Academic literature on the topic 'Embolic burden'
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Journal articles on the topic "Embolic burden"
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Twedt, Max H., Benjamin D. Hage, James M. Hammel, et al. "Most High-Intensity Transient Signals Are Not Associated With Specific Surgical Maneuvers." World Journal for Pediatric and Congenital Heart Surgery 11, no. 4 (2020): 401–8. http://dx.doi.org/10.1177/2150135120909761.
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Background: Mortality after congenital heart defect surgery has dropped dramatically in the last few decades. Current research on long-term outcomes has focused on preventing secondary neurological sequelae, for which embolic burden is suspected. In children, little is known of the correlation between specific surgical maneuvers and embolic burden. Transcranial Doppler ultrasound is highly useful for detecting emboli but has not been widely used with infants and children. Methods: Bilateral middle cerebral artery blood flow was continuously monitored from sternal incision to chest closure in 20 infants undergoing congenital heart defect repair or palliative surgery. Embolus counts for specific maneuvers were recorded using widely accepted criteria for identifying emboli via high-intensity transient signals (HITS). Results: An average of only 13% of all HITS detected during an operation were correlated with any of the surgical maneuvers of interest. The highest mean number of HITS associated with a specific maneuver occurred during cross-clamp removal. Cross-clamp placement also had elevated HITS counts that significantly differed from other maneuvers. Conclusions: In this study of infants undergoing cardiac surgery with cardiopulmonary bypass, the great majority of HITS detected are not definitively associated with a specific subset of surgical maneuvers. Among the measured maneuvers, removal of the aortic cross-clamp was associated with the greatest occurrence of HITS. Future recommended research efforts include identifying and confirming other sources for emboli and longitudinal outcome studies to determine if limiting embolic burden affects long-term neurological outcomes.
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Mackie, Benjamin D., Farheen Shirazi, Matthew J. Swadley, Byron R. Williams, Gautam Kumar, and S. Tanveer Rab. "Catastrophic Systemic Embolization from a Left Atrial Myxoma." Texas Heart Institute Journal 41, no. 1 (2014): 64–66. http://dx.doi.org/10.14503/thij-12-2964.
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We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old woman resulted in rapid clinical deterioration, multiorgan failure, and death. Among reported cases of left atrial myxoma, this degree of embolic burden is exceedingly rare. In addition to reporting the patient's case, we discuss the presentation and diagnosis of possible intracardiac sources of systemic emboli.
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Heller, Robert S., Venkata Dandamudi, Michael Lanfranchi, and Adel M. Malek. "Effect of antiplatelet therapy on thromboembolism after flow diversion with the Pipeline Embolization Device." Journal of Neurosurgery 119, no. 6 (2013): 1603–10. http://dx.doi.org/10.3171/2013.7.jns122178.
