20 research outputs found
Intracranial Vertebrobasilar Artery Dissection Associated with Postpartum Angiopathy
Background. Cervicocephalic arterial dissection (CCAD) is rare in the postpartum period. To our knowledge this is the first reported case of postpartum angiopathy (PPA) presenting with ischemic stroke due to intracranial arterial dissection. Case. A 41-year-old woman presented with blurred vision, headache, and generalized seizures 5 days after delivering twins. She was treated with magnesium for eclampsia. MRI identified multiple posterior circulation infarcts. Angiography identified a complex dissection extending from both intradural vertebral arteries, through the basilar artery, and into both posterior cerebral arteries. Multiple segments of arterial dilatation and narrowing consistent with PPA were present. Xenon enhanced CT (Xe-CT) showed reduced regional cerebral blood flow that is improved with elevation in blood pressure. Conclusion. Intracranial vertebrobasilar dissection causing stroke is a rare complication of pregnancy. Eclampsia and PPA may play a role in its pathogenesis. Blood pressure management may be tailored using quantitative blood flow studies, such as Xe-CT
Direct Retrograde IJ Access for DVSS
Dural Venous Sinus Stenting (DVSS) is increasingly being performed in select patients with medically refractory IIH. Criteria for stenting includes: significant pressure gradient across the stenosis and an obstructive outflow pattern. Direct retrograde internal jugular access represents a simple, safe, and technically feasible approach with inherent advantages
Disruption of tetR type regulator adeN by mobile genetic element confers elevated virulence in Acinetobacter baumannii
Acinetobacter baumannii is an important human pathogen and considered as a major threat due to its extreme drug resistance. In this study, the genome of a hyper-virulent MDR strain PKAB07 of A. baumannii isolated from an Indian patient was sequenced and analyzed to understand its mechanisms of virulence, resistance and evolution. Comparative genome analysis of PKAB07 revealed virulence and resistance related genes scattered throughout the genome, instead of being organized as an island, indicating the highly mosaic nature of the genome. Many intermittent horizontal gene transfer events, insertion sequence (IS) element insertions identified were augmenting resistance machinery and elevating the SNP densities in A. baumannii eventually aiding in their swift evolution. ISAba1, the most widely distributed insertion sequence in A. baumannii was found in multiple sites in PKAB07. Out of many ISAba1 insertions, we identified novel insertions in 9 different genes wherein insertional inactivation of adeN (tetR type regulator) was significant. To assess the significance of this disruption in A. baumannii, adeN mutant and complement strains were constructed in A. baumannii ATCC 17978 strain and studied. Biofilm levels were abrogated in the adeN knockout when compared with the wild type and complemented strain of adeN knockout. Virulence of the adeN knockout mutant strain was observed to be high, which was validated by in vitro experiments and Galleria mellonella infection model. The overexpression of adeJ, a major component of AdeIJK efflux pump observed in adeN knockout strain could be the possible reason for the elevated virulence in adeN mutant and PKB07 strain. Knocking out of adeN in ATCC strain led to increased resistance and virulence at par with the PKAB07. Disruption of tetR type regulator adeN by ISAba1 consequently has led to elevated virulence in this pathogen
Major complications of dural venous sinus stenting for idiopathic intracranial hypertension: case series and management considerations
Venous sinus stenting (VSS) is a safe, effective, and increasingly popular treatment option for selected patients with idiopathic intracranial hypertension (IIH). Serious complications associated with VSS are rarely reported. Serious complications after VSS were identified retrospectively from multicenter databases. The cases are presented and management strategies are discussed. Six major acute and chronic complications after VSS were selected from a total of 811 VSS procedures and 1466 venograms for IIH. These included an acute subdural hematoma from venous extravasation, cases of both intraprocedural and delayed stent thrombosis, an ultimately fatal cerebellar hemorrhage resulting in acute obstructive hydrocephalus, venous microcatheter perforation during venography and manometry, and a patient who developed subarachnoid hemorrhage and subdural hematoma after cerebellar cortical vein perforation. The six cases are reviewed and learning points regarding complication avoidance and management are presented. We report on six rare, major complications after VSS for IIH. Familiarity with these potential complications and appropriate timely management may allow for good clinical outcomes
Artery of Davidoff and Schechter: A Large Angiographic Case Series of Dural AV Fistulas.
