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Böhm I. Immunological Activity of Peripheral Blood Lymphocytes Points to Lupus-Related Cause of Stroke in Lupus Erythematosus. Ann Vasc Surg 2021; 74:e4-e5. [PMID: 33689755 DOI: 10.1016/j.avsg.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Universityhospital of Bern, University of Bern, Bern, Switzerland.
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Sievert K, Yu J, Bertog S, Hornung M, von Bardeleben RS, Gafoor S, Reinartz M, Matic P, Hofmann I, Grunwald I, Schnelle N, Sievert H. Post-Market Clinical Follow-Up With the Patent Foramen Ovale Closure Device IrisFIT (Lifetech) in Patients With Stroke, Transient Ischemic Attack, or Other Thromboembolic Events. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 30:72-75. [PMID: 33097460 DOI: 10.1016/j.carrev.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A patent foramen ovale (PFO) has been associated with embolic strokes and transient ischemic attacks (TIAs). Catheter closure of PFO is effective in preventing recurrent events. Residual shunts and procedure or device related complications can occur, including atrial fibrillation and thrombus formation. This study examines the initial experience with a new PFO closure device, the IrisFIT PFO-Occluder (Lifetech Scientific, Shenzhen, China). METHODS 95 patients with indications for PFO closure underwent percutaneous closure with the IrisFIT PFO-Occluder. The primary endpoint was the rate of accurate device placement with no/small residual shunt at 3 or 6 months follow-up. All patients underwent transoesophageal echocardiography (TEE) after 1 to 6 months. In case of a residual shunt, an additional TEE was performed after 12 months. Clinical follow-up was performed up to a mean of 33.1 ± 3.6 months. RESULTS The device was successfully implanted in 95 (100%) patients with no relevant procedural complications. At final TEE follow-up (7.6 ± 3.9 months) the effective closure rate was 96.8% with 1 moderate and 2 large residual shunts. There were 8 cases of new onset atrial fibrillation and 2 TIAs. There were no cases of device embolization or erosion. CONCLUSION The IrisFIT occluder is a new PFO closure device with several advantages compared to other devices. In this small study cohort, technical success rate, closure rate and adverse event rate were comparable to other devices. The rate of new onset atrial fibrillation was higher in comparison to other studies and warrants further investigation.
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Affiliation(s)
| | - Jiangtao Yu
- Helmut-G.-Walther-Klinikum, Lichtenfels, Germany
| | | | | | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | | | - Iris Grunwald
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
| | - Nalan Schnelle
- CardioVascular Center Frankfurt, Frankfurt, Germany; Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom.
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He D, Shi Q, Xu G, Hu Z, Li X, Li Q, Guo Y, Xu S, Lin Y, Yu Z, Wang W, Luo X. Clinical and infarction patterns of PFO-related cryptogenic strokes and a prediction model. Ann Clin Transl Neurol 2018; 5:1323-1337. [PMID: 30480027 PMCID: PMC6243387 DOI: 10.1002/acn3.647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/23/2018] [Accepted: 08/12/2018] [Indexed: 12/29/2022] Open
Abstract
Objectives The higher than expected PFO rate in CS patients has raised concerns that paradoxical embolism maybe the pathophysiologic mechanism for strokes. However, only a small proportion of pathogenic PFOs cause CS. Therefore, accurate recognition of patients with pathogenic PFOs among all CS patients could guide clinical decision making in selecting the most appropriate treatment. The aim of this study was to devise a new algorithm to stratify cryptogenic stroke (CS) patients into pathogenic patent foramen ovale (p‐PFO)‐ and non‐p‐PFO‐related patients. Methods A total of 1201 patients with acute ischemic stroke were recruited from two different medical centers, and 253 CS patients were identified. Of the 253 patients, 111 were diagnosed with PFO using contrast transcranial Doppler. Data on medical histories, neuroimaging and laboratory tests were compared in CS patients with or without PFO. Results Compared with PFO‐negative CS patients, PFO‐positive CS patients showed younger onset age, lower incidence of hypertension and dyslipidemia, characteristic infarction pattern in magnetic resonance imaging and specifically altered platelet activity and coagulation function. Based on the above information, we constructed a PFO judgment formula (Hr‐PFOJ) by means of feature weight estimation and predictive performance evaluation to predict pathogenic PFO in CS patients with a sensitivity of 76.3% and a specificity of 66.5%. Interpretations Hr‐PFOJ judgment formula is a useful screening tool for identification of patients with pathogenic PFO who may benefit from PFO‐related treatment.