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Object Flow-diverting stents offer a novel treatment approach to intracranial aneurysms. Data regarding the incidence of acute procedure-related thromboembolic complications following deployment of the Pipeline Embolization Device (PED) remain scant. The authors sought to determine the rate of embolic events in a bid to identify potential risk factors and assess the role of platelet inhibition. Methods Data in all patients receiving a PED for treatment of an intracranial aneurysm were prospectively maintained in a database. Diffusion-weighted 3-T MRI was performed within 24 hours of PED deployment. The incident rate of procedural embolism was established, and univariate analysis was then performed to determine any associations of embolic events with measured variables. The degree of platelet inhibition in response to aspirin and clopidogrel was evaluated by challenging the platelet samples with arachidonic acid and adenosine diphosphate, respectively, and then performing formal light transmission platelet aggregometry. Results Twenty-three patients with 26 aneurysms were eligible for inclusion in the study. Thirty-one PEDs were deployed in 25 procedures. All ischemic lesions detected on diffusion-weighted 3-T MRI were identified as embolic based on their location and distribution, with none appearing to be due to perforator artery occlusion. Procedural embolic events were found in the target parent vessel territory in 13 (52%) of 25 procedures, with no patients harboring lesions contralateral to the deployed PED. The number of embolic events per procedure ranged from 3 to 16, with a mean of 5.4. There was no significant difference between cases with and without procedural embolism in platelet inhibition by aspirin (mean 15% vs 12% residual activation; p = 0.28), platelet inhibition by clopidogrel (mean 41% vs 41% residual activation; p = 0.98), or intraprocedural heparin-induced anticoagulation (mean activated clotting time 235 seconds vs 237 seconds; p = 0.81). By multivariate analysis, the authors identified larger aneurysm size (p = 0.03) as the single variable significantly associated with procedural embolism. There was no significant relationship between aneurysm size and the number of embolic events (p = 0.32) or the total burden of the embolism lesion area (p = 0.53). Conclusions Acute embolism following use of the PED for treatment of intracranial aneurysms is more common than hypothesized. The only identifiable risk factor for embolism appears to be greater aneurysm size, perhaps indicating significant disturbed flow across the aneurysm neck with ingress and egress through the PED struts. The strength of antiplatelet therapy, as measured by residual platelet aggregation, did not appear to be associated with cases of procedural embolism. Further work is needed to determine the implications of these findings and whether anticoagulation regimens can be altered to lower the rate of complications following PED deployment.
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Malgor, Rafael D., Emily A. Wood, Otavio A. Iavarone, and Nicos Labropoulos. "Stratifying risk: asymptomatic carotid disease." Jornal Vascular Brasileiro 11, no. 1 (2012): 43–52. http://dx.doi.org/10.1590/s1677-54492012000100008.
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Stroke generates significant healthcare expenses and it is also a social and economic burden. The carotid artery atherosclerotic plaque instability is responsible for a third of all embolic strokes. The degree of stenosis has been deliberately used to justify carotid artery interventions in thousands of patients worldwide. However, the annual risk of stroke in asymptomatic carotid artery disease is low. Plaque morphology and its kinetics have gained ground to explain cerebrovascular and retinal embolic events. This review provides the readers with an insightful and critical analysis of the risk stratification of asymptomatic carotid artery disease in order to assist in selecting potential candidates for a carotid intervention.
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den Exter, P. L., L. J. M. Kroft, T. van der Hulle, F. A. Klok, D. Jiménez, and M. V. Huisman. "Embolic burden of incidental pulmonary embolism diagnosed on routinely performed contrast-enhanced computed tomography imaging in cancer patients." Journal of Thrombosis and Haemostasis 11, no. 8 (2013): 1620–22. http://dx.doi.org/10.1111/jth.12325.
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Duval, Cédric, Adomas Baranauskas, Tímea Feller та ін. "Elimination of fibrin γ-chain cross-linking by FXIIIa increases pulmonary embolism arising from murine inferior vena cava thrombi". Proceedings of the National Academy of Sciences 118, № 27 (2021): e2103226118. http://dx.doi.org/10.1073/pnas.2103226118.
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The onset of venous thromboembolism, including pulmonary embolism, represents a significant health burden affecting more than 1 million people annually worldwide. Current treatment options are based on anticoagulation, which is suboptimal for preventing further embolic events. In order to develop better treatments for thromboembolism, we sought to understand the structural and mechanical properties of blood clots and how this influences embolism in vivo. We developed a murine model in which fibrin γ-chain cross-linking by activated Factor XIII is eliminated (FGG3X) and applied methods to study thromboembolism at whole-body and organ levels. We show that FGG3X mice have a normal phenotype, with overall coagulation parameters and platelet aggregation and function largely unaffected, except for total inhibition of fibrin γ-chain cross-linking. Elimination of fibrin γ-chain cross-linking resulted in thrombi with reduced strength that were prone to fragmentation. Analysis of embolism in vivo using Xtreme optical imaging and light sheet microscopy demonstrated that the elimination of fibrin γ-chain cross-linking resulted in increased embolization without affecting clot size or lysis. Our findings point to a central previously unrecognized role for fibrin γ-chain cross-linking in clot stability. They also indirectly indicate mechanistic targets for the prevention of thrombosis through selective modulation of fibrin α-chain but not γ-chain cross-linking by activated Factor XIII to reduce thrombus size and burden, while maintaining clot stability and preventing embolism.
