Intravenous Thrombolysis Guided by Perfusion CT with Alteplase in >4.5 Hours from Stroke Onset.

INTRODUCTION: The benefit of intravenous thrombolysis (IVT) in wake-up stroke (WUS), stroke of unknown time of onset (SUKO), or when time exceeds 4.5 h from last-seen-normal (LSN) guided by CT perfusion (CTP) or MRI has been recently suggested. However, there is limited information of IVT in those patients in real-world studies. OBJECTIVE: Our aim was to evaluate safety and efficacy of IVT selected by CTP in patients with WUS, SUKO, or stroke of time onset beyond 4.5 h. MATERIAL AND METHODS: We studied a prospective cohort of patients who underwent IVT from January 2010 to December 2017. Two groups were defined: standard of care group (SC) included patients with time onset <4.5 h and CTP group included patients with WUS, SUKO, or onset beyond >4.5 h from LSN with penumbra area in CTP. We evaluated baseline characteristics, functional outcomes according to modified Rankin Scale (mRS) at discharge and at 90 days, and intracranial hemorrhages rates. RESULTS: 657 patients were studied: 604 (92%) were treated in the SC group and 53 (8%) in the CTP group. The mean NIHSS score was 9.8 in the CTP group versus 13 in the SC group (p = 0.001). Seventeen patients in the CTP group (32.1%) received bridging therapy with mechanical thrombectomy (MT). Last time seen well-to-needle time was 538 versus 155 min (p < 0.001). The incidence of symptomatic intracranial hemorrhage was equal in both groups (3.8 vs. 3.8%, p = 1). Good functional outcome (mRS < 2) was achieved in both groups (72 vs. 60.4%, p = 0.107). CONCLUSIONS: IVT in patients with WUS, SUKO, or stroke beyond >4.5 h from LSN, with salvageable brain tissue on CTP, seems to be safe and has similar functional outcomes at 90 days to the standard therapeutic window, even when combined with MT.

Targeting PDE10A GAF Domain with Small Molecules: A Way for Allosteric Modulation with Anti-Inflammatory Effects.

Phosphodiesterase (PDE) enzymes regulate the levels of cyclic nucleotides, cAMP, and/or cGMP, being attractive therapeutic targets. In order to modulate PDE activity in a selective way, we focused our efforts on the search of allosteric modulators. Based on the crystal structure of the PDE10A GAF-B domain, a virtual screening study allowed the discovery of new hits that were also tested experimentally, showing inhibitory activities in the micromolar range. Moreover, these new PDE10A inhibitors were able to decrease the nitrite production in LPS-stimulated cells, thus demonstrating their potential as anti-inflammatory agents.

Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial).

RATIONALE: In-stent reocclusion after endovascular therapy has a negative impact on outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Optimal antiplatelet therapy approach in these patients to avoid in-stent reocclusion is yet to be elucidated. AIMS: To assess efficacy and safety of intravenous tirofiban versus intravenous aspirin in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. SAMPLE SIZE ESTIMATES: Two hundred forty patients will be enrolled, 120 in every treatment arm. METHODS AND DESIGN: A multicenter, prospective, randomized, controlled (aspirin group), assessor-blinded clinical trial will be conducted. Patients fulfilling the inclusion criteria will be randomized at MT onset to the experimental or control group (1:1). Intravenous aspirin will be administered at a 500-mg single dose and tirofiban at a 500-mcg bolus followed by a 200-mcg/h infusion during the first 24 h. All patients will be followed for up to 3 months. STUDY OUTCOMES: Primary efficacy outcome will be the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. Primary safety outcome will be the rate of symptomatic intracranial hemorrhage. DISCUSSION: This will be the first clinical trial to assess the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. TRIAL REGISTRATION: The trial is registered as NCT05225961. February, 7th, 2022.

Novel adaptive law for super-twisting controller: USV tracking control under disturbances.

