scholarly journals Cryptogenic Stroke and Valvular Strands

2020 ◽  
Author(s):  
Cátia Castanheira Figueiredo ◽  
Carla Sofia Rebelo ◽  
Joana Lemos
Keyword(s):  
Aortic Valve ◽  
Ischaemic Stroke ◽  
Transesophageal Echocardiography ◽  
Anticoagulant Therapy ◽  
Correct Diagnosis ◽  
Cryptogenic Stroke ◽  
Case Description ◽  
Vascular Events ◽  
Antiaggregant Therapy

Background: Ischaemic stroke can be classified according to its aetiology. In cryptogenic stroke, Lambl’s excrescences should be considered since they can only be detected through transesophageal echocardiography (TEE), which is not routinely performed. Case description: The authors report the case of a 63-year-old Caucasian man with two ischaemic cerebral events associated with the presence of Lambl’s excrescences in the aortic valve detected with TEE. Switching antiaggregant therapy to anticoagulant therapy allowed the patient to remain asymptomatic throughout a 3-year follow-up. Conclusion: The lack of protocols for the management of cryptogenic stroke results in a delay in the identification of less frequent causes of stroke, leading to recurrent vascular events, morbidity and loss of functionality. The authors describe a patient who experienced multiple cerebral ischaemic events until the correct diagnosis was made.

scholarly journals Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yangyang Han ◽  
Xiquan Zhang ◽  
Fengwei Zhang
Keyword(s):  
Body Weight ◽  
Contrast Agents ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Percutaneous Closure ◽  
X Rays ◽  
Foramen Ovale ◽  
Pfo Closure

Abstract Background Percutaneous closure of patent foramen ovale (PFO) is routinely performed using plain fluoroscopy in the catheter room. This method results in inevitable radiation damage, adverse effects of contrast agents on kidneys, and high cost. We performed PFO closure with a simplified and economical transesophageal echocardiography (TEE)-only guided approach in the operating room. This study aimed to investigate the feasibility, safety, and effectiveness of the percutaneous closure of PFO by only using TEE. Methods We reviewed the medical records of patients who underwent percutaneous PFO closure at our center from December 2013 to December 2017. A total of 132 patients with PFO and cryptogenic strokes underwent PFO closure by using cardi-O-fix PFO device under TEE guidance. The participants comprised 64 and 68 male and female patients, respectively. The mean age and body weight of the patients were 39.40 ± 13.22 years old (12–68 years old) and 65.42 ± 9.70 kg (40–95 kg), respectively. All patients only received aspirin (3–5 mg/kg body weight, oral administration) for 6 months. Contrast-enhanced transthoracic echocardiography (c-TTE) with Valsalva maneuver was performed during follow-up, and questionnaire surveys were obtained at 3, 6, and 12 months after the procedure. Results All (100%) patients were successfully closed. Follow-ups were conducted for 13 months to 48 months, with an average of 27 months. No severe complications were found during the follow-up period. Paroxysmal atrial fibrillation occurred in 4 patients within 3 months after the procedure. No recurrent stroke or death occurred in all patients during the follow-up period. Transient ischemic attack occurred in one patient 6 months after the procedure. Ten (7.6%) patients had a right-to-left shunt, as demonstrated by c-TTE at 12 months of follow-up. Among the 57 patients suffering from migraine, significant relief or resolution was reported by 42 (73.7%) patients. Conclusion TEE-only guided PFO closure was a safe, feasible, and effective method that did not require the use of X-rays and contrast agents.

Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography

Cardiology ◽  
2016 ◽  
Vol 137 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Alexandra Goncalves ◽  
Charles Nyman ◽  
David R. Okada ◽  
Avinainder Singh ◽  
Jeffrey Swanson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Transthoracic Echocardiography ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Overall Mortality

Background: We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results: TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Conclusions: Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.

scholarly journals Use of aspirin in Chinese after recovery from primary intracranial haemorrhage

2012 ◽  
Vol 107 (02) ◽  
pp. 241-247 ◽  
Author(s):  
Boon-Hor Chong ◽  
Koon-Ho Chan ◽  
Vincent Pong ◽  
Kui-Kai Lau ◽  
Yap-Hang Chan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Chinese Patients ◽  
Vascular Events ◽  
Coronary Syndrome ◽  
Anti Platelet Therapy ◽  
Anti Platelet Agent ◽  
Increased Risk

SummaryIntracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996–2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07–3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06–3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.