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Mayasi, Yunis, Johanna Helenius, David D. McManus, et al. "Atrial fibrillation is associated with anterior predominant white matter lesions in patients presenting with embolic stroke." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 1 (2017): 6–13. http://dx.doi.org/10.1136/jnnp-2016-315457.
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ObjectiveHigh white matter hyperintensity (WMH) burden is commonly found on brain MRI among patients with atrial fibrillation (AF). However, whether the link between AF and WMH extends beyond a common vascular risk factor profile is uncertain. We sought to determine whether AF relates to a distinct WMH lesion pattern which may suggest specific underlying pathophysiological relationships.MethodsWe retrospectively analysed a cohort of consecutive patients presenting with embolic stroke at an academic hospital and tertiary referral centre between March 2010 and March 2014. In total, 234 patients (53% female, 74% anterior circulation infarction) fulfilled the inclusion criteria and were included in the analyses. WMH lesion distribution was classified according to previously defined categories. Multivariable logistic regression analysis was performed to determine variables associated with AF within 90 days of index hospital discharge.ResultsAmong included patients, 114 had AF (49%). After adjustment for the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, prior stroke/TIA (doubled), vascular disease, age 65–74 years, sex category (female)) score, WMH lesion burden as assessed on the Fazekas scale, embolic stroke pattern, infarct distribution and pertinent interaction terms, AF was significantly associated with presence of anterior subcortical WMH patches (OR 3.647, 95% CI 1.681 to 7.911, p=0.001).ConclusionsAF is associated with specific WMH lesion pattern among patients with embolic stroke aetiology. This suggests that the link between AF and brain injury extends beyond thromboembolic complications to include a cardiovasculopathy that affects the brain and can be detected and characterised by WMH.
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Le Roux, Pierre-Yves, Kate Burbury, Michael S. Hofman, and Rodney J. Hicks. "Short and long-term prognostic implications of a low embolic burden in oncology patients diagnosed with symptomatic pulmonary embolism." Annals of Hematology 95, no. 4 (2016): 651–52. http://dx.doi.org/10.1007/s00277-016-2593-2.
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Boriani, Giuseppe, Marco Vitolo, Jacopo Francesco Imberti, Tatjana S. Potpara, and Gregory Y. H. Lip. "What do we do about atrial high rate episodes?" European Heart Journal Supplements 22, Supplement_O (2020): O42—O52. http://dx.doi.org/10.1093/eurheartj/suaa179.
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Abstract Atrial high rate episodes (AHREs) are defined as asymptomatic atrial tachyarrhythmias detected by cardiac implantable electronic devices with atrial sensing, providing automated continuous monitoring and tracings storage, occurring in subjects with no previous clinical atrial fibrillation (AF) and with no AF detected at conventional electrocardiogram recordings. AHREs are associated with an increased thrombo-embolic risk, which is not negligible, although lower than that of clinical AF. The thrombo-embolic risk increases with increasing burden of AHREs, and moreover, AHREs burden shows a dynamic pattern, with tendency to progression along with time, with potential transition to clinical AF. The clinical management of AHREs, in particular with regard to prophylactic treatment with oral anticoagulants (OACs), remains uncertain and heterogeneous. At present, in patients with confirmed AHREs, as a result of device tracing analysis, an integrated, individual and clinically-guided assessment should be applied, taking into account the patients’ risk of stroke (to be reassessed regularly) and the AHREs burden. The use of OACs, preferentially non-vitamin K antagonists OACs, may be justified in selected patients, such as those with longer AHREs durations (in the range of several hours or ≥24 h), with no doubts on AF diagnosis after device tracing analysis and with an estimated high/very high individual risk of stroke, accounting for the anticipated net clinical benefit, and informed patient’s preferences. Two randomized clinical trials on this topic are currently ongoing and are likely to better define the role of anticoagulant therapy in patients with AHREs.
