ABSTRACT
BACKGROUND AND OBJECTIVES: Endovascular thrombectomy (EVT) is efficacious in patients with large vessel occlusion stroke (LVO). We explored whether internal carotid (ICA) tortuosity increases the technical difficulty of EVT thereby lowering the chances of successful recanalization and favorable outcomes. PATIENTS AND METHODS: Consecutive patients with LVO and patent ICAs who underwent EVT were included. Carotid tortuosity was determined on pre-EVT CTA and classified by raters blinded to outcomes into: type 1-straight ICA trunk and type 2-severe tortuosity potentially impeding adequate catheter placement. Thrombolysis in cerebral infarction (TICI) 2b-3 was considered successful recanalization, and 90-day-modified Rankin Scale ≤ 2 was considered favorable functional outcome. RESULTS: Among 302 patients (mean age 70 ± 15, median NIHSS 17), 53% had type 1, and 47% type 2 tortuosity. Overall, 85% had successful recanalization. Patients with type 2 tortuosity were significantly older (p < 0.0001) and less frequently achieved successful recanalization (80% vs. 90%; p = 0.019) but had similar outcomes compared with those without tortuosity. On regression analysis, marked tortuosity was associated with lower chances of successful recanalization (OR 0.43 95% CI 0.20-0.92) but had no effect on clinical outcomes. CONCLUSIONS: Carotid tortuosity does not appear to impact the likelihood of favorable functional outcome but may influence recanalization.
Subject(s)
Endovascular Procedures , Stroke , Aged , Aged, 80 and over , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Cerebral Infarction , Humans , Middle Aged , Retrospective Studies , Stroke/diagnostic imaging , Stroke/surgery , Thrombectomy , Treatment OutcomeSubject(s)
Ascites/therapy , Digestive System Surgical Procedures/adverse effects , Embolization, Therapeutic , Lymphatic Diseases/therapy , Lymphatic Vessels/injuries , Pancreatic Neoplasms/surgery , Ascites/diagnosis , Drug Combinations , Embolization, Therapeutic/methods , Humans , Liver , Lymphatic Diseases/diagnosis , Lymphatic Vessels/diagnostic imaging , Lymphography , Male , Middle Aged , Paracentesis , Peritoneovenous Shunt , Polyvinyls/administration & dosage , Tantalum/administration & dosage , Treatment OutcomeABSTRACT
We report a case of a 44-year-old female patient, presented to us after years of recurrent intermittent episodes of unilateral left neck swelling. An MR lymphangiogram demonstrated a lymphatic varix at the confluence of the left upper extremity lymphatic ducts, confirmed by intranodal axillary lymphangiography. After successful catheterization of the feeding lymphatic vessels, the varix was successfully embolized with detachable microcoils and an autologous blood patch. The patient has been free from symptoms on subsequent outpatient follow-up.
