BACKGROUND Diagnosing posterior inferior cerebellar artery dissection(PICAD)using radio-logical images is challenging.Massive cerebellar infarctions resulting from spon-taneous,isolated PICAD are rare,and the associat...BACKGROUND Diagnosing posterior inferior cerebellar artery dissection(PICAD)using radio-logical images is challenging.Massive cerebellar infarctions resulting from spon-taneous,isolated PICAD are rare,and the associated clinical,imaging,and treat-ment options remain unclear.CASE SUMMARY A 39-year-old man was admitted for dizziness and unstable gait for two days.Ph-ysical examination revealed decreased right-limb muscle strength and right-sided ataxia.Brain magnetic resonance imaging(MRI)showed a massive acute right cerebellar infarction,but other modalities,including head and neck computed tomographic angiography(CTA)and magnetic resonance angiography(MRA),showed no obvious abnormalities.High-resolution vessel wall MRI(HR-VW-MRI)revealed right PICAD.The patient was diagnosed with massive cerebellar infarction caused by PICAD and active conservative treatment was initiated.The initial PICAD lesion disappeared 1.5 months after discharge,after which the patient experienced only slight weakness in his right limb for three months.CONCLUSION Since MRA and CTA may fail to identify PICAD,HR-VW-MRI is key in diagnosis and follow-up evaluation.Aggressive medication may be effective and safe for treating PICAD.展开更多
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden cardiac death.It often occurs in females with no conventional cardiovascular risk factors.Bilateral iliac artery dissection i...Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden cardiac death.It often occurs in females with no conventional cardiovascular risk factors.Bilateral iliac artery dissection is also a rare disease.This case report describes a patient with spontaneous coronary artery dissection and iliac artery dissection.The authors believe that a conservative approach could be used as an effective therapy for a clinically stable patient.展开更多
BACKGROUND Spontaneous visceral artery dissection(SVAD)is a rare condition that affects the visceral arteries,such as the celiac,superior mesenteric,and inferior mesenteric arteries,without involving the aorta.Organ i...BACKGROUND Spontaneous visceral artery dissection(SVAD)is a rare condition that affects the visceral arteries,such as the celiac,superior mesenteric,and inferior mesenteric arteries,without involving the aorta.Organ ischemia or hemorrhage from vessel rupture can occur in SVAD;therefore,prompt detection and management is essential.Contrast-enhanced computed tomography(CECT)has been used to diagnose most of the previous cases,but few studies have explored the potential of contrast-enhanced ultrasound(CEUS)for early detection of this disease.CASE SUMMARY A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months.He had previously undergone transabdominal splenectomy,esophagogastric devascularization,and cholecystectomy for gallstones and severe portal hypertension.Liver ultrasound was performed in our department to assess liver status.An abnormal hepatic artery spectrum was observed,and dissection involving both the celiac artery and the common hepatic artery was observed.A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen,and dissection was subsequently confirmed by CECT.The patient was asymptomatic;therefore,treatment to control the blood pressure was provided,and follow-up was recommended.After 6 months of follow-up,the celiac artery was found to be dilated with an adherent thrombus visible in the wall,and the common hepatic artery was occluded with the presence of collateralization.Despite these findings,no significant changes in liver function were observed.CONCLUSION Multi-modal imaging is effective in diagnosing SVAD,and conservative treatment is a choice for asymptomatic patients.展开更多
BACKGROUND Traumatic internal carotid artery dissection(TICAD)is rare and can result in severe neurological disability and even death.No consensus regarding its diagnostic screening and management has been established...BACKGROUND Traumatic internal carotid artery dissection(TICAD)is rare and can result in severe neurological disability and even death.No consensus regarding its diagnostic screening and management has been established.AIM To investigate the clinical presentation,imaging features,diagnostic workup,and treatment of TICAD.METHODS In this retrospective case series,emergency admissions for TICAD due to closed head injury were analyzed.The demographic,clinical,and radiographic data were retrieved from patient charts and the picture archiving and communication system.RESULTS Six patients(five males and one female,age range of 43-62 years,mean age of 52.67 years)presented with TICAD.Traffic accidents(4/6)were the most frequent cause of TICAD.The clinical presentation was always related to brain hypoperfusion.Imaging examination revealed dissection of the affected artery and corresponding brain infarction.All the patients were definitively diagnosed with TICAD.One patient was treated conservatively,one patient underwent anticoagulant therapy,two patients were given both antiplatelet and anticoagulant drugs,and two patients underwent decompressive craniectomy.One patient fully recovered,while three patients were disabled at follow-up.Two patients died of refractory brain infarction.CONCLUSION TICAD can cause catastrophic outcomes and even refractory brain hernia.Early and efficient diagnosis of TICAD is essential for initiating appropriate treatment.The treatment of TICAD is challenging and variable and is based on clinician discretion on a case-by-case basis.展开更多
