Unsaturated Fatty Acids Improve Atherosclerosis Markers in Obese and Overweight Non-diabetic Elderly Patients.

BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.

High prevalence of subclinical atherosclerosis in Brazilian postmenopausal women with low and intermediate risk by Framingham score.

Cardiovascular diseases are the leading cause of mortality among women in several countries. Early detection of subclinical atherosclerosis (SA) could enable the adoption of preventive measures to avoid cardiovascular events. This study aimed to determine the prevalence of SA in Brazilian asymptomatic postmenopausal women in Framingham Risk Score (FRS) low and intermediate groups. Computed tomography (CT) and ultrasound (US) scans were performed in 138 asymptomatic postmenopausal women (56.1 ± 4.9 years of age) to survey for coronary artery and aortic calcification (CT scan) and assess carotid intima-media thickness (CIMT) and identify carotid plaques (US). The mean FRS was 2.64 ± 2.13 %. The prevalence of increased CIMT, carotid plaques, increased CIMT and/or plaques, coronary artery calcification (CAC) >0 and aortic calcification (AC) were, respectively, 45.7, 37.7, 62.3, 23.9 and 45.7 %. Normal imaging tests were found in 22.4 %. SA, defined as at least one abnormal imaging test, was associated with age, FRS, waist-to-rip ratio, systolic and diastolic blood pressure, HDL-c and ApoA1 levels, and ApoA1/ApoB ratio. In logistic regression, SA was associated with higher age (OR 1.108, 95 % CI 1.010-1.215, p = 0.029) and lower ApoA1 levels (OR 0.979, 95 % CI 0.960-0.998, p = 0.029). SA was prevalent in Brazilian postmenopausal women with low and intermediate risk groups (FRS) and was associated with higher age and lower levels of ApoA1. Carotid atherosclerosis was the most common presentation of SA in this group.

Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound.

OBJECTIVE: The purpose of this study was to determine the sonographic criteria for diagnosis of iliac venous outflow obstruction by assessing the correlation of this method with intravascular ultrasound (IVUS) in patients with advanced chronic venous insufficiency (CVI). METHODS: The evaluation included 15 patients (30 limbs; age, 49.4 ± 10.7 years; 1 man) with initial CVI symptoms (Clinical class, Etiology, Anatomy, and Pathophysiology [CEAP] classification, CEAP1-2) in group I (GI) and 51 patients (102 limbs; age, 50.53 ± 14.5 years; 6 men) with advanced CVI symptoms (CEAP3-6) in group II (GII). Patients from both groups were matched by gender, age, and race. The Venous Clinical Severity Score was considered. All patients underwent structured interviews and duplex ultrasound (DU) examination, measuring the flow phasicity, the femoral volume flows and velocities, and the velocity and obstruction ratios in the iliac vein. The reflux multisegment score was analyzed in both groups. Three independent observers evaluated individuals in GI. GII patients were submitted to IVUS, in which the area of the impaired venous segments was obtained and compared with the DU results and then grouped into three categories: obstructions <50%, obstructions between 50% and 79%, and obstructions ≥80%. RESULTS: The predominant clinical severity CEAP class was C1 in 24 of 30 limbs (80%) in GI and C3 in 54 of 102 limbs (52.9%) in GII. Reflux was severe (reflux multisegment score ≥3) in 3 of 30 limbs (10%) in GI and in 45 of 102 limbs (44.1%) in GII (P < .001). There was a moderately high agreement between DU and IVUS findings when they were grouped into three categories (κ = 0.598; P < .001) and high agreement when they were grouped into two categories (obstructions <50% and ≥50%; κ = 0.784; P < .001). The best cutoff points and their correlation with IVUS were 0.9 for the velocity index (r = -0.634; P < .001), 0.7 for the flow index (r = -0.623; P < .001), 0.5 for the obstruction ratio (r = 0.750; P < .001), and 2.5 for the velocity ratio (r = 0.790; P < .001). Absence of flow phasicity was observed in 62.5% of patients with obstructions ≥80%. An ultrasound algorithm was created using the measures and the described cutoff points with accuracy of 86.7% for detecting significant obstructions (≥50%) with high agreement (κ = 0.73; P < .001). CONCLUSIONS: DU presented high agreement with IVUS for detection of obstructions ≥50%. The velocity ratio in obstructions ≥2.5 is the best criterion for detection of significant venous outflow obstructions in iliac veins.

