1
|
Campos JK, Meyer BM, Khan MW, Zarrin DA, Beaufort JCCD, Amin G, Lin LM, Coon AL. Triple Stentriever "Bouquet" Deployment with Zoom 88 Large-Bore Aspiration and Walrus Balloon-Guide Catheter for the Definitive Thrombectomy of a Carotid Free-Floating Thrombus. J Neurol Surg Rep 2024; 85:e17-e22. [PMID: 38348015 PMCID: PMC10861319 DOI: 10.1055/s-0044-1778695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 02/15/2024] Open
Abstract
Formation of a carotid free-floating thrombus (CFFT) is a rare and life-threatening condition without an optimal management plan. A 78-year-old woman with a history of prior right internal carotid artery (ICA) mechanical thrombectomy and antiplatelet noncompliance presented with transient ischemic attacks secondary to a recurrent CFFT in the right ICA. Given her symptoms and recurrent CFFT, endovascular mechanical thrombectomy was performed. A balloon guide-catheter (BGC) and a Zoom 88 distal access catheter were brought into the right distal common carotid artery and proximal ICA bulb, respectively. Three 0.021-inch microcatheters, each loaded with a unique stentriever, were navigated beyond the thrombus into the upper cervical ICA and deployed in a bouquet fashion. The BGC was inflated to achieve flow arrest, and the Zoom 88 aspiration catheter was tracked over the three bouquet stentrievers to ingest the thrombus. Follow-up angiography demonstrated recanalization of the proximal cervical ICA without evidence of residual thrombus. Twenty-four-hour postoperative computed tomography imaging did not reveal any evidence of new infarction. The patient was discharged home with an intact neurological examination, compliant on aspirin and apixaban. We demonstrate a novel technique utilizing a large-bore catheter with a triple stentriever "bouquet" to thrombectomize a CFFT.
Collapse
Affiliation(s)
- Jessica K. Campos
- Department of Neurological Surgery, University of California Irvine, Orange, California, United States
| | - Benjamen M. Meyer
- University of Arizona, College of Medicine, Tucson, Arizona, United States
| | - Muhammad W. Khan
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| | - David A. Zarrin
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | | | - Gizal Amin
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| | - Li-Mei Lin
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| | - Alexander L. Coon
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| |
Collapse
|
2
|
Kazantsev AN, Korotkikh AV, Unguryan VM, Belov YV. Update in Carotid Disease. Curr Probl Cardiol 2023; 48:101676. [PMID: 36828045 DOI: 10.1016/j.cpcardiol.2023.101676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
This review of the literature analyzes publications over the past five years on various problems associated with carotid endarterectomy: 1. Is the eversion or classical technique of surgery with plastic repair of the reconstruction area with a patch more effective? 2. Carotid endarterectomy or carotid angioplasty with stenting is more optimal? 3. When should brain revascularization be performed after the development of ischemic stroke? 4. Should a temporary shunt be used to protect the brain during carotid endarterectomy? 5. How to prevent and treat different types of intraoperative ischemic strokes? 6. What tactics of treatment of patients with combined lesions of the carotid and coronary arteries is more effective? 7. What are the causes and methods of elimination of restenosis of the internal carotid artery known? 8. Is carotid endarterectomy safe in old age?
Collapse
Affiliation(s)
- Anton Nikolaevich Kazantsev
- Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma, Russian Federation; Kostroma oncological dispensary, Kostroma, Russian Federation.