Spontaneous coronary artery dissection(SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 7...Spontaneous coronary artery dissection(SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending(LAD) artery and left circumflex(LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.展开更多
BACKGROUND Vertebral artery dissection(VAD)is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery,leading to stenosis,occlusion or rupture.The clinical presentat...BACKGROUND Vertebral artery dissection(VAD)is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery,leading to stenosis,occlusion or rupture.The clinical presentation of VAD can be heterogeneous,with common symptoms including headache,dizziness and balance problems.Timely diagnosis and treatment are crucial for favorable outcomes;however,VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines.High-resolution magnetic resonance imaging(HRMRI)has emerged as a reliable diagnostic tool for VAD,providing detailed visualization of vessel wall abnormalities.CASE SUMMARY A young male patient presented with an acute onset of severe headache,vomiting,and seizures,followed by altered consciousness.Imaging studies revealed bilateral VAD,basilar artery thrombosis,multiple brainstem and cerebellar infarcts,and subarachnoid hemorrhage.Digital subtraction angiography(DSA)revealed vertebral artery stenosis but failed to detect the dissection,potentially because intramural thrombosis obscured the VAD.In contrast,HRMRI confirmed the diagnosis by revealing specific signs of dissection.The patient was managed conservatively with antiplatelet therapy and other supportive measures,such as blood pressure control and pain management.After 5 mo of rehabilitation,the patient showed significant improvement in swallowing and limb strength.CONCLUSION HR-MRI can provide precise evidence for the identification of VAD.展开更多
In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary ...In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary artery dissection(SCAD)phantoms.IVPAI provides high-resolution and high-penetration images of intramural hematoma(IMH)at different depths,so it is especially useful for imaging deep blood clots associated with imaging phantoms.IVOCT can readily visualize the double-lumen morphology of blood vessel walls to identify intimal tears.We also demonstrate the capability of this dual-mode endoscopic system using mimicking phantoms and biological samples of blood clots in ex vivo porcine arteries.The results of the experiments indicate that the combined IVPAI and IVOCT technique has the potential to provide a more accurate SCAD assessment method for clinical applications.展开更多
BACKGROUND:Spontaneous isolated superior mesenteric artery(SMA)dissection(SISMAD)is a rare cause of abdominal pain.The aim of the study is to investigate the role of a new parameter,the ratio of the SMA diameter to th...BACKGROUND:Spontaneous isolated superior mesenteric artery(SMA)dissection(SISMAD)is a rare cause of abdominal pain.The aim of the study is to investigate the role of a new parameter,the ratio of the SMA diameter to the superior mesenteric vein(SMV)diameter(SMA/SMV)based on non-enhanced computed tomography(CT),in the early diagnosis of SISMAD.METHODS:In a registry study from December 2013 to June 2021,97 abdominal pain SISMAD patients(SISMAD group)admitted to our hospital were enrolled.Meanwhile,the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group.Student’s t-test,Wilcoxon rank-sum test,and Chi-square test were used to compare differences between the SISMAD and control groups.Med Calc was used to generate receiver operating characteristic(ROC)curve.RESULTS:A total of 291 abdominal pain patients,including 97 SISMAD patients and 194 nonSISMAD patients,were included in the current study.The maximum SMA diameter,perivascular exudation,and SMA/SMV based on non-enhanced CT were significant between the two groups(all P<0.05).ROC curves showed that for the maximum SMA diameter,the area under the curve(AUC),cut-off,sensitivity,and specificity were 0.926,9.80,93.8%,and 79.4%,respectively.For SMA/SMV,its AUC,cut-off,sensitivity,and specificity were 0.956,0.83,88.7%,and 92.3%,respectively.The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter(P<0.05).The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency(AUC=0.970).CONCLUSION:SMA/SMV may be a potential marker for SISMAD.展开更多
BACKGROUND Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a rare disease that originates from the superior mesenteric artery,without the presence of aortic and other arterial dissections.Most cas...BACKGROUND Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a rare disease that originates from the superior mesenteric artery,without the presence of aortic and other arterial dissections.Most cases are diagnosed using contrastenhanced computed tomography(CECT),whereas the application of ultrasound is less common.CASE SUMMARY Here,we report a case of SISMAD with sudden epigastric pain that worsened as the main symptom after eating.The patient had a long history of hypertension with unknown blood pressure control but no history of smoking or alcohol consumption.This case was initially diagnosed using ultrasound and the results were later confirmed by CECT.After admission,the patient fasted,followed by parenteral nutrition support and fluid supplementation to maintain electrolyte and acid–base balance.Metoprolol succinate sustained-release tablets and aspirin were given as nonoperative treatments.After 1 wk,the symptoms improved,and the patient was discharged.During telephone follow-up,the patient did not develop similar symptoms.CONCLUSION Whether ultrasound can be used as a routine and noninvasive imaging method for the diagnosis of SISMAD needs further exploration.展开更多
Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 3...Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.展开更多
BACKGROUND Pregnancy-associated spontaneous coronary artery dissection(PSCAD)is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women.Pregnancy is considered an isolated ris...BACKGROUND Pregnancy-associated spontaneous coronary artery dissection(PSCAD)is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women.Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection.The etiology,pathogenesis,and incidence of PSCAD are not known.CASE SUMMARY We present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection.She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.CONCLUSION Most patients with PSCAD can be managed conservatively with medical management and have good outcomes.Patients with high-risk presentations benefit from the invasive approach.Coronary artery bypass graft may be required in select few patients based on angiography findings.Due to the risk of recurrent spontaneous coronary artery dissection,subsequent pregnancies are discouraged.展开更多
BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist s...BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist simultaneously,making it challenging for clinicians to treat and manage.Case reports lack consolidated AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed,EMBASE,Scopus,and Google Scholar databases till January 2023.Case reports described demographics,comorbidities,imaging,management,and results.RESULTS Twelve articles about 20 female patients were analyzed.30%of patients(n=6,>60 years)were elderly(mean age 56.2±9.07 years,range 36-70 years).Canada has 9 cases,United States 3,Australia 3,Sweden 2,Japan,Denmark,and France 1.Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS.Nine had hypertension,2 had hyperlipidemia,and 1 had prediabetes.5 patients(25%)smoked.10(50%)troponin-positive myocardial infarction patients reported chest discomfort.11(55%)of 20 instances had TTS/SCAD.12(60%)of 20 patients exhibited ST elevation and 3(15%)had T wave inversion on electrocardiogram.19/20 patients had elevated troponin.9(45%)of 20 people had apical akinesis with TTS ballooning on cardiac imaging.All 20 exhibited echocardiographic wall motion abnormalities.19(95%)of 20 coronary angiography cases had SCAD.10 of 19 SCAD patients had left anterior descending,2 diagonal,and 2 left circumflex coronary artery involvement.7 of 20 patients had left ventricular ejection fraction(LVEF)data.LVEF averaged 38.78±7.35%.5(25%)of the 20 cases underwent dual antiplatelet therapy.Three(15%)of 20 cases experienced occasional ectopic ventricular complexes,Mobitz ll AV block,and paroxysmal atrial fibrillation.All 20 cases recovered and survived.CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD,this subset needs more research to raise awareness and reduce morbidity.展开更多
Background:The standard treatment for internal carotid artery(ICA)dissection is obscure.Current therapeutic strategies include the use of antiplatelet drugs,anticoagulant drugs,intravenous thrombolysis,and endovascula...Background:The standard treatment for internal carotid artery(ICA)dissection is obscure.Current therapeutic strategies include the use of antiplatelet drugs,anticoagulant drugs,intravenous thrombolysis,and endovascular treatment.Endovascular treatment is important in acute internal carotid artery dissection.This study reports two acute internal carotid artery dissection cases that were treated successfully using the Xpert-Pro peripheral selfexpanding stent system.Case summary:The first case was of a 38-year-old male patient with transient speechlessness and paralysis of the right limb in July 2021.Cervical computed tomographic angiography(CTA)showed ICA occlusion on the left side.Digital subtraction angiography(DSA)showed severe stenosis of the C1 segment of the left internal carotid artery with intermural hematoma.The patient subsequently underwent Xpert-Pro peripheral self-expanding stent implantation,and his condition stabilized.The second case was of a 56-year-old male patient with speechlessness and paralysis of the right limb.Cervical CTA showed a dissected left ICA,and DSA showed an occluded left ICA and middle cerebral artery.The patient subsequently underwent stent implantation,and his condition stabilized.展开更多
Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a m...Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors.SCAD is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery walls.Patients with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or fluttery.During the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis.However,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease.Treatment of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac syndromes.Although conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of complications.The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients.Follow-up should be performed on a regular basis.展开更多
