ekos catheter

ekos 导管
  • 文章类型: Case Reports
    Prader-Willi综合征(PWS)是一种极为罕见的15号染色体先天性综合征,在所述个体中表现出多种合并症。患有这种疾病的人的相关生活质量往往严重下降;更悲惨的是,与该疾病相关的死亡率也增加。肺栓塞(PE)与死亡率高度相关,并且已被证明在PWS患者中更为普遍。此病例报告详细介绍了一名PWS患者,该患者在急性鞍状PE中幸存下来,并希望带来更多临床知识,可在与PWS患者打交道时应用。
    Prader-Willi syndrome (PWS) is an exceedingly rare congenital syndrome of chromosome 15 that presents multiple comorbidities in said individuals. The associated quality of life for those with the disease is often severely diminished; more tragically, mortality associated with the disease is also increased. Pulmonary embolism (PE) is highly associated with mortality and has been shown to be more prevalent in patients with PWS. This case report details a patient with PWS who survived an acute saddle PE and looks to bring more clinical knowledge that can be applied when dealing with individuals with PWS.
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  • 文章类型: Case Reports
    由称为严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的新型冠状病毒引起的COVID-19感染是一种症状和结果从轻度流感样症状到严重呼吸衰竭导致死亡的感染。由于COVID-19感染的高凝,血栓形成的风险增加。所有原因(内皮损伤,stasis,和高凝血症)被称为Virchow的三联征导致COVID-19感染中的血栓形成。然而,COVID-19高凝的发病机制尚不清楚。在这篇文章中,我们讨论了COVID-19感染恢复后独特的多发血栓事件以及我们对肺血栓形成的治疗策略.病人有干咳的症状,发烧,两个月前肌痛.他的COVID-19聚合酶链反应(PCR)检测呈阳性,但是没有必要住院。他的症状在7天内消失。但是,肠系膜上动脉(SMA)血栓形成发生在COVID-19感染后一个月,并进行了肠切除术。他因呼吸困难入院,胸痛,心悸,和声音嘶哑。进一步评估显示心动过速,低血压,呼吸急促,和焦虑。室内空气中的外周血氧饱和度(SpO2)为86%。他有血流动力学不稳定,右心室(RV)功能障碍,和D-Dimer标高。肺栓塞严重程度指数(PESI)计算为149。患者属于高危人群。我们的肺栓塞反应小组(PERT)决定应用导管定向溶栓(CDT)治疗肺血栓。EkoSonic™血管内系统(EKOS)(波士顿科学公司,马尔伯勒,美国)用于治疗。
    COVID-19 infection caused by the new coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an infection with symptoms and results ranging from mild flu-like symptoms to severe respiratory failure leading to death. The risk of thrombosis increases due to hypercoagulation in COVID-19 infection. All causes (endothelial injury, stasis, and hypercoagulopathy) known as Virchow\'s triad contribute to thrombosis in COVID-19 infection. However, the pathogenesis of hypercoagulability in COVID-19 is still unknown. In this article, we discuss the unique multiple thrombosis events following recovery from COVID-19 infection and our treatment strategy for pulmonary thrombosis. The patient had symptoms of dry cough, fever, and myalgia two months ago. His polymerase chain reaction (PCR) test for COVID-19 was positive, but there was no need for hospitalization. His symptoms resolved within seven days. But, thrombosis of the superior mesenteric artery (SMA) occurred one month after the COVID-19 infection, and bowel resection was performed. He was admitted to our hospital with dyspnea, chest pain, palpitations, and hoarseness. Further evaluation showed tachycardia, hypotension, tachypnea, and anxiety. Peripheral oxygen saturation (SpO2) was 86% at room air. He had hemodynamic instability, right ventricular (RV) dysfunction, and D-Dimer elevation. Pulmonary Embolism Severity Index (PESI) was calculated as 149. The patient was in the high-risk group. Our Pulmonary Embolism Response Team (PERT) decided to apply catheter-directed thrombolysis (CDT) for the treatment of pulmonary thrombosis. The EkoSonic™ Endovascular System (EKOS) (Boston Scientific Corporation, Marlborough, USA) was used for the treatment.