| | - Alexander Vladimirovich Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | | | - Yuriy Vladimirovich Belov
- First Moscow State Medical University named after Sechenov, Moscow, Russian Federation; Federal State Budgetary Scientific Institution Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russian Federation
| |
Collapse
|
3
|
Pensato U, Forlivesi S, Gentile M, Romoli M, Muccioli L, Ambrosi F, Foschini MP, Gallo C, Ballestrazzi MS, Teutonico P, Faggioli G, Gargiulo M, Galluzzo S, Taglialatela F, Simonetti L, Zini A. Carotid free-floating thrombus in COVID-19: a cerebrovascular disorder of cytokine storm-related immunothrombosis. Neurol Sci 2023; 44:1855-1860. [PMID: 36807242 PMCID: PMC9938732 DOI: 10.1007/s10072-023-06682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/11/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUNDS Several neurological manifestations, including stroke, have been reported in COVID-19 patients. The putative role of the COVID-19-related hyperinflammatory state in cerebrovascular disorders remains unclear. METHODS From March 2020 to September 2021, we searched for patients who exhibited an ischemic stroke related to carotid free-floating thrombus (CFFT) to investigate its incidence and relationship with COVID-19. RESULTS Of 853 ischemic strokes referred to our Stroke Centre during the study period, 5.7% (n = 49) were positive for SARS-CoV-2. Six had CFFT, of which two tested positive for SARS-CoV-2 (2/49 = 4.1%), and four did not (4/802 = 0.5%). The former were two middle-aged men suffering from COVID-19 pneumonia. Floating thrombi were promptly extracted by endarterectomy and endovascular thrombectomy, respectively, with no early and long-term complications. Notably, our COVID-19 patients exhibited little or no atherosclerosis burden on CT angiography, markedly elevated D-dimer levels, and extensive thrombus length. CONCLUSIONS COVID-19-induced immunothrombosis possibly played a significant pathogenic role in CFFT.
Collapse
Affiliation(s)
- Umberto Pensato
- grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy ,grid.417728.f0000 0004 1756 8807IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano Milan, Italy
| | - Stefano Forlivesi
- grid.416290.80000 0004 1759 7093IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Mauro Gentile
- grid.416290.80000 0004 1759 7093IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Michele Romoli
- grid.414682.d0000 0004 1758 8744Neurology and Stroke Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Lorenzo Muccioli
- grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Ambrosi
- grid.414405.00000 0004 1784 5501Unit of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | - Maria Pia Foschini
- grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy ,grid.414405.00000 0004 1784 5501Unit of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | - Carmine Gallo
- grid.414405.00000 0004 1784 5501Unit of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | | | - Paolo Teutonico
- grid.412311.4Vascular Surgery Unit, IRCCS Policlinico S. Orsola, Bologna, Italy
| | - Gianluca Faggioli
- grid.412311.4Vascular Surgery Unit, IRCCS Policlinico S. Orsola, Bologna, Italy
| | - Mauro Gargiulo
- grid.412311.4Vascular Surgery Unit, IRCCS Policlinico S. Orsola, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Simone Galluzzo
- grid.416290.80000 0004 1759 7093IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Francesco Taglialatela
- grid.416290.80000 0004 1759 7093IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Luigi Simonetti
- grid.416290.80000 0004 1759 7093IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.
| |
Collapse
|
4
|
Schwartzmann Y, Leker RR, Filioglo A, Molad J, Cohen JE, Honig A. Covid-19 associated free hanging clots in acute symptomatic carotid stenosis. J Neurol Sci 2023; 444:120515. [PMID: 36493703 PMCID: PMC9715260 DOI: 10.1016/j.jns.2022.120515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Thrombotic complications including stroke were previously described following Covid-19. We aim to describe the clinical and radiological characteristics of Covid-19 related with acutely symptomatic carotid stenosis (aSCS). METHOD All patients presenting with an aSCS were prospectively enrolled in an ongoing institutional database. Inclusion criteria for the Covid-19-aSCS group were a combination of both antigen test and a positive reverse-transcriptase (PCR) test for Covid-19 upon admission. Patients with additional potential etiologies for stroke including cardioembolism, carotid dissection or patients with stenosis of <50% on CTA were excluded. A cohort of non-Covid-19 related aSCS patients admitted to the same institution before the pandemic during 2019 served as controls. RESULTS Compared to controls (n = 31), Covid-19-aSCS (n = 8), were younger (64.2 ± 10.7 vs 73.5 ± 10, p = 0.027), and less frequently had hypertension (50% vs 90%, p = 0.008) or hyperlipidemia (38% vs 77%, p = 0.029) before admission. Covid-19-aSCS patients had a higher admission NIHSS score (mean 9 ± 7 vs 3 ± 4, p = 0.004) and tended to present more often with stroke (88% vs 55%, p = 0.09) rather than a TIA. Covid-19-aSCS patients had higher rates of free-floating thrombus and clot burden on CTA (88% vs 6.5%, p = 0.002). Covid-19 patients also less often achieved excellent outcomes, with lower percentage of mRS score of 0 after 90-days (13% vs 58%, p = 0.022). CONCLUSION Covid-19- aSCS may occur in a younger and healthier subpopulation. Covid-19- aSCS patients may have higher tendencies for developing complex clots and less often achieve excellent outcomes.
