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PubMed2001

[Intracardial thrombosis and primary antiphospholipid syndrome. A familial case report].

The main clinical manifestation of antiphospholipid syndrome is repeated thrombotic events in young patients without cardiovascular risk factors. There are several clinical features but the most frequent ones are repeated fetal losses and acute cerebral ischemic events. Cardiac involvement is less frequent. We present a family case with intracardiac thrombosis and secondary cerebral embolism.

Adult↗
PubMed2004

Thrombectomy for acute internal carotid thrombosis: five thrombectomy devices compared.

OBJECTIVE: To test the safety and efficiency of commercially available thrombectomy catheters in clearing simulated internal carotid artery (ICA) thrombosis. DESIGN: Comparative in vitro study. MATERIALS AND METHODS: A model of the ICA was filled with human thrombus, the 'circle of Willis' back pressure was set at either 10 or 30 cm of water. Five thrombectomy devices (Hydrolyser, Clot Buster, Acolysis System, AngioJet and Fogarty embolectomy catheter) were compared for (i) efficiency at removing thrombus, (ii) pressure changes at the tip of each device, and (iii) distal embolisation by flow cytometry. RESULTS: Thrombus clearance was greatest with the AngioJet (median 95%, range 92-97%) and least with the Acolysis System (median 34%, range 12-50%). The Clot Buster and Hydrolyser were safest as they produced only negative tip pressures, the AngioJet and Balloon catheter produced positive and negative pressures risking distal embolisation. The Acolysis system produced no pressure change during use. Distal embolisation (of particles between 5 and 40 microm diameter) was greatest with the Fogarty balloon catheter at 10 cm water (P<0.05) and least with the Hydrolyser and Clot Buster. CONCLUSION: Balloon embolectomy for ICA thrombosis risks further embolic cerebral damage. The Hydrolyser and the Clot Buster show the greatest promise for ICA thrombectomy.

Acute Disease↗
PubMed2001

Impact of immediate cerebral angiography for in-hospital cerebral thromboembolism after cardiovascular surgery.

OBJECTIVES: Postoperative stroke remains a serious problem in cardiovascular surgery. We studied the role of cerebral angiography in postcardiotomy stroke. METHODS: We retrospectively analyzed 5 in-hospital patients with stroke due to cerebral thromboembolism after cardiovascular surgery. RESULTS: The incidence of in-hospital cerebral thromboembolism was 0.5%, involving 5 patients among 913 adults undergoing cardiovascular operations. In-hospital cerebral thromboembolism occurred 3 to 9 days (average: 7 +/- 2 days) after surgery. Causes of cerebral thromboembolism were chronic atrial fibrillation in 1, transient atrial fibrillation in 2, artificial valve in 1, and intracranial arterial stenosis in 1. Immediate cerebral angiography, after exclusion of intracranial hemorrhage and complete cerebral infarction by computed tomography, revealed cerebral embolism in 3 and cerebral thrombosis in 2 with occlusion or stenosis of intracranial arteries. Local intraarterial administration of a thrombolytic agent was done in the 3 patients with cerebral embolism and occluded arteries were recanalized. Fibrinolysis was not done in 2 because of recanalized arteries or sufficient peripheral blood supply through collateral feeders. No patients exhibited rebleeding into the pericardial space or wound bleeding. All patients survived with moderate or full functional recovery. CONCLUSION: Immediate cerebral angiography with/without local thrombolysis may improve functional outcome and survival in patients with postcardiotomy cerebral thromboembolism.

Aged↗