ABSTRACT
We present an interesting complication of late stent thrombosis after percutaneous treatment of aortic coartaction and a new modality of treatment with radiofrequency perforation and implantation of additional stent to resolve this problem.
Subject(s)
Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Aortic Coarctation/therapy , Catheter Ablation , Stents , Thrombosis/surgery , Adult , Aortic Coarctation/diagnostic imaging , Aortic Coarctation/physiopathology , Aortography/methods , Female , Hemodynamics , Humans , Thrombosis/etiology , Thrombosis/physiopathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The aortic aneurysm is part of the acute aortic syndromes (AAS). Aortic aneurysms have a weakened tunica media. Acute aneurysm expansion may herald rupture with high morbility and mortality. Five percent of AAS are diagnosed as pentetrating atherosclerotic ulcer which is an ulceration of an atherosclerotic lesion of the aorta that penetrates the internal elastic lamina and allows hematoma formation within the tunica media of the aortic wall. Endovascular treatment is an alternative to surgery and has provided an adequate rate of successful repair. There is another type of treatment which combines surgery and endovascular repair (the hybrid open-endovascular repair) which provides adequate results. The afford mention case is about a patient with a penetrating atherosclerotic ulcer. The hematoma that results from this ulcer extends and self-contains the aneurysm, with a high risk of rupture. We will also describe the aneurysm treatment options.
Subject(s)
Aorta, Thoracic , Aortic Aneurysm, Thoracic/etiology , Aortic Aneurysm, Thoracic/surgery , Aortic Diseases/complications , Aortic Diseases/surgery , Atherosclerosis/complications , Atherosclerosis/surgery , Ulcer/complications , Ulcer/surgery , Humans , Male , Middle Aged , Vascular Surgical Procedures/methodsABSTRACT
The aortic aneurysm is part of the acute aortic syndromes (AAS). Aortic aneurysms have a weakened tunica media. Acute aneurysm expansion may herald rupture with high morbility and mortality. Five percent of AAS are diagnosed as pentetrating atherosclerotic ulcer which is an ulceration of an atherosclerotic lesion of the aorta that penetrates the internal elastic lamina and allows hematoma formation within the tunica media of the aortic wall. Endovascular treatment is an alternative to surgery and has provided an adequate rate of successful repair. There is another type of treatment which combines surgery and endovascular repair (the hybrid open-endovascular repair) which provides adequate results. The afford mention case is about a patient with a penetrating atherosclerotic ulcer. The hematoma that results from this ulcer extends and self-contains the aneurysm, with a high risk of rupture. We will also describe the aneurysm treatment options.
Subject(s)
Humans , Male , Middle Aged , Aorta, Thoracic , Aortic Aneurysm, Thoracic , Aortic Aneurysm, Thoracic , Aortic Diseases , Aortic Diseases , Atherosclerosis , Atherosclerosis , Ulcer , Ulcer , Vascular Surgical Procedures/methodsABSTRACT
The cardiomyopathies are defined as a primary disease of the myocardium and occur in children as well as in adults. Restrictive cardiomyopathy is the least common type of cardiomyopathy and is characterized by the restriction of ventricular filling. This condition can affect one or both ventricles. The appropriate diagnostic tool includes a detailed clinical record supported by imaging and hemodynamic studies. The purpose of this study was to evaluate adult patients with suspicion of restrictive miocardiopathy of the right ventricle, from the out-patients clinic using echocardiogram, magnetic resonance imaging, and hemodynamic studies and to establish a differential diagnosis with other cardiovascular diseases. Between May 2003 to January 2006 three patients with different initial diagnoses, such as Ebstein's anomaly, interatrial septal defect, and tumor of the right ventricle were studied. However, once the protocol of the study was completed, the final diagnosis was of right ventricular restrictive cardiomyopathy by endomyocardial fibrosis.