Comparative study of the use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach.

OBJECTIVE: To evaluate the impact of the use, prior to the procedure, of injectable diltiazem to prevent complications. METHODS: Between September 2000 and July 2001, 50 patients underwent transradial coronary angiography and were randomized to receive placebo (GI) or diltiazem (GII) through a catheter inserted into the radial artery. All patients received isosorbide mononitrate. Ultrasound analyses of the radial artery were performed before examination, 30 minutes afterwards, and 7 days afterwards to evaluate the flow, the diameter, and the artery output. RESULTS: The radial artery diameter of GI was 2.4d +/- 0.5 mm before the procedure and 2.3 +/- 0.5 mm after 30 minutes (NS), whereas in GII the diameter was 2.2 +/- 0.3 mm before the examination and +/- 2.5 0.4 mm 30 minutes after it (P<0.001). Radial artery output in group 1 was 7.3 +/- 5.l2 mL/min before the examination and 6.1 +/- 3.5 mL/min 30 minutes after the examination (NS), and GII had an increase of 5.9 +/- 2.5 mL/min before examination to 9.05 +/- 7.78 mL/min after the examination (P=0.04). Complications (spasm, occlusion, and partial obstruction) occurred in 4 patients (17.4%) in GI and did not occur in GII (P=0.04). CONCLUSION: The study suggests a decrease in vascular complications through the transradial access for coronary angiography with the use of diltiazem as an antispasmodic drug, resulting in the significant increase in the diameter of the radial artery and radial artery output.

Improvement of atherosclerotic markers in non-diabetic patients after bariatric surgery.

BACKGROUND: The objective of this study was to assess the impact of bariatric surgery performed in extremely obese non-diabetic subjects on the following parameters: endothelial function, inflammatory processes (assessed by high-sensitivity C-reactive protein [hs-CRP]), carotid artery intima-media thickness (CIMT), and glucose and lipid profiles. METHODS: Forty-seven obese individuals with body mass index >40 kg/m(2) underwent bariatric surgery and returned for post-procedure assessment between 6 and 19 months after surgery. Ninety-three percent of patients were female. Their age ranged from 18 to 65 (mean 41) years old at baseline. Baseline was defined as the maximum of 30 days before surgery. Before and after surgery, all patients were subjected to a brachial artery ultrasound examination to evaluate endothelial-dependent dilation, CIMT by ultrasound, and laboratory analyses including glucose, lipid and inflammatory profiles were performed. RESULTS: Subjects lost an average of 33 % of their original weight (p < 0.001). Flow-mediated dilation showed significant improvement after surgery from 7.4 % to 18.9 % (p < 0.001) on average. There was regression of CIMT, with the median being reduced from 0.8 to 0.5 mm (p < 0.001). The median Hs-CRP reduced from 0.83 to 0.18 mg/dl (p < 0.001), while glucose and lipid profiles were also improved after surgery. CONCLUSIONS: This study shows that severely obese, non-diabetic patients who had pronounced weight loss after bariatric surgery had an overall improvement in brachial flow-mediated dilation, CIMT, high-sensitivity CRP, and glucose and lipid metabolism. The best responses of the brachial flow-mediated dilation after surgery were observed in non-smokers and in younger subjects.

