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Clinical Perspective on Dual Energy Computed Tomography
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Charis McNabney, Shamir Rai, Darra T. Murphy
Early recognition of hemorrhagic transformation of a stroke is critical. It is a major complication of reperfusion therapy such as thrombolysis and tends to occur 12–24 hours following treatment. An initial CT brain scan is performed to diagnose stroke and may have involved contrast to assess related vessels. In the follow-up scan, differentiating acute hemorrhage from residual contrast from the initial scan, can pose a diagnostic challenge in single energy non-contrast CT. DECT can help accurately distinguish intraparenchymal hemorrhage from iodinated contrast medium, by means of iodine mapping (Gupta et al. 2010) (Figure 3.3).
Diagnosis, treatment & management of prosthetic valve thrombosis: the key considerations
Published in Expert Review of Medical Devices, 2020
Sabahattin Gündüz, Macit Kalçık, Mustafa Ozan Gürsoy, Ahmet Güner, Mehmet Özkan
Patients presenting with acute ischemic stroke and PHVT are of particular concern. When these patients present early after the start of symptoms, current guidelines recommend a relatively rapid TT protocol for improving the outcome of stroke. However, such a strategy can not be considered safe for all patients since those with large PHVT can suffer from re-embolism caused by rapid thrombolysis. As an expert opinion, we suggest mechanical reperfusion whenever available, for saving the brain, followed by early TEE and a delayed safer and efficacious TT regimen (i.e. slow/ultra-slow infusion of low-dose t-PA) for PHVT. For late presenting stroke patients with PHVT, in whom acute reperfusion therapy is not an option, or for those with successful cerebral reperfusion, the optimal time delay of TT for PHVT is unknown. Although TT has generally been considered a contraindication 3 to 6 months after stroke, this recommendation was based on the concern of cerebral bleeding that may be caused by relatively faster TT regimens (i.e. maximum of 90 mg over 60 min) with bolus dose. Our experience shows that 3 weeks of watchful waiting followed by neuroradiological assessment to exclude hemorrhagic transformation may be a sufficient time delay for proceeding with slow or ultraslow infusion of low-dose t-PA protocol in patients with PHVT presenting late after stroke.
Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents
Published in Expert Review of Medical Devices, 2019
Christina Iosif, Alessandra Biondi
Delayed ipsilateral parenchymal hemorrhage (DIPH) is another complication of FD use, which is not yet well understood. In the RADAR survey that retrospectively analyzed the rate of aneurysm rupture following FD treatment in 53 centers worldwide, DIPH was observed in 14/720 patients (1.9%) [69]. DIPH was observed in 1.1–8.5% in several series [8,69–72] and occurred within 1 to 14 days post-intervention. Potential mechanisms, according to the authors, could involve hemorrhagic transformation of a previously existing or embolic ischemic lesion, hemodynamic modifications of the vasculature due to the presence of the FD stent and the presence of predisposing factors for hemorrhage such as hypertension, cerebrovascular or cardiovascular disease in association with the antiplatelet regimen.