Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

With the advancement of endovascular coil devices, aneurysm embolization with coiling is becoming the more preferred treatment approach compared to craniotomy with microsurgical clipping. Between 2020 and 2023, thirty cerebral aneurysms were treated with at least 80% utilization of the Balt Optima™ Coil System.

Aneurysm 40

Aneurysm Embolism Stents Stent 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

However, its effectiveness hasn't been examined in countries with low and middle incomes, like Mexico.MethodsLongitudinal, retrospective study of the patients who received care at a tertiary center between November 2020 and April 2022. Adults older than 18 with non‐ruptured intracranial aneurysms were included.

Aneurysm 40

Aneurysm Embolism Angioplasty Stents 40

Stroke Journal

FEBRUARY 1, 2024

We used previously validated ICD-10-CM codes for acute ischemic stroke, intracerebral and subarachnoid hemorrhage, cerebral venous thrombosis, acute myocardial infarction, pulmonary embolism, and acute deep venous thrombosis to define our study outcome.Results:We identified a total of 747 patients with OHSS in HCUP.

Thrombosis 40

Thrombosis Inpatient Embolism Myocardial Infarction 40

Stroke Journal

FEBRUARY 1, 2024

We isolated a cohort of patients with likely embolic PCA occlusions (those with atrial fibrillation) and compared outcomes associated with IVT and EVT versus medical management (MM).Methods:The Patterns were also similar when patients with a concomitant BAO were included (routine discharge adjusted OR for IVT: 1.57, 95% CI:1.03-2.38).Conclusion:Our

Atrial Fibrillation 40

Atrial Fibrillation Thrombolysis Outcomes Embolism 40

Dr. Smith's ECG Blog

JANUARY 8, 2024

Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. It is of course pulmonary embolism. The Queen diagnosed "OMI with high confidence" due to the ST Elevation in V1-V3. What is the clear diagnosis and reason for arrest?

Chest Pain 71

Chest Pain Pulmonary Embolism STEMI 71

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. CT chest showed left sided pulmonary embolism and a pulmonary infarct that had previously been mistaken for pneumonia. Instead, he was diagnosed with pneumonia — that turned out to be a left-sided pulmonary embolism that was initially missed.

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Chest Pain STEMI Pulmonary Embolism 73

Stroke Journal

JANUARY 30, 2025

Previous research in this area suggests presence of right-to-left shunt as a possible underlying mechanism of paradoxical embolism in patients with cancer diagnosis within one year of the stroke. However, the relationship between cancer and stroke is not well studied.

Cancer 40

Cancer Stroke Strokes Embolism 40

Stroke Journal

FEBRUARY 1, 2024

8290 aneurysms embolizations were performed (13.5% of SAH cases were treated with neurosurgical clipping, demonstrating a decrease tendency after 2020, as well other procedures, such as Craniectomy and Angioplastia. Rates of Thrombolysis were alarming, but with an increasing tendency: 22969 were performed, from 1.6% in 2017 to 2.3%

Cerebrovascular Disease 40

Cerebrovascular Disease Thrombolysis Public Health Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

Therefore, we aimed to evaluate an artificial intelligence (AI)-enabled ECG algorithm to predict AF detected by PCT after index stroke.Methods:This retrospective study included all adult patients with ischemic stroke evaluated at Mayo Clinic with baseline electrocardiogram (ECG) and PCT between 2018-2020.

Atrial Fibrillation 40

Atrial Fibrillation Electrocardiogram Embolism Strokes 40

Stroke Journal

FEBRUARY 1, 2024

We have developed a Proximal balloon Occlusion With forcEd aspiRation (POWER) technique to prevent distal embolization in CAS with the filter protection device. Purpose:Since the balloon protection device became unavailable in Japan three years ago, the DWI-positive rate after carotid artery stenting (CAS) has increased.