Collapse
Affiliation(s)
- Y Schwartzmann
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - R R Leker
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Filioglo
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J Molad
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - J E Cohen
- Departments of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| |
Collapse
|
5
|
Netiazhenko VZ, Mostovyi SI, Safonova OM, Gurianov VG, Mikhaliev KO. INTRACARDIAC HEMODYNAMICS, CEREBRAL BLOOD FLOW AND MICROEMBOLIC SIGNAL BURDEN IN STABLE CORONARY ARTERY DISEASE PATIENTS WITH CONCOMITANT COVID-19. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1205-1215. [PMID: 37364074 DOI: 10.36740/wlek202305211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To estimate the changes in intracardiac hemodynamics, cerebral blood flow (CBF), and microembolic signals` (MES) burden in stable coronary artery disease (SCAD) patients with concomitant COVID-19. PATIENTS AND METHODS Materials and methods: The cross-sectional study analyzed the data from 80 patients, being subdivided as follows: group 1 (G1) - SCAD without COVID-19 (n=30); group 2 (G2) - SCAD with concomitant COVID-19 (n=25); group 3 (G3) - COVID-19 without SCAD (n=25). The control group (CG) included 30 relatively healthy volunteers. CBF and total MES count were assessed by transcranial Doppler ultrasound. RESULTS Results: Transthoracic echocardiography data from G2 revealed the most pronounced left ventricular (LV) dilation and its contractility decline (the rise of end-systolic volume (ESV) and ejection fraction decrease), as compared to G1 and G3. G1-G3 patients (vs. CG) presented with lower peak systolic velocities in all the studied intracranial arteries (middle and posterior cerebral arteries bilaterally, and basilar artery), along with the higher MES count. Such a drop in CBF was the most pronounced in G2. Both G2 and G3 demonstrated the highest amount of MES, with slightly higher count in G2. We built a linear neural network, discriminating the pattern of both higher LV ESV and MES count, being inherent to G2. CONCLUSION Conclusions: G2 patients demonstrated the LV dilation and its systolic function impairment, and presented with CBF drop and MES burden increase, being more advanced in contrast to G1 and G3. LV contractility decrease was associated with the higher MES load in the case of SCAD and COVID-19 constellation.