Subject(s)
Cardiomyopathy, Restrictive/diagnosis , Adult , Diagnosis, Differential , Female , Heart Diseases/diagnosis , HumansABSTRACT
The cardiomyopathies are defined as a primary disease of the myocardium and occur in children as well as in adults. Restrictive cardiomyopathy is the least common type of cardiomyopathy and is characterized by the restriction of ventricular filling. This condition can affect one or both ventricles. The appropriate diagnostic tool includes a detailed clinical record supported by imaging and hemodynamic studies. The purpose of this study was to evaluate adult patients with suspicion of restrictive miocardiopathy of the right ventricle, from the out-patients clinic using echocardiogram, magnetic resonance imaging, and hemodynamic studies and to establish a differential diagnosis with other cardiovascular diseases. Between May 2003 to January 2006 three patients with different initial diagnoses, such as Ebstein's anomaly, interatrial septal defect, and tumor of the right ventricle were studied. However, once the protocol of the study was completed, the final diagnosis was of right ventricular restrictive cardiomyopathy by endomyocardial fibrosis.
Subject(s)
Adult , Female , Humans , Cardiomyopathy, Restrictive , Diagnosis, Differential , Heart DiseasesABSTRACT
BACKGROUND AND OBJECTIVE: Although patients with ischemic attacks (TIA) experience cardiovascular events frequently within the first 90 days after symptoms onset, strong clinical predictors of early recurrence are lacking. We investigate the value of combined carotid/transcranial ultrasound testing (UST) on the prognosis of TIA patients. PATIENTS AND METHOD: UST was performed < 24 h after symptoms onset among 311 consecutive TIA patients. Stroke recurrence, myocardial infarction, or any vascular event was recorded at 7 and 90 days of follow-up. RESULTS: A total of 20 patients suffered an stroke within 7 days of symptoms onset. During the next 90 days after index TIA, 58 (18.6%) patients experienced an endpoint: 51 cerebral ischemic events, one peripheral arterial disease, 5 myocardial infarctions and one cerebellum hemorrhage. Cox proportional hazards multivariate analyses identified the presence of intracranial stenoses (HR = 3.05; 95% CI, 1.21-7.70; p = 0.018) and carotid territory implication (HR = 15.91; 95% CI, 2.11-120.04; p = 0.007) as independent predictors of stroke within the first 7 days after index TIA. Moreover, at 90 days of follow-up, large-artery occlusive disease was an independent predictor of stroke (HR = 3.07; 95% CI, 1.76-5.38; p < 0.001). CONCLUSIONS: TIA patients with moderate to severe intracranial or extracranial stenoses have a higher risk of stroke recurrence. The routine use of UST within the first 24 h after index TIA can be useful for identifying those patients at high risk in order to plan aggressive prevention therapies.
Subject(s)
Brain/blood supply , Carotid Arteries/diagnostic imaging , Early Diagnosis , Emergency Medical Services , Ischemic Attack, Transient/diagnostic imaging , Ultrasonography, Doppler, Transcranial/methods , Cerebellum/pathology , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/pathology , Electrocardiography , Follow-Up Studies , Humans , Hypertension/epidemiology , Ischemic Attack, Transient/epidemiology , Myocardial Infarction/epidemiology , Peripheral Vascular Diseases/epidemiology , Prognosis , Prospective StudiesABSTRACT
Fundamento y objetivo: Los pacientes con un accidente vascular cerebral isquémico transitorio (AIT) y estenosis tanto intracraneal como extracraneal de grado moderado a importante tienen mayor riesgo de recurrencia de ictus. Investigamos el valor de realizar un estudio ultrasonográfico (EUS) transcraneal/carotídeo precoz en el pronóstico de estos pacientes. Pacientes y método: Estudiamos de forma prospectiva a 311 pacientes con AIT atendidos en el servicio de urgencias a los que se realizó un EUS transcraneal/carotídeo dentro de las primeras 24 h. Resultados: Durante los primeros 90 días, 58 pacientes tuvieron un episodio vascular (isquemia cerebral, 51; isquemia coronaria, 5; hemorragia cerebelosa, 1, y arteriopatía periférica, 1); 20 pacientes presentaron un infarto