Resultados do uso de stents de nitinol superflexíveis na artéria femoral superficial / Outcomes after implantation of superflexible nitinol stents in the superficial femoral artery

As intervenções endovasculares na artéria femoral superficial para o tratamento da doença arterial oclusiva periférica têm crescido nas últimas décadas. A primeira e a segunda geração de stents na artériafemoral superficial falharam em demonstrar a melhora da perviedade do vaso tratado, devido às altas taxas defratura. O objetivo deste estudo foi avaliar os desfechos clínicos no curto prazo com o uso de stents de nitinolsuperflexíveis de terceira geração no tratamento de lesões ateroscleróticas na artéria femoral superficial. Métodos: Trata-se de um estudo retrospectivo, realizado em único centro, no período de junho de 2013 a maio de 2014. Um total de 27 pacientes foi submetido à angioplastia com stents de nitinol superflexíveis de terceira geração em lesões ateroscleróticas da arterial femoral superficial. Resultados: A média de idades foi de 68 ± 12 anos, 55,6% eram do sexo feminino e 74,1%, diabéticos. Os pacientes foram classificados em TASC B e C em 77,7% dos casos. O sucesso técnico foi de 100%. Houve aumento do índice tornozelo-braquial de 0,35 ± 0,1 pré-intervenção para 0,75 ± 0,2 na alta hospitalar. O seguimento médio dos pacientes foi de 6,7 ± 2,3 meses. A taxa de patência primária foi de 96,3%. A taxa de salvamento de membro foi de 100%. Não ocorreram fraturas de stent documentadas por raios X. Conclusões: A angioplastia com uso de stent de nitinol superflexível de terceira geração demonstrou ser efetiva no tratamento das lesões ateroscleróricas da artéria femoral superficial...

Endovascular interventions in the superficial femoral artery for the treatment of peripheral arterial occlusive disease have increased over the last decades. The first- and second-generation stents in the superficial femoral artery have failed to demonstrate improved patency of the treated vessel due to high fracture rates. The aim of this study was to evaluate the clinical, short-term outcomes of using third-generation superflexible nitinol stents in the treatment of atherosclerotic lesions in the superficial femoral artery. Methods: This was a retrospective study carried out in a single center, from June 2013 to May 2014. A total of 27 patients underwent angioplasty with third-generation superflexible nitinol stents in atherosclerotic lesions of the superficial femoral artery. Results: The mean age was 68 ± 12 years, 55.6% were females, and 74.1% were diabetics. Patients were classified as TASC B and C in 77.7% of cases. Technical success was 100%. There was an increase in the anklebrachial index from 0.35 ± 0.1 before the intervention to 0.75 ± 0.2 at hospital discharge. The mean followupof patients was 6.7 ± 2.3 months. The primary patency rate was 96.3%. The limb salvage rate was 100%. There were no stent fractures documented by X-rays. Conclusions: Angioplasty with third-generation superflexible nitinol stent placement was shown to beeffective in the treatment of atherosclerotic lesions of the superficial femoral artery...

Doppler ecografia das artérias carótidas: critérios de velocidade validados pela arteriografia / Doppler Ultrasonography of Carotid Arteries: Velocity Criteria Validated by Arteriography