scholarly journals P1526 Updated prevalence of lambls excrescences using the latest three-dimensional transesophageal echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Takahashi ◽  
K Kusunose ◽  
S Hayashi ◽  
S Morita ◽  
Y Torii ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Transesophageal Echocardiography ◽  
Severe Aortic Stenosis ◽  
Cryptogenic Stroke ◽  
Three Dimensional ◽  
Poor Quality ◽  
Prosthetic Valves ◽  
And Gender ◽  
Right Coronary Cusp

Abstract Background Lambl’s excrescences (LEs), filiform strands that occur at sites of cardiac valves, have been suggested the cause cryptogenic stroke. The diagnosis is primarily based upon the echocardiographic study, but conventional two-dimensional transthoracic echocardiography has limitation to detect such as small strands. Latest three dimensional-transesophageal echocardiography (3D-TEE) have high-resolution images with many slices, so small structures are able to be clearly visible and detected. Purpose The aim of this study was to assess the prevalence of LEs using the latest 3D-TEE images. Methods We retrospectively reviewed consecutive 140 patients who underwent 3D-TEE from November 2018 to May 2019. Forty-seven patients were excluded due to unmeasurable, such as mitral valve prolapse, severe aortic stenosis, prosthetic valves and poor-quality images. We carefully evaluated the mitral and aortic valve leaflets in order to find mobile string structure (diameter &lt;1 mm and length 1–20 mm) in each cardiac cycle. Total analyzed images were over 50 slices per one patient. Results Among 93 patients, 83 patients (89%) was detected the presence of LEs. No difference in age and gender were found between patients with LEs and patients without LEs. Of the total 83 patients, there were 35 patients with strands on mitral valve, 32 patients with strands on aortic valve, and 16 patients with strands on both valves. Distribution of LEs at each valve leaflet were shown in Figure. Right coronary cusp of aortic valve (42%) and P2 of mitral valve (35%) were high prevalence among leaflets. Conclusions 3D-TEE provides an update prevalence of LEs. The prevalence of LEs might be potentially high in the real world. Abstract P1526 Figure.

scholarly journals Evolution of Left Atrial Thrombus with Anticoagulant Therapy-Follow-up by Transesophageal Echocardiography

1995 ◽  
Vol 10 (2) ◽  
pp. 143-145 ◽  
Author(s):  
Cheol Ho Kim ◽  
Seung Woo Park ◽  
Joo Hee Zo ◽  
Byung Hee Oh ◽  
Myoung Mook Lee ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Anticoagulant Therapy ◽  
Left Atrial ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus

scholarly journals Transcatheter Patent Foramen Ovale Closure Guided Only by Transesophageal Echocardiography Without fluoroscopy

2020 ◽  
Author(s):  
Tianli Zhao ◽  
Qin Wu ◽  
Hendrik Ruge ◽  
Rüdiger Lange ◽  
Yifeng Yang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Clinical Experiences ◽  
Serious Adverse Events ◽  
Ischemic Attack ◽  
Pfo Closure

Abstract Background Standby of transesophageal echocardiography (TEE) is necessary for any PFO closure in case of some cases with complicated anatomy of patent foramen ovale (PFO). The safety and effectiveness of Transcatheter PFO closure guided only by TEE navigation without fluoroscopy is unclear.Methods From 2017.06 to 2019.11, we included 38 patients who were recommended for PFO closure by the department of neurology at our hospital. The procedure was performed in a regular operating room by TEE navigation without fluoroscopy. Follow-up was given at 1st month, 3rd month, 6th month, 1st year and 2nd year after operation for each patient.Results All 38 patients were successfully performed PFO-closure guided by TEE. Procedural and intrahospital survival was 100%. Survival after a mean follow-up of 17.1±1.6months was 100%. "Catheter in sheath” technique was adopted in 16 cases. After the procedure, all 28 migraines with aura alleviated at different degree. All 10 patients suffering from pre-operational cryptogenic stroke survived and showed no evidence for recurrence of stroke (fatal or non-fatal), peripheral embolism or transient ischemic attack during follow-up. No serious adverse events in the PFO closure procedure and during the follow-up period.Conclusion First clinical experiences showed that percutaneous TEE guided PFO closure is safe and effective and might be promoted.