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Affiliation(s)
- Dan He
- Department of Neurology National Key Clinical Department and Key Discipline of Neurology The First Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong China
| | - Qiang Shi
- School of Software Engineering Huazhong University of Science & Technology Wuhan China
| | - Guangjing Xu
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Zheng Hu
- Department of Obstetrics and Gynecology The First Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong China
| | - Xuefei Li
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Qian Li
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Yinping Guo
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Shabei Xu
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Yongbo Lin
- Department of Neurology Wuhan Dongxihu People's Hospital Wuhan China
| | - Zhiyuan Yu
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Wei Wang
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Xiang Luo
- Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
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Cardiac Emboli Documented by Intraoperative Transesophageal Echocardiogram During Administration of a Topical Hemostatic Agent Prior to Pedicle Subtraction Osteotomy. Spine (Phila Pa 1976) 2016; 41:E556-60. [PMID: 27128259 DOI: 10.1097/brs.0000000000001307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a case report. OBJECTIVE Describe the occurrence of cardiac emboli recorded on transesophageal echocardiogram (TEE) after the injection of a topical hemostatic agent into a vertebra prior to performing a pedicle subtraction osteotomy (PSO). SUMMARY OF BACKGROUND DATA Hemostasis during spinal surgery is critical for adequate visualization and to reduce the risk of perioperative complications. Adult spinal deformity surgery can involve performing PSOs which are useful in cases of fixed spinal deformities and are associated with increased blood loss secondary to epidural and cancellous bleeding. Prior to performing a PSO, a topical hemostatic agent can be injected into the vertebra through the pedicle screw pilot holes in an attempt to decrease cancellous bleeding. Injected hemostatic agents can pressurize the vertebral body similar to cementation in vertebroplasty and during fracture reaming and prosthetic implantation in the femur. Patients with cardiac defects such as patent foramen ovale or atrial septal defect may be more prone to systemic embolic events resulting in morbidity or mortality. METHODS We injected a topical hemostatic matrix agent through the pedicle screw pilot holes into the L1 vertebral body prior to performing a PSO while simultaneously recording with TEE. RESULTS The TEE recorded large visible emboli traveling through the heart into the pulmonary vasculature. The patient remained stable throughout the remainder of the case and a postoperative spiral computed tomography (CT) scan was negative for filling defects. The patient had an uneventful hospital course. CONCLUSION Questions remain about the exact consistency of these emboli, when they are most likely to occur, how much cardiopulmonary insult can be tolerated without resulting in complications, or how to prevent their occurrence. Patients undergoing spinal surgery with the plan to inject hemostatic matrix agents into the vertebral body may benefit from a preoperative TEE to reduce the risk of complications associated with embolic events, especially in patients with undiagnosed patent foramen ovale or atrial septal defect. LEVEL OF EVIDENCE 5.
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Bayar N, Arslan Ş, Çağırcı G, Erkal Z, Üreyen ÇM, Çay S, Köklü E, Yüksel İÖ, Küçükseymen S. Assessment of Morphology of Patent Foramen Ovale with Transesophageal Echocardiography in Symptomatic and Asymptomatic Patients. J Stroke Cerebrovasc Dis 2015; 24:1282-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/18/2015] [Accepted: 01/30/2015] [Indexed: 11/25/2022] Open
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Steinberg DH, Bertog SC, Momberger J, Franke J, Hofmann I, Renkhoff K, Joy S, Vaskelyte L, Sievert H. Initial experience with the novel patent foramen ovale occlusion device Nit-Occlud® in patients with stroke or transient ischemic attack. Catheter Cardiovasc Interv 2015; 85:1262-7. [DOI: 10.1002/ccd.25580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/14/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | | | | | - Sonya Joy
- CardioVascular Center Frankfurt; Frankfurt Germany
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Consoli D, Paciaroni M, Galati F, Aguggia M, Melis M, Malferrari G, Consoli A, Vidale S, Bosco D, Cerrato P, Sacco S, Gandolfo C, Bovi P, Serrati C, Del Sette M, Cavallini A, Diomedi M, Postorino P, Reboldi P, Ricci S. Prevalence of Patent Foramen Ovale in Ischaemic Stroke in Italy: Results of SISIFO Study. Cerebrovasc Dis 2015; 39:162-9. [PMID: 25720306 DOI: 10.1159/000375152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although several authors have studied the association between patent foramen ovale (PFO) and ischaemic stroke, the matter is still controversial; few have suggested an association between cryptogenetic stroke and PFO, while others have denied this association. The aim of this study was to evaluate PFO prevalence in the whole ischaemic stroke population, independently from age and stroke subtypes and to identify the characteristics associated with the presence of PFO. METHODS SISIFO study was a multicenter, prospective, single-wave, cross-sectional survey conducted on consecutive patients with acute ischemic stroke admitted to selected clinical centres. Data regarding vascular risk factors were registered for each patient; all patients underwent computed tomography scan and/or magnetic resonance imaging of the brain; an electrocardiogram and standard laboratory blood tests were performed. A Doppler ultrasound study of extra-cranial arteries was performed too. The cases were classified according to TOAST and OCSP criteria. Each patient underwent transcranial Doppler or transcranial color-coded duplex sonography with bubble test as diagnostic tool for right-to-left-shunt. Where right-to-left shunt was detected, PFO presence was confirmed by echocardiography. FINDINGS 1,130 consecutive patients were included. We found a PFO in 247 (21.9%; 95% CI, 19.5-24.3%) patients; PFO was present in 23.5% of patients with cryptogenic stroke and in 21.3% of patients with stroke of known causes; this difference was not statistically significant. At the univariate analysis, decreasing age, hypertension, diabetes mellitus, and atrial fibrillation, and stroke characteristics such as NIHSS, OCSP and TOAST were predictors of PFO presence. At the multivariate analysis, we found a significant interaction between age and OCSP syndrome. Being LACI the reference category, the prevalence of PFO in PACI and POCI decreased significantly along with age, whereas there was no change in TACI. CONCLUSION If any relationship exists between stroke and PFO, this is more likely in PACI and POCI at a younger age. Our results are consistent with recent findings that underline PFO alone must not be considered a significant independent predictor for stroke; so the presence of PFO alone doesn't permit rushed causal correlations or 'therapeutic aggressiveness'.
