vascular neurology, neuro-interventional, neurocritical care, and anesthesiology teams.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/therapy , Carotid Artery, Internal , Carotid Stenosis/therapy , Endovascular Procedures , Ischemic Stroke/therapy , Thrombectomy , COVID-19/diagnosis , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/etiology , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Child , Endovascular Procedures/instrumentation , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/etiology , Male , Stents , Treatment Outcome
11.
PLoS One ; 15(6): e0233981, 2020.
Article in English | MEDLINE | ID: covidwho-1456053

ABSTRACT

We aimed to examine aneurysm hemodynamics with intra-saccular pressure measurement, and compare the effects of coiling, stenting and stent-assisted coiling in proximal segments of intracranial circulation. A cohort of 45 patients underwent elective endovascular coil embolization (with or without stent) for intracranial aneurysm at our department. Arterial pressure transducer was used for all measurements. It was attached to proximal end of the microcatheter. Measurements were taken in the parent artery before and after embolization, at the aneurysm dome before embolization, after stent implantation, and after embolization. Stent-assisted coiling was performed with 4 different stents: LVIS and LVIS Jr (Microvention, Tustin, CA, USA), Leo (Balt, Montmorency, France), Barrel VRD (Medtronic/ Covidien, Irvine, CA, USA). Presence of the stent showed significant reverse correlation with intra-aneurysmal pressure-both systolic and diastolic-after its implantation (r = -0.70 and r = -0.75, respectively), which was further supported by correlations with stent cell size-r = 0.72 and r = 0.71, respectively (P<0.05). Stent implantation resulted in significant decrease in diastolic intra-aneurysmal pressure (p = 0.046). Systolic or mean intra-aneurysmal pressure did not differ significantly. Embolization did not significantly change the intra-aneurysmal pressure in matched pairs, regardless of the use of stent (p>0.05). In conclusion, low-profile braided stents show a potential to divert blood flow, there was significant decrease in diastolic pressure after stent placement. Flow-diverting properties were related to stent porosity. Coiling does not significantly change the intra-aneurysmal pressure, regardless of packing density.


Subject(s)
Blood Pressure , Intracranial Aneurysm/physiopathology , Stents , Aged , Arterial Pressure , Blood Circulation , Blood Vessel Prosthesis , Brain/blood supply , Brain/physiopathology , Embolization, Therapeutic , Female , Hemodynamics , Humans , Intracranial Aneurysm/therapy , Male , Middle Aged
12.
Interv Neuroradiol ; 26(5): 557-565, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1455862

ABSTRACT

BACKGROUND: The Low-profile Visualized Intraluminal Support device (LVIS) has been successfully used to treat cerebral aneurysm, and the push-pull technique has been used clinically to compact the stent across aneurysm orifice. Our aim was to exhibit the hemodynamic effect of the compacted LVIS stent. METHODS: Two patient-specific aneurysm models were constructed from three-dimensional angiographic images. The uniform LVIS stent, compacted LVIS and Pipeline Embolization Device (PED) with or without coil embolization were virtually deployed into aneurysm models to perform hemodynamic analysis. Intra-aneurysmal flow parameters were calculated to assess hemodynamic differences among different models. RESULTS: The compacted LVIS had the highest metal coverage across the aneurysm orifice (case 1, 46.37%; case 2, 67.01%). However, the PED achieved the highest pore density (case 1, 19.56 pores/mm2; case 2, 18.07 pores/mm2). The compacted LVIS produced a much higher intra-aneurysmal flow reduction than the uniform LVIS. The PED showed a higher intra-aneurysmal flow reduction than the compacted LVIS in case 1, but the results were comparable in case 2. After stent placement, the intra-aneurysmal flow was further reduced as subsequent coil embolization. The compacted LVIS stent with coils produced a similar reduction in intra-aneurysmal flow to that of the PED. CONCLUSIONS: The combined characteristics of stent metal coverage and pore density should be considered when assessing the flow diversion effects of stents. More intra-aneurysmal flow reductions could be introduced by compacted LVIS stent than the uniform one. Compared with PED, compacted LVIS stent may exhibit a flow-diverting effect comparable to that of the PED.


Subject(s)
Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Stents , Subarachnoid Hemorrhage/therapy , Angiography, Digital Subtraction , Cerebral Angiography , Computer Simulation , Hemodynamics , Humans , Hydrodynamics , Imaging, Three-Dimensional , Intracranial Aneurysm/diagnostic imaging , Magnetic Resonance Angiography , Prosthesis Design , Subarachnoid Hemorrhage/diagnostic imaging
13.
Neurosurgery ; 87(3): 516-522, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1455333

ABSTRACT

BACKGROUND: Pipeline embolization device (PED; Medtronic) and stent-assisted coiling (SAC) are established modalities for treatment of intracranial aneurysms. OBJECTIVE: To comparatively assess the efficacy of these techniques. METHODS: We conducted a retrospective analysis of patients with aneurysms treated at our institution with either PED from 2013 to 2017 or SAC from 2009 to 2015. All large (>10 mm), ruptured, fusiform, anterior communicating artery, posterior circulation aneurysms, and patients with no available follow-up imaging were eliminated before running the propensity score matching (PSM). Patients were matched using nearest neighbor controlling for: age, gender, smoking, exact location, maximal diameter, and presence of multiple aneurysms. Total hospital costs for equipment and implants were calculated from procedure product and hospital billing records, and compared between the propensity-matched pairs. RESULTS: Out of 165 patients harboring 202 aneurysms; 170 (84.2%) were treated with the PED, and 32 (15.8%) were treated using SAC. PSM resulted in 23 matched pairs; with significantly longer follow up in the SAC group (mean 29.8 vs 14.1 mo; P = .0002). Complete occlusion rates were not different (82.6 vs 87%; P = .68), with no difference between the groups for modified Rankin Scale on last clinical follow-up, procedural complications or retreatment rates. Average total costs calculated from the hospital records, including equipment and implants, were not different between propensity-score matched pairs (P = .48). CONCLUSION: PED placement and SAC offer equally efficacious occlusion rates, functional outcomes, procedural complication rates, and cost profiles for small unruptured anterior circulation saccular aneurysms which do not involve the anterior communicating artery.


