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Lin Y, Chen Q, Zhang G, Xie L, Yang X, Zhong H, Xu J, Zhang M. Sodium octanoate alleviates cardiac and cerebral injury after traumatic cardiac arrest in a porcine model. Am J Emerg Med 2024; 78:48-56. [PMID: 38199096 DOI: 10.1016/j.ajem.2023.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Traumatic cardiac arrest (TCA) is a severe condition with a high mortality rate, and patients who survive from TCA face a poor prognosis due to post-resuscitation injury, including cardiac and cerebral injury, which remains a serious challenge. Sodium octanoate has shown protective effects against various diseases. The present study aims to investigate sodium octanoate's protective effects against cardiac and cerebral injury after TCA in a porcine model. METHODS The study included a total of 22 male domestic pigs divided into three groups: Sham group (n = 7), TCA group (n = 7), and sodium octanoate (SO) group (n = 8). Hemorrhage was initiated via the right femoral artery by a blood pump at a rate of 2 ml·kg-1·min-1 to establish TCA model. The Sham group underwent only endotracheal intubation and arteriovenous catheterization, without experiencing the blood loss/cardiac arrest/resuscitation model. At 5 min after resuscitation, the SO group received a continuous sodium octanoate infusion while the TCA group received the same volume of saline. General indicators were monitored, and blood samples were collected at baseline and at different time points after resuscitation. At 24 h after resuscitation, pigs were sacrificed, and heart and brain were obtained for cell apoptosis detection, iron deposition staining, oxidative stress detection, and the expression of ferroptosis-related proteins (ACSL4 and GPX4). RESULTS Sodium octanoate significantly improved mean arterial pressure, cardiac output and ejection fraction induced by TCA. Serum biomarkers of cardiac and cerebral injury were found to increase at all time points after resuscitation, while sodium octanoate significantly reduced their levels. The apoptosis rates of cardiomyocytes and cerebral cortex cells in the SO group were significantly lower than in the TCA group, along with a reduced area of iron deposition staining. The sodium octanoate also reduced oxidative stress and down-regulated ferroptosis which was indicated by protein level alteration of ACSL4 and GPX4. CONCLUSION Our study's findings suggest that early infusion of sodium octanoate significantly alleviates post-resuscitation cardiac and cerebral injury in a porcine model of TCA, possibly through inhibition of cell apoptosis and GPX4-mediated ferroptosis. Therefore, sodium octanoate could be a potential therapeutic strategy for patients with TCA.
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Affiliation(s)
- Yao Lin
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Qi Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Emergency Medicine, The First People's Hospital of Fuyang Hangzhou, Hangzhou, China
| | - Gongping Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Emergency Medicine, Lishui Municipal Central Hospital, Lishui, China
| | - Lutao Xie
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Emergency Medicine, Lishui Municipal Central Hospital, Lishui, China
| | - Xuelin Yang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Emergency Medicine, Lishui Municipal Central Hospital, Lishui, China
| | - Huiming Zhong
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Jiefeng Xu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
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Uyanik M, Yildirim U, Avci B, Soylu K. Assessment of silent brain injury in patients undergoing elective percutaneous coronary intervention due to chronic total occlusion. Scand Cardiovasc J Suppl 2023; 57:25-30. [PMID: 36443919 DOI: 10.1080/14017431.2022.2150786] [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: 11/30/2022]
Abstract
Objective: Silent brain infarcts (SBI) are thromboembolic complications associated with cardiac surgery, diagnostic angiography, and percutaneous interventions. Serum neuron-specific enolase (NSE) is the proven biomarker for measuring neuronal damage. This study aimed to evaluate the incidence of SBI, defined as elevated NSE after coronary chronic total occlusion (CTO) intervention and elective coronary stenting. Design: The study population consisted of two patient groups: the CTO group included consecutive patients with coronary CTO intervention, and the control group consisted of patients who underwent elective coronary intervention. NSE blood levels were measured before and 12-18 h after the procedure. NSE blood levels of >20 ng/mL were considered SBI. Results: A total of 108 patients were included in the study. Of these, 55 (50.9%) had SBI after the procedure. The SBI rate was 59.7% in the CTO group and 39.1% in the control group. Patients with SBI were more likely to have diabetes mellitus, hyperlipidemia, higher HbA1c, higher total stent length, and longer procedural time. Multivariate logistic regression analysis showed that CTO procedure (odds ratio [OR]: 3.129; 95% confidence interval [CI]: 1.246-7.858; p < 0.015) and diabetes mellitus (OR: 2.93; 95% CI: 1.185-7.291; p < 0.020) are independent predictors of SBI. Conclusion: Our data suggest that SBI occurs more frequently after CTO intervention than after non-CTO intervention. Intervention complexity and patient clinical characteristics may explain the increased incidence.