cerebral durante la primera semana. El análisis multivariable (regresiones de Cox) identificó como predictores independientes de infarto cerebral, a los 7 días, los episodios de territorio carotídeo (razón de riesgos [RR] = 15,91; intervalo de confianza [IC] del 95%, 2,11-120,04; p = 0,007) y la presencia de estenosis intracraneal (EIC) (RR = 3,05; IC del 95%, 1,21-7,70; p = 0,018), mientras que la etiología aterotrombótica se identificó como predictor independiente para ictus isquémico a los 90 días (RR = 3,07; IC del 95%, 1,76-5,38; p < 0,001). Conclusiones: Los pacientes con AIT y estenosis intracraneal o extracraneal de grado moderado a importante tienen mayor riesgo de recurrencia de ictus. El EUS es útil para identificar a los pacientes de mayor riesgo e instaurar sin demora el tratamiento más adecuado
Background and objective: Although patients with ischemic attacks (TIA) experience cardiovascular events frequently within the first 90 days after symptoms onset, strong clinical predictors of early recurrence are lacking. We investigate the value of combined carotid/transcranial ultrasound testing (UST) on the prognosis of TIA patients. Patients and method: UST was performed < 24 h after symptoms onset among 311 consecutive TIA patients. Stroke recurrence, myocardial infarction, or any vascular event was recorded at 7 and 90 days of follow-up. Results: A total of 20 patients suffered an stroke within 7 days of symptoms onset. During the next 90 days after index TIA, 58 (18.6%) patients experienced an endpoint: 51 cerebral ischemic events, one peripheral arterial disease, 5 myocardial infarctions and one cerebellum hemorrhage. Cox proportional hazards multivariate analyses identified the presence of intracranial stenoses (HR = 3.05; 95% CI, 1.21-7.70; p = 0.018) and carotid territory implication (HR = 15.91; 95% CI, 2.11-120.04; p = 0.007) as independent predictors of stroke within the first 7 days after index TIA. Moreover, at 90 days of follow-up, large-artery occlusive disease was an independent predictor of stroke (HR = 3.07; 95% CI, 1.76-5.38; p < 0.001). Conclusions: TIA patients with moderate to severe intracranial or extracranial stenoses have a higher risk of stroke recurrence. The routine use of UST within the first 24 h after index TIA can be useful for identifying those patients at high risk in order to plan aggressive prevention therapies
Subject(s)
Male , Female , Humans , Stroke , Ultrasonography, Doppler , Ischemic Attack, Transient , Prognosis , Prospective Studies , Cerebral Infarction/prevention & control , Risk Factors , Early DiagnosisABSTRACT
Angiotensin converting enzyme (ACE) influences vessels tone and the coagulation/fibrinolysis system. The ACE gene I/D polymorphism has been linked with PAI-1 and fibrinogen levels and with Factors VII and X activities. Therefore, we aimed to test whether I/D polymorphism could be related to thrombolysis safety and efficacy. We studied strokes involving the middle cerebral artery (MCA) territory of patients who received t-PA <3 h of stroke onset. Blood samples were obtained before t-PA administration to measure fibrinogen, PAI-1, Factors VII and X. I/D polymorphism was determined by polymerase chain reaction and agarose electrophoresis. Recanalization rates were serially evaluated by Transcranial Doppler. Among 96 included patients the genotype frequency was: DD=33.3%, ID=57.3% and II=9.4%. A strong association was found between DD homozygous and successful recanalization rates (DD=69.2%, ID+II=31.6%, p=0.002 at 1 h; DD=91.3%, ID+II=51%, p=0.001 at 6 h; DD=100%, ID+II=72.3%, p=0.003 at 24 h post-t-PA administration). In fact, DD genotype was an independent predictor of recanalization (OR=4.3 95% CI 1.35-13.49, p=0.013). No relation was found between I/D polymorphism and symptomatic hemorrhagic complications (p=0.237). No association between ACE genotypes and Factor VII or Factor X activities, neither with fibrinogen or PAI-1 levels was observed. DD homozygous is strongly associated with MCA recanalization following t-PA treatment. Mechanisms of benefit remain unknown since I/D polymorphism had similar FVII and X activities and PAI-1 and fibrinogen levels in our stroke population.