A novel adaptive super-twisting control algorithm, for Unmanned Surface Vehicles (USV) tracking control is presented. The proposed adaptive law is obtained using a Lyapunov approach, to analyze the system closed-loop stability. Furthermore, several conditions are given to guarantee robustness in presence of unknown bounded disturbances/uncertainties, chattering mitigation and the finite-time convergence. This adaptive control strategy has the advantage that the controller gains, which are in terms of a single control parameter, requires adjusting a small number of parameters compared with other adaptive strategies, moreover and its dynamics is smooth, improving the controller performance. To assess the proposed control methodology effectiveness, a trajectory tracking control is designed and implemented on an unmanned surface vehicle under the action of bounded unknown uncertainties and external perturbations. Numerical simulations and experimental results conducted with a vessel prototype demonstrate the performance and advantages under payload variations and external environmental conditions. Finally, a comparative study between the proposed approach with other adaptive super-twisting works has been conducted.

Relevance of Carotid Reocclusion in Tandem Lesions.

AIMS: Carotid reocclusion (CRO) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to tandem lesion (TL) or isolated internal carotid occlusion (ICO) is associated with worse clinical outcomes. Our aim was to analyze the predictors and clinical impact of CRO. METHODS: A retrospective single-center analysis of all patients with anterior circulation strokes who underwent MT prospectively included in a registry between 2017 and 2020 was performed. ICO and TL as stroke causes were included. Stent deployment was left to the discretion of the interventionist. All patients received at least intravenous aspirin during MT. CRO was assessed using ultrasound within the first 24 h after MT. Efficacy and safety of stenting were assessed. RESULTS: Among 1304 AIS cases, 218 (16.7%) were related to TL or ICO. Of them, 5% (n=11) were associated with internal CRO 24 h after the endovascular procedure. After adjusting per confounders, multivariate analysis showed that the independent variables associated with CRO were the TICI recanalization grade [TICI 2b-3; OR 0.1, 95% confidence interval (CI) 0.01-0.89, p=0.040], pial collateral circulation presence (OR 0.09, 95% CI 0.02-0.45, p=0.03), stent deployment during MT (OR 0.17, 95% CI 0.03-0.84, p=0.030), and general anesthesia use (OR 2.92, 95% CI 1.13-7.90, p=0.034). CRO showed a trend toward worst outcomes (modified Rankin scale 3-6) at 3 months (OR 3.4, 95% CI 0.96-12, p=0.057). After multivariate analysis, variables independently associated with worse outcomes at 90 days were intrastent platelet aggregation phenomena during endovascular therapy, admission National Institute of Health Stroke Scale, and age. Conversely, intravenous thrombolysis and TICI 2b-3 recanalization grade were identified as independent predictors of good outcomes at 90 days. CONCLUSIONS: CRO has a relevant clinical impact in our study, associating lower rates of good functional outcomes at 3 months. Independent factors of CRO were the recanalization degree, presence of pial collateral circulation, use of a stent as a protective factor, and use of general anesthesia during thrombectomy.

Safety and efficacy of tirofiban in acute ischemic stroke due to tandem lesions undergoing mechanical thrombectomy: A multicenter randomized clinical trial (ATILA) protocol.

Background: In-stent thrombosis after mechanical thrombectomy (MT) worsen outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Although an optimal antiplatelet therapy is needed, the best approach to avoid in-stent thrombosis is yet to be elucidated. Hypothesis: Low-dose intravenous tirofiban is superior to intravenous aspirin in avoiding in-stent thrombosis in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. Methods: The ATILA-trial is a multicenter, prospective, phase IV, randomized, controlled (aspirin group as control), assessor-blinded clinical trial. Patients fulfilling inclusion criteria (AIS due to TL, ASPECTS ⩾ 6, pre-stroke modified Rankin Scale ⩽2 and onset <24 h) will be randomized (1:1) at MT onset to experimental (intravenous tirofiban) or control group (intravenous aspirin). Intravenous aspirin will be administered at a 500 mg single dose and tirofiban at a 500 µg bolus followed by a 200 µg/h infusion during first 22 h. All patients will be followed up to 3 months. Sample size estimated is 240 patients. Outcomes: The primary efficacy outcome is the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. The primary safety outcome is the rate of symptomatic intracranial hemorrhage. Secondary outcomes include functional independence defined as modified Rankin Scale 0-2, proportion of patients undergoing rescue therapy due to in-stent aggregation during MT and carotid reocclusion at 30 days. Discussion: ATILA-trial will be the first clinical trial regarding the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. Trial registration: NCT0522596.

