Comparison of Clopidogrel and Ticagrelor for Dual Antiplatelet Therapy of Patients with Unruptured Cerebral Aneurysms Undergoing Endovascular Treatment.

BACKGROUND: Thromboembolic events are critical complications in neuroendovascular procedures, and dual antiplatelet therapy (DAPT) can reduce them. The effects of using aspirin and clopidogrel in DAPT are well characterized, but use of aspirin and ticagrelor has been less studied. METHODS: This retrospective cohort study, conducted between April 1, 2015, and December 30, 2020, included patients with endovascular treatment with flow-diverting and non-flow-diverting stents for unruptured cerebral aneurysms who received DAPT with aspirin and clopidogrel or with aspirin and ticagrelor. RESULTS: Of 148 patients with unruptured intracranial aneurysms with flow-diverting and non-flow-diverting stents started on DAPT with aspirin (100 mg/day) and clopidogrel (75 mg/day), 24 had a poor response to clopidogrel according to the VerifyNow test and had DAPT changed to aspirin (100 mg/day) and ticagrelor (90 mg every 12 hours). One thrombotic complication (0.81%) and 1 bleeding complication (0.81%) occurred in patients receiving DAPT with clopidogrel and aspirin during the procedure. These complications did not occur (0.00%) in patients receiving DAPT with ticagrelor and aspirin. At the 6-month follow-up, 4 patients (3.15%) in the clopidogrel group presented with thrombotic complications, whereas no patients (0.00%) in the ticagrelor group experienced this complication. At 6-month follow-up, 4 patients (3.23%) in the clopidogrel group presented with hemorrhagic complications, whereas only 1 patient (4.17%) in the ticagrelor group experienced this complication. CONCLUSIONS: Our study showed that DAPT with ticagrelor (90 mg every 12 hours) and aspirin (100 mg/day) is a safe and effective alternative to DAPT with clopidogrel (75 mg/day) and aspirin (100 mg/day) for patients with an inadequate response to clopidogrel.

Síndrome de Mirizzi tipo V: Manejo laparoscópico / Mirizzi syndrome type V: laparoscopic management

Resumen Introducción: El Síndrome de Mirizzi es una complicación infrecuente de la enfermedad litiásica biliar, con una incidencia menor al 1% en países desarrollados, puede desarrollarse en cinco variantes, siendo menos frecuente la variante tipo V. La literatura actual discrepa sobre el manejo de esta condición, afirmando que la cirugía laparoscópica no es segura como procedimiento estándar. Caso Clínico: Se presenta el caso de Síndrome de Mirizzi en un hombre de 80 años, que es remitido al departamento de urgencias por sospecha de sepsis de origen abdominal, con estudio ecográfico de colelitiasis, neumobilia y dilatación de las vías biliares. Se realizó Colangiopancreatografía retrógrada endoscópica con imposibilidad técnica para la movilización y extracción de los cálculos por gran tamaño, recurriéndose a exploración a través de técnica laparoscópica, obteniéndose resultados satisfactorios. Conclusión: Para tratar el Síndrome de Mirizzi, es necesario considerar las características del paciente y la experiencia del cirujano ya que ambos factores influyen directamente en la modalidad del tratamiento, sus complicaciones y tasas de éxito. En el presente caso, la experiencia del autor principal en el manejo de procedimientos mínimamente invasivos y la consideración de reducir el riesgo de complicaciones como infecciones en un paciente frágil, fueron los factores que influyeron para la decisión de intervención laparoscópica.

Abstract Introduction: Mirizzi's syndrome is an infrequent complication of biliary lithiasic disease, with an incidence of less than 1% in developed countries, being even less frequent the type V variant. Current literature disagrees on the management of this condition, stating that laparoscopic surgery is not safe as a standard procedure. Clinical Case: We present the case of Mirizzi's Syndrome in an 80-year-old man, which is referred to the emergency department for suspicion of sepsis of abdominal origin, with ultrasound study of cholelithiasis, pneumoobilia and dilation of the bile ducts. Retrograde endoscopic cholangiopancreatography was performed with technical impossibility for the mobilization and extraction of large-size stones, resorting to exploration through laparoscopic technique, obtaining satisfactory results. Conclusion: It is necessary to emphasize that the type of Mirizzi syndrome, the patient's characteristics and the surgeon's experience directly influence the treatment modality, its complications and/or success rates. In the present case, the experience of the main author in the management of minimally invasive procedures and the consideration of reducing the risk of complications such as infections in a fragile patient, were the factors that influenced the decision for laparoscopic intervention.

Incidencia de endofugas en pacientes con aneurismas de aorta abdominal infrarrenal intervenidos con técnica endovascular / Incidence of endoleaks in patients with infrarenal abdominal aortic aneurysms treated on with the endovascular technique

Introducción: Las endofugas son la complicación más frecuente de los tratamientos endovasculares de aneurismas de aorta abdominal y torácica. El objetivo de este estudio es describir la frecuencia de endofugas en pacientes con aneurismas de aorta infrarrenal tratados con técnicas endovasculares. Metodología: Estudio de cohorte retrospectivo en el que se incluyeron pacientes con aneurismas infrarrenales tratados con terapia endovascular en dos instituciones de alta complejidad entre el 1 de septiembre de 2013 y el 1 de marzo de 2021. Se incluyeron datos demográficos, antecedentes, características morfológicas del cuello y saco del aneurisma, tipo de prótesis utilizada, presencia y tipo de endofuga. Se realizó un análisis descriptivo univariado. Los intervalos de confianza se describieron con un 95%. Resultados: Se incluyeron 99 pacientes, la media de edad fue 74,37 años, la media de la longitud del cuello fue de 29,47 mm, el 90,24% tuvieron una longitud favorable (>15mm). La media del ángulo fue de 44,57°, el 67,86% tenía un ángulo favorable (<60°). El 28,28% de los pacientes presentaron endofugas, la frecuencia de las endofugas tipo Ia fue de 7,07%, las de tipo Ib 8,08%, las de tipo II 18,37%, las de tipo IIIa y IIIb 1,01%. No se presentaron endofugas tipo IV ni V. Conclusiones: La frecuencia de presentación de endofugas fue del 28,28%; la endofuga más frecuente es la de tipo II 18,37%, ligeramente inferior a lo descrito en la literatura.

Introduction: Endoleaks are the most common complication of endovascular treatment of abdominal and thoracic aortic aneurysms.. The objective of this study is to describe the frequency of endoleaks in patients with infrarenal aortic aneurysms treated with endovascular techniques. Methodology: Retrospective cohort study that included patients from September 1, 2013, to March 1, 2021, with infrarenal aneurysms treated with endovascular therapy at the FOSCAL and FOSCAL international clinics. Demographic data, history, morphological characteristics of the aneurysm neck and sac, type of prosthesis used, presence, and type of endoleak were included. A univariate descriptive analysis was performed. Confidence intervals were reported at 95%. Results: 99 patients were included, the mean age was 74.37 years, the mean neck length was 29.47 mm, 90.24% had a favorable length (>15 mm); The mean angle was 44.57, 67.86% had a favorable angle (<60º). 28.28% of the patients presented endoleaks, the frequency of type Ia endoleaks was 7.07%, type Ib endoleaks 8.08%, type II 18.37%, type IIIa, and IIIb endoleaks 1, 01%. There were no type IV or type V endoleaks. Conclusions: The frequency of presentation of endoleaks was 28.28%; the most frequent endoleak is type II 18.37%. slightly lower than that reported in the literature