Penetrating Trauma of the Thoracic Aorta Caused by a Knitting Needle

Abstract

A n 82-year-old woman was admitted to our institution after stabbing herself with a knitting needle through her right supraclavicular fossa. Computed tomography showed the needle penetrating the aortic arch at the origin of the left subclavian artery. The exit point was in the descending aorta, corresponding to the eighth thoracic vertebral body ( Fig 1A). A large left hemothorax and extensive mediastinal hemorrhages surrounding the aortic arch were present ( Figs 1B, 1C, 1D).The patient was hemodynamically stable. Treatment options were discussed with the involvement of cardiothoracic surgeons, interventional radiologists, and vascular surgeons. Given the complexity of a potential surgical repair, a complete endovascular approach was proposed, with immediate surgical support as required.Under general anesthesia, a 24F delivery sheath was advanced through the right common femoral artery and a 37 Â 150 mm GORE TAG stent graft (W. L. Gore & Associates, Flagstaff, AZ) was deployed under permissive hypotension, preserving the left common carotid artery ostium ( Fig 1E). The left subclavian artery origin was then embolized with 0.035-inch coils through percutaneous left brachial artery access, preserving the origin of the left vertebral artery. The knitting needle was then withdrawn under fluoroscopy. Completion angiography demonstrated successful repair and preservation of flow to the left subclavian artery through retrograde flow in the left vertebral artery ( Fig 1F).Strong teamwork and multidisciplinary collaboration of cardiothoracic surgeons, interventional radiologists, and vascular surgeons provided successful treatment of this peculiar case. Fig 1.

Recanalization Treatment of Acute Ischemic Stroke Caused by Large-Artery Occlusion in the Elderly: A Comparative Analysis of “the Elderly” and “the Very Elderly”

“…Thrombus location was determined using angiography, and the Solitaire AB stent removal device was preferentially used for thrombus removal. The degree of recanalization was measured by modified thrombolysis in cerebral infarction (mTICI), with grade ≥ 2b representing successful recanalization and grade 3 representing complete recanalization [ 12 ].…”

Ability to knit may be impaired following right temporal lobe resection for drug-resistant epilepsy

“…It is tempting to relate this loss to the considerable literature in animal and patient studies linking spatial navigation to right hippocampal function [4] . We have been unable to find much in the literature on the neurobiological processes that underpin knitting (most of the literature on knitting relates to rather gruesome incidents involving knitting needles [5] , [6] , [7] , [8] , [9] ) however a competence in knitting and other similar craft activities has been linked to preserved spatial processing in ageing populations [10] . KP's difficulties in knitting are unlikely to represent the drug changes she underwent 6 months after the surgery since her difficulties became apparent immediately after the operation and before these changes were implemented.…”