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Affiliation(s)
- Muhammet Uyanik
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Ufuk Yildirim
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Bahattin Avci
- Faculty of Medicine, Department of Biochemistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Korhan Soylu
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
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Arslan U, Erdoğan G, Yenerçağ M, Aksan G, Uçar M, Görgün S, Akpinar ÇK, Öztürk O, Yontar OC, Karagöz A. Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2029-2039. [PMID: 37358708 DOI: 10.1007/s10554-023-02895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. METHODS A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. RESULTS TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. CONCLUSIONS Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.
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Affiliation(s)
- Uğur Arslan
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey.
| | - Güney Erdoğan
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Mustafa Yenerçağ
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Melisa Uçar
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Selim Görgün
- Department of Microbiology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Çetin Kürşat Akpinar
- Department of Neurology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Onur Öztürk
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Ahmet Karagöz
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
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Smith JC. Feasibility of Transtibial Access for Uterine Artery Embolization. J Vasc Interv Radiol 2022; 33:554-557. [PMID: 35489785 DOI: 10.1016/j.jvir.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/04/2022] [Accepted: 02/06/2022] [Indexed: 10/18/2022] Open
Abstract
Ten women with a mean body mass index of 31.5 kg/m2 and symptomatic uterine pathology underwent uterine artery embolization (UAE) via transtibial access (TTA). Nine out of 10 UAEs were successfully performed via TTA, with 2 minor adverse events. Outpatients with leiomyomas had stable to improved symptoms at follow-up; hospitalized patients with abnormal uterine bleeding from malignant tumors or arteriovenous malformations were discharged shortly after UAE with the cessation of hemorrhage. TTA is a feasible alternative for UAE for patients with obesity, diminutive radial arteries, or atherosclerosis that may confer an added risk of rare neurologic adverse events from transradial access.
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Affiliation(s)
- Jason C Smith
- Division of Interventional Radiology, Department of Radiology, Loma Linda University Health, Loma Linda, California.
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Goksuluk H, Ozyuncu N, Duzen IV, Vurgun VK, Tan TS, Gulec S. Comparison of frequency of silent cerebral infarction as assessed by serum neuron specific enolase in patients with non-valvular atrial fibrillation: Warfarin versus direct oral anticoagulant. Acta Cardiol 2022; 78:320-326. [PMID: 35469540 DOI: 10.1080/00015385.2022.2066777] [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: 11/01/2022]
Abstract
BACKGROUND Cerebral infarction in patients with atrial fibrillation (AF) may clinically vary from being silent to catastrophic. Silent cerebral infarction (SCI) is the neuronal injury in the absence of clinically appearent stroke or transient ischaemic attack. Serum neuron specific enolase (NSE) is suggested to be a valid surrogate biomarker that allows to detect recent neuronal injury. We aimed to evaluate the incidence of recent SCI by positive NSE levels in patients with non-valvular AF (NVAF) on oral anticoagulants. METHODS Blood samples for NSE were collected from 197 consecutive NVAF patients. NSE levels of greater than 12 ng/ml was considered as positive and suggestive of SCI. RESULTS Patients were mainly female with a mean age of 69 years. Ninety-eight of them (49.7%) were taking warfarin. Mean INR level was 2.3 ± 0.9. Mean CHA2DS2-VASc score of the study population was 3.5 ± 1.5. Seventy-two patients (36.5%) were found to have NSE elevation. They were more likely to have history of chronic heart failure and previous stroke/TIA. Increased left atrial diameter and higher CHA2DS2-VASc were other factors associated with SCI. Patients on DOACs and patients taking aspirin on top of oral anticoagulant treatment were less likely to have SCI. Multivariate analysis demonstrated that increased left atrial diameter (OR: 2.5; 95% CI: 1.52-4; p < 0.001) and use of warfarin (OR: 2.8; 95% CI: 1.37-5.61; p = 0.005) were detected as independent predictors of SCI. CONCLUSIONS Our study revealed that DOACs were associated with significantly reduced SCIs compared with warfarin, probably due to more effective and consistent therapeutic level of anticoagulation.