Introdução: Doppler Ecografia (DE) é largamente utilizada no diagnóstico das estenoses carotídeas. Em 2003, a Sociedade Americana de Radiologia divulgou um consenso propondo critérios para graduação das estenoses da Artéria Carótida Interna (ACI). Em 2009, um grupo do Reino Unido apresentou recomendações para realização da DE das artérias carótidas.Objetivo: Avaliar a acurácia dos critérios velocimétricos utilizados na graduação das estenoses da artéria carótidainterna por Doppler Ecografia comparados à arteriografia.Métodos: Em 73 pacientes (146 ACI), foram avaliados: Pico de Velocidade Sistólica (PVS), Velocidade DiastólicaFinal (VDF) da ACI e razão PVS ACI/Artéria Carótida Comum (ACC), para detecção de estenoses < 50%, 50% - 69% (PVS: 125 - 230 cm/s), 70% - 99% (PVS > 230 cm/s). A correlação entre DE e arteriografia foi feita pelo método de Spearman e p < 0,05 considerado estatisticamente significativo. Resultados: A idade média dos pacientes foi 69 anos, 47 (64%) homens, 27 (37%) com acidente vascular encefálico, e 13 (18%)ataque isquêmico transitório. O melhor critério para estenoses de 50% - 69% foi PVS ACI ≥ 141 cm/s (sensibilidade: 94%, especificidade: 90%, acurácia: 93%) (AUC 0,97). Para estenoses entre 70% ‑ 99%, PVS ACI ≥ 176 cm/s mostrou sensibilidade: 92%; especificidade: 87%; acurácia: 90%; PVS ACI ≥ 230 cm/s teve sensibilidade: 89%; especificidade: 89%; acurácia:89% (AUC 0,96); e a razão PVS ACI/ACC≥ 4,0 teve sensibilidade: 70%; especificidade: 100%; e acurácia: 81% (AUC 0,96). Seis oclusões de ACI foram detectadas à DE e arteriografia. A correlação DE e arteriografia foi: PVS (0,81 – p < 0,001); VDF (0,78 – p < 0,001) e razão PVS ACI/ACC (0,81 – p < 0,001). Conclusões: Doppler Ecografia é um método confiável na detecção das estenoses carotídeas, correlacionando-se bem com a arteriografia, sendo importante validar os critérios DE que melhor se aplicam a cada serviço.

Introduction: The Doppler Ultrasonography (DU) is largely used to diagnose carotid stenoses. In 2003, the American Society of Radiology issued a consensus establishing criteria for gradating the stenoses of the Internal Carotid Artery (ICA). In 2009, a group in the United Kingdom presented recommendations for performing DU of carotid arteries. Objective: Evaluating the accuracy of the velocimetric criteria used to gradate internal carotid artery stenoses by Doppler Ultrasonographycompared to arteriography. Methods: We evaluated 73 patients (146 ICA): Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV) of ICA and the ICA/Common Carotid Artery (CCA) PSV ratio to detect stenoses < 50%, 50% - 69% (PSV: 125-230 (cm/s), 70% - 99% (PSV > 230 (cm/s). The correlation between DU and arteriography was ascertained with the Spearman’s method and p < 0.05 deemed statistically significant.Results: The patients’ average age was 69 years, 47 (64%) men, 27 (37%) with cerebrovascular accident, and 13 (18%), transient ischemic attack.The best criterion for stenoses of 50% - 69% was ICA PSV ≥ 141 cm/s (sensitivity: 94%, specificity: 90%, accuracy: 93%) (AUC 0.97). For stenoses between 70% - 99%, ICA PSV ≥ 176 cm/s presented sensitivity: 92%; specificity: 87%; accuracy: 90%; ICA PSV ≥ 230 cm/s presented sensitivity:89%; specificity: 89%; accuracy: 89% (AUC 0.96); and ICA/CCA PSV ratio ≥ 4.0 presented sensitivity: 70%; specificity: 100%; and accuracy:81% (AUC 0.96). Six ICA occlusions were detected by DU and arteriography. The DU and arteriography correlation was: PSV (0.81 – p < 0.001);EDV (0.78 – p < 0.001) and ICA/CCA PSV ratio (0.81 – p < 0.001).Conclusions: The Doppler Ultrasonography is a reliable method for detecting carotid stenoses, having a good correlation with arteriography.In this respect, validating the DU criteria which better suit each service is important.

Resultados do Uso de Stent de Nitinol Superflexível em Artérias Poplíteas / Outcomes of the Use of a Superflexible Nitinol Stent in the Popliteal Artery

