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1.
Curr Cardiol Rep ; 23(11): 161, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34599416

RESUMO

PURPOSE OF REVIEW: Carotid artery stenosis is a major risk factor for ischemic stroke. Although effective treatment options exist, careful assessment of benefits and risks for individual patients is needed in clinical decision-making. This article reviews contemporary treatments for carotid artery stenosis, the underlying evidence, and areas of uncertainties. RECENT FINDINGS: Specific recommendations are available to guide the standard of care of carotid artery stenosis. Nonetheless, significant uncertainties are noted in patient selection for surgical treatment of asymptomatic carotid stenosis and in optimal treatment targets for pharmacological therapies. Advanced imaging has been used to predict future risk of ipsilateral stroke and clarify mechanisms of actions of pharmacological therapies, primarily in observational studies. Pharmacological and surgical treatments for extracranial carotid artery stenosis continue to evolve with many relevant clinical trials completed and clinical guidelines updated in recent years. Future clinical trials to tackle the areas of uncertainties are warranted.


Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Angioplastia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/complicações , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
2.
Medicina (Kaunas) ; 57(9)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34577867

RESUMO

We report the case of a 65-year-old man with acute GFR decline to 37 mL/min and uncontrolled high blood pressure. He was suspected for renovascular hypertension and underwent a renal color Doppler ultrasound scan that detected a bilateral atherosclerotic renal artery stenosis. A digital selective angiography by percutaneous transluminal angioplasty and stenting (PTRAs) was successfully performed. Blood pressure rapidly normalized, GFR increased within a few days, and proteinuria disappeared thereafter. These clinical goals were accompanied by a significant increase of circulating renal stem cells (RSC) and a slight increase of resistive index (RI) in both kidneys. This single observation suggests the need for extensive studies aimed at evaluating the predictive power of RI and RSC in detecting post-ischemic renal repair mechanisms.


Assuntos
Hipertensão Renovascular , Obstrução da Artéria Renal , Idoso , Angioplastia , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/terapia , Rim/diagnóstico por imagem , Rim/cirurgia , Masculino , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/cirurgia , Células-Tronco , Stents
3.
Catheter Cardiovasc Interv ; 98(3): 570-571, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34498395

RESUMO

Among patients with lower extremities arterial disease (LEAD), treatment of below the arteries has been historically limited to the treatment of chronic limb-threatening ischemia (CLTI), as recommended by available guidelines. In this study, the authors provided new data on the role of different endovascular revascularization anatomical strategies of the below the knee (BTK) arteries adopted in claudicant LEAD patients. The revascularization of the anterior tibial artery seems more effective for symptoms relieves than of the posterior territories and most of the adverse events occurred in the follow up period were target vessel revascularization, suggesting that revascularization of single vessel is enough to achieve clinical success.


Assuntos
Angioplastia , Salvamento de Membro , Humanos , Isquemia/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Isr Med Assoc J ; 23(9): 590-594, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472237

RESUMO

BACKGROUND: Among dialysis patients, occlusive mesenteric vascular disease has rarely been reported. OBJECTIVES: To report on the experience of one center with regard to diagnosing and treating this complication. METHODS: The retrospective case-series involved six patients (3 females, 3 males; age 52-88 years; 5/6 were smokers) on chronic hemodialysis at a single center. All patients with symptoms suggestive of occlusive mesenteric disease and a subsequent angiographic intervention were included. Demographic, clinical, and laboratory data were collected from patient charts for the period before and after angioplasty and stenting of the mesenteric vessels. A Wilcoxon signed-rank test was used to compare the relevant data before and after the intervention. RESULTS: All participants had variable co-morbidities and postprandial abdominal pain, food aversion, and weight loss. CT angiography was limited due to heavy vascular calcifications. All underwent angioplasty with stenting of the superior mesenteric artery (4 patients) or the celiac artery (2 patients). All procedures were successful in resolving abdominal pain, malnutrition, and inflammation. Weight loss before was 15 ± 2 kg and weight gain after was 6 ± 2 kg. C-reactive protein decreased from 13.4 ± 5.2 mg/dl to 2.2 ± 0.4 mg/dl (P < 0.05). Serum albumin increased from 3.0 ± 0.2 g/dl to 3.9 ± 0.1 g/dl (P < 0.05). Two patients underwent a repeat procedure (4 years, 5 months, respectively). Follow-up ranged from 0.5-7 years. CONCLUSIONS: Occlusive mesenteric ischemia occurs among dialysis patients. The diagnosis requires a high degree of suspicion, and it is manageable by angiography and stenting of the most involved mesenteric artery.