Stents 40

Stents Stent Stenosis Embolism 40

Stroke Journal

JANUARY 30, 2025

We longitudinally followed the patients by linking the registry data to the Center for Medicare&Medicaid Service (CMS) claims data. Model fit was assessed using the Hosmer-Lemeshow test.Results:Among 142 eligible pre-ICH statin users (median age [IQR]: 77.5 [72-86] 72-86] years; 57.0% female; 66.0% female; 69.5%

Medicare 40

Medicare CMS Medicaid Myocardial Infarction 40

Stroke Journal

JANUARY 30, 2025

We aim to assess how AI-ECG prediction model outputs, specifically the AF probability and delta age, are associated with adverse vascular outcomes in patients with migraine.Adult patients diagnosed with MwA and MwoA from 2000-2020 with at least one digital, standard 12-lead ECG were identified. 14.5), and the average follow-up time was 71.6

Atrial Fibrillation 40

Atrial Fibrillation Outcomes Coronary Artery Disease Myocardial Infarction 40

Circulation

NOVEMBER 11, 2024

A pathological classification of no-reflow was proposed: structural no-reflow—microvessels within the necrotic myocardium exhibit loss of capillary integrity (it is usually irreversible)—and functional no reflow—patency of microvasculature is compromised due to distal embolization, spasm, ischemic injury, reperfusion injury.

Ultrasound 40

Ultrasound Plaque Blood Pressure Myocardial Infarction 40

Dr. Smith's ECG Blog

MAY 23, 2023

And they of course activated the cath lab immediately, where he was found to have acute thrombotic occlusion (TIMI 0) of the proximal LAD, as well as embolic D1 occlusion. Instead, they reviewed the ECG immediately regardless of the computer interpretation of "normal." LCX and RCA were described as "normal" in the cath report.

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Chest Pain STEMI Blog Stents 98

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

MAY 19, 2020

pulmonary embolism, sepsis, etc.), Coronary thrombosis or embolism can result in MINOCA, either with or without a hypercoagulable state. Shark Fin morphology has been discussed a number of times on Dr. Smith’s ECG Blog ( For review — See the June 11, 2018 post and the January 24, 2020 post , to name just 2 instances ).

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. JAMA Cardiol [Internet] 2020;Available from: [link] 4. JAMA Cardiol [Internet] 2020;Available from: [link] 5. Guo T, Fan Y, Chen M, et al.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

AUGUST 14, 2023

The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) When you suspect pulmonary embolism due to large RV on POCUS, always look for right axis deviation and a large R-wave in V1 because the large RV may be entirely due to chronic RVH, not acute PE. Here is his triage ECG: What do you think?

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction. This is not the case.

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Plaque Angina Blog Stents 127

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. 2020 Sep;31(9):2474-2483. J Cardiovasc Electrophysiol. Gourraud JB, Barc J, Thollet A, Le Marec H, Probst V.

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Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 20, 2013

Normal 0 false false false EN-US X-NONE X-NONE Normal 0 false false false EN-US X-NONE X-NONE The final diagnosis on his ED note: pulmonary embolism AND pericarditis. Does subsegmental pulmonary embolism matter? The ST/T ratio in V6, however, is slightly greater. How do we know that the benefits outweigh the risks of anticoagulation?

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Pericarditis Chest Pain Pulmonary Embolism 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

No definite evidence of RV hypertrophy (normal axis, no large R-wave in V1) Late transition typical of COPD (R/S = 1 in V5) No evidence of old MI (no QS-waves in V1-V3, as seen in the presenting ECG) Other similar cases of acute right heart strain See this case of asthma whose ECG mimics acute PE: Is it pulmonary embolism? Kosuge et al.

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As The November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ". Putting all the data together, the patient likely suffered an anterior OMI in the days or weeks prior to presentation.

Chest Pain 64

Chest Pain Blog Arrhythmia Critical Care 64

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Transient and partial thrombosis at the site of a non-obstructive plaque with subsequent spontaneous fibrinolysis and distal embolization may be one of the mechanisms responsible for the occurrence of MINOCA. This is not the case.

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Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. There is a literature on this subject ( GGF van der Schoot et al: Neth Heart J 28(6):301-308, 2020 — and — Egred et al — Postgrad Med 81(962): 741-745, 2005 — to name just 2 reports ). No further troponins were measured.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 12, 2023

CT pulmonary angiogram was negative for pulmonary embolism. If the patient continues to have reperfusion, then we would expect progressive terminal T wave inversion then full T wave inversion over time in the future ECGs. Second troponin T resulted at 1,318 ng/L. Chest x-ray was read as normal. Heparin was started. Reocclusion!

