Renal Subcapsular Hematoma after Intravenous Thrombolysis in a Patient with Acute Cerebral Infarction

La, Yun Kyung; Kim, Ji Hwa; Lee, Ki Young

doi:10.5469/neuroint.2016.11.2.127

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…Three prior cases of RSH were found in the literature (Table 2). The speculated causes of renal hematoma include recombinant tissue plasminogen activator (rTPA) use in stroke patients, 4 guidewire injury to the proximal portion of the left accessory renal artery, 5 and guidewire passing deeply into the right renal artery when the guiding sheath was navigated into the abdominal aorta. 7 One report directly observed guidewire piercing the renal artery, 7 and two reports attributed the renal hematoma to guidewire manipulation, 5,7 which correlates with observations in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…The case involving rTPA could be attributed to guidewire-related injury. 4 In the authors' experience, the renal artery can be highly vulnerable to puncture and an operator might experience only slight resistance as the guidewire pierces the wall of the renal artery. There are some limitations to this study: (1) a relatively small number of cases; (2) retrospective design without standard treatment of this complication; (3) diverse neurointerventional procedures; and (4) the procedural course was reported retrospectively by the operators and there was no objective quantification of the resistance of the guidewire.…”

Section: Operator's Level Of Experiencementioning

confidence: 99%

“…Few cases of IRPH from NIPs and their management have been reported. [4][5][6][7][8] The present retrospective study evaluated clinical and imaging presentations and the management of IRPH after NIPs at the authors' institute. The anticipated results may facilitate early diagnosis of IRPH, thereby ameliorating the impact of this complication of neurointervention.…”

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confidence: 99%

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Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention

Tai

Ling

et al. 2022

Journal of the Chinese Medical Association

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Background: To evaluate the clinical and imaging presentation, management, and outcome of iatrogenic retroperitoneal hematomas (IRPHs) during a series of neurointerventional procedures (NIPs). Methods: Six IRPH patients with complications, including five renal subcapsular hematomas (RSH) and one retroperitoneal hemorrhage, were observed among 2290 NIPs performed at our hospital from 2000 through 2020. The medical records, neurointerventional techniques, imaging data, and management of these six IRPH patients were retrospectively reviewed. All six patients received preprocedural dual antiplatelet medication and intraprocedural heparinization. Results: All patients underwent right femoral access. The guidewires were not handled under full course fluoroscopy monitoring. The most common symptom of IRPH was periprocedural flank/abdominal pain (6/6, 100%), including five on the left side (83.3%). Hypotension or shock was observed in three patients (50%). Two patients (33%) were diagnosed intraoperatively by sonogram and received on-site treatment, whereas the other four were diagnosed by postprocedural abdominal computed tomography. Active extravasation from a renal artery was diagnosed by angiogram in the five patients with RSH and was successfully treated with embolization. Multiple bleeders in the branches of the renal artery were noted in three RSH patients (60%). The patient with retroperitoneal hematoma was treated conservatively. Conclusion: Unexplained periprocedural or postprocedural abdominal/flank pain, especially contralateral to the femoral access side of the NIPs, should raise the possibility of IRPH. To prevent IRPH, the authors suggest using full visual fluoroscopic monitoring for guidewire navigation during femoral catheterization of NIPs.

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Section: Discussionmentioning

confidence: 99%

Section: Operator's Level Of Experiencementioning

confidence: 99%

mentioning

confidence: 99%

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Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention

Tai

Ling

et al. 2022

Journal of the Chinese Medical Association

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“…Iatrogenic renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our literature search revealed only one other similar case, although this was following administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic cerebrovascular accident [11]. In the context of percutaneous intervention, there have been reports of renal hematoma following percutaneous transluminal stent placement in the renal artery (via direct perforation) and percutaneous coronary intervention via femoral-access (via plaque dislodgement at the aorto-renal junction, following catheter or guidewire passage, lacerating the aorta and dissecting into the perirenal space) [10,12,13].…”

Section: Discussionmentioning

confidence: 99%

Massive, Spontaneous Ruptured Renal Subcapsular Haematoma Following Thrombolytic Therapy in Acute ST-Elevation Myocardial Infarction