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Knol, Wiebe G., Ad J. J. C. Bogers, Loes M. M. Braun, et al. "Aortic calcifications on routine preoperative chest X-ray and perioperative stroke during cardiac surgery: a nested matched case–control study." Interactive CardioVascular and Thoracic Surgery 30, no. 4 (2019): 507–14. http://dx.doi.org/10.1093/icvts/ivz295.
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Abstract OBJECTIVES Perioperative stroke in cardiac surgery is most often embolic in origin. Preoperative chest X-ray (CXR) is routinely used amongst others to screen for relevant aortic calcification, a potential source of embolic stroke. We performed a nested matched case–control study to examine the relationship between aortic calcifications on CXR and the occurrence of embolic stroke. METHODS Among all consecutive patients undergoing cardiac surgery in our hospital between January 2014 and July 2017, we selected all patients with perioperative embolic stroke (cases). Controls, all patients without perioperative stroke, were matched on age, sex and type of surgery. All preoperative CXRs were scored for aortic calcifications (none, mild, severe) in the ascending aorta, arch, aortic knob and descending aorta. RESULTS Out of the 3038 eligible patients, 27 cases were detected and 78 controls were selected. In the stroke group, mild-to-severe calcifications were found least often in the ascending aorta [9% of patients, 95% confidence interval (CI) 1–29%] and most frequently in the aortic knob (63% of patients, 95% CI 44–78%). The distribution of aortic calcification was comparable in cases versus controls. CONCLUSIONS Calcification burden was comparable between the cases and their matched controls. In our study population, CXR findings on aortic calcification were not related to the risk of embolic stroke. In these patients, the correlation between findings on the preoperative CXR and the risk of stroke might, therefore, be too weak to use the CXR directly for the assessment of the safety of manipulating the ascending aorta during surgery.
Dissertations / Theses on the topic "Embolic burden"
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Bulajic, Bojana. "Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29664.
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Introduction: The diagnosis of Pulmonary Embolism (PE) is challenging to make and is often missed in the Emergency Centre. The true incidence of PE in South Africa is unknown. The diagnostic work-up of PE has been improved by the use of Clinical decision rules (CDRs) and CT Pulmonary Angiography (CTPA) in high-income countries. Currently used CDRs have not been validated in the South African environment, where HIV and TB are highly prevalent. Both conditions are known to induce a hyper-coagulable state. Methods: This study was a retrospective chart review of patients with suspected PE that had CTPAs performed from October 2013 to October 2015 at Mitchell’s Plain Hospital in South Africa. Data was collected on demographics, presenting symptoms and signs, vitals, bedside investigations, HIV and TB status, use of CDRs and CTPA result. A Revised Geneva Score was calculated retrospectively and compared to the CTPA result. Results: The median age of patients with confirmed PE was 45 years and 68% were female. The CTPA yield for PE in our study population was 32%. The most common presenting complaint was dyspnoea (83%), followed by cough and chest pain. 29% of patients also had clinical features of DVT. No sign or symptom was seen to be markedly different in those with confirmed PE compared to those without. Among patients with confirmed PE, 37% were HIV positive and 52% had current TB. The retrospective revised Geneva Scores compared poorly with the CTPA results. Discussion: PE remains a diagnostic challenge. Worldwide, the use of CDRs has shown to improve the utilization of CTPA. In our study, the retrospectively calculated CDR was not predictive of PE in a population with a high prevalence of HIV and TB. Emergency physicians should be cautious when making a clinical probability assessment of PE in this setting. However, further studies are needed to determine whether HIV and TB could be independent risk factors for PE.