Collapse
Affiliation(s)
- Vasyl Z Netiazhenko
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE; STATE INSTITUTION OF SCIENCE "RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE" STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Serhii I Mostovyi
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE; SE «MEDBUD», KYIV, UKRAINE
| | | | | | - Kyrylo O Mikhaliev
- STATE INSTITUTION OF SCIENCE "RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE" STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| |
Collapse
|
6
|
Adam LC, Burgstaller M, Taetweiler U, Mueller J. Successful Systemic Lysis Therapy of a Floating Carotid Thrombus in an Acute Stroke Patient with Known Immune Thrombocytopenia (ITP) on Ongoing Eltrombopag Therapy and Acute COVID-19 Infection: a Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:133. [PMID: 37151759 PMCID: PMC10140722 DOI: 10.1007/s42399-023-01465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Patients with immune thrombocytopenia (ITP) under eltrombopag therapy are vulnerable to thrombotic disbalance, both due to the disease itself and therapy-related hypercoagulability. Vascular events such as the development of a free-floating carotid thrombus are known rare complications of acute COVID-19 infections due to endothelial inflammation and presumptive underlying hypercoagulable state. In patients at risk, the onset of new focal neurological symptoms should prompt immediate angiographic diagnostics and, if necessary, appropriate treatment. Here, we report a case of a 38-year-old female with a medical history of ITP and the presence of COVID-19 infection presenting an acute sensorimotor hemiparesis of the right side while on eltrombopag therapy. Initial CT angiography revealed a free-floating thrombus in the left common carotid artery. Upon admission, the patient's platelet count was significantly elevated at 896 × 109/l. After systemic lysis therapy, the thrombus was fully dissolved. Follow-up diffusion-weighted imaging revealed multilocular cortical infarction of the left MCA territory. The patient soon recovered and was discharged with residual mild sensorimotor deficits in the right arm. Eltrombopag was paused at admission, and the patient's platelet count was quickly returning to normal. She was discharged with a daily intake of acetylsalicylic acid, a reduced daily dose of eltrombopag, and weekly monitoring of her platelet count for the next three months. This unique case highlights the need for caution in patients at vascular risk who contract COVID-19 and discusses thrombocytic derailment under thrombopoietin receptor agonist therapy in the context of an acute COVID-19 infection.
Collapse
Affiliation(s)
- Lucas C. Adam
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Urs Taetweiler
- Department of Hematology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Joerg Mueller
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| |
Collapse
|
7
|
Samimiardestani S, Irani S, Hasibi M, Seyedahadi M, Bastaninejad S, Firouzifar M, Mohammadi Ardehali M, Berijani S, Erfanian R, Kazemi MA, Etemadi-Aleagha A, Rahimi A, Karimi Yarandi K, Ahadi S. Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e66. [PMID: 36381973 PMCID: PMC9637258 DOI: 10.22037/aaem.v10i1.1644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Since the emergence of COVID-19 pandemic, several articles have reported the co-existence of mucormycosis and COVID-19. This study aimed to distinguish the characteristics of COVID-19-associated rhinocerebral mucormycosis. METHODS In this case series, 18 patients with COVID-19-associated rhinocerebral mucormycosis and unique clinical manifestations and outcomes, who were referred to Amiralam Hospital, a tertiary otorhinolaryngology center, Tehran, Iran, during the COVID-19 era, were reported. RESULTS Eighteen patients with the mean age of 62.0 ± 11.6 (range: 42 - 83) years were studied (50% males). The mean time interval between diagnosis of COVID-19 and first manifestation of mucormycosis was 15.5 ± 9.7 days. The most common presenting symptom was facial paresthesia (72.2%). Fifty percent of patients developed frozen eye. Palatal necrosis was seen in 7 cases (38.8%). Remarkably, facial paralysis was observed in 5 (27.7%) patients. Another notable clinical picture was cavernous sinus thrombosis, seen in 7 patients. We also had two cases of carotid artery occlusion. Three patients, unfortunately, passed away. CONCLUSION Rhinocerebral mucormycosis is one of the most important complications of COVID-19 patients, especially those with underlying diseases. It seems that the key to proper management of mucormycosis is early diagnosis and timely intervention, which could give a patient a chance to live more.