Abstract WP240: Association Between Mitral and Annular Calcification or Aortic Valve Calcification and Complex Aortic Atheroma in Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kentaro Ishizuka ◽  
Takao Hoshino ◽  
Kyomi Ashihara ◽  
Kazuo Kitagawa
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Aortic Valve ◽  
Transesophageal Echocardiography ◽  
Cryptogenic Stroke ◽  
Aortic Valve Calcification ◽  
Stroke Patients ◽  
Valve Calcification ◽  
Aortic Atheroma ◽  
Annular Calcification

Background and aims: The aim of this study was to investigate the prevalence of mitral annular calcification (MAC) and aortic valve calcification (AVC) according to the presence or absence of complex aortic atheroma (CAA), using transesophageal echocardiography (TEE) data. Methods: This study included 130 (mean age 59.5 years; male 68.5%) consecutive patients who admitted in our hospital with acute ischemic stroke and underwent transesophageal echocardiography (TEE) for determination of stroke etiology during hospitalization. Stroke subtypes were classified with TOAST criteria. Embolic stroke with undetermined source (ESUS) was defined on the basis of the Cryptogenic Stroke/ESUS International Working Group criteria. MAC and AVC were defined as focal areas of high echogenicity of mitral valve annulus and aortic leaflet, respectively. CAA was assessed by TTE and defined as ≥4 mm and/or ulceration and/or mobile plaques. Comparisons were made between patients with and without CAA (CAA and non-CAA group, respectively) with regard to clinical and echocardiological findings. Results: Of the 130 patients, 26 (20.0%) had CAA. The patients in the CAA and non-CAA groups showed significant differences in age (mean, 69.5 vs. 57.0, P < 0.001), hypertension (88.5% vs. 44.2%, P < 0.001), chronic kidney disease (46.2% vs. 22.1%, P = 0.013), diabetes mellitus (61.5% vs. 23.1%, P < 0.001), hyperlipidemia (69.2% vs. 37.5%, P = 0.004), MAC (23.1% vs. 2.9%, P < 0.001), AVC (19.2% vs. 5.8%, P = 0.022), and MAC or/and AVC (34.6% vs. 7.7%, P < 0.001). When restricted to ESUS patients, there were significant differences in age (mean, 65.0 vs. 53.3, P = 0.042), hypertension (mean, 80.0% vs. 43.6%, P = 0.040), history of coronary artery disease (40.0% vs. 2.6%, P < 0.001), diabetes mellitus (60.0% vs. 12.8%, P = 0.001), hyperlipidemia (80.0% vs. 30.8%, P = 0.004), AVC (37.5% vs. 6.8%, P = 0.012), and MAC or/and AVC (34.6% vs. 7.7%, P = 0.030) between the 2 groups, whereas the prevalence of MAC was not different between CAA and non-CCA groups (12.5% vs. 2.3%, P = 0.16). Conclusions: Stroke patients with CAA frequently have concurrent MAC and/or AVC, which may prompt an effort to detect CAA for patients with MAC and /or AVC in transthoracic echocardiography.

scholarly journals Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) – study protocol for a randomised controlled trial

2021 ◽  
Vol 6 (2) ◽  
pp. 222-228
Author(s):  
Peter Kelly ◽  
Christian Weimar ◽  
Robin Lemmens ◽  
Sean Murphy ◽  
Francisco Purroy ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Ischaemic Stroke ◽  
Usual Care ◽  
Artery Stenosis ◽  
Cardioembolic Stroke ◽  
Lipid Lowering ◽  
Large Artery ◽  
Vascular Events ◽  
Anti Inflammatory

Background Inflammation contributes to unstable atherosclerotic plaque and stroke. In randomised trials in patients with coronary disease, canukinumab (an interleukin-1B antagonist) and colchicine (a tubulin inhibitor with pleiotropic anti-inflammatory effects) reduced recurrent vascular events. Hypothesis: Anti-inflammatory therapy with low-dose colchicine plus usual care will reduce recurrent vascular events in patients with non-severe, non-cardioembolic stroke and TIA compared with usual care alone. Design CONVINCE is a multi-centre international (in 17 countries) Prospective, Randomised Open-label, Blinded-Endpoint assessment (PROBE) controlled Phase 3 clinical trial in 3154 participants. The intervention is colchicine 0.5 mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Included patients are at least 40 years, with non-severe ischaemic stroke (modified Rankin score ≤3) or high-risk TIA (ABCD2 > 3, or positive DWI, or cranio-cervical artery stenosis) within 72 hours-28 days of randomisation, with qualifying stroke/TIA most likely caused by large artery stenosis, lacunar disease, or cryptogenic embolism. Exclusions are stroke/TIA caused by cardio-embolism or other defined cause (e.g. dissection), contra-indication to colchicine (including potential drug interactions), or incapacity for participation in a clinical trial. The anticipated median follow-up will be 36 months. The primary analysis will be by intention-to-treat. Outcome The primary outcome is time to first recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation with unstable angina (non-fatal or fatal). Summary CONVINCE will provide high-quality randomised data on the efficacy and safety of anti-inflammatory therapy with colchicine for secondary prevention after stroke. Schedule First-patient first-visit was December 2016. Recruitment to complete in 2021, follow-up to complete in 2023.