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Affiliation(s)
- Huseyin Goksuluk
- Cardiology Department, Istinye University Bahcesehir Liv Hospital, Istanbul, Turkey
| | - Nil Ozyuncu
- Cardiology Department, Ankara University, Ankara, Turkey
| | | | | | | | - Sadi Gulec
- Cardiology Department, Ankara University, Ankara, Turkey
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Zuin M, Rigatelli G, Zuliani G. Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults. JAMA 2021; 326:1212-1213. [PMID: 34581746 DOI: 10.1001/jama.2021.11976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Nakamura Y, Nishijima S, Kuroda M, Nakayama T, Tsuruta R, Yoshiyama D, Yasumoto Y, Ito Y. Perfusion strategy using axillary or femoral cannulation for minimally invasive cardiac surgery: experience in 270 patients with computed tomography-based criteria. Eur J Cardiothorac Surg 2021; 59:1200-1207. [PMID: 33448282 DOI: 10.1093/ejcts/ezaa469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/18/2020] [Accepted: 11/25/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES In patients with atherosclerotic disease, minimally invasive cardiac surgery using retrograde perfusion for cardiopulmonary bypass via femoral cannulation (FC) carries a higher risk of brain embolization compared with antegrade perfusion. However, guidelines for selecting antegrade versus retrograde perfusion do not exist. We developed a computed tomography (CT)-based perfusion strategy and assessed outcomes. METHODS We studied 270 minimally invasive cardiac surgery patients, aged 68 ± 13, 124 female, body surface area 1.6 ± 0.2 m2. Antegrade perfusion using axillary cannulation (AC) was selected if any of the following preoperative enhanced CT scan criteria were satisfied anywhere in the aorta or iliac arteries: thrombosis thickness >3 mm, thrombosis >one-third of the total circumference and calcification present in the total circumference. FC was selected otherwise. Asymptomatic brain injury was assessed by diffusion-weighted magnetic resonance imaging. RESULTS AC and FC were selected in 95 (35%) and 175 patients, respectively. AC patients were 10 years older (P < 0.001) and had higher EuroSCORE II (2.7 ± 3.4 vs 1.7 ± 1.9, P = 0.002). The median cardiopulmonary time and cross-clamp times were not significantly different. No patients died in hospital. There was no immediate stroke in either group during 48 h after surgery. Asymptomatic brain injury was detected in 25 (26%) and 27 (15%) AC and FC patients, respectively, P = 0.03. CONCLUSIONS We believe our CT-based perfusion strategy using AC or FC minimized brain embolic rates. AC can be a good alternative to prevent brain embolization for minimally invasive cardiac surgery patients with advanced atherosclerotic disease.
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Affiliation(s)
- Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Shuhei Nishijima
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan
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Reed GW, Krishnaswamy A, Kapadia SR. Silent brain infarction after TAVR: common but of unclear significance. Eur Heart J 2021; 42:1016-1018. [PMID: 33693578 DOI: 10.1093/eurheartj/ehaa1110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Grant W Reed
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
| | - Amar Krishnaswamy
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
| | - Samir R Kapadia
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
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Weinberg JH, Sweid A, Hammoud B, Asada A, Greco-Hiranaka C, Piper K, Gooch MR, Tjoumakaris S, Herial N, Hasan D, Zarzour H, Rosenwasser RH, Jabbour P. A comparative study of transradial versus transfemoral approach for flow diversion. Neuroradiology 2021; 63:1335-1343. [PMID: 33560470 DOI: 10.1007/s00234-021-02672-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Data in neurointerventional literature is extremely limited regarding the safety and efficacy of flow diversion using transradial access (TRA). We aim to demonstrate the safety and efficacy of intracranial aneurysm treatment with the Pipeline Embolization Device (PED) using TRA compared to transfemoral access (TFA). METHODS We conducted a retrospective analysis of a prospectively maintained database and identified 79 consecutive patients who underwent neuroendovascular embolization for cerebral aneurysms using the PED from April 2018 through October 2019. Patients were divided into 2 groups: TRA (32 patients) and TFA (47 patients). A comparative analysis was performed between the two groups. RESULTS There was no significant difference in postoperative intracranial hemorrhage (p>.99), symptomatic ischemic stroke (p=.512), access site complications (p=.268), or other complications (p=.512). However, there was a significant increase in overall complications (14.9% vs. 0.0%, p=.038) and procedure duration (71.4 min ± 31.2 vs. 58.5 ± 20.3, p=.018) in the TFA group. There was no significant difference in complete occlusion at latest follow-up (19/25, 76.0% vs. 35/40, 87.5%; p=.311), 6-month follow-up (17/23, 73.9% vs. 33/38, 86.8%; p=.303), or 12-month follow-up (8/8, 100.0% vs. 5/6, 83.3%; p=.429). There was also no significant difference in rate of retreatment (p>.99), morbidity (p=.512), mortality (p>.99), latest follow-up (p=.985), or loss of follow-up (p=.298). CONCLUSIONS The feasibility and efficacy of flow diversion with the PED via TRA for the treatment of intracranial aneurysms is comparable to TFA. Widespread adoption of this approach may be facilitated by improvements in device navigation and manipulation via radial-specific engineering.