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Reuter, Judith. "Risikostratifizierung bei Patienten mit akuter Lungenembolie anhand der in der Computertomographie abgeschätzten Thrombuslast und des Verhältnisses von rechts- zu linksventrikulärem Diameter." Doctoral thesis, 2020. http://hdl.handle.net/21.11130/00-1735-0000-0005-144B-1.
Full textBooks on the topic "Embolic burden"
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Irani, Zubin, and Sara Zhao. Dual and Balloon-Assisted AngioJet Thrombectomy for Iliofemoral Deep Venous Thrombosis. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0038.
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Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.
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Adam, Sheila, Sue Osborne, and John Welch. Trauma and major haemorrhage. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0011.
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This chapter discusses the medical and nursing management of trauma patients from their initial assessment in the emergency department to their subsequent management in the critical care unit. Each section of the chapter covers a specific area of trauma and describes its underlying physiology, management, and associated complications. Injuries discussed include spinal, head, chest, cardiovascular, genitourinary, renal, abdominal, pelvic, musculoskeletal, burn injury, hypothermia, and drowning. Major complications, such as fat embolism syndrome, compartment syndrome, and rhabdomyolysis, are described in detail. The chapter also discusses the management of major haemorrhage and the complications of massive blood replacement therapy.
Book chapters on the topic "Embolic burden"
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Sinharay, Rudy. "Chest Medicine." In Oxford Assess and Progress: Clinical Medicine. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198812968.003.0009.
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Respiratory conditions are common, and the burden of morbidity on the general population is high. You only have to take part in a few general medical takes as a junior doctor to realize this. As the on- call bleep goes off again, you are referred another exacerbation of chronic obstructive pulmonary disease (COPD) or asthma, a breathless patient (is it a pulmonary embolism, pneumothorax, or something less common?), or a patient with haemoptysis and weight loss [is it lung cancer or tuberculosis (TB)?] or productive cough (pneumonia or bronchiectasis?). The number of different respiratory conditions can be bewildering, and it is essential for the developing physician to be able to manage ‘common presentations’, as well as potentially life- threatening situations such as an asthma attack or an acute pulmonary embolism. The nuances of history taking is often key to successfully clinching a diagnosis: ● What chronic conditions, respiratory or otherwise, do your patients have? ● What is the onset of symptoms? Sudden breathlessness may indicate a pneumothorax or pulmonary embolus. A chronic productive cough may indicate COPD or bronchiectasis. ● Social history— do they smoke, what are their living conditions, what is their occupation? Luckily, we have other tools to help us. The age- old art of inspection, palpation, percussion, and auscultation during an examination is essential when assessing the patient. Combined with imaging techniques, including chest radiography, CT scanning, and bedside thoracic ultrasound, the answer is often easily obtained. Keeping an open mind to the less common causes of breathlessness, cough, and haemoptysis is important. Combined with lung function testing, autoimmune blood tests, and bronchoscopy, subtler diagnoses such as interstitial lung disease, fungal lung disease, and autoantibody- induced haemoptysis may be revealed. And a word to the wise— not all breathlessness originates from the lungs! For instance, an increased body mass index will cause a physical restriction on the mechanics of breathing and a compensated metabolic acidosis may cause tachypnoea. As with all chronic diseases, the management of chronic respiratory disease is becoming increasingly complicated with the advent of biologics, immunotherapy, antifibrotic therapy, and a genuinely confusing array of inhalers.
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Lijfering, Willem M., and Suzanne C. Cannegieter. "Predisposing factors for first and recurrent venous thrombosis." In ESC CardioMed. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0656.
