Revascularización carotídea con stent: implicaciones clínicas y para el procedimiento de la presencia de una lesión suboclusiva / Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis

Introducción y objetivos: La conveniencia del implante de stent en lesiones carotídeas suboclusivas es un tema controvertido. Nuestro trabajo valoró las implicaciones clínicas y de procedimiento de la revascularización de lesiones carotídeas suboclusivas. Métodos: Se incluyó a 205 pacientes con enfermedad carotídea revascularizados con stent: los pacientes con lesiones suboclusivas (n = 54) fueron comparados con el resto de la población (n = 151). Resultados: No hubo diferencias entre grupos para la edad, el sexo y la tasa de pacientes sintomáticos (que constituían 3 cuartas partes de la población). El implante de stent en lesiones suboclusivas cursó con una alta tasa de éxito (96%), similar al resto de las lesiones (98%). La revascularización de las lesiones suboclusivas condicionó un mayor uso de protección proximal (54% vs. 20,5%, p < 0,001) y necesidad de predilatación (33% vs. 17%, p = 0,01). El abordaje de lesiones suboclusivas ocasionó un mayor desprendimiento de placa, manifestado por una mayor tasa de material embólico extraído (18,5% vs. 7%, p = 0,01) y de lesiones isquémicas cerebrales periprocedimiento (47% vs. 31%, p = 0,07). A los 30 días de la revascularización, la tasa de eventos neurológicos (muerte, ictus mayor, ictus menor) mostró tendencia a ser mayor para el grupo con lesiones suboclusivas (9,2% vs. 3,2%, p = 0,08). Conclusiones: La revascularización con stent de lesiones carotídeas suboclusivas presenta una alta tasa de éxito de procedimiento; sin embargo, su mayor carga de placa ocasiona un superior porcentaje de lesiones isquémicas cerebrales, y de eventos neurovasculares en el primer mes (AU)

Introduction and objectives: The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. Methods: We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151). Results: No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08). Conclusions: Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure (AU)

Chromosomal data of two pholcids (Araneae, Haplogynae) A new diploid number and the first cytogenetical record for the New World clade

Mesabolivar luteus (Keyserling 1891) and Micropholcus fauroti (Simon 1887) specimens were collected in Ubatuba and Rio Claro, both in the state of São Paulo, Brazil. Mesabolivar luteus showed 2n (♂) = 15 = 14 + X and 2n (♀) = 16 = 14 + XX in mitotic metaphases and 7II + X in diplotenic cells. During late prophase I, all bivalents presented a ring shape, evidencing two chiasmata per bivalent. In this species, some diplotenic cells appear in pairs, maybe due to specific characteristics of the intercellular bridges. The metaphases II showed n = 7 or n = 8 = 7 + X chromosomes. Micropholcus fauroti evidenced 2n (♂) = 17 = 16 + X in spermatogonial metaphases and 8II+X in diplotenic cells, with only one chiasma per bivalent, contrasting with M. luteus. In both species, all chromosomes were metacentrics. The sexual chromosome X was the largest element and appeared as a univalent during meiosis I. These are the first cytogenetical data for the genera Mesabolivar and Micropholcus. Additionally, M. luteus is the first chromosomally analyzed species of the New World clade and the observed diploid number for M. fauroti had not yet been recorded in Pholcidae.