Preoperative embolization for the treatment of cervical Castleman disease.

Castleman disease (CD) is a rare benign lymphoproliferative disorder commonly described as a hypervascular mass that causes progressive lymph node enlargement. Head and neck involvement occurs only in 15% to 20% of cases. The recommended treatment in solitary CD is radical resection. Few reports have described the use of angiographic study and preoperative embolization to minimize the intraoperative risk of hemorrhage. We report a clinical case of a solitary large painless, slow-growing mass located in the neck of a 34-year-old woman. Contrast-enhanced computed tomographic and magnetic resonance imaging scan demonstrated a well-defined mass with internal calcifications and peripheral vessels located in the posterior cervical space, extending inferiorly to the supraclavicular space, which moderately enhanced after contrast administration. In the preoperative arteriography, a hypervascularized mass was identified, which mainly received an arterial supply from thyrocervical trunk. Successful embolization with polyvinyl alcohol microparticles was performed, resulting in a significant reduction of intraoperative bleeding, allowing a subsequently safe removal of the tumor. Histopathologic examination corresponded to hyaline vascular-type CD.

Clinical significance of baseline Pan-Immune-Inflammation Value and its dynamics in metastatic colorectal cancer patients under first-line chemotherapy.

Pan-Immune-Inflammation Value (PIV) has been recently proposed as a new blood-based prognostic biomarker in metastatic colorectal cancer (mCRC). Herein we aimed to validate its prognostic significance and to evaluate its utility for disease monitoring in patients with mCRC receiving first-line chemotherapy. We conducted a single-centre retrospective study involving 130 previously untreated mCRC patients under first-line standard chemotherapy in a real-world scenario. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count at three different time-points: baseline, week 4 after therapy initiation, and at disease progression. We analyzed the influence of baseline PIV on overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and overall response rate (ORR). We also explored the utility of PIV dynamics for disease monitoring. Baseline PIV high was significantly associated with worse OS in univariate [hazard ratio (HR) = 2.10, 95% CI, 1.41-3.15; p = 0.000299] and multivariate (HR = 1.82, 95% CI, 1.15-2.90; p = 0.011) analyses. Baseline PIV was also associated with worse PFS in univariate (HR = 2.04, 95% CI, 1.40-2.97; p = 0.000187) and multivariate (HR = 1.56, 95% CI, 1.05-2.31; p = 0.026) analyses. Baseline PIV was not correlated either with DCR or ORR. Regarding PIV dynamics, there was a statistically significant increase from week 4 to disease progression (p = 0.0003), which was at the expense of cases with disease control as best response (p < 0.0001). In conclusion, this study validates the prognostic significance of baseline PIV in patients with mCRC receiving first-line standard chemotherapy in a real-world scenario. Moreover, it suggests the potential utility of PIV monitoring to anticipate the disease progression among those patients who achieve initial disease control.

Circulating microRNA after autologous bone marrow mononuclear cell (BM-MNC) injection in patients with ischemic stroke.