Subject(s)
Blood Vessel Prosthesis , Embolization, Therapeutic/instrumentation , Endovascular Procedures/instrumentation , Intracranial Aneurysm/therapy , Stents , Adult , Aged , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Female , Humans , Male , Middle Aged , Propensity Score , Retrospective Studies , Treatment Outcome
14.
Curr Med Imaging ; 17(8): 1025-1030, 2021.
Article in English | MEDLINE | ID: covidwho-1456181

ABSTRACT

INTRODUCTION: Carotid cavernous fistulae (CCF) are rare, and they occur when there is a communication between the internal carotid artery (ICA) and cavernous sinus. These lesions are associated with blunt or penetrating traumatic injuries of the carotid arteries. We present the first cases of cavernous dural arteriovenous fistulae (cDAVF) in the middle meningeal artery (MMA) after the treatment of direct CCF in the ICA with Willis-covered stents (WCSs). CASE PRESENTATION: Our patients comprised 22 and 50-year-old males with histories of head injuries months before admission at our facility. In both patients above, cerebral angiography revealed fistulae in the right ICA and left ICA, respectively. They were treated with WCSs via the trans-artery endovascular route. In both cases, the treatments were not in the way attempted via the MMA. Subsequently, they developed cDAVF in the middle meningeal artery (MMA), which were treated with Onyx Liquid Embolic System (Onyx HD-500) (Covidien / ev3 Neurovascular) and conservatively, respectively. CONCLUSION: These are the first cases in whom WCSs for the management of direct CCF resulted in cDAVF at the MMA. The WCSs inside the ICA could have resulted in the cDAVF via unknown mechanisms but not iatrogenic.


Subject(s)
Carotid-Cavernous Sinus Fistula , Meningeal Arteries , Adult , Carotid Artery, Internal , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Humans , Male , Middle Aged , Stents , Treatment Outcome , Young Adult
15.
Monaldi Arch Chest Dis ; 92(2)2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1412860

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a non-compliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made.


Subject(s)
COVID-19 , Drug-Eluting Stents , Thrombosis , Adult , COVID-19/complications , COVID-19 Testing , Drug-Eluting Stents/adverse effects , Humans , Male , Platelet Aggregation Inhibitors , SARS-CoV-2 , Stents/adverse effects , Thrombosis/diagnostic imaging , Thrombosis/etiology
17.
18.
Medicina (Kaunas) ; 57(6)2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1270080

ABSTRACT

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.


Subject(s)
Aneurysm, Infected , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , COVID-19 , Endovascular Procedures , Aged , Aneurysm, Infected/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Humans , Male , SARS-CoV-2 , Stents , Treatment Outcome
19.
ANZ J Surg ; 91(12): 2599-2605, 2021 12.
Article in English | MEDLINE | ID: covidwho-1228710

ABSTRACT

BACKGROUND: We aimed to define the published impact, efficacy, cost-effectiveness and precise role of the Isiris-α device: the world's first sterile, single-use grasper integrated flexible cystoscope (SUGIFC) for ureteral stent removal. METHODS: After PROSPERO registration (CRD42021228755), the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were utilized. The search terms "Grasper Integrated Flexible Cystoscope," and "Isiris," within the following databases: PubMed, Scopus, Cochrane Library, Web of Science and EMBASE were searched. RESULTS: In this review, a cumulative total experience (10 publications) included 970 "SUGIFC" procedures (755 patients). However, only 366/970 procedures were actually used for "ureteral stent removal," with the remainder being surveillance cystoscopy only (603/970) or foreign body retrieval (1/970). Procedure-related and device failures in planned "removal of ureteral stents," was reported in 8/366 (346 patients) and 1/366 (346 patients), respectively. The cost-benefit utilizing the SUGIFC device is advantageous compared to "in-theatre" stent removals and favours less busy centres where maintenance, repair and replacement costs are more relevant. Other listed benefits include shorter stent indwelling times, shorter procedure duration, lower rates of bacteriuria and urinary tract infections, fewer emergency department visits and lower readmission rates. Technical limitations include the absence of an independent working channel, a narrower visual field and the lack of image universality since the monitor is device-specific. CONCLUSION: The SUGIFC device needs to be outweighed against local costs and individual health systems. Its application in ambulatory ureteral stent removal may become significant due to the accessibility and convenience that it offers the attending urologist.


Subject(s)
Cystoscopes , Cystoscopy , Humans , Stents
20.
Ideggyogy Sz ; 74(3-4): 129-134, 2021 Mar 30.
Article in Hungarian | MEDLINE | ID: covidwho-1212100

ABSTRACT

In SARS-CoV-2 positive patients with corresponding neurological symptoms the presence of carotid bifurcation macrothrombus should always be considered. Hypercoagulopathy caused by viral endotheliitis, systemic inflammation and cytokine storm play an important role in its development. Here we present two patients treated with different treatment strategies because of carotid bifurcation macrothrombus as a complication of SARS-CoV-2 infection. In both cases, the soft macrothrombus was eliminated and the patients' neurological condition were improved. Intravenous thrombolysis, acute carotid stenting with embolic filter protection device and mechanical thrombectomy with aspiration are effective treatments.


Subject(s)
COVID-19 , Stroke , Thrombosis , Humans , SARS-CoV-2 , Stents , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/therapy , Treatment Outcome
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