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Venous thrombosis, which mainly manifests as deep vein thrombosis of the leg or pulmonary embolism, is a major contributor to global disease burden. With a recurrence rate of approximately 25% in 5 years, and a 30-day case fatality rate of 5–10%, identification of predisposing factors for venous thrombosis is imperative. Dozens of risk factors for first venous thrombosis are known today, which can be grouped into three categories: first venous thrombosis ‘provoked by a transient risk factor’, ‘provoked by a persistent risk factor’, or ‘unprovoked’. This chapter comments on how risk factors known today can be classified into these categories, how this classification determines recurrence risk, and how knowledge on predisposing risk factors should be interpreted and integrated for optimal clinical use. The chapter proposes that predisposing factors for venous thrombosis are not the same for each high-risk situation. This is important to consider when one wants to identify high-risk groups in, for example, cancer patients, surgical patients, in patients with a medical illness, or in patients at risk for recurrent venous thrombosis. This way it will be possible to expose only those patients at unacceptably high risk of thrombosis to the risks and burden of anticoagulant treatment. In conclusion, the knowledge on predisposing factors for venous thrombosis is extensive, but the patient will benefit most when this knowledge is properly integrated, depending on the clinical situation.
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Cohen, Alexander T., Marjolein P. A. Brekelmans, and Carlos Martinez. "Epidemiology and socioeconomic consequences of venous thromboembolism." In ESC CardioMed. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0655.
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Venous thromboembolism (VTE) is a common disease with numerous well-characterized risk factors and many different clinical manifestations. There is great variation in the epidemiology and socioeconomic impact depending on the disease associations and the site of the thrombosis. The regional rates vary and in Western countries the incidence rate for first events is in the order of 100–250 per 100,000 person-years, attack rates (new and recurrent events) are about 250 per 100,000 person-years. The annual prevalence (a cross-sectional view) is about 400 per 100,000 population. Following hospitalization for medical or surgical conditions, the rates are higher and these events contribute to around half the population attributable risk. During periods of active cancer the incidence rates are very high. Post-thrombotic syndrome complicates 20–50% of deep vein thrombosis cases and is severe in 5–10%. Chronic thromboembolic pulmonary hypertension contributes significantly to the burden of VTE. Around 0.4–4% of patients with pulmonary embolism will eventually develop chronic thromboembolic pulmonary hypertension. Incidence rates for first episodes and attack rates have been widely studied, but incidence rates of recurrent events, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension have not and generally only the cumulative incidence has been characterized. VTE mortality is significant particularly in the first 3 months, following that it is strongly related to the underlying diseases. The socioeconomic consequences of VTE are significant with respect to disability and costs.
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Cohen, Alexander T., Anne-Céline Martin, and Carlos Martinez. "Epidemiology and socioeconomic consequences of venous thromboembolism." In ESC CardioMed. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0655_update_001.
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Venous thromboembolism (VTE) is a common disease with numerous well-characterized risk factors and many different clinical manifestations. There is great variation in the epidemiology and socioeconomic impact depending on the disease associations and the site of the thrombosis. The regional rates vary and in Western countries the incidence rate for first events is in the order of 100–250 per 100,000 person-years, attack rates (new and recurrent events) are about 250 per 100,000 person-years. The annual prevalence (a cross-sectional view) is about 400 per 100,000 population. Following hospitalization for medical or surgical conditions, the rates are higher and these events contribute to around half the population attributable risk. During periods of active cancer the incidence rates are very high. Post-thrombotic syndrome complicates 20–50% of deep vein thrombosis cases and is severe in 5–10%. Chronic thromboembolic pulmonary hypertension contributes significantly to the burden of VTE. Around 0.4–4% of patients with pulmonary embolism will eventually develop chronic thromboembolic pulmonary hypertension. Incidence rates for first episodes and attack rates have been widely studied, but incidence rates of recurrent events, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension have not and generally only the cumulative incidence has been characterized. VTE mortality is significant particularly in the first 3 months, following that it is strongly related to the underlying diseases. The socioeconomic consequences of VTE are significant with respect to disability and costs.
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Emmett, Stevan R., Nicola Hill, and Federico Dajas-Bailador. "Neurology." In Clinical Pharmacology for Prescribing. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780199694938.003.0017.