The artery of Davidoff and Schechter (ADS) is the only meningeal branch of the posterior cerebral artery (PCA), supplying the medial tentorial margin and posterior portions of the falx. Given its small size, it is rarely identified on angiographic studies, unless enlarged in pathologies such as dural arteriovenous fistulas (DAVFs) or vascularized masses. This artery was first described by Wollschlaeger and Wollschlaeger in 1965, and to date, only a few reports have described its significance. The objective of this study is to report our experience with the ADS in dural fistulas from 2 tertiary medical centers and to emphasize the importance of recognizing this artery during angiographic examination of vascular tentorial and posterior fossa lesions. To our knowledge, this report demonstrates the largest angiographic case series published to date, recognizing a total of 7 patients with ADS arising secondary to a posterior fossa or tentorial DAVF and one of the largest reported series of DAVFs supplied by the ADS treated by endovascular and surgical techniques. Our cases validate the importance of prompt identification of the ADS for the diagnosis as well as endovascular treatment of vascular malformations in the posterior fossa and tentorial region
Distal radial artery (snuffbox) access for carotid artery stenting - Technical pearls and procedural set-up
PURPOSE: To report use of distal radial artery (dRA) access for carotid artery stenting (CAS) and to discuss procedural setup and technical considerations for a successful intervention.
METHODS: A retrospective review of our prospective neurointerventional database of CAS was conducted between May 2019 and March 2020. All CAS cases via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data was collected.
RESULTS: 22 CAS procedures in 20 patients via dRA were identified. Patients\u27 mean age was 69.4 years (range 53-87 years). 3 patients were female. Mean radial artery diameter was 2.1 mm (range 1.6-2.8 mm). dRA access was achieved in all cases. Conversion to femoral access was required in 2 cases (9.1%) due to persistent radial artery vasospasm resulting in patient discomfort despite multiple additional doses of intraarterial vasodilators and added intravenous sedation as well as tortuous vessel anatomy and limited support of the catheters in a type 3 aortic arch for left CAS.
CONCLUSION: Our preliminary experience with dRA access for CAS suggests this approach to be feasible and safe for patients. Technical considerations are important and preprocedural planning is necessary for a successful intervention. Catheter systems and devices specifically designed for radial access are needed to enable more interventionalists to safely perform neurointerventional procedures via wrist access
Abstract Number ‐ 9: Prospective Evaluation Of The Safety And Suitability Of The 088 Infinity Catheter For Radial Neurointerventions
Introduction Transradial access (TRA) for neuroendovascular interventions has been associated with multiple benefits, including decreased risk of complications, faster recovery times, and improved overall patient satisfaction in comparison to transfemoral access (TFA). We sought to assess the safety and suitability of an 088 catheter, in this case the Infinity guide catheter, to understand the optimal patient population for utilization in neurointerventions. To our knowledge, this is the first prospective study to investigate procedural characteristics and complications associated with the use of an 088 catheter. Methods After obtaining approval from our Institutional Review Board, prospective patients undergoing neurointerventional procedures at our institution, beginning from December 2020 to present, were serially enrolled after evaluation for suitability for TRA by ultrasound visualization and measurement of vessel diameter. A prospective Excel database was generated on an encrypted and password‐protected computer, with variables including patient demographics, co‐morbidities, procedure type, catheter specifics, vessel diameter, procedural characteristics, TRA to TFA conversion, and complications. Results 78 patients were enrolled over a 1.5 year study period (Table 1). The average patient age was 62.4 ± 16.1 years, with a moderate male predilection (46/78 (59%)). Procedure subtypes for enrolled patients included 36 (46.2%) patients who underwent stroke intervention, 6 (7.7%) aneurysm coil embolization, 9 (11.5%) aneurysm flow diversion, 5 (6.4%) carotid stenting, 5 (6.4%) AVM/AVF embolization, 4 (5.1%) tumor embolization, and 13 other procedures (9 (11.5%) MMA embolization, 3 (3.8%) vessel embolization, 1 (1.3%) aneurysm Onyx embolization). All procedures were performed via right radial access under direct ultrasound visualization. Average radial diameter was 2.97 ± 0.46mm and average fluoroscopy time was 48.99 ± 23.54 minutes. Parent vessel spasm was noted in 25/78 (32.1%) of cases and guide catheter kinking was noted in 4/78 (5.1%). TRA to TFA conversion was noted in 14/78 (17.9%) patients, primarily due to vessel tortuosity (57.1%; 8/14 cases). Minor complications included post‐procedural hand/wrist pain in 14/78 (17.9%) patients, and hand bruising in 6/78 (7.7%). Post‐operative vessel patency was noted in 71/78 (91%) of cases via ultrasound, with 57/78 (73.1%) having good pulsation noted on reverse Barbeau testing. No serious radial artery complications were noted. The overall rate of major complications was 7.7%, with two cases of ischemic stroke, contrast extravasation/intracerebral hemorrhage, and vessel rupture noted. Conclusions This prospective pilot study demonstrates the safety and suitability of the 088 Infinity guide catheter via TRA radial approach for neuroendovascular interventions. Further studies will be needed to assess the efficacy of the 088 Infinity in comparison to other 088 catheters, as well as the optimal settings by which we can minimize rates of TFA conversion and TRA‐related complications