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Urquieta E, Varon J, Lin PH. Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair With Hyperbaric Oxygen and Therapeutic Hypothermia. Vasc Endovascular Surg 2017; 51:517-520. [PMID: 28820047 DOI: 10.1177/1538574417725238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neurological adverse events with spinal cord ischemia (SCI) remain one of the most feared complications in patients undergoing thoracic endovascular aortic repair (TEVAR). These patients can develop irreversible paraplegia with lifelong consequences with physical and psychological agony. CASE PRESENTATION We herein present a patient who developed SCI with bilateral lower leg paraplegia on the third postoperative day following TEVAR. Spinal catheter was inserted for spinal fluid drainage. A hyperbaric oxygen therapy was initiated for 90 minutes for 2 days, which was followed by therapeutic hypothermia for 24 hours with a target temperature of 33°C. The patient exhibited significant neurological recovery following these treatments, and he ultimately regained full neurological function without spinal deficit. DISCUSSION This represents the first reported case of full neurological recovery of a patient who developed complete SCI following TEVAR procedure. The neurological recovery was due in part to immediate therapeutic hypothermia and hyperbaric oxygen therapy which reversed the spinal ischemia.
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Affiliation(s)
- Emmanuel Urquieta
- 1 Division of Aerospace Medicine, Department of Internal Medicine, Wright State University, Dayton, OH, USA
| | - Joseph Varon
- 2 Division of Critical Care Medicine, Department of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.,3 The University of Texas Medical Branch at Galveston, Galveston, TX, USA.,4 University General Hospital, Houston, TX, USA
| | - Peter H Lin
- 5 Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,6 University Vascular Associates, Los Angeles, CA, USA
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Chen JX, Lai LF, Zheng K, Li GX, He XY, Li LP, Duan CZ. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment. J Neurol 2015; 262:2115-23. [PMID: 26100332 DOI: 10.1007/s00415-015-7824-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely.
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Affiliation(s)
- Jia-Xiang Chen
- Department of Neurosurgery, Guangzhou Red Cross Hospital, The Fourth Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Ling-Feng Lai
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Kuang Zheng
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Guo-Xiong Li
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Xu-Ying He
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Liang-Ping Li
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China
| | - Chuan-Zhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China.
- Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Institute of Neurosurgery, Southern Medical University, Guangzhou, 510200, Guangdong, People's Republic of China.
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Abstract
BACKGROUND Fifty percent of aortic dissections in women younger than 40 years occur in association with pregnancy. Of these, half of type B dissections occur in the postpartum period. CASE A 30-year-old woman was status post spontaneous vaginal delivery at 30 weeks of gestation for fetal death, complicated by an eclamptic seizure. On postpartum day 4, she suffered an acute, complicated type B aortic dissection treated with endovascular stent graft placement. CONCLUSION Endovascular repair may be an attractive option for the treatment of complicated type B aortic dissections in pregnancy and the peripartum period, with reduced maternal and fetal mortality. This may allow the fetus to remain in situ and avoid the risks of surgery and possible cardiopulmonary bypass, with little radiation risk to the fetus.
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Kim K, Reynolds T, Donayre C, Kopchok G, White R, De Virgilio C, Chauvapun J. Predictability of Cerebral Embolization from Aortic Arch Manipulations During Thoracic Endovascular Repair. Am Surg 2011. [DOI: 10.1177/000313481107701029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is no sensitive tool to monitor embolic events and predict patients at a risk for strokes during thoracic endovascular aortic repair. We examined the relationship between the number of high intensity transient signals (HITS) by transcranial doppler ultrasound and the extent of atherosclerotic plaques in aortic arch. Thirteen patients were treated as a part of a single center United States Food and Drug Administration-approved investigational device exemption for various thoracic aortic pathologies. Bilateral transcranial doppler ultrasound transducers recorded the number of HITS. CT angiography and intravascular ultrasound were used to measure the thickness of mural thrombi and determine their arch location. All 13 patients had detectable HITS, and one patient sustained a stroke. Eleven patients had quantifiable mural thrombi. The highest HITS were observed in patients with thrombi in zones 2 to 3. All three patients with bovine arch had more HITS in the right middle cerebral artery whereas the patients with normal arch anatomy had more HITS in the left middle cerebral artery. The presence of mural thrombi in zones 2 and 3, irrespective of their thickness, was associated with increased HITS during thoracic endovascular aortic repair. This is the first study to characterize the significance of mural thrombi in aortic arch and their relationship to embolic events during aortic arch manipulations.
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Affiliation(s)
- Karen Kim
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Tyler Reynolds
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Carlos Donayre
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - George Kopchok
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Rodney White
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Christian De Virgilio
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Joe Chauvapun
- Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California
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