Coronary artery dissection and acute myocar-dial infarction（AMI） after blunt chest trauma （BCT） has rarely been reported1＇2. This report describes two cases of the left anterior de-scending（LAD） artery dissecti...Coronary artery dissection and acute myocar-dial infarction（AMI） after blunt chest trauma （BCT） has rarely been reported1＇2. This report describes two cases of the left anterior de-scending（LAD） artery dissection and AMI after BCT, successfully treated with percutaneous coronary intervention （PCI） and they dis-charged without complications.展开更多
Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass ef...Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.展开更多
Fibromuscular dysplasia(FMD)is a rare disease with a typical clinical manifestations.This article will describe the clinical features of a FMD case with severe headache misdiagnosed as cerebral artery dissection(CAD)....Fibromuscular dysplasia(FMD)is a rare disease with a typical clinical manifestations.This article will describe the clinical features of a FMD case with severe headache misdiagnosed as cerebral artery dissection(CAD).Treatment remedies:we collected the clinical data of a patient with severe headache and performed brain MRI(magnetic resonance imaging)and cerebral arteriovenous MRA(magnetic resonance angiography).The preliminary diagnosis was considered as right vertebral artery dissection,and then cerebral DSA(digital subtraction angiography)was performed for further diagnosis.Post treatment evaluating:cerebral angiography showed that the vessel wall was stiff,with multiple(insect phagocytic)-like changes,and severe stenosis of local long segments.Some vessels showed“double lumen sign”,which was consistent with the performance of FMD.After anticoagulant treatment,the patient’s condition was improved.Conclusions:for severe headache,in addition to common diseases,the possibility of FMD should also be paid great attention.Early cerebrovascular screening is conducive to early diagnosis and timely treatment.展开更多
Vertebral artery dissection(VAD) is an acute vascular condition characterized by intimal tearing that leads to the formation of intramural hematomas or pseudoaneurysms.^([1,2]) The pathogenesis of VAD involves a multi...Vertebral artery dissection(VAD) is an acute vascular condition characterized by intimal tearing that leads to the formation of intramural hematomas or pseudoaneurysms.^([1,2]) The pathogenesis of VAD involves a multifactorial interplay of genetic susceptibility,structural vessel wall abnormalities,and mechanical stressors.^([3]) We present a case of VAD triggered by cervical mechanical stress,and explore the diagnostic workup and the role of multidisciplinary coordination in therapeutic decision-making.展开更多
Background Recent studies show cervical artery dissection(CeAD)is equally common between sexes,and that the incidence of CeAD has risen at a greater rate in females than males.In this population-based study,we identif...Background Recent studies show cervical artery dissection(CeAD)is equally common between sexes,and that the incidence of CeAD has risen at a greater rate in females than males.In this population-based study,we identify sex differences in patients diagnosed with spontaneous and traumatic CeAD.Methods 144 patients with spontaneous or traumatic CeAD were studied for sex differences in medical comorbidities,presenting symptoms and outcomes.Results Females were more likely to carry a diagnosis of migraine,while males were more likely to have hyperlipidaemia.Females were more likely to present with neck pain,males with stroke.Females were significantly more likely to develop recurrent dissections in the study period.Conclusions These findings underscore the importance of understanding CeAD through the lens of sex differences and may explain the significant rise in the diagnosis of CeAD in females.These findings support the importance of considering sex-specific risk factors and medical comorbidities with sex predilection in the diagnosis and management of CeAD.Furthermore,it emphasises the importance of female patients understanding risk factors and presenting signs that should prompt evaluation for CeAD.展开更多
We value the interest in our work(Schipani et al)1 expressed by Zhang et al2 in their recent letter to the editor.We welcome the oppor-tunity to respond and offer the following clarifications.Traditionally,spontaneous...We value the interest in our work(Schipani et al)1 expressed by Zhang et al2 in their recent letter to the editor.We welcome the oppor-tunity to respond and offer the following clarifications.Traditionally,spontaneous and trau-matic cervical artery dissections(CeAD)have been classified separately.However,despite conflicting results from observational cohorts,3 there is currently no convincing evidence supporting significant differences in the underlying pathophysiology between the two types.Therefore,we believe this distinc-tion to be arbitrary.展开更多
基金Supported by Shenzhen Second People’s Hospital Clinical Research Fund of Shenzhen High-level Hospital Construction Project,No.20243357001.