Previous studies have shown the potential of microRNAs (miRNA) in the pathological process of stroke and functional recovery. Bone marrow mononuclear cell (BM-MNC) transplantation improves recovery in experimental models of ischemic stroke that might be related with miRNA modifications. However, its effect on circulating miRNA has not been described in patients with stroke. We aimed to evaluate the circulating levels of miRNAs after autologous BM-MNC transplantation in patients with stroke. We investigate the pattern of miRNA-133b and miRNA-34a expression in patients with ischemic stroke included in a multicenter randomized controlled phase IIb trial (http://www.clinicaltrials.gov; unique identifier: NCT02178657). Patients were randomized to 2 different doses of autologous intra-arterial BM-MNC injection (2×106/kg or 5×106/kg) or control group within the first 7 days after stroke onset. We evaluate plasma concentration of miRNA-113b and miRNA-34a at inclusion and 4, 7, and 90 days after treatment. Thirteen cases (8 with 2×106/kg BM-MNC dose and 5 with 5×106/kg dose) and 11 controls (BM-MNC non-treated) were consecutively included. Mean age was 64.1±12.3 with a mean National Institutes of Health Stroke Scale score at inclusion of 14.5. Basal levels of miRNA were similar in both groups. miR-34a-5p and miR-133b showed different expression patterns. There was a significant dose-dependent increase of miRNA-34a levels 4 days after BM-MNC injection (fold change 3.7, p<0.001), whereas miRNA-133b showed a significant increase in the low-dose BM-MNC group at 90 days. Intra-arterial BM-MNC transplantation in patients with ischemic stroke seems to modulate early circulating miRNA-34a levels, which have been related to precursor cell migration in stroke and smaller infarct volumes.

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study.

OBJECTIVES: The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). BACKGROUND: CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS: The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). RESULTS: A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). CONCLUSIONS: The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.

Risk factors and neurological consequences of syncopes induced by internal carotid artery angioplasty.

BACKGROUND AND PURPOSE: Syncope and carotid sinus reactions (CSR) occur frequently in patients undergoing carotid angioplasty (CA). We investigated risk factors and the neurological consequences of carotid sinus syncope induced by CA. METHODS: We examined 359 consecutive patients. Patients underwent assessment of cerebrovascular reserve before CA and continuous electroencephalographical monitoring during the procedure. We examined the impact of vascular risk factors, cerebral hemodynamics, characteristics of plaque, and procedural modality on the incidence of CSR and syncope. The effect of syncopes on periprocedural complication rates was also investigated. RESULTS: CSR and syncope occurred in 62.7% and 18.0% of the procedures, respectively. The occurrence of CSR during angioplasty was significantly associated with the appearance of syncope. The incidence of syncope was significantly higher in longer plaques located in the carotid bifurcation, in the presence of contralateral carotid stenosis, or when protection devices were used. Although TIA during CA was more common in syncopal patients, stroke or death rates were similar in the 2 groups. CONCLUSIONS: Syncope occurs more frequently in patients with long plaques proximal to the carotid bifurcation, but it does not increase the periprocedural complications rate.

Experiencia inicial en nuestro centro con la embolización preventiva de la arteria mesentérica inferior en el tratamiento endovascular de los aneurismas de aorta abdominal / Early experience with preventive embolization of the inferior mesenteric artery in the endovascular treatment of abdominal aortic aneurysms