Assuntos
Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Diálise Renal/efeitos adversos , Stents , Dor Abdominal/etiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Artéria Celíaca/fisiopatologia , Artéria Celíaca/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Artérias Mesentéricas/fisiopatologia , Artérias Mesentéricas/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
J Neurol Sci ; 428: 117588, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34403954

RESUMO

Background The optimal approach to treat the cervical carotid artery lesion during endovascular thrombectomy (EVT) for acute strokes with tandem occlusions is unclear. While carotid artery stenting (CAS) might be a more definitive recanalization method, the potential risk of intracranial hemorrhage (ICH) limits its routine usage. In this study, we aimed to evaluate the safety outcomes of CAS and carotid artery angioplasty (CAA) in patients with acute tandem occlusions. Methods In this retrospective cohort study, data were obtained from the Nationwide Readmissions Database 2016-2017. The primary safety outcome was a composite of ICH and all-cause in-hospital mortality. Logistic regression analysis was used to compare the in-hospital outcomes. Survival analysis was used to estimate the 30-day readmissions. Results We identified 2042 hospitalizations meeting the study inclusion criteria (median age: 66 years, female 31.3%). Of these, 1391 (68.1%) had undergone CAS and 651 (31.9%) CAA alone. Baseline characteristics between the two groups were similar, except patients with CAS were more likely to be on anti-thrombotic medications and were less likely to have received intravenous thrombolysis. There was no significant difference in the clinical outcomes including ICH, in-hospital mortality, gastrostomy tube placement, prolonged mechanical ventilation, length of stay, hospital charges, and 30-day readmissions between the two groups, however, patients with CAS were more likely to be discharged home after adjusting for the confounding variables [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05-2.12, P 0.025]. Conclusion The emergent CAS-EVT approach appears to be safe with no adverse outcomes compared to CAA alone.


Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Angioplastia , Artéria Carótida Primitiva , Estenose das Carótidas/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Fatores de Risco , Stents , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(30): e26780, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397727

RESUMO

BACKGROUND: Until now, target-controlled infusion of remifentanil with midazolam in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for percutaneous transluminal balloon angioplasty under monitored anesthesia care. METHODS: A prospective, randomized controlled trial including patients who received a percutaneous transluminal balloon angioplasty between March 2019 and March 2021 was conducted. Group 1 and Group 2 were, respectively, administered an initial effect-site concentration of remifentanil of 1.0 and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL with intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4, mean arterial pressure and heart rate at baseline levels ±â€Š30%, and patient comfort (remaining moveless). The primary outcome was to determine the appropriate effect-site concentration of remifentanil for the procedure in terms of patient comfort (remaining moveless), hemodynamic conditions, and adverse events. Secondary endpoints included the total dosage of anesthetics and total times of target-controlled infusion pump adjustments. RESULTS: A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between 2 groups, except Group 1 having higher peripheral oxygen saturation, while local anesthetic injection compared with Group 2. In addition, Group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 6, P = .034), less remifentanil consumption (189.65 ±â€Š69.7 vs 243.8 ±â€Š76.1 µg, P = .001), but more intraoperative movements affecting the procedure (14 vs 4; P = .016), total times of target-controlled infusion pump adjustment [2 (1-4) vs 1 (1-2), P < .001] compared with Group 2. CONCLUSION: In percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided appropriate hemodynamic conditions, sufficient sedation and analgesia, and acceptable apnea with desaturation.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Angioplastia , Midazolam/administração & dosagem , Remifentanil/administração & dosagem , Idoso , Anestesia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Medicine (Baltimore) ; 100(32): e26935, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397942