文摘BACKGROUND Diagnosing posterior inferior cerebellar artery dissection(PICAD)using radio-logical images is challenging.Massive cerebellar infarctions resulting from spon-taneous,isolated PICAD are rare,and the associated clinical,imaging,and treat-ment options remain unclear.CASE SUMMARY A 39-year-old man was admitted for dizziness and unstable gait for two days.Ph-ysical examination revealed decreased right-limb muscle strength and right-sided ataxia.Brain magnetic resonance imaging(MRI)showed a massive acute right cerebellar infarction,but other modalities,including head and neck computed tomographic angiography(CTA)and magnetic resonance angiography(MRA),showed no obvious abnormalities.High-resolution vessel wall MRI(HR-VW-MRI)revealed right PICAD.The patient was diagnosed with massive cerebellar infarction caused by PICAD and active conservative treatment was initiated.The initial PICAD lesion disappeared 1.5 months after discharge,after which the patient experienced only slight weakness in his right limb for three months.CONCLUSION Since MRA and CTA may fail to identify PICAD,HR-VW-MRI is key in diagnosis and follow-up evaluation.Aggressive medication may be effective and safe for treating PICAD.
文摘Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden cardiac death.It often occurs in females with no conventional cardiovascular risk factors.Bilateral iliac artery dissection is also a rare disease.This case report describes a patient with spontaneous coronary artery dissection and iliac artery dissection.The authors believe that a conservative approach could be used as an effective therapy for a clinically stable patient.
基金National Natural Science Foundation of China,No.82071940.
文摘BACKGROUND Spontaneous visceral artery dissection(SVAD)is a rare condition that affects the visceral arteries,such as the celiac,superior mesenteric,and inferior mesenteric arteries,without involving the aorta.Organ ischemia or hemorrhage from vessel rupture can occur in SVAD;therefore,prompt detection and management is essential.Contrast-enhanced computed tomography(CECT)has been used to diagnose most of the previous cases,but few studies have explored the potential of contrast-enhanced ultrasound(CEUS)for early detection of this disease.CASE SUMMARY A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months.He had previously undergone transabdominal splenectomy,esophagogastric devascularization,and cholecystectomy for gallstones and severe portal hypertension.Liver ultrasound was performed in our department to assess liver status.An abnormal hepatic artery spectrum was observed,and dissection involving both the celiac artery and the common hepatic artery was observed.A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen,and dissection was subsequently confirmed by CECT.The patient was asymptomatic;therefore,treatment to control the blood pressure was provided,and follow-up was recommended.After 6 months of follow-up,the celiac artery was found to be dilated with an adherent thrombus visible in the wall,and the common hepatic artery was occluded with the presence of collateralization.Despite these findings,no significant changes in liver function were observed.CONCLUSION Multi-modal imaging is effective in diagnosing SVAD,and conservative treatment is a choice for asymptomatic patients.