Introducción: la endofuga de tipo II (EFT2) es la más frecuente tras la reparación endovascular de aneurismas de aorta abdominal (EVAR). Objetivos: analizar la presencia de endofugas de tipo II durante el seguimiento, la regresión del saco aneurismático, la tasa de reintervención debido a EFT2, el análisis de los resultados en nuestra serie de casos tratados con embolización de la AMI antes del implante de la endoprótesis aórtica como método útil para disminuir las EFT2 durante el seguimiento. Material y métodos: análisis retrospectivo de los pacientes tratados en nuestro centro con embolización de la AMI previa al EVAR en el periodo 2019-2021. Los criterios utilizados para la embolización de la AMI fueron: diámetro > 3 mm y AL con diámetro > 2 mm o aneurismas aortoilíacos. Se incluyeron 7 pacientes varones (edad media: 72,1 años). El 42 % presentaba aneurismas aortoilíacos. En dos casos se llevó a cabo la embolización de la AMI en un primer tiempo y posteriormente el EVAR; en los restantes se realizó en el mismo procedimiento. El diámetro medio de la AMI fue 5,02 ± 0,9 mm. Todos los pacientes presentaban, al menos, dos AL enfrentadas al origen de la AMI con un diámetro > 2 mm. Resultados: el éxito técnico fue del 100 %. La mediana de seguimiento, 20,7 meses. En los angio TAC al mes y a los 12 meses se objetivó una correcta embolización de la AMI. No hubo fugas de tipo II durante el seguimiento. En todos los casos se visualizó una disminución en el diámetro del saco aneurismático (mediana de regresión: 5,08 mm). No hubo reintervenciones relacionadas con la patología aórtica. Conclusiones: la embolización de la AMI previa al EVAR en pacientes con un diámetro > 3 mm y al menos dos AL con diámetro > 2 mm o aneurismas aortoilíacos parece proteger frente al desarrollo de EFT2 a los 12 meses, a la espera de poder confirmar los resultados a medio y largo plazo. Alto éxito técnico y aceptable regresión del saco aneurismático.(AU)

Introduction: type II endoleak (T2EL), through the inferior mesenteric artery (IMA) or lumbar arteries (LA), is themost common endoleak after endovascular abdominal aortic aneurysm repair (EVAR). Objectives: the primary endpoint was the presence of type II endoleak at follow-up. Secondary endpoints includedaneurysm sac regression and reoperation rate due to T2EL, as well as the analysis of the results in our series of casestreated with IMA embolization prior to the endovascular procedure as a useful method to reduce T2EL at follow-up. Material and methods: this was a retrospective analysis of patients treated at our unit with IMA embolizationprior to EVAR from 2019 through 2021. The criteria used for IMA embolization were IMA diameter > 3 mm, presenceof LA with a diameter > 2 mm, or aortoiliac aneurysms. A total of 7 male patients were included with a mean age of72.1 years. A total of 42 % had aortoiliac aneurysms. In 2 of the cases, IMA embolization was performed initiallyfollowed by EVAR while in the remaining cases it was performed within the same procedure. The mean diameterof IMA was 5.02 mm ± 0.9 mm. All patients had at least 2 LAs facing the origin of the IMA with a diameter > 2 mm.Results: technical success was 100 %. The median follow-up was 20.7 months. In the CCTA performed 1 monthand 12 months postoperatively, correct IMA embolization was observed. There were no type II leaks at follow-up.In all cases, a decrease in the diameter of the aneurysmal sac was observed with a mean regression of 5.08 mm. There were no subsequent reinterventions associated with aortic valve disease. Conclusions: IMA embolization prior to EVAR in patients with a diameters > 3 mm and the presence of at least2 ALs with diameters > 2 mm and/or aortoiliac aneurysms seems to protect against the development of T2EL at12 months, waiting to be able to confirm the results in the mid- and long-term...(AU)

Pharmacological tools based on imidazole scaffold proved the utility of PDE10A inhibitors for Parkinson's disease.

AIM: Since neuroinflammation is partially mediated by cAMP levels and PDE10A enzyme is able to regulate these levels being highly expressed in striatum, its inhibitors emerged as useful drugs to mitigate this inflammatory process and hence the neuronal death associated with Parkinson's disease (PD). Methodology & results: To study the utility of PDE10A as a pharmacological target for PD, in this work we propose the search and development of new PDE10A inhibitors that could be useful as pharmacological tools in models of the disease and presumably as potential drug candidates. By using different medicinal chemistry approaches we have discovered imidazole-like PDE10A inhibitors and showed their neuroprotective actions. CONCLUSION: Here, we demonstrate the neuroprotective effect of PDE10A inhibitors in cellular models of PD. [Formula: see text].