RESUMO

ABSTRACT: Transplant renal artery stenosis (TRAS) is the most common (1%-23%) vascular complication following kidney transplantation. The aim of this study was to review our experience with an endovascular approach to treat TRAS.We retrospectively reviewed kidney transplant recipients who underwent percutaneous transluminal angioplasty (PTA) due to TRAS in our institute from January 2009 to December 2015. We analyzed the patient's baseline characteristics, postoperative renal function, blood pressure evolution, and the number of pre- and post-procedure antihypertensive drugs.A total of 21 patients (15 men, 6 women) were treated with the endovascular technique. The predominant presentation was graft dysfunction (76.2%). Stenosis or hemodynamic kinking was located at the anastomosis in 7 (33.3%) patients, proximal to the anastomosis in 13 (61.9%) patients, and distal the anastomosis in 1 (4.8%) patient. PTA without stent placement was performed in 7 patients (33.3%), and PTA with stent placement was performed in 14 patients (67.7%). Serum creatinine levels demonstrated no difference between the pre-procedure level and that on discharge day (1.61 mg/dl [0.47-3.29 mg/dl] vs 1.46 mg/dl [0.47-3.08 mg/dl]; P = .33). The glomerular filtration rate also showed no difference between the pre-procedure value and that on discharge day (53.6 ml/min [22.4-145.7 ml/min] vs 57.0 ml/min [17.56 -145 ml/min]; P = .084). Systolic blood pressure and diastolic blood pressure (DBP) varied from 137 mm Hg (120-160 mm Hg) and 84 mm Hg (70-100 mm Hg) pre-procedure to 129 mm Hg (90-150 mm Hg) and 79 mm Hg (60-90 mm Hg) at discharge, respectively (P = .124 and P = .07). The number of antihypertensive medications significantly decreased from 1.5 (0-6) pre-procedure to 0.5 (0-2) at discharge (P = .023). In our study, there were no technical failures, procedure-related complications or deaths. During the follow-up period, the free-from-reintervention rate was 100%, and graft failures occurred in 2 patients (9.5%) due to rejection.Endovascular procedures for TRAS show a high technical success rate with a low complication rate and a low reintervention rate. PTA showed a trend toward a positive impact on lowering serum creatinine, systolic blood pressure, and diastolic blood pressure and improving estimated glomerular filtration rate, and the number of antihypertensive medications could be significantly reduced after this procedure.


Assuntos
Angioplastia/métodos , Procedimentos Endovasculares/métodos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Obstrução da Artéria Renal/cirurgia , Stents , Grau de Desobstrução Vascular/fisiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Fatores de Tempo , Transplantados , Resultado do Tratamento
8.
Rev Med Liege ; 76(7-8): 592-594, 2021 Jul.
Artigo em Francês | MEDLINE | ID: mdl-34357709

RESUMO

Pulmonary artery stenting is usually performed in congenital heart diseases and in cases of extrinsic compression due to a mediastinal tumor or fibrosis. We report one clinical case of a 61-year-old man treated by radiation and chemotherapy for T3N1M0 non-small cell lung carcinoma. He complained of disabling dyspnea. Pulmonary scintigraphy showed an absence of perfusion in the left lung. Chest computed tomography revealed a severe stenosis of the left pulmonary artery due to tumoral extrinsic compression. Under general anesthesia, we performed percutaneous angioplasty with self expandable nitinol stent. There was no peroperative complication. Dyspnea decreased immediately despite the natural course of the disease was not altered. Percutaneous stenting of pulmonary artery is safe and a feasible option for tumoral extrinsic compression. It is a palliative treatment but it can improve patient's quality of life.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Pulmonares , Angioplastia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Qualidade de Vida , Stents
9.
BMJ Case Rep ; 14(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389585

