Prospective evaluation of acute cerebral injury by DW-MRI following transcarotid artery revascularization using a double-layer micromesh stent.

BACKGROUND: Transcervical carotid artery revascularization (TCAR) has demonstrated a low overall stroke rate in carotid artery stenting (CAS). Furthermore, the use of a double-layer micromesh stent is expected to reduce embolization and plaque prolapse. The combination of TCAR and the double layer stent may lead to improved results compared to previously reported outcomes. The objective of this study is to present the findings of a prospective study including patients treated with the Roadsaver stent and TCAR. METHODS: Between January 2017 and May 2022, 85 patients were enrolled. Every patient underwent TCAR with the Roadsaver stent. As per our protocol, a neurological examination and an ultrasound were performed within 24 hours before and after the procedure, and again 30 days after. A diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted 24 hours before the procedure and 48-72 hours after the procedure. The primary endpoint was the detection of new ischemic lesions on postoperative DW-MRI. The secondary endpoint was a composite of all strokes, death, and myocardial infarction within 30 days. RESULTS: Sixty-four patients (75.29%) were symptomatic, out of which 25 were treated within 14 days of the onset of the symptoms. Pre and postprocedural DW-MRI were performed in 83 patients. Postprocedural lesions were found in nine patients (10.84%). There were no strokes or death within 30 days, but two patients experienced a myocardial infarction. CONCLUSIONS: Our study suggests that the use of TCAR and the Roadsaver stent could be a safe alternative to carotid endarterectomy because it entails a low incidence of cerebral embolization, even in recently symptomatic and elderly patients.

Calidad de vida subjetiva en personas de 65 a 74 años y la influencia del género / Subjective quality of life in people aged 65-74 and the influence of gender

Objetivo: Conocer la percepción de calidad de vida (CV) en la población de entre 65 y 75 años y su relación con distintas variables. Diseño: Observacional, analítico, corte transversal. Emplazamiento: Atención Primaria. Ámbito urbano. Participantes: Pacientes de 65 a 75 años de edad. Tamaño muestral calculado para nivel de confianza del 95 %, precisión del 1 %, desviación estándar del 10 %, y asumiendo un porcentaje de pérdidas del 15 %. Muestreo sistemático por listado. Mediciones Principales: Se incluyeron la edad, sexo, comorbilidades, número de fármacos, hábitos tóxicos y CV percibida por los pacientes (cuestionario SF-36 versión 2). Resultados: Se incluyeron 423 personas, con un 54,6 % de mujeres. La percepción global de salud fue calificada como "buena-muy buena" en un 80,6 % (IC95% 76,8-84,4), "regular" en un 16,2 % (IC95 %: 12,7-19,7) y como "mala-muy mala" en un 3,2 % (IC95 %: 1,5-4,9). Comparada con el año previo, referían tener "mejor salud" el 11,6 % (IC95 %: 8,5-14,7), "igual salud" el 66,2 % (IC95 %: 61,7-70.7) y "peor salud" el 22,2 % (IC95 %: 18,2-26,2). La puntuación media en la esfera física fue de 50,84 (IC95 %: 50,15-51,53) y en la esfera psíquica de 54,11(IC95 % 53,15-55,07). Se realizó un estudio multivariante con aquellas variables asociadas a una peor percepción de calidad de vida en el análisis bivariante, y se encontró que el deterioro percibido en las esferas física y mental fue mayor entre las mujeres (p<0,01). Patologías cardiaca (p<0,05), digestiva (p<0,05) y reumatológica (p<0,01), y el mayor consumo de fármacos (p<0,05) se relacionaron con una peor percepción de la salud en su esfera física y la patología psiquiátrica con un mayor deterioro percibido en la esfera mental (p<0,01). Conclusiones: CV en consonancia con poblaciones similares, con tendencia al declive. Sexo femenino, obesidad, mayor consumo de fármacos y presencia de patologías digestiva, cardiaca, reumatológica o psiquiátrica se relacionaron con una peor percepción de CV

Objective: To know the perception of quality of life (QoL) in the population between 65 and 75 years of age, and its relationship to different variables. Design: Observational, analytical, cross-sectional study. Location: Primary care. Urban area. Participants: Patients aged 65 to 75. Sample size calculated for a 95% confidence level, a precision of 1%, a standard deviation of 10%, and assuming a loss rate of 15%. Systematic sampling by listing. Main measures: Age, sex, comorbidities, number of drugs, toxic habits, and patient-perceived QoL (SF-36 questionnaire version 2) were included. Results: 423 patients were included, 54.6 % women. The overall perception of health was classified as "good-very good" by 80.6 % (95%CI, 76.8-84.4), "fair" by 16.2 % (95%CI, 12.7-19.7), and "bad-very bad" by 3.2% (95%CI, 1.5-4.9). Compared to the previous year, 11.6% (95%CI, 8.5-14.7) said to have "better health", 66.2 % (95%CI, 61.7-70.7) "same health", and 22.2 % (95%CI, 18.2-26.2) "poorer health". The average score in the physical sphere was 50.84 (95%CI, 50.15-51.53) and in the psychological sphere was 54.11 (95%CI, 53.15-55.07). A multivariate study was carried out with those variables associated with a worse perception of quality of life in the bivariate analysis, and it was found that perceived deterioration in the physical and mental spheres was greater among women (p<0.01). Cardiac (p<0.05), digestive (p<0.05) and rheumatologic (p<0.01) diseases, and increased drug use (p<0.05) were related to a poorer perception of health in physical terms, whereas psychiatric disorders were related to a greater perceived deterioration in mental terms (p<0.01). Conclusions: QoL in line with similar populations, on a declining trend. Female sex, obesity, increased drug use, and presence of digestive, cardiac, rheumatologic or psychiatric diseases were connected with a poorer perception of QoL