文摘BACKGROUND Traumatic internal carotid artery dissection(TICAD)is rare and can result in severe neurological disability and even death.No consensus regarding its diagnostic screening and management has been established.AIM To investigate the clinical presentation,imaging features,diagnostic workup,and treatment of TICAD.METHODS In this retrospective case series,emergency admissions for TICAD due to closed head injury were analyzed.The demographic,clinical,and radiographic data were retrieved from patient charts and the picture archiving and communication system.RESULTS Six patients(five males and one female,age range of 43-62 years,mean age of 52.67 years)presented with TICAD.Traffic accidents(4/6)were the most frequent cause of TICAD.The clinical presentation was always related to brain hypoperfusion.Imaging examination revealed dissection of the affected artery and corresponding brain infarction.All the patients were definitively diagnosed with TICAD.One patient was treated conservatively,one patient underwent anticoagulant therapy,two patients were given both antiplatelet and anticoagulant drugs,and two patients underwent decompressive craniectomy.One patient fully recovered,while three patients were disabled at follow-up.Two patients died of refractory brain infarction.CONCLUSION TICAD can cause catastrophic outcomes and even refractory brain hernia.Early and efficient diagnosis of TICAD is essential for initiating appropriate treatment.The treatment of TICAD is challenging and variable and is based on clinician discretion on a case-by-case basis.
文摘Spontaneous coronary artery dissection(SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending(LAD) artery and left circumflex(LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.
基金Supported by The Clinical Innovation Guidance Program of Hunan Provincial Science and Technology Department,China,No.2021SK51714The Hunan Nature Science Foundation,China,No.2023JJ30531.
文摘BACKGROUND Vertebral artery dissection(VAD)is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery,leading to stenosis,occlusion or rupture.The clinical presentation of VAD can be heterogeneous,with common symptoms including headache,dizziness and balance problems.Timely diagnosis and treatment are crucial for favorable outcomes;however,VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines.High-resolution magnetic resonance imaging(HRMRI)has emerged as a reliable diagnostic tool for VAD,providing detailed visualization of vessel wall abnormalities.CASE SUMMARY A young male patient presented with an acute onset of severe headache,vomiting,and seizures,followed by altered consciousness.Imaging studies revealed bilateral VAD,basilar artery thrombosis,multiple brainstem and cerebellar infarcts,and subarachnoid hemorrhage.Digital subtraction angiography(DSA)revealed vertebral artery stenosis but failed to detect the dissection,potentially because intramural thrombosis obscured the VAD.In contrast,HRMRI confirmed the diagnosis by revealing specific signs of dissection.The patient was managed conservatively with antiplatelet therapy and other supportive measures,such as blood pressure control and pain management.After 5 mo of rehabilitation,the patient showed significant improvement in swallowing and limb strength.CONCLUSION HR-MRI can provide precise evidence for the identification of VAD.
基金funding from the National Natural Science Foundation of China(NSFC)under grants 61627827,61705068the Natural Science Foundation of Fujian Province 2021J01813the Fujian Medical University Research Foundation of Talented Scholars XRCZX2021004.
文摘In this work,we present an intravascular dual-mode endoscopic system capable of both intravascular photoacoustic imaging(IVPAI)and intravascular optical coherence tomography(IVOCT)for recognizing spontaneous coronary artery dissection(SCAD)phantoms.IVPAI provides high-resolution and high-penetration images of intramural hematoma(IMH)at different depths,so it is especially useful for imaging deep blood clots associated with imaging phantoms.IVOCT can readily visualize the double-lumen morphology of blood vessel walls to identify intimal tears.We also demonstrate the capability of this dual-mode endoscopic system using mimicking phantoms and biological samples of blood clots in ex vivo porcine arteries.The results of the experiments indicate that the combined IVPAI and IVOCT technique has the potential to provide a more accurate SCAD assessment method for clinical applications.
