Carotid artery stenting prior to coronary artery bypass grafting in patients with carotid stenosis: Clinical outcomes.

OBJECTIVES: Management of patients undergoing coronary artery bypass grafting (CABG) with obstructive disease of the carotid arteries is still a matter of debate. We compared the results of staged carotid artery stenting (CAS) before CABG in patients with carotid lesions. MATERIALS AND METHOD: Patients with significant carotid artery disease who were deemed to simultaneously suffer from an obstructive coronary artery disease requiring CABG from 2008 to 2018 were screened and enrolled in this study. We performed a staged CAS in cases with ≥60% stenosis and neurological symptoms or asymptomatic patients with ≥80% carotid artery stenosis. Patients with bilateral carotid lesions received sequential CAS within three weeks. Six weeks after the CAS procedure, all patients underwent CABG. RESULTS: A total of 142 patients were included. Eighty-five of these had neurological symptoms, while the remaining 40% were asymptomatic. Thirty-one patients underwent sequential CAS for bilateral lesions. The cerebrovascular event (CVE) following CAS (3 patients) and CABG (3 patients) was 4.2%. There was only a single case of mortality in this cohort. Although it was not statistically significant, CVE after CABG was more frequent in patients with bilateral carotid disease. CONCLUSIONS: Our results showed that staged CAS could be performed with minimal adverse outcomes in patients suffering from a simultaneous occlusive disease of carotids and coronary arteries before CABG. Bilateral CAS will further decrease cerebrovascular events and could be performed consequently or concomitantly.

COVID-19 prognostic modeling using CT radiomic features and machine learning algorithms: Analysis of a multi-institutional dataset of 14,339 patients.

BACKGROUND: We aimed to analyze the prognostic power of CT-based radiomics models using data of 14,339 COVID-19 patients. METHODS: Whole lung segmentations were performed automatically using a deep learning-based model to extract 107 intensity and texture radiomics features. We used four feature selection algorithms and seven classifiers. We evaluated the models using ten different splitting and cross-validation strategies, including non-harmonized and ComBat-harmonized datasets. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were reported. RESULTS: In the test dataset (4,301) consisting of CT and/or RT-PCR positive cases, AUC, sensitivity, and specificity of 0.83 ± 0.01 (CI95%: 0.81-0.85), 0.81, and 0.72, respectively, were obtained by ANOVA feature selector + Random Forest (RF) classifier. Similar results were achieved in RT-PCR-only positive test sets (3,644). In ComBat harmonized dataset, Relief feature selector + RF classifier resulted in the highest performance of AUC, reaching 0.83 ± 0.01 (CI95%: 0.81-0.85), with a sensitivity and specificity of 0.77 and 0.74, respectively. ComBat harmonization did not depict statistically significant improvement compared to a non-harmonized dataset. In leave-one-center-out, the combination of ANOVA feature selector and RF classifier resulted in the highest performance. CONCLUSION: Lung CT radiomics features can be used for robust prognostic modeling of COVID-19. The predictive power of the proposed CT radiomics model is more reliable when using a large multicentric heterogeneous dataset, and may be used prospectively in clinical setting to manage COVID-19 patients.

Allopurinol as a preventive contrivance after acute ischemic stroke in patients with a high level of serum uric acid: a randomized, controlled trial.

OBJECTIVES: To assess the clinical relevance (functional outcome) of a 3-month allopurinol regimen in patients with high serum uric acid (SUA) levels and acute ischemic stroke without considering the changes in SUA levels. MATERIALS AND METHODS: In a randomized, double-blind, controlled study, 70 patients (45 females, 25 males) with acute ischemic stroke who had elevated levels of SUA were included. They were divided in two 35-patient groups to investigate the effect of 3 months of an allopurinol (200 mg/day) regimen versus placebo on their functional outcome, which was evaluated using a modified Rankin scale. RESULTS: The overall mean age was 68.9 ± 11.33 years (range 27-89). The final favorable functional status (mRS = 0-2) was 23 (65.7%) and 14 (40.0%) in the treated and placebo groups, respectively, which was strongly associated with allopurinol consumption (OR = 4.646, p = 0.014) and age ≤70 years (OR = 0.139, p = 0.005) in patients with ischemic stroke after adjusting for confounders. There was no significant difference in death between allopurinol-treated cases (3; 8.6%) and placebo-treated ones (6; 17.2%; p = 0.278). CONCLUSION: Allopurinol treatment was well tolerated and improved the 3-month functional status of patients with acute ischemic stroke who had high levels of SUA without considering the decreasing effect of allopurinol on SUA.