RESUMO

A 34-year-old patient with a short history of severe hypertension was admitted to our hospital. Considering the young age and the severity of hypertension, we investigated the most common causes of secondary hypertension. Exposure to a single dose of an ACE inhibitor resulted in a rapid decline of the renal function. Further MRIrevealed a tight stenosis of both renal arteries closely to the ostium. In young patients, the most common cause of bilateral renal artery stenosis might be expected to be fibromuscular dysplasia. After recovery of renal function, invasive angiography, however, confirmed severe atherosclerotic lesion of both renal arteries. Therefore, angioplasty of both renal arteries was performed as a staged procedure. Hence, renal function showed rapid improvement and the patient had to be treated with a combination of a low-dose calcium antagonist and valsartan and especially a high-intensity statin.


Assuntos
Displasia Fibromuscular , Hipertensão Renovascular , Hipertensão , Obstrução da Artéria Renal , Adulto , Angioplastia , Displasia Fibromuscular/complicações , Displasia Fibromuscular/diagnóstico por imagem , Humanos , Hipertensão/etiologia , Hipertensão Renovascular/etiologia , Masculino , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico por imagem
10.
J Invasive Cardiol ; 33(7): E516-E521, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34224380

RESUMO

The use of large-bore sheaths has risen exponentially in the last decade partly due to the growth of structural heart interventions and various mechanical circulatory support options. Meanwhile, the interventional community has gradually shifted from an open surgical to endovascular closure. However, vascular access complications and bleeding still remain a significant risk. Various techniques involving an additional access site have been described to allow for endovascular bailout of potential complications. However, these by themselves create an additional burden to procedural morbidity. Furthermore, the weight of additional procedural time, contrast, radiation and the need for advanced peripheral endovascular skills constitute considerable downsides to the "second arterial access" strategy. For that reason, we propose an alternative strategy, the "single-access dry-closure" technique, which provides vascular access control without the additional burden and risk of a second arterial access. This involves the use of low-pressure iliac artery occlusive angioplasty, delivered through the ipsilateral sheath during the endovascular closure. We hereby describe the steps, advantages and disadvantages of this novel technique. We also include the description of multiple technical variations depending on the use of one or two preclosed Proglide devices. This novel approach seems to be a safe, effective, simple, fast and economical technique that has the potential to decrease procedural morbidity by avoiding an additional arterial access. It also lowers contrast volume and radiation exposure while improving the overall set-up and operator ergonomics.


Assuntos
Cateterismo Periférico , Dispositivos de Oclusão Vascular , Angioplastia , Cateterismo Periférico/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Hemorragia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
J Invasive Cardiol ; 33(7): E581-E583, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34224390

RESUMO

IVC stenosis is a rare complication of bicaval orthotopic heart transplant. IVC stenosis can occur at either the cavo-atrial anastomosis, or the caval cannulation site, with presentations ranging from acute shock early post transplant to a more indolent course. Causes include extensive hemostatic suturing, fibrous contraction, and donor-recipient size mismatch. Treatment strategies include percutaneous balloon angioplasty, stenting, and surgical revision. Evaluating for IVC stenosis is recommended for unexplained lower-extremity edema, new-onset ascites, or liver abnormalities after bicaval heart transplant.


Assuntos
Ascite , Transplante de Coração , Anastomose Cirúrgica , Angioplastia , Ascite/diagnóstico , Ascite/etiologia , Edema/diagnóstico , Edema/etiologia , Transplante de Coração/efeitos adversos , Humanos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
12.
Physiother Res Int ; 26(4): e1919, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34231290