Complete femoral artery transection following handlebar trauma.

Complete transection of the common femoral artery is more frequent after penetrating injuries than after blunt trauma, with most of the cases occurring in combination with fractures. Contusion from a bicycle handlebar is a rare form of injury to the femoral vessels. Hereby, we present a case of complete common femoral artery transection caused by a direct bicycle handlebar trauma. The patient suffered severe hypovolemia during his transfer to the Emergency room. He required an emergency intervention and a bypass reconstruction.

Resultados de cirugía de aneurisma abdominotorácico abierto mediante circulación extracorpórea parcial izquierda en un centro de bajo volumen / Results of open thoracoabdominal aneurysm repair with left partial cardiopulmonary bypass in a low-volume center

Introducción: la reparación abierta del aneurisma de aorta abdominotorácica (AATA) es técnicamente un reto, tanto desde el punto de vista quirúrgico como circulatorio, y en consecuencia conlleva un riesgo significativo de morbilidad y mortalidad operatorias. El objetivo de este estudio es analizar los resultados y las complicaciones de este tipo de intervenciones en nuestro centro. Métodos: se recogieron los antecedentes, los datos intraoperatorios y las complicaciones posoperatorias de pacientes tratados de aneurisma abdominotorácico abierto en un periodo de 15 años. Resultados: entre enero de 2005 y diciembre de 2019 se intervinieron un total de 27 pacientes por aneurisma abdominotorácico. 25 pacientes presentaban aneurisma y 2, disección crónica. 5 pacientes ya tenían realizada una cirugía aórtica previa: 2 fueron tratados de AAA mediante bypass aortoaórtico y aortobiilíaco, 2 pacientes por disección aórtica de tipo I mediante sustitución del arco aórtico y 1 por aneurisma de aorta torácica en el que se realizó TEVAR y bypass carótido-carotídeo y carótido-subclavio. La edad media fue de 66,5 ± 7,77 años y el 21 % fueron mujeres. En cuanto a la clasificación de Crawford de los aneurismas abdominotorácicos, 1 era del tipo I, 7 del tipo II, 9 del tipo III, 9 del tipo IV y 1 del tipo V. 23 intervenciones fueron de manera programada y 4, urgentes. Los AATA de tipo I, II, III y V se trataron mediante circulación extracorpórea parcial izquierda. La mortalidad total fue del 14,81 % y la programada, del 8,69 %. La incidencia de paraparesia posquirúrgica fue del 7,4 %. No hubo casos de paraplejia ni de ictus. La incidencia de infarto agudo de miocardio fue del 7,4 % y la de complicaciones respiratorias, del 48 %. La incidencia de insuficiencia renal aguda fue del 29,6 %. 5 de estos 8 pacientes requirieron hemodiálisis temporal.(AU)

Introduction: open TAA repair is technically challenging, both from a surgical and circulatory point of view, and consequently carries a significant risk of operative morbidity and mortality. The aim of this study is to analyze results and complications of this type of intervention in our center. Methods: demographic characteristics, intraoperative data and postoperative complications of patients who underwent open thoracoabdominal aneurysm repair were collected between January 2005 and December 2019 in our center. Results: a total of 27 patients underwent thoracoabdominal aneurysm surgery. 25 patients had aortic aneurysm and 2 chronic dissection. 5 patients had already undergone previous aortic intervention. The mean age was 66.5 ± 7,77 and 21% were women. Regarding Crawford's classification of thoracoabdominal aneurysms, there were 1 Type I, 7 Type II, 9 Type III, 9 Type IV, and 1 Type V. 23 patients were treated electively and 4 urgently. Types I, II, III, and V TAAA were treated with left partial cardiopulmonary bypass. Total mortality was 14.81 % and elective mortality was 8.69 %. The incidence of postsurgical paraparesis was 7.4 %. There were no cases of paraplegia or stroke. The incidence of acute myocardial infarction was 7.4 % and of pulmonary complications 48 %. The incidence of acute renal failure was 29.6 %. 5 of these eight patients required temporary hemodialysis. 1 patient presented postoperative visceral ischemia requiring left hemicolectomy. The median intensive care unit length of stay was 4 days and median hospital length of stay was 16 days. Conclusions: despite the complexity of open thoracoabdominal aneurysm surgery and the significant risk of complications, surgical repair with left partial cardiopulmonary bypass can be performed with acceptable results in a low-volume center.(AU)