Collapse
Affiliation(s)
- Seyedhadi Samimiardestani
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Irani
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding Author: Shirin Irani; Amiralam Hospital, North Sa’di Street, Enghelab Street, Tehran, Iran. Fax Number: +98 2166343177, , Cell phone: +98 912 4182775
| | - Mehrdad Hasibi
- Infectious Disease Department, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Seyedahadi
- Neurology Department, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Firouzifar
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Berijani
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Etemadi-Aleagha
- Department of Anesthesiology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Rahimi
- Department of Ophthalmology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | | | - Samira Ahadi
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Carotid free-floating thrombus during COVID-19 vaccine era: causality or not? Neurol Sci 2022; 43:6179-6183. [PMID: 35921016 PMCID: PMC9362674 DOI: 10.1007/s10072-022-06307-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
Carotid free-floating thrombus (FFT) is very rarely diagnosed in patients with acute ischemic stroke. It is a real clinical emergency due to the significant risk of death associated with thromboembolic complications. Herein, we present three patients with ischemic stroke caused by carotid FFT after less than 20 days from administration of mRNA vaccine BNT162b1 (Pfizer/BioNTech) for Severe Acute Respiratory Syndrome—CoronaVirus 2 (SARS-CoV-2). To our knowledge, these are the first cases reporting carotid FTT following SARS-CoV-2 vaccination.
Collapse
|
9
|
Weil EL, Klaas JP. Extensive intraluminal thrombus involving the extracranial internal carotid artery. Pract Neurol 2022; 22:332-333. [PMID: 35688620 DOI: 10.1136/practneurol-2022-003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Erika L Weil
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James P Klaas
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Kazantsev AN, Karkayeva MR, Tritenko AP, Korotkikh AV, Zharova AS, Chernykh KP, Bagdavadze GS, Lider RY, Kazantseva YG, Zakharova KL, Shmatov DV, Kravchuk VN, Peshekhonov KS, Zarkua NE, Lutsenko VA, Sultanov RV, Artyukhov SV, Kharchilava EU, Solotenkova KN, Zakeryayev AB. CAROTID ENADRTERECTOMY FOR INTERNAL CAROTID THROMBOSIS IN PATIENTS WITH COVID-19. Curr Probl Cardiol 2022:101252. [PMID: 35577077 PMCID: PMC9109971 DOI: 10.1016/j.cpcardiol.2022.101252] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/12/2022]
Abstract
Analysis of the results of emergency carotid endarterectomy (CEE) against the background of internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVA) in patients with COVID-19. During the COVID-19 pandemic (April 1, 2020-May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019-March 1, 2020). According to laboratory parameters, patients with COVID-19 had severe coagulopathy (with an increase in D-dimer: 3832 ± 627.2 ng/mL, fibrinogen: 12.6 ± 3.1 g/L, prothrombin: 155.7 ± 10, 2%), inflammatory syndrome (increased ferritin: 646.2 ± 56.1 ng/mL, C-reactive protein: 161.3 ± 17.2 mg/L, interleukin-6: 183.3 ± 51.7 pg/mL, leukocytosis: 27.3 ± 1.7 10E9/L). In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n = 1; group 2: 1.1%, n = 1; P= 0.81; OR=2.09; 95 % CI = 0.12-34.3) myocardial infarction (group 1: 2.3%, n = 1; group 2: 0%; P= 0.7; OR = 6.3; 95% CI = 0.25-158.5), CVA (group 1: 2.3%, n = 1; group 2: 2.2%, n = 2; P= 0.55; OR = 1.03; 95% CI = 0,.09-11.7). ICA thrombosis and hemorrhagic transformations were not recorded. However, due to severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n = 5; group 2: 1.1%, n = 1; P= 0.02; OR = 11.5; 95% CI = 1.3-102.5). In all cases, the flow of hemorrhagic discharge came from the drainage localized in the subcutaneous fat. This made it possible to remove skin sutures in a dressing room, suturing the source of bleeding and applying secondary sutures under local anesthesia. Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.