RESUMO

PURPOSE: The purpose of this trial was to compare the effectiveness of standardized outpatient cardiac rehabilitation combined with treadmill power walking versus standardized outpatient cardiac rehabilitation alone on health-related quality of life (HQoL), functional exercise capacity (FEC), left ventricular ejection fraction (LVEF) and metabolic equivalent of tasks (METs) in patients who went post coronary angioplasty (CA). Further this study evaluated the association between average numbers of steps taken with above clinical outcomes. METHODS: In a pragmatic sequential randomized clinical trial, 24 patients were randomized into two groups (n = 12) and participated in a standardized outpatient cardiac rehabilitation program (SOCRP) with treadmill power walking as an intervention group and SOCRP alone in control group. Scores obtained before and after 4 weeks of intervention, that is, after 12 treatment sessions were assessed using a HQoL questionnaire and 6-min walk test (6 MWT). Average number of steps taken throughout the 4 weeks, METs and LVEF values were obtained by pedometer, exercise stress testing and echocardiogram respectively. RESULTS: Significant improvements were found in intergroup and intragroup comparison after 4 weeks of cardiac rehabilitation (p < 0.05). Scores of 6 MWT and LVEF significantly improved in the intervention group (p < 0.003) compared to the control group (p < 0.032). HQoL components that is, global and physical, MET values and average number of steps were significantly higher in the intervention group compared to the control group (p < 0.001). CONCLUSION: SOCRP with power walking was more effective in improving HQoL, FEC, LVEF, METs and average numbers of steps than SOCRP alone although both interventions were significant after 4 weeks in patients underwent CA and completed cardiac rehabilitation program. Positive significant associations were found between the average number of steps taken with scores of METs and scores of global and physical domains of HQoL.


Assuntos
Reabilitação Cardíaca , Angioplastia , Terapia por Exercício , Humanos , Pacientes Ambulatoriais , Qualidade de Vida , Volume Sistólico , Função Ventricular Esquerda , Caminhada
13.
BMC Cardiovasc Disord ; 21(1): 323, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193057

RESUMO

BACKGROUND: Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. METHODS: In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. RESULTS: We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). CONCLUSIONS: COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.


Assuntos
Angioplastia/instrumentação , Artéria Femoral/fisiopatologia , Hemodinâmica , Doença Arterial Periférica/terapia , Stents Metálicos Autoexpansíveis , Ligas , Angioplastia/efeitos adversos , Animais , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/patologia , Humanos , Modelos Animais , Neointima , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/patologia , Doença Arterial Periférica/fisiopatologia , Desenho de Prótese , Falha de Prótese , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Estresse Mecânico , Sus scrofa , Fatores de Tempo , Resultado do Tratamento
14.
J Clin Hypertens (Greenwich) ; 23(8): 1631-1633, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34216535

RESUMO

The authors present a case of a patient who experienced a rare complication after attempted renal angioplasty and stenting, Page kidney. This patient presented with new onset hypertension secondary to bilateral renal artery stenosis and was referred for revascularization given hypertension refractory to medical management. The right renal artery underwent successful angioplasty and stenting; however, the left renal artery experienced recoil stenosis. Post-procedure the patient developed acute kidney injury secondary to Page kidney from subcapsular and extracapsular hematoma. This was managed conservatively with transfusions and the hematoma and acute kidney injury self-resolved over the next 4 months. This case highlights the importance of revascularization for refractory hypertension secondary to hemodynamically significant bilateral renal artery stenosis, the rare complication of Page kidney with attempted revascularization of renal artery stenosis and the involvement of a hypertension specialist in the decision of revascularization of renal artery stenosis.


Assuntos
Injúria Renal Aguda , Angioplastia com Balão , Hipertensão , Obstrução da Artéria Renal , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Angioplastia/efeitos adversos , Angioplastia com Balão/efeitos adversos , Humanos , Hipertensão/etiologia , Rim , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Stents/efeitos adversos
15.
Br J Radiol ; 94(1125): 20210215, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34233490

RESUMO

OBJECTIVES: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. METHODS: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. RESULTS: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10-5 mm2/s to 331.51 ± 31 10-5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10-5 mm2/s vs 332.47 ± 22.95 10-5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64-0.93). CONCLUSIONS: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. ADVANCES IN KNOWLEDGE: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.