Tratamiento endovascular del arco aórtico asegurando la salida de los troncos supraaórticos mediante fenestración in situ / Endovascular treatment of the aortic arch securing the supraaortic trunks through in-situ fenestration

El tratamiento endovascular para las lesiones del arco aórtico es cada vez más frecuente gracias al empleo de endoprótesis fenestradas. En situaciones de urgencia no siempre es posible la disponibilidad de este tipo de prótesis. Presentamos el caso de un paciente con infección reciente por COVID-19 y pseudoaneurisma del arco aórtico sintomático tratado mediante endoprótesis torácica con fenestración manual y guías precargadas.(AU)

The use of endovascular repair for aortic arch lesions is increasing thanks to fenestrated endoprothesis. In emergency situations the availability of these endografts is not always possible. We present the case of a patient with recent COVID-19 infection and a symptomatic aortic arch pseudoaneurysm treated with a physician-made fenestrated endograft and externalized guidewires.(AU)

[Percutaneous occlusion with coils of coronary artery fistulas in adults]. / Fístulas de arterias coronarias en adultos. Oclusión percutánea mediante coils.

Coronary artery fistulas are one of the most common congenital anomalies of the coronary arteries. Most fistulas are small and of no clinical significance, although larger or multiple fistulas can be symptomatic and produce complications. Early percutaneous occlusion is now always recommended, and surgical closure is restricted to use for multiple or large fistulas. Here we report four cases of coronary fistula draining from the coronary arteries to the pulmonary vascular bed, which were treated with percutaneous occlusion by coils.

Enfermedad quística adventicial con recanalización espontánea de la arteria poplítea / Adventitial cystic disease with spontaneous recanalization of popliteal artery

La enfermedad quística adventicial (EQA) de la arteria poplítea es una enfermedad poco frecuente. El síntoma más frecuente es la claudicación. Los pacientes suelen ser jóvenes y sin factores de riesgo para ateroesclerosis. Presentamos el caso de un paciente de 52 años con clínica de claudicación y hallazgo de trombosis de la arteria poplítea que al año recanalizó espontáneamente. Dada la persistencia de la clínica y la lesión sospechosa de quiste poplíteo, se decidió realizar la resección de dicha lesión y la revascularización mediante injerto protésico

Cystic adventitial disease of the popliteal artery is a rare disease that usually manifests with intermittent claudicating. Patients are usually young and without risk factors for atherosclerosis. In this report, we present a case of a 52 years old man with thrombosis of popliteal artery which recanalized spontaneously a year later. Given the persistence of claudicating and the suspicion of cystic adventitial disease, we decided to perform resection of the affected artery and revascularization with prosthetic grafting

Asociación de aneurismas aórtico y viscerales con lesiones óseas / Association of aortic and visceral aneurysms with bone lesions

Paciente de 22 años con rigidez congénita de miembro superior izquierdo y hallazgos en angio TAC de pseudocoartación aórtica y aneurismas a varios niveles (aorta ascendente, cayado aórtico, arteria mesentérica superior, mesentérica inferior, renales segmentarias, aorta abdominal y arteria hipogástrica izquierda). Presenta imagen en "gota de cera" en radiografía de pelvis y en angio RM destacan lesiones esclerosas poliostóticas y malformación arteriovenosa en partes blandas de cadera izquierda. No se realiza estudio genético por la negativa del paciente

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