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Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Batoul Hammoud
- Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashlee Asada
- Drexel University College of Medicine, Drexel University, Philadelphia, PA, USA
| | | | - Keenan Piper
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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In Response to: Weighing the pros and cons of radial access for the endovascular management of trauma patients. J Trauma Acute Care Surg 2020; 89:e189-e190. [PMID: 32890349 DOI: 10.1097/ta.0000000000002929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non-CTOs. Int J Cardiovasc Imaging 2020; 36:2107-2113. [PMID: 32681317 DOI: 10.1007/s10554-020-01939-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12 h after the interventions. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.
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Nishijima S, Nakamura Y, Yoshiyama D, Yasumoto Y, Kuroda M, Nakayama T, Tsuruta R, Ito Y, Shikata F, Takeda T, Kato N. Silent brain infarction after minimally invasive cardiac surgery with retrograde perfusion. J Card Surg 2020; 35:1927-1932. [PMID: 32667074 DOI: 10.1111/jocs.14866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM There is no report on silent brain infarction (SBI) after minimally invasive cardiac surgery (MICS) with retrograde perfusion. Thus, the current study aimed to investigate the incidence of SBI after MICS using magnetic resonance imaging (MRI). METHODS This study included 174 patients who underwent MICS with retrograde perfusion between July 2014 and July 2018. Preoperative computed tomography (CT) angiography was routinely performed and vascular pathology was evaluated for patient selection. Postoperative MRI was performed to investigate the occurrence of SBI. RESULTS Out of the total 174 patients, 26 (14.9%) presented with SBI. A total of 61 SBI lesions were found in the 26 patients; of these, 34 (56%) SBI lesions were in the right hemisphere and 27 (44%) in the left hemisphere. SBIs were primarily observed in the posterior cerebral artery territory. Multivariate analysis revealed aortic stenosis to be the only risk factor of SBI. CONCLUSIONS Retrograde perfusion via femoral cannulation may not increase the incidence of SBI in selected MICS patients based on preoperative CT findings.
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Affiliation(s)
- Shuhei Nishijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Tetsuji Takeda
- Department of Neuro Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
| | - Nobuyuki Kato
- Department of Radiology, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
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Smith JC, Cho AL, Fujimoto ST. Tibial access for supra-inguinal embolization in extremely obese patients. CVIR Endovasc 2020; 3:15. [PMID: 32147759 PMCID: PMC7061097 DOI: 10.1186/s42155-020-00105-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Extreme obesity is a risk factor for hemorrhagic complications of femoral access (FA). Femoral lines, hematomas, pelvic binders and coagulopathy in the trauma scenario may also add difficulty and/or risk to FA. Radial access (RA) for routine peripheral endovascular procedures has been popularized owing to decreased hemorrhagic complications, increased patient satisfaction, and decreased operator radiation dose. However, though uncommon, cerebrovascular complications from RA approach are a known risk. Relatively recently, tibial access (TA) has been used for lower extremity peripheral vascular disease interventions. The advantages of TA mirror that of RA, with few and mostly minor complications, and the risk of iatrogenic cerebral embolization is nil. We report the feasibility of TA for supra-inguinal embolization in two extremely obese patients {body mass index > 40 kg/m2} following motor vehicle accidents. Commercially available base and microcatheters were used to perform embolization of the affected lower abdominal or pelvic arteries in standard fashion via a novel trans-tibial artery approach.
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Affiliation(s)
- Jason C Smith
- Department of Radiology, Loma Linda University, 11234 Anderson Street, Loma Linda, California, 92354, USA.
| | - Alex L Cho
- Department of Radiology, Loma Linda University, 11234 Anderson Street, Loma Linda, California, 92354, USA
| | - Scott T Fujimoto
- Department of Radiology, Loma Linda University, 11234 Anderson Street, Loma Linda, California, 92354, USA
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