Searched for: in-biosketch:true
person:sistaa01
Massive pulmonary embolism in pregnancy treated with catheter-directed tissue plasminogen activator [Case Report]
Pick, Jeremy; Berlin, David; Horowitz, James; Winokur, Ron; Sista, Akhilesh K; Lichtman, Adam D
Pulmonary embolism is a leading cause of maternal death in the United States, contributing to the death of approximately 2 women per 100,000 live births each year. Thrombosis during pregnancy traditionally is treated conservatively with unfractionated heparin or low-molecular-weight heparin; however, cardiovascular collapse associated with a large pulmonary embolus may require immediate aggressive intervention to save the mother and fetus. We report the use of catheter infusion thrombolysis in the successful management of a third-trimester pregnant patient with a hemodynamically significant saddle pulmonary embolus.
PMID: 25827861
ISSN: 2325-7237
CID: 2063642
Successful catheter-directed thrombolysis of a massive pulmonary embolism in a patient after recent pneumonectomy [Case Report]
Lee, Kyungmouk S; Sista, Akhilesh K; Friedman, Oren A; Horowitz, James M; Port, Jeffrey L; Madoff, David C
Massive pulmonary embolism (PE) after major thoracic surgery is an uncommon but life-threatening event that is challenging to manage. At present, the treatment of acute PE is either anticoagulation with or without systemic thrombolytic therapy. We report a case of a 65-year-old female with recent left pneumonectomy who developed a massive PE. The patient was successfully and safely treated with catheter-directed thrombolysis. To our knowledge, this is the first patient treated in this fashion.
PMID: 25457536
ISSN: 1873-4499
CID: 2063672
Characterization of in vivo ablation zones following percutaneous microwave ablation of the liver with two commercially available devices: are manufacturer published reference values useful?
Winokur, Ronald S; Du, Jerry Y; Pua, Bradley B; Talenfeld, Adam D; Sista, Akhilesh K; Schiffman, Marc A; Trost, David W; Madoff, David C
PURPOSE: To analyze in vivo ablation properties of microwave ablation antennae in tumor-bearing human livers by performing retrospective analysis of ablation zones following treatment with two microwave ablation systems. MATERIALS AND METHODS: Percutaneous microwave ablations performed in the liver between February 2011 and February 2013 with use of the AMICA and Certus PR ablation antennae were included. Immediate postablation computed tomography images were evaluated retrospectively for ablation length, diameter, and volume. Ablation length, diameter, and volume indices were calculated and compared between in vivo results and references provided from each device manufacturer. The two microwave antenna models were then also compared versus each other. RESULTS: Twenty-five ablations were performed in 20 patients with the AMICA antenna, and 11 ablations were performed in eight patients with the Certus PR antenna. The AMICA and Certus PR antennae showed significant differences in ablation length (P = .013 and P = .009), diameter (P = .001 and P = .009), and volume (P = .003 and P = .009). The AMICA ablation indices were significantly higher than the Certus PR ablation indices in length (P = .026) and volume (P = .002), but there was no significant difference in ablation diameter indices (P = .110). CONCLUSIONS: In vivo ablation indices of human tumors are significantly smaller than reference ex vivo ablation indices, and there are significant differences in ablation indices and sphericity between devices.
PMID: 25307296
ISSN: 1535-7732
CID: 2063652
Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal [Guideline]
Vedantham, Suresh; Sista, Akhilesh K; Klein, Seth J; Nayak, Lina; Razavi, Mahmood K; Kalva, Sanjeeva P; Saad, Wael E; Dariushnia, Sean R; Caplin, Drew M; Chao, Christine P; Ganguli, Suvranu; Walker, T Gregory; Nikolic, Boris
PMID: 25000825
ISSN: 1535-7732
CID: 2063552
Postprocedural management of patients undergoing endovascular therapy for acute and chronic lower-extremity deep venous disease
Sista, Akhilesh K
Endovascular therapy for acute and chronic lower-extremity deep venous disease seeks to improve patency and flow to ameliorate severe symptoms, prevent the postthrombotic syndrome, and treat existing chronic venous disease. Close postprocedure monitoring in the weeks to months following the intervention with implementation of an anticoagulation and symptom management strategy maximizes the likelihood of a durable result. This article outlines several such strategies based on the presenting pathology, results of the intervention, and biological characteristics of the patient.