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Cerebrovascular disease encompasses all disorders that temporarily or permanently affect the way oxygen and glucose are delivered to the brain via cerebral blood vessels. Stroke is a sudden focal event that leads to neurological deficit, because of disturbed circulation. Ischaemic strokes account for around 80% of total numbers and are caused by inadequate blood flow secondary to occlusion by an atheroma, embolus, or less commonly, severe local vasospasm. The remaining 20% are haemorrhagic strokes that occur because of a bleed through ruptured vessels and may be defined by their location. Historically, symptomatology in stroke exceeds 24 hours and where symptoms resolve before this, i.e. a transient vessel occlusion, is termed a transient ischaemic attack (TIA). More recently, however, a TIA has been defined by the American Heart Association and American Stroke Association (AHA/ ASA) as a ‘transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction’. TIAs occur more commonly in men, increasing with age and affecting 35 per 100 000 people. It is also associated with an increased risk of stroke. Stroke is a major health burden in the UK, with an annual incidence in excess of 150 000, accounting for approximately 40 000 deaths/ year. Furthermore, there are approximately 1.2 million people in the UK living with the effects of a stroke. Modification of risk factors, rapid clinical diagnosis, and efficient early intervention is essential in reducing incidence and improving outcomes (see Figure 9.1). Ischaemic stroke, the most common form of cerebrovascular disease, results mainly from the enlargement or rupture of an atheromatous plaque, or from an embolus that travels from the systemic arterial system into the CNS vasculature. The subsequent reduction in oxygenated blood flow by 20– 30% deprives brain tissues, normally completely dependent on aerobic metabolism, of glucose and oxygen. At a cellular level the resultant anaerobic conditions trigger the ischaemic cascade, so that cells ultimately undergo apoptosis and die. Persistent ischaemia lasting more than 1 hour leads to local tissue necrosis, neuro-inflammation, and oedema. Prior to cellular apoptosis, the normally maintained electrochemical gradient across the cell membrane is disrupted, such that intracellular Ca<sup>2+</sup>, Na<sup>+</sup>, and Cl<sup>-</sup> levels rise uncontrollably, bringing with it an inflow of water causing neurons and glia to swell.
Conference papers on the topic "Embolic burden"
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Kim, Kyung Chan, Dae Sung Hyun, Sang Chae Lee, and Kyung Jae Jung. "Embolic Burden Score And Risk Of Death Due To Pulmonary Thromboembolism." In American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans. American Thoracic Society, 2010. http://dx.doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a1929.
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Caroff, J., R. King, R. Arslanian, et al. "O-007 Crossing the clot with a micro-catheter during a mechanical thrombectomy: in vitro evaluation of its impact on the distal emboli burden." In SNIS 15TH ANNUAL MEETING, July 23–26, 2018, Hilton San Francisco Union Square San Francisco, CA. BMJ Publishing Group Ltd., 2018. http://dx.doi.org/10.1136/neurintsurg-2018-snis.7.
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Bach, C., C. Wright, R. J. White, S. J. Cameron, and D. Lachant. "The Efficacy of Direct Oral Anticoagulants on Residual Clot Burden in Obese and Non-Obese Patients with Massive and Submassive Pulmonary Embolism." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6060.
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Chesen, B. E., T. Al-Bermani, S. Nath, et al. "An Audit of Computed Tomography Angiography Scans of Chest Ordered in a University Hospital to Rule Out Pulmonary Embolism and Its Financial Burden." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a2005.
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Lowe, G. D. O. "EPIDEMIOLOGY AND RISK PREDICTION OF VENOUS THROMBOEMBOLISM." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642965.