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Transient and partial thrombosis at the site of a non-obstructive plaque with subsequent spontaneous fibrinolysis and distal embolization may be one of the mechanisms responsible for the occurrence of MINOCA. Smith — the post -reperfusion ECG seen in Figure-1 is not consistent with the expected findings of Takotsubo Cardiomyopathy. (

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Journal of the American Heart Association

NOVEMBER 28, 2023

BackgroundNew treatment regimens have been introduced in the past 20 years, which may influence the short‐ and long‐term prognosis for patients with and without a cancer diagnosis following pulmonary embolism. 8.0%) in 2018 to 2020 (hazard ratio [HR], 0.36 [95% CI, 0.32–0.40];P<0.001). In total, 60 614 patients (29.6%

Cancer 40

Cancer Embolism Pulmonary 40

Stroke Journal

DECEMBER 28, 2023

BACKGROUND:Many ischemic strokes are diagnosed as embolic strokes of undetermined source (ESUS). Stroke, Ahead of Print. Recent evidence suggests that nonstenotic carotid plaque (nsCP) may be a substantial contributor to the risk for ESUS.

Risk Factors 75

Risk Factors Plaque Embolism Stroke 75

Stroke Journal

DECEMBER 20, 2024

We assessed the association between high-risk cardioembolic sources on cardiac CT and AIS.METHODS:We performed a case-control study using data from a prospective cohort including consecutive adult patients with suspected stroke who underwent cardiac CT acquired during the initial stroke imaging protocol between 2018 and 2020.

Embolism 40

Embolism Atrial Fibrillation Stroke Strokes 40

Stroke Journal

FEBRUARY 1, 2024

Methods:Adult patients with CVT diagnosis from 2020-2022 in TriNetX COVID research network were included in the study. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), epilepsy, deep vein thrombosis and pulmonary embolism were secondary outcomes. All-cause mortality was the primary outcome.

COVID-19 40

COVID-19 Outcomes Thrombosis Embolism 40

Stroke Journal

FEBRUARY 1, 2024

The role of paradoxical embolization as a stroke etiology in patients with cancer is uncertain. Methods:We included AIS patients hospitalized at our comprehensive stroke center between January 2015 and December 2020 with available PFO status as detected on transesophageal echocardiography.

Cancer 40

Cancer Stroke Strokes Thrombosis 40

Stroke Journal

FEBRUARY 1, 2024

Prolonged ICU LoS is reported to be associated with worse clinical outcomes, but factors associated with prolonged LoS after MT are not established.Methods:A retrospective analysis of 499 patients undergoing EVT at a single large comprehensive stroke center from January 2015 to May 2020 was performed. P<0.001). ASPECTS < 7 (6.9

ICU 40

ICU Strokes Stroke Embolism 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

In the present study, we investigated clinical and procedural characteristics predictive of MT success and failure.MethodsWe conducted a retrospective analysis of MT patients with LVO presenting to our academic comprehensive stroke center from 2015‐2020. Recanalization failure was defined as TICI 0‐2a and success as TICI 2b‐3.

Atherosclerosis 40

Atherosclerosis Stents Stent Academic 40

Dr. Smith's ECG Blog

MARCH 1, 2025

Angiogram: --"Suspected culprit for the patient's non-ST elevation myocardial infarction with refractory chest discomfort (although it had resolved prior to arrival to the cardiac catheterization lab), is a ruptured plaque in the distal circumflex with local embolic occlusion of the distal OM 3."

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Chest Pain STEMI Stents Stent 121

Dr. Smith's ECG Blog

FEBRUARY 16, 2025

Even if it is not atherosclerotic, young people can have embolic OMIs. If I had to guess, I think some of the cognitive errors that may have contributed to this case are: The patient was young, in his mid 30s. But you are never too young to have an OMI. Here are cases of Young Women The ECG was perceived as having diffuse ST elevations.

STEMI 72

STEMI Pericarditis Chest Pain Echocardiogram 72