Apixaban for massive intracoronary thrombosis: A case series.
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ABSTRACT:
SUBMITTER: Esenboga K
PROVIDER: S-EPMC8443197 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:A woven coronary artery is a rare congenital coronary anomaly and incidentally found in coronary angiogram. Coronary angiography is the major diagnostic modality, which shows the main trunk of coronary divides into several channels which later reconnect with normal blood flow (J Int Cardiol 113:121-123 2006). However, some cases and reviews inferred that this characteristic might be mimicked by recanalized coronary thrombus, which occurs following thrombotic occlusion. In some case, the multiple intraluminal channels have a 'Swiss cheese', a 'Spider web-like', a 'Honeycomb' or a 'Lotus root' appearance and most of them appear in local segment (Int J Cardiol 186: 239-240, 2015). As these images are nonspecific findings, there is no angiographic uniform definition of intracoronary thrombus. More information about the characteristics and the development of this woven-like structure is needed. CASE PRESENTATION:A 67-year-old male patient was admitted to our hospital because of chest pain. Coronary artery angiogram revealed that the right coronary artery (RCA) divided into multiple thin channels from proximal to distal, which was similar to the so-called woven coronary artery. Compared with his prior coronary angiograms which showed a tiny hazy lesion in distal segment of RCA, we found the woven-like phenomena should be caused by a late-stage recanalized coronary thrombus. Percutaneous coronary intervention (PCI) was performed to restore the RCA flow, and the angina symptom was extremely improved during clinical follow-up. CONCLUSIONS:The diagnostic criteria of woven coronary artery was based on angiographic image. However, some cases and reviews inferred that thrombotic recanalization might also share the same characteristic. In this case, we collected the baseline angiograms and intracoronary images then successfully diagnosed the woven-like RCA as thrombotic recanalization. For this kind of woven-like coronary artery, PCI could be a better treatment strategy. Detailed history collection and intracoronary image techniques should be emphasized in future clinical practice in the differentiating and treatment of woven-like phenomena.
| S-EPMC6936085 | biostudies-literature
Project description:BackgroundIntraventricular masses are a relatively rare condition ranging from asymptomatic to potentially life-threatening situations.Case summaryHerein, we report a case of a 49-year-old woman under investigation for a massive right ventricular (RV) mass who underwent complete investigation for possible differential diagnosis, in the suspect of RV tumour. Multimodality imaging with cardiac computed tomography and magnetic resonance imaging showed the presence of a massive thrombus partially obliterating the right ventricle. Surgical removal of the mass showed a large area of stratified thrombosis with an underlying area of endocardial fibrosis. The patient has been then discharged in good clinical condition and with lifetime oral anticoagulation.DiscussionMassive RV thrombosis is a rare yet potentially fatal condition. Invasive management is preferable and lifetime anticoagulation is required to reduce possible downstream thrombotic complications.
| S-EPMC8343560 | biostudies-literature
Project description:BackgroundData regarding thrombosis after COVID-19 vaccination are scarce.MethodsClinical and laboratory data were collected from all patients who developed thrombosis within 4 weeks of receiving the Pfizer or Oxford/AstraZeneca vaccine. None had a COVID-19-positive swab.ResultsSeventeen patients were included, with average age of 48.8 years and equal proportion of females to males. Our data suggest that thrombosis occurred in 1 in 163,000 of all individuals who had received any dose of any type of COVID-19 vaccine: six (1 in 123,000) patients after the first dose of Oxford/AstraZeneca, none after the second dose of Oxford/AstraZeneca, four (1 in 257,000) patients after the first dose of the Pfizer vaccine, and seven (1 in 102,000) patients after the second dose of Pfizer vaccine. Three of 17 patients with thrombosis (17.6%) died.ConclusionsWe believe this report to be one of the earliest in the literature to address the question of whether isolated thrombosis is a possible complication of COVID-19 vaccination.
| S-EPMC8734543 | biostudies-literature
Project description:The coronavirus disease 2019 (COVID-19) pandemic originated from Wuhan, China, in late 2019. In addition to the respiratory system, COVID-19 also affects other organ systems. The disease can lead to cardiovascular complications such as myocarditis, acute myocardial infarction, acute heart failure, and venous thromboembolism; patients with COVID-19 experience more thrombotic events than non-COVID-19 patients. A 50-year-old male cigarette smoker presented to the emergency department (ED) with typical chest pain. His electrocardiography (ECG) showed an anterior STEMI. He developed multiple episodes of ventricular fibrillation (VF) and received defibrillator shocks. His angiogram showed thrombotic severe in-stent restenosis (ISR) of the left anterior descending (LAD) artery stents. A 70-year-old diabetic hypertensive woman presented to the ED with dyspnea and chest pain. The patient had undergone angioplasty two times beforehand, and a fresh angiogram revealed severe thrombotic ISR of LAD stents and another far midpart lesion after the stents. She underwent successful percutaneous coronary intervention (PCI). A 54-year-old man presented to the ED with typical chest pain commencing an hour beforehand. He had undergone angioplasty about 10 years earlier. The patient received the Oxford/AstraZeneca COVID-19 vaccine 36 h before developing chest pain. The ECG revealed an infero-posterior STEMI, and the angiogram depicted thrombotic occluded ISR in the RCA. The patient underwent successful PCI. Patients with COVID-19 or even with COVID-19 vaccination experience stent thrombosis due to a hypercoagulable state. Hence, we need standard guidelines to prevent stent thrombosis.