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Mallick AA, O’Callaghan FJK. Risk factors and treatment outcomes of childhood stroke. Expert Rev Neurother 2014; 10:1331-46. [DOI: 10.1586/ern.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Lantz M, Sjöstrand C, Kostulas K. Ischemic Stroke and Patent Foramen Ovale: Risk Factors and Genetic Profile. J Stroke Cerebrovasc Dis 2013; 22:841-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/28/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022] Open
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Cerebellar infarction in a patient with cerebral vein thrombosis and patent foramen ovale: brain-to-brain embolism? Neurol Sci 2012; 33:1415-7. [PMID: 22210158 DOI: 10.1007/s10072-011-0908-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
Abstract
Although the association between PFO and cryptogenic stroke is well shown in young adults, the causality is still unclear. The pathogenetic mechanism of ischemic stroke related to PFO is not entirely understood. Indeed, besides the well-known paradoxical embolism, formations of thrombi in situ, especially in the presence of ASA, a higher incidence of atrial fibrillation have been often observed. Cerebral sinus venous thrombosis may be due to local inflammation or to acquired or genetic thrombophilia including hyperhomocysteinemia. We report a case of a young man presenting with a cerebellar infarction probably secondary to a paradoxical brain-to-brain embolism, in which the only detectable embolic source was a cerebral vein thrombosis.
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Kujime S, Hara H, Enomoto Y, Yoshikawa H, Itaya H, Noro M, Suzuki M, Nakamura M, Sugi K. A case of paradoxical embolic ST-segment elevation myocardial infarction triggered by sleep apnea. Intern Med 2012; 51:1851-5. [PMID: 22821099 DOI: 10.2169/internalmedicine.51.7069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes an obese 39-year-old man who experienced ST-segment elevation myocardial infarction with total thrombotic occlusion of the right coronary artery. Culprit vessel flow was improved by aspiration. Data suggested that myocardial infarction had resulted from paradoxical embolus via a patent foramen ovale triggered by the Mueller maneuver, which had induced negative intrathoracic pressure following an acute increase of right-heart volume in the context of obesity and sleep-disordered breathing (SDB). Obesity is increasing among younger populations and it represents a risk for SDB and thrombosis. Thus, this mechanism should be included within the differential diagnosis for myocardial infarction in young patients.
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Affiliation(s)
- Shingo Kujime
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan.
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Schmitt R, Westhoff-Bleck M, Haller H, Wagner AD. Paradoxical renal embolism in a patient with congenital cardiac malformation. QJM 2011; 104:885-7. [PMID: 21047811 DOI: 10.1093/qjmed/hcq200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Schmitt
- Department of Nephrology and Hypertension, Medical School Hannover, 30625 Hannover, Germany.
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Biller J, Hocker S, Morales-Vidal S. Neurologic complications of cardiac surgery and interventional cardiac procedures. Hosp Pract (1995) 2010; 38:83-89. [PMID: 21068531 DOI: 10.3810/hp.2010.11.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Neurologic complications of cardiac surgery and interventional cardiac procedures may affect the central nervous system or the peripheral nervous system. The most common central nervous system complications are strokes and seizures. This article provides a succinct neuroanatomic and pathophysiologic approach to a wide array of neurologic complications associated with cardiac procedures.
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Affiliation(s)
- José Biller
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL 60153, USA.
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Steinberg DH, Staubach S, Franke J, Sievert H. Defining structural heart disease in the adult patient: current scope, inherent challenges and future directions. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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McKenzie JA, Edwards WD, Hagler DJ. Anatomy of the patent foramen ovale for the interventionalist. Catheter Cardiovasc Interv 2009; 73:821-6. [DOI: 10.1002/ccd.21889] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cecità monoculare transitoria. Neurologia 2009. [DOI: 10.1016/s1634-7072(09)70508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Revel MP, Faivre JB, Letourneau T, Henon H, Leys D, Delannoy-Deken V, Remy-Jardin M, Remy J. Patent Foramen Ovale: Detection with Nongated Multidetector CT. Radiology 2008; 249:338-45. [DOI: 10.1148/radiol.2491071874] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Benbassat J, Baumal R. Variability in duration of follow up may bias the conclusions of cohort studies of patients with patent foramen ovale. Eur J Neurol 2008; 15:909-15. [DOI: 10.1111/j.1468-1331.2008.02237.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Women, their age, and their cholesterol values. Cardiol Rev 2007; 16:21-2. [PMID: 18091398 DOI: 10.1097/crd.0b013e31815d29f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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