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  • 文章类型: Case Reports
    静脉血栓栓塞可能是真性红细胞增多症(PV)和原发性血小板增多症患者的主要表现。大多数患者首先出现静脉或动脉血栓栓塞后被诊断为真性红细胞增多症。大多数患者倾向于在诊断之前或诊断时出现血栓形成,随着时间的推移,这种风险会降低。年龄>60岁有既往血栓形成病史的患者,血细胞比容升高,和白细胞增多是血栓形成的最大风险。我们报告了一例74岁的患者,出现呼吸急促三天。计算机断层扫描肺血管造影显示双侧肺栓塞伴右心劳损。他接受了紧急EkoSonic™血管内系统溶栓(EKOS™,波士顿科学公司,马尔伯勒,MA).患者Janus激酶2基因突变(JAK2)检测呈阳性,满足PV的两个主要和一个次要标准,口服抗凝药物出院回家.Janus激酶2(JAK2V617F)突变在真性红细胞增多症患者中相当常见,血小板增多症,和骨髓纤维化,这些患者有动脉和静脉血栓形成的风险,因此,他们需要长期的后续行动。
    Venous thromboembolism may be the primary presentation in patients with polycythaemia vera (PV) and essential thrombocythemia. Most patients get diagnosed with polycythaemia vera after presenting with venous or arterial thromboembolism in the first place. Most patients tend to develop thrombosis just before or at the time of diagnosis, and this risk decreases over time. Patients aged >60 years with a history of previous thrombosis, elevated haematocrit, and leukocytosis are most at risk of thrombosis. We report a case of a 74-year-old patient presenting with shortness of breath for three days. A computerized tomography pulmonary angiogram showed bilateral pulmonary emboli with right heart strain. He underwent emergency EkoSonic™ endovascular system-directed thrombolysis (EKOS™, Boston Scientific, Marlborough, MA). The patient tested positive for the Janus kinase 2 gene mutation (JAK2), met two major and one minor criterion for PV, and was discharged home on oral anticoagulation. The Janus kinase 2 (JAK2V617F) mutation is quite common in patients with polycythaemia vera, thrombocythemia, and myelofibrosis, and these patients are at risk of both arterial and venous thrombosis, hence they require long-term follow-up.
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  • 文章类型: Case Reports
    静脉血栓栓塞症(VTE)是一种在身体静脉系统中形成血凝块的疾病。它包括深静脉血栓(DVT),当血块在深静脉形成时,更常见于下肢,和肺栓塞(PE),因为凝块破裂并通过血流进入肺动脉。VTE可导致显著的发病率和死亡率。这是一种可预防的医疗状况,在大多数情况下,抗凝和机械血栓切除术的治疗是直接的。这里,我们讨论了一个罕见的病例,一个40岁的男性复发性VTE,对不同的可用治疗选择,如直接口服抗凝药(DOAC),维生素K拮抗剂,肝素,和导管指导溶栓,在整个右侧深静脉结构中出现闭塞性血栓,最低限度地保留股总静脉的流量。
    Venous thromboembolism (VTE) is a condition in which blood clots form in the venous system of the body. It includes deep venous thrombosis (DVT) that occurs when a blood clot forms in a deep vein, more common in lower extremities, and pulmonary embolism (PE) as the clot breaks loose and travels through the bloodstream to the pulmonary arteries. VTE can result in significant morbidity and mortality. It is a preventable medical condition with the treatment being straightforward in most cases with anticoagulation and mechanical thrombectomy. Here, we discuss a rare case of a 40-year-old male with recurrent VTE that was resistant to different available therapeutic options such as direct oral anticoagulants (DOAC), vitamin k antagonists, heparin, and catheter-directed thrombolysis presenting with occlusive thrombus in the entirety of the right-sided deep venous structures, with minimal preservation of flow in the common femoral vein.