| S-EPMC9117711 | biostudies-literature
Project description:Background?:Pathological studies have reported that patients with acute coronary syndrome (ACS) may have different plaque morphologies at culprit lesions, and one of the underlying mechanisms for ACS is plaque erosion. However, the morphological features of plaque erosion obtained by multiple intracoronary imaging modalities have not been fully elucidated. Case summary?:We experienced two cases with ACS of culprit lesions exhibiting optical coherence tomography (OCT)-defined plaque erosion. Additional examinations using near-infrared spectroscopy (NIRS)-intravascular ultrasound and coronary angioscopy suggested the presence of two distinct phenotypes of plaque erosion. These two types of erosion differ in the extent of NIRS-derived lipid core burden and coronary angioscopy-derived luminal surface colour. Discussion?:OCT-defined plaque erosion may not be the unique entity but have at least two distinct plaque morphologies, and NIRS and/or coronary angioscopy may provide incremental ability of discriminating these plaque phenotypes classified as plaque erosion by OCT.
| S-EPMC7047054 | biostudies-literature
Project description:INTRODUCTION:Incarceration and necrosis of rectal prolapse is rare but when it occurs it requires urgent management. Perineal rectosigmoidectomy (Altemeier's procedure) may be a reasonable approach for the treatment of this condition. In some cases, a diverting stoma may be necessary. METHODS:We report two cases of incarcerated massive rectal prolapse, one of which also manifested tissue necrosis, that were successfully treated with perineal rectosigmoidectomy. In one case a diverting colostomy was required. Both patients recovered uneventfully. RESULTS:A literature review was performed to determine the optimal management of incarcerated and necrotic rectal prolapse, and to determine the indication for fecal diversion. CONCLUSION:Perineal rectosigmoidectomy (Altemeier's procedure) can be utilized in emergency circumstances and, in our experience, the procedure was both safe and effective. The need for fecal diversion depends on the condition of the patient and the experience and judgement of the surgeon.
| S-EPMC6170932 | biostudies-literature
Project description:BackgroundVitamin K antagonists (VKAs) have been regarded as the therapy of choice for intracardiac thrombosis for decades based mostly on observational data. The advent of direct oral anticoagulants (DOACs) has displaced VKAs as the first-line therapy for multiple thrombotic disorders but not for intracardiac thrombosis. Although limited, there is growing evidence that DOACs are effective for intracardiac thrombosis and some data suggest that thrombus resolution might be superior to that with warfarin.Case summaryHere, we present a series of six patients with left atrial appendage thrombi were treated with a venous thromboembolic dose of DOACs with resolution within 2-6 months with no reported complications.DiscussionThis case series adds to the accumulating evidence supporting the efficacy of DOACs in the treatment of intracardiac thrombi.
| S-EPMC7649461 | biostudies-literature
Project description:BackgroundThe prevalence of cement embolism after percutaneous vertebroplasty ranges from 2.1 to 26%, in literature. Even if most cases remain asymptomatic, intracardiac cement embolism becomes symptomatic in up to 8.3% of the cases.Case summaryWe report a case series of two cases with massive cardiopulmonary cement embolism, which lead to perforation of the right ventricle and needed cardiothoracic surgery.DiscussionAs this entity affects different fields of medical specialties and may lead to fatal outcome, we believe that the efforts of better understanding its development, avoidance, detection, and treatment need to be intensified. For this purpose, systematic and interdisciplinary studies to follow up patients after vertebroplasty are needed.
| S-EPMC9511273 | biostudies-literature
Project description:IntroductionInvolvement of the large vessels is rarely reported and poorly understood in cases of Corona virus disease-19 (COVID-19). The aim of this study is to present a series of cases with large vessel thrombosis (LVT).MethodsThis is a multicenter prospective case series study. The participants were consecutive in order. All the patients were diagnosed as cases of COVID-19 with documented LVT were included in the study. Large vessels were defined as any vessel equal or larger than popliteal artery. The mean duration of follow up was 4 months.ResultsThe study included 22 cases, 19 (86.4%) cases were male, 3 (13.6%) patients were females. The age ranged from 23 to 76 with a mean of 48.4 years. Four (18.2%) cases had pulmonary embolism confirmed by IV contrast enhanced chest CT scan. All of the cases showed pulmonary parenchymal ground glass opacities (GGO) and high D-Dimers (ranging from 1267 to 6038 ng/ml with a mean of 3601 ng/ml).ConclusionCOVID-19 is a hidden risk factor of LVT that may endanger the patient's life and lead to major amputation. Despite therapeutic anticoagulants still all COVID-19 patients are at risk for LVT, a high index of suspicion should be created and with minimal symptoms surgical consultation should be obtained.
| S-EPMC7658560 | biostudies-literature
Project description:BackgroundPrimary percutaneous coronary intervention (PCI) is the cornerstone of management for ST-elevation myocardial infarction (STEMI). However, large intracoronary thrombus burden complicates up to 70% of STEMI cases. Adjunct therapies described to address intracoronary thrombus include manual and mechanical thrombectomy, use of distal protection device and intracoronary anti-thrombotic therapies.Case summaryThis series demonstrates the use of intracoronary thrombolysis in the setting of large coronary thrombus, bifurcation lesions with vessel size mismatch, diffuse thrombosis without underlying plaque rupture, and improving coronary flow to allow vessel wiring and proceeding to definitive revascularization.DiscussionLarger intracoronary thrombus burden correlates with greater infarct size, distal embolization, and the associated no-reflow phenomena, and propagates stent thrombosis, with subsequent increase in mortality and major adverse cardiac events. Intracoronary thrombolysis may provide useful adjunct therapy in highly selected STEMI cases to reduce intracoronary thrombus and facilitate revascularization.
| S-EPMC7649476 | biostudies-literature