A comparison of risk factors and severity of ischemic stroke in female and male genders in North-West Iran: A cross-sectional study.

BACKGROUND: Gender difference has been reported in stroke risk factors and disease history. The aim of this study was to compare risk factors and the severity of ischemic stroke based upon modified Rankin Scale (mRS) and hospital mortality between two genders. METHODS: In a cross-sectional study, 341 patients (44% males and 56% females with a mean age of 68.94 ± 12.74 years) with ischemic stroke, who were hospitalized in the neurology wards of two referral university hospital of North-West Iran (Imam Reza and Razi Hospitals), from the beginning to the end of 2011 were selected and assessed. Gender difference in terms of demographic findings, vascular risk factors, 7(th) day mRS, and hospital mortality (during admission) were evaluated. RESULTS: In 2.6% of cases, mRS was found to be less than 2 (favorable) and in 97.4% of cases; mRS was 2-5 (with disability). No significant difference in ischemic stroke severity based on mRS was observed between two genders. There was a significant difference in the rate of hypertension (females = 72.3%, males = 59.3%, P = 0.010), diabetes (females = 28.8%, males = 18.7%, P = 0.030), smoking (females = 6.3%, males = 35.3%, P < 0.001). No significant difference was seen in other risk factors between two genders. There was no significant difference in the mortality rate, which constituted 8.9% and 4.7% in females and males respectively (P = 0.140). CONCLUSION: The evidence from the present study suggests that despite the existence of some difference between risk-factors in two genders, there was no difference in terms of ischemic stroke severity and mortality rate between two genders.

A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial.

BACKGROUND: Atherosclerotic stenosis of the major intracranial arteries is the most common cause of ischemic stroke. There are limited treatments for severe intracranial stenosis, and stent placement versus medical treatment remains controversial. The aim of this study was to compare functional outcomes of these two modalities in patients with severe symptomatic intracranial stenosis. METHODS: At a single center, between 2008 and 2011, patients with angiographically demonstrated severe (70-90%) symptomatic intracranial atherosclerosis were divided into two groups: group A, which received only medical treatment, and group B, which underwent endovascular stent implant treatment. The severity and location of the stenosis was determined by digital subtraction angiography and the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial criteria in all patients. The exclusion criteria were: specific causes other than atherosclerosis, such as artery dissection, fibromuscular dysplasia, vasculitis, radiation and intracranial hemorrhage, focal neurological deficit that did not correlate to internal carotid artery or middle cerebral artery stenosis. All procedures were done under light anesthesia. Technical success was defined as the reduction of stenosis to <30% with complete enveloping of the lesion after the procedure. Early and late adverse events and functional outcomes were compared between the groups using the modified Rankin Scale (mRS). RESULTS: Overall, 63 patients (29 in group A and 34 in group B) were evaluated and followed for a mean period of 15.22 months (range 6-25). The technical success rate was 97% in a total of 34 stents in 34 patients. There was no difference between the early (within 30 days) adverse event rates of the two groups. The median follow-up duration for the stent implant patients was 15 months (range 6-25), and for the medically treated cohort it was 14 months (range 8-25). The re-stenosis rate was 5.8% and the total number of late (>30 days) adverse events, including stroke, myocardial infarction and death, was 1 (2.9%) and 6 (20.7%) in the stent implant and medical groups, respectively (p = 0.042). The stent implant group had significantly better favorable functional outcomes according to the mRS than the medical group (93.9 vs. 63.0%). The cumulative secondary adverse event-free survival was significantly lower in the stent implant group. CONCLUSION: Stent implants can be considered more durable and safe for patients with symptomatic severe stenosis of the internal carotid artery or middle cerebral artery, despite optimal medical therapy. Randomized, multicenter trials are required to confirm these results.