Mycotic aneurysms are uncommon, especially those located in visceral arteries. We present a case of a patient with two visceral mycotic aneurysms due to bacterial endocarditis, one located in right upper pole renal artery and the second in the splenic artery. Both aneurysms were treated as endovascular embolization using microcoils. In the aneurysm located at the renal artery, the technique of stent-assisted coils embolization was preferred to avoid coils migration due to its wide neck. The stent used was the Solitaire AB, which was designed for the treatment of intracranial aneurysms and was used recently in acute stroke as a mechanical thrombectomy device. Complete embolization of the aneurysm was achieved, preserving all the arterial branches without nephrogram defects in the final angiogram.
Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or carotid artery stenting (CAS), often not well tolerated in patients with coronary artery disease. The purpose of this study is to assess whether CAS without angioplasty is beneficial in patients with severe carotid artery disease before coronary revascularization surgery (CABG) regarding the occurrence of HD. Between October 2002 and August 2006, 39 CAS were performed in 35 patients before cardiac surgery. Outcome measures, including periprocedural and 30-day post stenting and cardiac surgery complications, were assessed. Twenty-seven patients underwent CABG and eight combined CABG and valve replacement. During or immediately after CAS there was no episode of bradycardia or hypotension necessitating medical treatment. In the period between CAS-CABG, there was no case of HD. We also found no myocardial infarction. There were five neurological complications, two of them in the period between CAS-CABG (one transitory ischemic attack (TIA) and one minor stroke) and three after CABG (one TIA and two strokes). Three of them were discharged symptom-free. CAS without angioplasty can be a safe alternative to treat patients with coexistence of carotid and cardiac disease, since does not produce hemodynamic depression, therefore diminishing the cardiac complications.
Figure 1. Sixteen-row multislice computed tomography: interventricular communication.An 82-year-old female was admitted for syncope with previous history of chest pain. Physical examination revealed low blood pressure and an apical murmur. Echocardiogram: sinus rhythm and ST-segment elevation leads II, III and, aVF. Transthoracic echocardiogram was of poor technical quality because of obesity. Multislice computed tomography (MCT) was performed, which revealed a dilated right ventricle and apical ventricular septum rupture (Fig. 1). 1 Coronary angiography revealed severe left coronary atherosclerosis and occlusion of the right coronary artery. Shunt from the left to the right ventricle was confirmed by angiography (Fig. 2).Multislice computed tomography is a useful tool for patients with myocardial infarction and murmur. Figure 2. Left ventricle angiogram with contrast shunt to right ventricle (Big picture: right anterior oblique view. Small picture: left anterior oblique view).Reference 1. Zipes DP, Libby P, Bonow RO, Braunwald E: Braunwald's Hert Disease.
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