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  • 文章类型: Case Reports
    我们讨论了一名31岁的男性患者的病例,该患者自就诊当天早晨以来出现呼吸急促和胸痛。他的聚合酶链反应(PCR)测试对严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)呈阳性,导致2019年冠状病毒病(COVID-19),两周前,他的主要症状是呼吸急促,干咳,全身疼痛,和发烧。他没有接种过COVID-19病毒疫苗。他没有因COVID-19需要住院治疗,自诊断之日起第10天,他的症状有所改善;然而,他在就诊当天出现胸膜炎性胸痛伴呼吸急促。他被发现患有呼吸加快症,缺氧,和心动过速评估。他的心电图显示右束支传导阻滞伴窦性心动过速。他接受了CT肺动脉造影(CTPA)检查,显示双侧大肺栓塞从双侧主肺动脉延伸至亚节段水平。扫描上有右心劳损的证据。他在CT扫描后还做了床边超声心动图检查,显示右心室增大,但无左心室血栓。他的血液结果显示D-二聚体水平为14,000ng/mL,肌钙蛋白T为255ng/L。他接受了低分子量肝素(LMWH)治疗,并接受了紧急EkoSonic™血管内系统(EKOS)溶栓(波士顿科学,马尔伯勒,MA).在接下来的12小时内,他继续进行超声加速溶栓(USAT),并显示出显着改善,并在EKOS溶栓后脱离氧气。住院48小时后,他口服利伐沙班出院;两个月后随访显示右心室大小正常,没有肺动脉高压的证据。
    We discuss a case of a 31-year-old male patient who presented to the accident and emergency department with shortness of breath and chest pain since the morning of the day of presentation. His polymerase chain reaction (PCR) test had returned positive for severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), which causes coronavirus disease 2019 (COVID-19), two weeks ago and his main symptoms had been shortness of breath, dry cough, generalized body pain, and fever. He was not vaccinated against the COVID-19 virus. He had not required hospitalization for COVID-19 and his symptoms had improved on day 10 from the date of diagnosis; however, he developed pleuritic chest pain with shortness of breath on the day of presentation. He was found to have tachypnoea, hypoxia, and tachycardia on assessment. His electrocardiogram showed a right bundle branch block with sinus tachycardia. He underwent a CT pulmonary angiography (CTPA) that showed bilateral large pulmonary emboli extending from the main pulmonary arteries bilaterally extending to the sub-segmental level. There was evidence of right heart strain on the scan. He also had a bedside echocardiogram performed after the CT scan, which showed an enlarged right ventricle but no left ventricular thrombus. His blood results showed D-dimer levels of 14,000 ng/mL and troponin T of 255 ng/L. He received treatment with low molecular weight heparin (LMWH) and underwent emergency EkoSonic™ Endovascular System (EKOS) thrombolysis (Boston Scientific, Marlborough, MA). He remained on ultrasound-accelerated thrombolysis (USAT) for the next 12 hours and showed significant improvement and was taken off oxygen post-EKOS thrombolysis. He was discharged home on oral rivaroxaban after 48 hours of hospital stay; follow-up after two months showed normal-sized right ventricle with no evidence of pulmonary hypertension.
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  • 文章类型: Case Reports
    严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)或COVID-19是导致2019年全球大流行的病毒。COVID-19的肺部并发症在文献中得到了证实。然而,这种病毒会引起许多肺外表现,尤其是急性主动脉闭塞(AAO)。COVID-19通过上调血管内皮细胞中多种促凝血细胞因子而产生高凝状态。我们介绍了一名63岁的患者,该患者先前没有血栓形成前疾病史,该患者在COVID-19收缩后在远端腹主动脉和双侧髂总动脉中出现AAO。该患者是不良的手术候选者,并接受了通过EkoSonic™血管内系统(EKOS)导管使用双侧经股入路给予的纤维蛋白溶解剂治疗。此病例突出了AAO非手术候选人的独特治疗选择。
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 is the virus responsible for the 2019 global pandemic. Pulmonary complications of COVID-19 are well established in the literature. However, the virus causes numerous extrapulmonary manifestations, notably acute aortic occlusion (AAO). COVID-19 creates a hypercoagulable state via the upregulation of numerous procoagulant cytokines in endothelial cells of blood vessels. We present a case of a 63-year-old patient without a previous history of prothrombotic disorders who developed AAO in the distal abdominal aorta and bilateral common iliac arteries after contracting COVID-19. The patient was a poor surgical candidate and was treated with fibrinolytics that were administered via an EkoSonic™ Endovascular System (EKOS) catheter using a bilateral transfemoral approach. This case highlights a unique treatment option for non-surgical candidates with AAO.
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    文章类型: Journal Article
    BACKGROUND: Pulmonary embolism (PE) endovascular interventions are often approached from an internal jugular or femoral venous access. There are multiple advantages of right basilic vein (RBV) access for both patient and operator, especially in the setting of morbid obesity. We hereby describe the case of a 48-year-old, morbidly obese man who presented with acute respiratory insufficiency and was found to have bilateral submassive subocclusive PE, worse on the right. The right ventricular to left ventricular ratio was 2.1 and troponin was elevated. A 7 Fr sheath was placed in the RBV under ultrasound guidance. Selective bilateral pulmonary arteriography was then performed. A 106 x 12 cm EKOS catheter was placed in the segment of highest thrombotic burden for a 6-hour protocol of catheter-directed ultrasound-facilitated thrombolytic therapy. The patient recovered well on a direct oral anticoagulant and his acute symptoms resolved. Treating massive/submassive PE from a RBV access offers the convenience and safety of superficial venous access (for patient and operator), better patient comfort, less venous stasis during therapy with ability to ambulate, less potential for bleeding and vascular complications, less potential for operator radiation exposure when compared with the jugular approach, and better operator ergonomics.
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  • 文章类型: Comparative Study
    UNASSIGNED: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI.
    UNASSIGNED: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss.
    UNASSIGNED: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts (P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group (P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system.
    UNASSIGNED: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.
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