基金supported by Clinical Scientific Research Fund of Zhejiang Medical Association(2021ZYC-A73)。
文摘BACKGROUND:Spontaneous isolated superior mesenteric artery(SMA)dissection(SISMAD)is a rare cause of abdominal pain.The aim of the study is to investigate the role of a new parameter,the ratio of the SMA diameter to the superior mesenteric vein(SMV)diameter(SMA/SMV)based on non-enhanced computed tomography(CT),in the early diagnosis of SISMAD.METHODS:In a registry study from December 2013 to June 2021,97 abdominal pain SISMAD patients(SISMAD group)admitted to our hospital were enrolled.Meanwhile,the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group.Student’s t-test,Wilcoxon rank-sum test,and Chi-square test were used to compare differences between the SISMAD and control groups.Med Calc was used to generate receiver operating characteristic(ROC)curve.RESULTS:A total of 291 abdominal pain patients,including 97 SISMAD patients and 194 nonSISMAD patients,were included in the current study.The maximum SMA diameter,perivascular exudation,and SMA/SMV based on non-enhanced CT were significant between the two groups(all P<0.05).ROC curves showed that for the maximum SMA diameter,the area under the curve(AUC),cut-off,sensitivity,and specificity were 0.926,9.80,93.8%,and 79.4%,respectively.For SMA/SMV,its AUC,cut-off,sensitivity,and specificity were 0.956,0.83,88.7%,and 92.3%,respectively.The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter(P<0.05).The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency(AUC=0.970).CONCLUSION:SMA/SMV may be a potential marker for SISMAD.
文摘BACKGROUND Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a rare disease that originates from the superior mesenteric artery,without the presence of aortic and other arterial dissections.Most cases are diagnosed using contrastenhanced computed tomography(CECT),whereas the application of ultrasound is less common.CASE SUMMARY Here,we report a case of SISMAD with sudden epigastric pain that worsened as the main symptom after eating.The patient had a long history of hypertension with unknown blood pressure control but no history of smoking or alcohol consumption.This case was initially diagnosed using ultrasound and the results were later confirmed by CECT.After admission,the patient fasted,followed by parenteral nutrition support and fluid supplementation to maintain electrolyte and acid–base balance.Metoprolol succinate sustained-release tablets and aspirin were given as nonoperative treatments.After 1 wk,the symptoms improved,and the patient was discharged.During telephone follow-up,the patient did not develop similar symptoms.CONCLUSION Whether ultrasound can be used as a routine and noninvasive imaging method for the diagnosis of SISMAD needs further exploration.
文摘Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.
文摘BACKGROUND Pregnancy-associated spontaneous coronary artery dissection(PSCAD)is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women.Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection.The etiology,pathogenesis,and incidence of PSCAD are not known.CASE SUMMARY We present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection.She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.CONCLUSION Most patients with PSCAD can be managed conservatively with medical management and have good outcomes.Patients with high-risk presentations benefit from the invasive approach.Coronary artery bypass graft may be required in select few patients based on angiography findings.Due to the risk of recurrent spontaneous coronary artery dissection,subsequent pregnancies are discouraged.
文摘BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist simultaneously,making it challenging for clinicians to treat and manage.Case reports lack consolidated AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed,EMBASE,Scopus,and Google Scholar databases till January 2023.Case reports described demographics,comorbidities,imaging,management,and results.RESULTS Twelve articles about 20 female patients were analyzed.30%of patients(n=6,>60 years)were elderly(mean age 56.2±9.07 years,range 36-70 years).Canada has 9 cases,United States 3,Australia 3,Sweden 2,Japan,Denmark,and France 1.Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS.Nine had hypertension,2 had hyperlipidemia,and 1 had prediabetes.5 patients(25%)smoked.10(50%)troponin-positive myocardial infarction patients reported chest discomfort.11(55%)of 20 instances had TTS/SCAD.12(60%)of 20 patients exhibited ST elevation and 3(15%)had T wave inversion on electrocardiogram.19/20 patients had elevated troponin.9(45%)of 20 people had apical akinesis with TTS ballooning on cardiac imaging.All 20 exhibited echocardiographic wall motion abnormalities.19(95%)of 20 coronary angiography cases had SCAD.10 of 19 SCAD patients had left anterior descending,2 diagonal,and 2 left circumflex coronary artery involvement.7 of 20 patients had left ventricular ejection fraction(LVEF)data.LVEF averaged 38.78±7.35%.5(25%)of the 20 cases underwent dual antiplatelet therapy.Three(15%)of 20 cases experienced occasional ectopic ventricular complexes,Mobitz ll AV block,and paroxysmal atrial fibrillation.All 20 cases recovered and survived.CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD,this subset needs more research to raise awareness and reduce morbidity.