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Uses of epidemiology. Venous thromboembolism continues to be an important cause of death and disability in Western Countries. Its epidemiology may provide clues to etiology, e.g. the increased incidence in oral contraceptive users, and the low prevalence at autopsy in Central Africa or Japan compared to the U.S.A. A second use is the monitoring of time-trends: the diagnosis of pulmonary embolism increased during the 1970s, although the case fatality decreased. A third use is the identification and quantification of risk factors: these could be modified in the hope of prevention, or else used to select high risk groups for selective prophylaxis, e.g. during acute illness. Prevention is the only feasible approach to reducing the burden of venous thromboembolism, since most cases are not diagnosed, and since the value of current treatment is debatable.Case definition. Presents problems: clinical diagnosis is unreliable, and should if possible be supported by objective methods. Autopsy studies are performed on selected populations, at a decreasing rate; the frequency of thromboembolism depends on technique; and pathologists cannot be blinded and are open to bias. It can also be difficult to judge whether a patient dying with pulmonary embolism died from pulmonary embolism. 125I-fibrinogen scans indicate minimal disease, and now present ethical problems in screening due to risks of viral transmission. Venography is invasive and is not readily repeatable, which limits its use as a screening method. Plethysmography merits wider evaluation, since it is non-invasive, and sensitive to major thrombosis.Community epidemiology. Data on the community epidemiology are limited. The risk increases with age. When age is taken into account, there is little sex difference. Overweight in women, use of oral contraceptives and blood group A increase the risk: smoking, varicose veins, blood pressure, cholesterol and glucose do not, on current evidence. Long-term follow-up of patients with proven thromboembolism shows an increased risk of malignancy, hence occult cancer may also be a risk factor. Polycythaemia and certain congenital deficiencies (e.g. antithrombin III) are also well-recognised risk factors, although uncommon.Hospital epidemiology. Data on hospital epidemiology are derived largely from autopsy prevalence, and from short-term incidence of minimal thrombosis detected by 125I—fibrinogen scanning. Old, immobile and traumatised patients are most at risk. Previous thromboembolism, polycythaemia, antithrombin III deficiency, hip and leg fractures, elective hip and leg surgery, hemiplegia, paraplegia, and heart failure carry high risks, and merit consideration for routine prophylaxis. The risk in elective surgery precedes the operation, and increases with age, overweight, malignancy, varicose veins, non-smoking, and operative factors (duration, approach, general anaesthesia, intravenous fluids). Diabetics appear to have no extra risk. Combinations of clinical variables can be used to predict high risk groups for selective prophylaxis, but combination indices require further study. Laboratory variables may increase the predictability of deep vein thrombosis, but the results of published studies are conflicting, and the cost-effectiveness of laboratory prediction should be evaluated.
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Levine, M., A. Arnold, L. Kelleher, et al. "CANCER CHEMOTHERAPY AND THROMBOSIS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643203.
Full textAbstract:
Malignant disease is recognized as a risk factor for venous thromboembolism. A number of recent reports have suggested that cancer chemotherapy may contribute to this risk, but it was not possible to separate the role of chemotherapy from the effects of the malignant disease. We are conducting a randomized trial to determine the optimal duration of adjuvant chemotherapy in women with Stage II breast carcinoma. These ambulatory patients, with negligible tumour burden, receive either 12 weeks of chemo-hormonal therapy (cyclophosphamide, methotrexate, 5 fluorouracil, vincristine, prednisone, adriamycin and tamoxifen) or 36 weeks of chemotherapy (cyclophosphamide, methotrexate, 5 fluorouracil, vincristine and prednisone). This study has provided us with an opportunity to evaluate the thrombogenic effects of chemotherapy since patients in the 12 week group, while off chemotherapy, can be compared directly to the patients in the other group who are still on chemotherapy. This allows the confounding influence of the malignant process to be circumvented. All patients undergo screening tests for thrombosis (impedance plethysmography and Doppler ultrasound) and routine clinical assessments. Suspected venous thrombosis is confirmed by venography and suspected pulmonary embolism by either pulmonary angiography or high probability ventilation perfusion scanning. There have been 11 episodes of venous thromboembolism to date among 191 patients of whom 164 have completed the first 36 weeks of study. There were 3 episodes in each group during the first 12 weeks. During the subsequent 24 weeks there have been no events in the group whose treatment was stopped and 5 events in the group still on treatment (p 0.03). These findings demonstrate that chemotherapy per se is an important risk factor for venous thromboembolism in patients with malignant disease.