Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications.

INTRODUCTION: Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. METHODS: We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. RESULTS: The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P=.02), and SC was activated sooner (50, 100, and 125minutes, respectively; P<.001). Furthermore, post-catheterisation SC were more frequently due to transient ischaemic attack (38%, 8%, and 9%, respectively; P<.001) and less frequently to proximal artery occlusion (17.9%, 31.4%, and 39.2%, respectively; P=.023). The majority of patients with post-catheterisation strokes (89.7%) did not receive reperfusion therapy; 60% of the patients with proximal artery occlusion received endovascular treatment. The mortality rate was 12.95% for post-catheterisation strokes and 25% for all other in-hospital strokes. Although patients with post-catheterisation stroke had a better functional prognosis, the adjusted analysis showed that this effect was determined by their lower initial severity. CONCLUSIONS: Post-catheterisation stroke is initially less severe, and presents more often as transient ischaemic attack and less frequently as proximal artery occlusion. Most post-catheterisation strokes are not treated with reperfusion; in case of artery occlusion, mechanical thrombectomy is the preferred treatment.

Pulmonary artery pseudoaneurysms: endovascular management after adequate imaging diagnosis.

Pulmonary artery pseudoaneurysms (PAPs) are rare serious vascular abnormalities mostly due to infections and trauma, although other conditions such as vasculitis, neoplasms, or inflammatory lung diseases can also predispose to this entity. Endovascular techniques such as embolization or covered stent placement have mostly substituted surgical approaches, for their lower invasiveness and greater security, mainly in patients with life-threatening hemoptysis. The purpose of this manuscript is to describe the imaging findings of pulmonary artery pseudoaneurysms and their endovascular management including tips to help interventional radiologists. PAP should be diagnosed as accurately and early as possible in order to prompt endovascular management of further life-threatening hemoptysis. KEY POINTS: • Pulmonary artery pseudoaneurysms (PAPs) are rare serious vascular abnormalities that may represent a life-threatening condition, mainly due to Staphylococcus, Streptococcus, or Mycobacterium tuberculosis. • Radiologists should know the imaging findings of PAP in order to make an accurate and early diagnosis to prompt endovascular management of further life-threatening hemoptysis.

Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications. / Ictus isquémico como complicación del cateterismo cardíaco. Características clínicas, radiológicas y evolutivas e implicaciones terapéuticas.

INTRODUCTION: Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. METHODS: We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. RESULTS: The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P=.02), and SC was activated sooner (50, 100, and 125minutes, respectively; P<.001). Furthermore, post-catheterisation SC were more frequently due to transient ischaemic attack (38%, 8%, and 9%, respectively; P<.001) and less frequently to proximal artery occlusion (17.9%, 31.4%, and 39.2%, respectively; P=.023). The majority of patients with post-catheterisation strokes (89.7%) did not receive reperfusion therapy; 60% of the patients with proximal artery occlusion received endovascular treatment. The mortality rate was 12.95% for post-catheterisation strokes and 25% for all other in-hospital strokes. Although patients with post-catheterisation stroke had a better functional prognosis, the adjusted analysis showed that this effect was determined by their lower initial severity. CONCLUSIONS: Post-catheterisation stroke is initially less severe, and presents more often as transient ischaemic attack and less frequently as proximal artery occlusion. Most post-catheterisation strokes are not treated with reperfusion; in case of artery occlusion, mechanical thrombectomy is the preferred treatment.

[Intrathoracic splenosis: a case report]. / Esplenosis intratorácica: a propósito de un caso.

Splenosis is the implantation of functionally active splenic tissue in the serous membranes of the peritoneal cavity and different solid organs such as the lungs, kidneys, or liver. The presence of subpleural pulmonary nodules, whether associated or not to intraabdominal nodules, should raise the diagnostic possibility of intrathoracic splenosis in patients with a history of partial or total splenectomy and/or trauma affecting the spleen. We report the case of a patient splenectomized 16 years prior for splenic lesions suffered in a traffic accident who presented with subpleural nodules with a nonspecific appearance.

Esplenosis intratorácica: a propósito de un caso / Intrathoracic splenosis: a case report

La esplenosis es la implantación de tejido esplénico, funcionalmente activo, heterotópico sobre serosas, cavidad peritoneal y distintos órganos sólidos como pulmón, riñón o hígado. La presencia de nódulos pulmonares subpleurales, asociados o no a nódulos intraabdominales, junto con la existencia de antecedentes de esplenectomía parcial o total, traumática o no, deben hacer sospechar la presencia de una esplenosis intratorácica. Se presenta el caso de un paciente esplenectomizado hace 16 años por lesiones esplénicas en un accidente de tráfico, que presenta nódulos subpleurales de aspecto inespecífico (AU)

Splenosis is the implantation of functionally active splenic tissue in the serous membranes of the peritoneal cavity and different solid organs such as the lungs, kidneys, or liver. The presence of subpleural pulmonary nodules, whether associated or not to intraabdominal nodules, should raise the diagnostic possibility of intrathoracic splenosis in patients with a history of partial or total splenectomy and/or trauma affecting the spleen. We report the case of a patient splenectomized 16 years prior for splenic lesions suffered in a traffic accident who presented with subpleural nodules with a nonspecific appearance (AU)