文摘Background:The standard treatment for internal carotid artery(ICA)dissection is obscure.Current therapeutic strategies include the use of antiplatelet drugs,anticoagulant drugs,intravenous thrombolysis,and endovascular treatment.Endovascular treatment is important in acute internal carotid artery dissection.This study reports two acute internal carotid artery dissection cases that were treated successfully using the Xpert-Pro peripheral selfexpanding stent system.Case summary:The first case was of a 38-year-old male patient with transient speechlessness and paralysis of the right limb in July 2021.Cervical computed tomographic angiography(CTA)showed ICA occlusion on the left side.Digital subtraction angiography(DSA)showed severe stenosis of the C1 segment of the left internal carotid artery with intermural hematoma.The patient subsequently underwent Xpert-Pro peripheral self-expanding stent implantation,and his condition stabilized.The second case was of a 56-year-old male patient with speechlessness and paralysis of the right limb.Cervical CTA showed a dissected left ICA,and DSA showed an occluded left ICA and middle cerebral artery.The patient subsequently underwent stent implantation,and his condition stabilized.
文摘Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors.SCAD is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery walls.Patients with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or fluttery.During the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis.However,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease.Treatment of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac syndromes.Although conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of complications.The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients.Follow-up should be performed on a regular basis.
文摘Coronary artery dissection and acute myocar-dial infarction（AMI） after blunt chest trauma （BCT） has rarely been reported1＇2. This report describes two cases of the left anterior de-scending（LAD） artery dissection and AMI after BCT, successfully treated with percutaneous coronary intervention （PCI） and they dis-charged without complications.
文摘Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.
文摘Fibromuscular dysplasia(FMD)is a rare disease with a typical clinical manifestations.This article will describe the clinical features of a FMD case with severe headache misdiagnosed as cerebral artery dissection(CAD).Treatment remedies:we collected the clinical data of a patient with severe headache and performed brain MRI(magnetic resonance imaging)and cerebral arteriovenous MRA(magnetic resonance angiography).The preliminary diagnosis was considered as right vertebral artery dissection,and then cerebral DSA(digital subtraction angiography)was performed for further diagnosis.Post treatment evaluating:cerebral angiography showed that the vessel wall was stiff,with multiple(insect phagocytic)-like changes,and severe stenosis of local long segments.Some vessels showed“double lumen sign”,which was consistent with the performance of FMD.After anticoagulant treatment,the patient’s condition was improved.Conclusions:for severe headache,in addition to common diseases,the possibility of FMD should also be paid great attention.Early cerebrovascular screening is conducive to early diagnosis and timely treatment.
文摘Vertebral artery dissection(VAD) is an acute vascular condition characterized by intimal tearing that leads to the formation of intramural hematomas or pseudoaneurysms.^([1,2]) The pathogenesis of VAD involves a multifactorial interplay of genetic susceptibility,structural vessel wall abnormalities,and mechanical stressors.^([3]) We present a case of VAD triggered by cervical mechanical stress,and explore the diagnostic workup and the role of multidisciplinary coordination in therapeutic decision-making.
文摘Background Recent studies show cervical artery dissection(CeAD)is equally common between sexes,and that the incidence of CeAD has risen at a greater rate in females than males.In this population-based study,we identify sex differences in patients diagnosed with spontaneous and traumatic CeAD.Methods 144 patients with spontaneous or traumatic CeAD were studied for sex differences in medical comorbidities,presenting symptoms and outcomes.Results Females were more likely to carry a diagnosis of migraine,while males were more likely to have hyperlipidaemia.Females were more likely to present with neck pain,males with stroke.Females were significantly more likely to develop recurrent dissections in the study period.Conclusions These findings underscore the importance of understanding CeAD through the lens of sex differences and may explain the significant rise in the diagnosis of CeAD in females.These findings support the importance of considering sex-specific risk factors and medical comorbidities with sex predilection in the diagnosis and management of CeAD.Furthermore,it emphasises the importance of female patients understanding risk factors and presenting signs that should prompt evaluation for CeAD.
文摘We value the interest in our work(Schipani et al)1 expressed by Zhang et al2 in their recent letter to the editor.We welcome the oppor-tunity to respond and offer the following clarifications.Traditionally,spontaneous and trau-matic cervical artery dissections(CeAD)have been classified separately.However,despite conflicting results from observational cohorts,3 there is currently no convincing evidence supporting significant differences in the underlying pathophysiology between the two types.Therefore,we believe this distinc-tion to be arbitrary.