Introdução: As taxas de patência primária no longo prazo para a angioplastia transluminal percutânea, com implante de stents de primeira e segunda gerações, no tratamento da artéria poplítea, têm sido desapontadoras. No entanto, resultados com novos stents de nitinol parecem promissores. Nosso objetivo foi avaliar desfechos clínicos no curto prazo do uso de stents de nitinol superflexíveis no tratamento de lesões ateroscleróticas nos segmentos poplíteos. Métodos: Estudo retrospectivo, longitudinal, realizado no período de abril a dezembro de 2013. Foram avaliados as características populacionais, os dados do procedimento e os exames de imagem aos 6 meses, sendo obtidas as taxas de patência do stent e de salvamento de membro. Resultados: Incluímos, nesta análise, 14 pacientes, com idade de 73 ± 11 anos, 50% do sexo masculino e 64,3% diabéticos. Todos os pacientes apresentavam lesão trófica nos membros tratados. As lesões arteriográficas foram classificadas pelo critério Trans-Atlantic Inter-Society Consensus (TASC) em B e C em igual proporção. Na avaliação do leito de escoamento, 78,6% dos pacientes possuíam apenas uma artéria pérvia, sendo a artéria fibular a mais frequentemente observada. As zonas de aterrissagem dos stents foram o segmento médio da artéria poplítea em 57,1% dos casos e, nos demais, o segmento distal da artéria, cruzando a articulação do joelho. Durante o seguimento de 6 meses, não foram observadas fraturas dos stents. A taxa de patência primária foi de 85,7% e a de salvamento do membro foi de 100%. Conclusões: A angioplastia com uso de stent de nitinol superflexível demonstrou ser segura e efetiva no tratamento das lesões ateroscleróticas da artéria poplítea...

Background: The long-term primary patency rates for percutaneous transluminal angioplasty using first and second generation stents for the treatment of the popliteal artery have been disappointing. However, results with the new nitinol stents seem promising. Our objective was to evaluate short-term clinical outcomes using the superflexible nitinol stent in the treatment of atherosclerotic lesions in popliteal segments. Methods: Retrospective longitudinal study conducted from April to December 2013. Population characteristics, procedure-related data and imaging tests were assessed at 6 months. Stent patency and limb salvage rates were obtained. Results: A total of 14 patients with mean age of 73 ± 11 years were included, of which 50% were male and 64.3% diabetic. All patients had trophic lesions in the treated limbs. The arteriographic lesions were classified according to the criteria of the Trans-Atlantic Inter-Society Consensus (TASC) criteria as TASC B and C inequal proportions. In the assessment of below-the-knee runoff, 78.6% of the patients had only one distal pervious artery, of which the fibular artery was the most frequently observed. The stent landing zone was the mid segment of the popliteal artery in 57.1% of the cases and the distal segment, crossing the knee joint, in the remaining patients. During the 6 month follow-up there were no stent fractures. The primary patency rate was 85.7% and the limb salvage rate was 100%. Conclusions: In our study, angioplasty using the super flexible nitinol stent demonstrated to be safe and effective for the treatment of atherosclerotic lesions of the popliteal artery...

Tratamento endovascular dos aneurismas de artéria poplítea / Endovascular treatment of popliteal artery aneurysms

Introdução: Com os recentes avanços nas técnicas endovasculares e com o surgimento de endopróteses mais flexíveis, o tratamento das lesões aneurismáticas da artéria poplítea tem se tornado mais frequente. O objetivo desse estudo foi avaliar os desfechos clínicos a curto e médio prazos do tratamento de lesões aneurismáticas da artéria poplítea com o uso de endopróteses flexíveis. Métodos: Estudo retrospectivo, longitudinal, realizado em dois centros, no período de janeiro de 2011 a fevereiro de 2014. Foram avaliados características populacionais, dados do procedimento e imagens radiológicas no seguimento médio de 1 ano, sendo obtidas as taxas de morbimortalidade, complicações e perviedade da endoprótese. Resultados: Treze pacientes do sexo masculino, com idade de 66 ± 9 anos, foram submetidos ao tratamento de aneurismas de artéria poplítea em 15 membros. Na avaliação do leito de deságue, a maior parte dos pacientes possuía pelo menos duas artérias da perna pérvias (92,3%). O implante do stent ocorreu no segmento médio em 57,1% e, no segmento distal da artéria poplítea, em 42,9% dos procedimentos. Foi possível realizar a revascularização da lesão-alvo em todos os casos, sendo que, em quatro membros, foi necessário o uso de dois stents. Foram utilizados 17 stents Viabahn® e 2 stents Multilayer®. Durante o seguimento de 12 meses, não ocorreram fraturas de stents. A taxa de perviedade primária foi de 53,3% e a de salvamento de membro de 100%. Conclusões: O tratamento endovascular do aneurisma de artéria poplítea demonstrou ser eficaz no seguimento de médio prazo...