PMID: 24840969
ISSN: 1557-9808
CID: 2063712
Automatic implantable cardiac defibrillator implantation may precipitate effort-induced thrombosis in young athletes: a case report and literature review [Case Report]
Wadhawan, Abhishek; Laage Gaupp, Fabian M; Sista, Akhilesh K
Upper extremity deep vein thrombosis (DVT) is a common finding after implantation of an automatic implantable cardiac defrillator (AICD). We describe the case of a patient who developed a left upper extremity DVT 4.5 months after implantation of an AICD and was found to have a lead-induced stenosis with possible underlying Paget-Schroetter syndrome (PSS) in the midbrachiocephalic vein on venography. While his symptoms resolved after the combination of pharmacomechanical thrombolysis, angioplasty, and anticoagulation, his long-term management is complicated by the presence of both PSS and lead-induced stenosis. Herein, we discuss his presentation, treatment, and future management options.
PMID: 24794202
ISSN: 1873-4499
CID: 2063632
Transarterial therapies for primary liver tumors
Talenfeld, Adam D; Sista, Akhilesh K; Madoff, David C
Over the last decade, transarterial therapies have gained worldwide acceptance as standard of care for inoperable primary liver cancer. Survival times after transarterial chemoembolization (TACE) continue to improve as the technique and selection criteria are refined. Transarterial treatments, frequently provided in an outpatient setting, are now safely and effectively being applied to patients with even advanced malignancy or partially decompensated cirrhosis. In the coming years, newer transarterial therapies such as radiation segmentectomy, boosted-transarterial radioembolzation, combined TACE-ablation, TACE-portal vein embolization, and transarterial infusion of cancer-specific metabolic inhibitors promise to continue improving survival and quality of life.
PMID: 24560113
ISSN: 1558-5042
CID: 2063702
Catheter-directed clot fragmentation using the Cleaner device in a patient presenting with massive pulmonary embolism [Case Report]
Barjaktarevic, I; Friedman, O; Ishak, C; Sista, A K
Massive pulmonary embolism not amenable to systemic thrombolysis is a therapeutic challenge. Catheter directed clot fragmentation and thrombolysis have been efficacious in this setting. We describe successfully treating a massive pulmonary embolism with catheter-directed thrombolysis and clot fragmentation using local tPA, aspiration, and the Cleaner device in a patient with an absolute contraindication to systemic thrombolysis.
PMCID:4037251
PMID: 24967017
ISSN: 1943-0922
CID: 1909152
CT angiography in the detection of carotid body enlargement in patients with hypertension and heart failure
Nair, Sreejit; Gupta, Ajay; Fudim, Marat; Robinson, Christopher; Ravi, Vinay; Hurtado-Rua, Sandra; Engelman, Zoar; Lee, Kyungmouk S; Phillips, C Douglas; Sista, Akhilesh K
INTRODUCTION: The carotid body (CB) has previously been found to be enlarged and hyperactive in various disease states such as heart failure (HF), hypertension (HTN), and respiratory disease. Evaluation of CB size in these disease states using imaging has not been performed. The purpose of this case-control study was to compare CB sizes in patients with HF and HTN with those of controls using CT angiography. METHODS: A retrospective review was performed on 323 consecutive patients who had neck computed tomography angiography (CTA) exams in 2011. Following extensive review, 17 HF and HTN patients and 14 controls were identified. Two radiologists blinded to the patient disease status made consensus bilateral carotid body (CB) measurements on the CTA exams using a previously described standardized protocol. CB axial cross-sectional areas were compared between HF and HTN cases and controls using a paired t test. RESULTS: The right CB demonstrated a mean cross-sectional area of 2.79 mm(2) in HF and HTN patients vs. 1.40 mm(2) in controls (p = 0.02). The left CB demonstrated a mean cross-sectional area of 3.13 mm(2) in HF and HTN patients vs. 1.53 mm in controls (p = 0.03). CONCLUSION: Our results provide imaging evidence that the carotid bodies are enlarged in patients with HF and HTN. Our case-control series suggests that this enlargement can be detected on neck CTA.
PMID: 24005832
ISSN: 1432-1920
CID: 2063542
Building a pulmonary emoblism lysis practice : Our strategy for assembling a team of specialists to provide efficient and effective acute PE care
Sista, Akhilesh K; Friedman, Oren A; Horowitz, James M; Salemi, Arash
ORIGINAL:0011069
ISSN: 1551-1944
CID: 2063722