Shariff¹,

Kasim²

2019

JCHS

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Background: Thrombolytic therapy remains widely used in majority of developing countries, where delivery of primary percutaneous coronary intervention (PCI) remains a challenge. Unfortunately, complications following such therapy remains prominent, predominantly bleeding-related problems. We present a rare case of massive renal subcapsular haemorrhage and hematoma following thrombolytic therapy. Case Report: A 61-year old gentleman presented following an episode of chest pain due to acute ST-elevation myocardial infarction. Due to potential delays in obtaining PCI, the patient was counselled for thrombolysis using streptokinase which he had consented to. Unfortunately, within 36 hours of admission, he developed abdominal pain, haematuria, hypotension and altered mental status, associated with acute drops in haemoglobin levels. Following initial resuscitation efforts, a Computed Tomography scan of the abdomen was performed revealing a massive renal subcapsular hematoma, likely secondary to previous thrombolysis. Discussion: Renal subcapsular hematoma can either be spontaneous or iatrogenic, the latter often due to coexisting renal-based neoplasm or vasculitidies. Iatrogenic causes include trauma, following renal biopsies or anticoagulation therapy amongst a few others. Iatrogenic renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our literature search revealed only one other similar case, although this was following administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic cerebrovascular accident. Conclusion: This case highlights the complexity in management, following the findings in terms of need for cessation of dual antiplatelet therapy and timing for PCI and stent selection.

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“…After the treatment of acute cerebral infarction, the activation volume of the ipsilateral brain area of the affected limb decreased, while the activation volume of the contralateral brain area increased, indicating that the reorganization of brain function changes with different periods of cerebral infarction and the activation pattern gradually tends to be original. At present, many studies have proved that resting fMRI can observe the network connection between the functional areas of the entire brain, that is, the functional connection that reflects the subcortex [8].…”

Section: Scientific Programmingmentioning

confidence: 99%

Optimized CSMRI Algorithm-Based MRI Image Analysis in the Active Rehabilitation Method for Patients with Acute Cerebral Infarction

Zeng

Chen

Liu

et al. 2021

Scientific Programming

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This paper combines optimized CSMRI algorithm (CS) and magnetic resonance imaging (MRI) to shorten the scanning time of MRI image data and improve the imaging quality. At the same time, the paper applies functional magnetic resonance imaging (BOLD-fMRI) based on the principle of blood oxygen level dependence to explore the application value of the nerve function reconstruction therapy system for the rehabilitation of active and passive motor functions in patients with acute cerebral infarction. Methods. In this paper, 20 patients with acute cerebral infarction were included. The random drawing method was used to divide them into active group and passive group, each with 10 cases. Both groups were treated with conventional medication and acupuncture. The active group used the active mode of the nerve function reconstruction treatment system to guide the patients’ limb active exercise; all training in the passive group is provided by the nerve function reconstruction treatment system to passively exercise the patients’ limbs; both groups undergo BOLD-fMRI examination before treatment and after 2 weeks of treatment and observe the activated parts of the brain functional area and corresponding parts of the two groups before and after treatment. We observe the activation volume and, at the same time, the ADL score. Results. After treatment, the activation volume and ADL scores of brain functional areas in the two groups were significantly improved compared with those before treatment, and the difference was statistically significant ( P < 0.05 ). Conclusion. The combination of optimized CSMRI algorithm (CS) and magnetic resonance imaging (MRI) can be used to evaluate the early rehabilitation efficacy of patients with acute cerebral infarction and has certain guiding value for clinical treatment.

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Renal Subcapsular Hematoma after Intravenous Thrombolysis in a Patient with Acute Cerebral Infarction

Cited by 6 publications

References 9 publications

Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention

Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention

Massive, Spontaneous Ruptured Renal Subcapsular Haematoma Following Thrombolytic Therapy in Acute ST-Elevation Myocardial Infarction

Optimized CSMRI Algorithm-Based MRI Image Analysis in the Active Rehabilitation Method for Patients with Acute Cerebral Infarction

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