Background: With the recent advances in endovascular techniques and the emergence of more flexible endoprosthesis, the treatment of popliteal artery aneurysms has become more frequent. The objective of this study was to evaluate the short and mid-term clinical outcomes of the treatment of popliteal artery aneurysms with the use of a flexible endoprosthesis. Methods: Retrospective longitudinal study conducted in two sites from January of 2011 to February of 2014. Populational characteristics, procedure-related data, and radiologic imaging were evaluated at a mean follow-up of 1 year. Morbidity and mortality rates, complication rates, and stent patency rates were obtained. Results: A total of 13 male patients, mean age 66 ± 9 years, were submitted to popliteal artery aneurysm treatment in 15 limbs. Run-off vessel evaluation showed that most patients had at least two patent arteries in the legs (92.3%). Stents were implanted in the middle segment in 57.1% and in the distal segment of the popliteal artery in 42.9% of the procedures. Target lesion revascularization was achieved in all of the cases and two stents were required in four limbs. Seventeen ViabahnTM and two MultilayerTM stents were used. During the 12-month follow-up there were no stent fractures. The primary patency rate was 53.3% and limb salvage rate was 100%. Conclusions: Endovascular treatment of popliteal artery aneurysm was shown to be effective in the mid-term follow-up...

Aneurisma venoso gigante de veia ilíaca externa secundário a fístula arteriovenosa traumática: relato de caso / Giant external-iliac-vein aneurysm secondary to traumatic arteriovenous fistula: a case report

Aneurismas venosos abdominais são raros. Os localizados nas veias ilíacas externas estão entre os mais infrequentes aneurismas venosos publicados na literatura. Relatamos o caso de um paciente jovem com aneurisma venoso gigante de veia ilíaca externa secundário a uma fístula arteriovenosa adquirida há 20 anos, tratado pelos métodos convencional e endovascular com sucesso.

Venous abdominal aneurysms are rare entities, especially at the external iliac vein. We report the case of a young male patient who presented with a giant external-iliac-vein aneurysm secondary to an arteriovenous fistula acquired 20 years earlier, and treated successfully by conventional and endovascular methods in our service.

Experiência inicial com o sistema de reversão de fluxo em pacientes submetidos a angioplastia carotídea / Initial experience with the flow reversal system in patients undergoing carotid angioplasty

Introdução: O tratamento endovascular da doença aterosclerótica carotídea vem evoluindo continuamente, embora possam ocorrer complicações embólicas ou isquêmicas, mesmo com o uso dos sistemas de proteção cerebral. Este estudo teve como objetivo avaliar os resultados de uma série inicial de pacientes que utilizaram o sistema de reversão de fluxo durante angioplastia carotídea. Métodos: Estudo prospectivo, não-randomizado, não-controlado, realizado em um único centro. Foram incluídos pacientes assintomáticos com lesão > 70% ou sintomáticos com lesão > 50% em artéria carótida interna. Foi utilizado o sistema de reversão de fluxo, com pré-dilatação em casos selecionados e uso de stents de células abertas em todos os casos. Avaliou-se a ocorrência de acidentes vasculares encefálicos (AVEs) maiores e menores, ataques isquêmicos transitórios (AITs), infarto agudo do miocárdio (IAM) e óbito até 30 dias pós-procedimento. Resultados: Entre setembro de 2010 e fevereiro de 2011 foram realizadas angioplastias carotídeas em 17 pacientes, a maioria do sexo masculino (70,6%), com médiade idade de 66,7 + 8 anos, sendo 17,6% diabéticos. Cerca de metade dos pacientes era sintomática, 5 pacientes tinham história de AVE prévio (29,4%) e 3, de AIT (17,7%) prévio. Sucesso técnico foi obtido em 100% dos casos. Houve um caso de óbito (5,9%), 24 horas após o procedimento, em paciente de alto risco cirúrgico tratado na fase evolutiva de IAM por apresentar AITs de repetição. Não ocorreram casos de AVE maior ou menor ou AIT durante o período de acompanhamento. Conclusões: Neste estudo, o sistema dereversão de fluxo mostrou ser eficiente e seguro em pacientes submetidos a angioplastia carotídea.