Collapse
Affiliation(s)
- A N Kazantsev
- Alexander Hospital, St. Petersburg, Russian Federation.
| | - M R Karkayeva
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation
| | - A P Tritenko
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - A V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - A S Zharova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - K P Chernykh
- Alexander Hospital, St. Petersburg, Russian Federation
| | - G Sh Bagdavadze
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - Ye G Kazantseva
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - K L Zakharova
- Alexander Hospital, St. Petersburg, Russian Federation
| | - D V Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | - V N Kravchuk
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | | | - N E Zarkua
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - V A Lutsenko
- Kemerovo Regional Clinical Hospital named after S.V. Belyaeva, Kemerovo, Russian Federation
| | - R V Sultanov
- Kemerovo Regional Clinical Hospital named after S.V. Belyaeva, Kemerovo, Russian Federation
| | - S V Artyukhov
- Alexander Hospital, St. Petersburg, Russian Federation
| | - E U Kharchilava
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - K N Solotenkova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - A B Zakeryayev
- Research Institute - Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky
| |
Collapse
|
11
|
Kazantsev AN, Chernykh KP, Artyukhov SV, Bagdavadze GS, Dzhanelidze MO, Lider RY, Abdullaev AD, Zarkua NE, Kalinin EY, Chikin AE, Zaitseva TE, Linets YP. [Carotid endarterectomy in patients with internal carotid artery thrombosis in the acutest period of ischemic stroke with COVID-19]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:25-31. [PMID: 34874651 DOI: 10.17116/jnevro202112110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Analysis of the results of emergency carotid endarterectomy (CEE) in internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVI) in patients with COVID-19. MATERIAL AND METHODS During the COVID-19 pandemic (April 1, 2020 - May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019 - March 1.2020). RESULTS In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n=1; group 2: 1.1%, n=1; p=0.81; OR=2.09; 95% CI=0.12-34.3) myocardial infarction (group 1: 2.3%, n=1; group 2: 0%; p=0.7; OR=6.3; 95% CI=0.25-158.5), CVA (group 1: 2.3%, n=1; group 2: 2.2%, n=2; p=0.55; OR=1.03; 95% CI=0.09-11.,7). ICA thrombosis and hemorrhagic transformations were not recorded. However, in view of severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n=5; group 2: 1.1%, n=1; p=0.02; OR=11.5; 95% CI=1.3-102.5). CONCLUSION Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.
Collapse
Affiliation(s)
- A N Kazantsev
- City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - K P Chernykh
- City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - S V Artyukhov
- City Alexandrovskaya Hospital, St. Petersburg, Russia.,Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - G Sh Bagdavadze
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - M O Dzhanelidze
- Western Regional Center of Modern Medical Technologies, Kutaisi, Georgia
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russia
| | - A D Abdullaev
- Pskov Regional Infectious Diseases Hospital, Pskov, Russia
| | - N E Zarkua
- City Alexandrovskaya Hospital, St. Petersburg, Russia.,Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - E Yu Kalinin
- City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - A E Chikin
- City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - T E Zaitseva
- City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - Yu P Linets
- City Alexandrovskaya Hospital, St. Petersburg, Russia
| |
Collapse
|
12
|
COVID-19 and Peripheral Artery Thrombosis: A Mini Review. Curr Probl Cardiol 2021; 47:100992. [PMID: 34571103 PMCID: PMC8462005 DOI: 10.1016/j.cpcardiol.2021.100992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
For more than 2 years, health care systems have been floundering in a massive crisis of coronavirus disease 2019 (COVID-19) pandemic. While acute respiratory distress syndrome is the main complication in patients with COVID-19, as the pandemic continues, more data about the nonrespiratory effects of the coronavirus is obtained, including developing Coagulopathy-related manifestations, in the form of venous and arterial thromboembolism. Although arterial thrombosis a rare complication of this disease, it proves to be an effective factor in the mortality and morbidity of COVID-19 patients. The pathophysiology of thrombosis reveals a complex relation between hemostasis and immune system that can be disrupted by COVID-19. Thrombectomy, anticoagulant therapy, and thrombolysis are the main treatments in these patients. In addition, appropriate thromboprophylaxis treatment should be considered in COVID-19 patients. In this article, we have successfully reviewed the arterial thrombotic events in patients reported around the world, including the diagnostic and management method of choice.
Collapse
|
13
|
Kazantsev AN. Thrombectomy vs conservative therapy in patients with COVID-19. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|