Cardiac Surgery, with Synchronous Carotid Angioplasty, our Experience.

INTRODUCTION: The identification of carotid stenosis in patients proposed for coronary artery bypass grafting, proves that atherosclerosis is a systemic disease. In patients with carotid disease and in need of cardiac surgery, there are still questions about the best method of treatment - medical, surgical or percutaneous, the degree of stenosis considered for intervention and the best time for treatment (pre, peri or postoperative heart surgery). The surgical treatment of the carotid stenosis is currently the gold standard. However, percutaneous treatment has expanded its indications. It is our goal to present the initial results of our experience in the implementation of a synchronous strategy for the treatment of percutaneous carotid disease treatment, followed by cardiac surgery. METHODS: Between July/2013 and August/2017, 37 patients were eligible for this procedure. Demographic, perioperative and postoperative data were collected to evaluate the incidence of cerebrovascular complications (severe stroke, death due to stroke, transient ischemic stroke), cardiac complications (acute myocardial infarction (AMI)), or renal impairment. RESULTS: The majority of patients (83.7%) were male, with a mean age of 74 years (51-90). Coronary artery disease was the most prevalent surgical indication (59%). Hypertension, dyslipidemia, and smoking, in this order of magnitude, were the most prevalent risk factors. One patient had documented previous stroke. The efficacy of carotid angioplasty was 97.3%, as in one patient it was impossible due to technical reasons. In six patients, the carotid procedure was associated with percutaneous treatment of coronary disease. The interval between both procedures was 1 hour, in average. In- hospital mortality was 5,4% (2 patients) and 1 AMI was documented. Renal injury and atrial fibrillation were the most common complications, found in 27% and 19%, respectively. The mean follow-up time was 523 days (50-1525 days). Two deaths were documented during follow-up. No re-stenosis was found. CONCLUSION: The approach presented here (percutaneous treatment of carotid stenosis, concomitant treatment of coronary disease and proximity between procedures) is feasible and effective in reducing the risk of cerebrovascular complications in patients in need of cardiac surgery. Long-term follow-up results, associated with permeability studies, may boost this technique for clinical acceptance, with changes in guidelines, in this set of patients.

Carotid stenting for radiation-induced carotid artery stenosis: a challenge?

Endovascular treatment of radiation-induced carotid lesions is challenging and very demanding from a technical standpoint. The authors report the case of a 48-year-old male patient who presented in the emergency department with a non-ST elevation acute coronary syndrome. He had a past history of lung carcinoma treated with radiotherapy. Diagnostic workup included coronary angiography (showing predominantly ostial coronary artery disease) and carotid angiography, which showed a long ulcerated lesion in the right carotid artery. Carotid angioplasty was performed using distal cerebral embolic protection. The post-procedure course was uneventful. At 24 months the patient is well and no major adverse cardiovascular events have been reported. The case presented demonstrates that carotid artery stenting can be safely performed in high risk lesions and highlights the importance of stenting technique and of thorough follow-up.

Dietary xylanase and live yeast supplementation influence intestinal bacterial populations and growth performance of piglets fed a sorghum-based diet.

This study was to evaluate the effect of xylanase supplementation and the addition of live yeast, Saccharomyces cerevisiae, on growth performance and intestinal microbiota in piglets. One hundred and eighty commercial crossbred 23-d-old piglets (PIC 417) were sorted by initial BW and allocated to 3 treatments: control (CTR) diet, CTR diet supplemented with xylanase at 16,000 birch xylan units/kg (XYL) and XYL diet supplemented with live yeast (2 × 1010 CFU/g) at 1 kg/t (XYL + LY). Each treatment had 10 replicates, with 6 animals each. A sorghum-based diet and water were available ad libitum for 42 d of the study. Average daily gain (ADG) and average daily feed intake (ADFI) were measured from 0 to 42 d (23- to 65-d-old) and feed conversion ratio (FCR) calculated. At the end of the study, bacterial identification through 16S rRNA (V3 to V4) sequencing of the ileal and caecal digesta from one piglet per replicate was performed. No treatment effects were observed on ADFI. Pigs offered the live yeast in addition to the xylanase had increased ADG compared with those supplemented with xylanase alone (XYL + LY vs. XYL; P = 0.655). FCR was improved with XYL and XYL + LY compared with CTR (P = 0.018). Clostridiaceae counts in the ileum tended to reduce by 10% with XYL and 14% with XYL + LY compared to CTR (P = 0.07). XYL and XYL + LY increased the counts of Lactobacillaceae in the caecum compared with CTR (P < 0.0001). Dietary supplementation of live yeast combined with xylanase improved growth performance and microbial balance of piglets during the nursery phase.

[Blood pressure control after bilateral carotid angioplasty in a patient with severe hypertension--case report]. / Normalização da pressão arterial em hipertenso grave após angioplastia carotídea bilateral.

Carotid artery angioplasty with stenting is an effective treatment for carotid artery stenosis, but is frequently associated with acute transient hemodynamic changes. We present the case of a 73-year-old female patient with long-standing refractory hypertension who remained normotensive during a three-year follow-up after undergoing staged bilateral carotid angioplasty.