Background: The endovascular treatment of carotid atherosclerotic disease has continuously evolved, although ischemic or embolic complications may occur even with the use of cerebral protection systems. This study was aimed at evaluating the perioperative results of an initial series of patients using the flow reversal system during carotid angioplasty. Methods: This was a prospective, non-randomized, non-controlled, singlecenterstudy. Asymptomatic patients with lesions > 70% or symptomatic patients with lesions > 50% in the internal carotid artery were included. The flow reversal system was used with pre-dilation in selected cases and open-cell stents were used in all cases. We evaluated the occurrence of major and minor strokes, transient ischemic attacks (TIAs), acute myocardial infarction (AMI) and death within 30 days after the procedure. Results: Between September 2010 and February 2011 carotid angioplasty was performed in 17 patients, most of them male (70.6%), with mean age of 66.7 +8 years, of which 17.6% were diabetic. Approximately half of the patients were symptomatic, 5 patients had a prior history of stroke (29.4%) and 3 had TIA (17.7%). Technical success was achieved in 100% of the patients. There was one death (5.9%), 24 hours after the procedure in a high surgical risk patient treated in the evolution phase of an AMI due to repetitive TIAs. There were no cases of major or minor strokes or TIAs during the follow-up. Conclusions: In our study, the flow reversal system proved to be effective and safe in patients undergoing carotid angioplasty.

Estudo comparativo do uso do diltiazem como droga antiespástica em cinecoronariografia por via transradial / Comparative study of the use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach

OBJECTIVE: To evaluate the impact of the use, prior to the procedure, of injectable diltiazem to prevent complications. METHODS: Between September 2000 and July 2001, 50 patients underwent transradial coronary angiography and were randomized to receive placebo (GI) or diltiazem (GII) through a catheter inserted into the radial artery. All patients received isosorbide mononitrate. Ultrasound analyses of the radial artery were performed before examination, 30 minutes afterwards, and 7 days afterwards to evaluate the flow, the diameter, and the artery output. RESULTS: The radial artery diameter of GI was 2.4± 0.5 mm before the procedure and 2.3±0.5 mm after 30 minutes (NS), whereas in GII the diameter was 2.2±0.3 mm before the examination and 2.5±0.4 mm 30 minutes after it (P<0.001). Radial artery output in group 1 was 7.3±5.l2 mL/min before the examination and 6.1±3.5 mL/min 30 minutes after the examination (NS), and GII had an increase of 5.9±2.5 mL/min before examination to 9.05± 7.78 mL/min after the examination (P=0.04). Complications (spasm, occlusion, and partial obstruction) occurred in 4 patients (17.4 percent) in GI and did not occur in GII (P=0.04). CONCLUSION: The study suggests a decrease in vascular complications through the transradial access for coronary angiography with the use of diltiazem as an antispasmodic drug, resulting in the significant increase in the diameter of the radial artery and radial artery output

O impacto da cirurgia bariátrica na função endotelial, variáveis ecocardiográficas e perfil inflamatório / The impact of bariatric surgery on endothelial function, echocardiographic variables and inflammatory profile

A obesidade está relacionada ao risco aumentado de numerosas doenças, que podem levar à alteração da função endotelial, do perfil inflamatório e de aspectos estruturais do coração. O tratamento cirúrgico tem sido a única alternativa para muitos pacientes obesos...