scholarly journals Resolution of leaflet thrombosis under anticoagulant therapy in patients after transcatheter aortic valve implantation: influence of prosthesis type and size

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Ferstl ◽  
M Arnold ◽  
M Goeller ◽  
F Ammon ◽  
S Smolka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Anticoagulant Therapy ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Univariate Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Introduction Leaflet thrombosis can frequently be identified by computed tomography angiography (CTA) in patients after transcatheter aortic valve implantation (TAVI). Oral anticoagulation is assumed to lead to resolution of thrombosis. We analyzed the resolution of leaflet thrombosis after TAVI by anticoagulant therapy in serial CTA and assessed the influence of prosthesis type. Methods Consecutive TAVI patients who underwent CTA follow-up were screened and individuals with leaflet thrombosis on CTA (defined by the presence of hypo-attenuated leaflet thickening, HALT) in whom oral anticoagulation was initiated and who underwent follow-up CTA were included. The type of anticoagulation was according to physicians' discretion. We assessed the resolution of HALT and compared patients with and without resolution of HALT regarding prosthesis type, prosthesis diameter and type of anticoagulation. Results Out of 395 patients screened for participation, 36 patients (mean age 80±7, 67% men) with leaflet thrombosis underwent follow-up CTA at a medial interval of 3 months (IQR: 3; 5.75 months) after anticoagulation was initiated. 36 patients received either vitamin-K antagonists (n=28, 78%) or Factor-Xa Inhibitors (n=8, 22%). A total of 22 (61%) balloon-expandable and 14 (39%) self-expandable transcatheter aortic valves were implanted. Nominal prosthesis diameter was 23, 25, 26, 27 and 29 mm in 7 (19%), 1 (3%), 10 (28%), 7 (19%) and 11 (31%) patients, respectively. 30 patients (83%) with anticoagulation showed resolution of HALT, whereas persistent HALT was detected in 6 patients (17%), of whom 1 patient with balloon-expandable and 5 patients with self-expandable valve. No difference was seen in duration of anticoagulation between patients with and without resolution of HALT (p=0.984). In univariate analysis, prosthesis type (balloon-expandable vs. self-expandable valves) showed a significant association of self-expandable valves with lack of resolution of leaflet thrombosis (p=0.017). In multivariable logistic regression analysis, this association persisted (p=0.043) and was independent of the type of anticoagulation (p=0.660) and prosthesis diameter (p=0.942). Conclusion Persisting leaflet thrombosis despite anticoagulation is not infrequent and seems to be associated with prosthesis-type rather than small valve diameter or type of anticoagulation. Further research is necessary to identify structural aortic valve determinants for this finding. Funding Acknowledgement Type of funding source: None

scholarly journals Repeated Mechanical Thrombectomy of Recurrent Large Vessel Occlusion: Case Report and Brief Review of the Literature

2019 ◽  
Author(s):  
Yun-Long Ding ◽  
Ting-Ting Zhai ◽  
Li Ma ◽  
Zhi-Qun Gu ◽  
Jia-Li Niu ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vascular Events ◽  
Vessel Occlusion ◽  
Case Presentation ◽  
Short Period ◽  
Recurrent Strokes

Abstract Background Endovascular mechanical thrombectomy (MT) can significantly improve the prognosis of patients with Large Vessel Occlusion (LVO) stroke. It is still unclear whether it is safe and effective to perform MT again in patients with renal failure and atrial fibrillation (AF) in a short period of time. Case presentation We present the case of a LVO petients with concomitant AF and uremia who was successfully treated by MT for M1 segment occlusion of right middle cerebral artery (MCA) with good outcome. 15 days after the first MT, the patient's stroke recurred, angiography again revealed M1 segment and branch occlusion of right MCA, and repeated MT were performed. The recurrent strokes might attributed to no anticoagulant therapy. In an 4-months follow-up, no further vascular events occurred. Conclusions Repeated MT for recurrent LVO appears safe and effective. In patients with uremia and AF, it might be beneficial to give anticoagulant therapy after careful assessment of the patient's condition, which needs further evidence.

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