Assuntos
Angioplastia/métodos , Pé/irrigação sanguínea , Isquemia/diagnóstico por imagem , Isquemia/terapia , Imageamento por Ressonância Magnética/métodos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Adulto , Idoso , Índice Tornozelo-Braço/métodos , Estudos de Viabilidade , Feminino , Pé/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
16.
Ther Umsch ; 78(6): 277-289, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291662

RESUMO

Atherosclerosis of the intracranial arteries and of the extracranial carotid artery. Abstract. Intracranial atherosclerotic stenoses are the most common cause of ischemic stroke worldwide. Nowadays, three therapeutic approaches are available for consideration for patients with intracranial atherosclerotic stenoses: A conservative therapy (best medical treatment, management of vascular risk factors and healthy lifestyle), endovascular and surgical therapy. Conservative approach has been recommended for patients with asymptomatic intracranial atherosclerotic stenoses, as well as for those with symptomatic stenoses. Endovascular therapy should be considered as a treatment option for carefully selected patients with recurrent ischemic strokes attributed to the stenotic artery while receiving best medical therapy. Surgical revascularisation is rarely favored in patients with intracranial stenoses. In patients with extracranial atherosclerotic stenoses, carotid endarterectomy (CEA) has been associated with a lower risk of death and recurrent stroke when compared to carotid angioplasty and stenting (CAS). Especially in elderly patients over 70 years of age CEA is preferred over CAS due to the twofold increased 30-day risk of recurrent stroke or death in patients treated with CAS. Results from contemporary studies using modern techniques and devices are expected. It remains unclear whether patients with asymptomatic extracranial atherosclerotic stenoses receiving best medical treatment would benefit of invasive procedures such as CEA or CAS.


Assuntos
Aterosclerose , Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Aterosclerose/terapia , Artérias Carótidas , Estenose das Carótidas/terapia , Humanos , Fatores de Risco , Stents , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
18.
Angiol Sosud Khir ; 27(2): 92-98, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166348

RESUMO

AIM: The study was aimed at analysing the in-hospital results of carotid re-endarterectomy and plasty of the zone of reconstruction with a biological patch in patients with haemodynamically significant restenosis and contraindications to carotid angioplasty with stenting. PATIENTS AND METHODS: During the period from 2008 to 2019, we operated on a total of 22 patients presenting with carotid restenosis and found to have contraindications to carotid angioplasty with stenting (an extended lesion, unstable neointima, calcification, pronounced tortuosity). Carotid re-endarterectomy was performed according to the classical technique. The time period after the first intervention to regression of pathology amounted to 48.5±21.3 months. All patients with clinical manifestations of angina pectoris were at the preoperative stage subjected to coronarography, as a result of which in one case a hybrid intervention was performed in the scope of percutaneous coronary intervention and carotid endarterectomy. The endpoints included death, myocardial infarction, acute impairment of cerebral circulation, and lesions of craniocerebral nerves. RESULTS: Carotid re-endarterectomy was most often carried out according to the classical technique with plasty of the zone of reconstruction using a xenopericardial patch. Only in 1 case it was required to perform eversion carotid re-endarterectomy due to tortuosity of the internal carotid artery. During the in-hospital postoperative period no lethal outcomes, myocardial infarctions, nor haemorrhagic complications were registered. One patient was found to develop acute impairment of cerebral circulation. The most frequent complication was unilateral laryngeal paresis caused by lesions of craniocerebral nerves (n=3; 13.6%), with reversible neurological deficit. No cases of either thrombosis/restenosis or elevated pressure gradient in the area of implantation of the xenopericardial patch were revealed. The composite endpoint amounted to 18.2% (n=4). CONCLUSION: The classical carotid re-endarterectomy was not accompanied by cases of thrombosis and restenosis during either the in-hospital or remote period of follow up, however turned out to be associated with a high frequency of the development of complications such as acute impairment of cerebral circulation and lesions of craniocerebral nerves.


Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Angioplastia/efeitos adversos , Artérias Carótidas , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Contraindicações , Endarterectomia das Carótidas/efeitos adversos , Humanos , Resultado do Tratamento
19.
J Clin Neurosci ; 89: 311-318, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119286

RESUMO

BACKGROUND AND PURPOSE: Contrast extravasation is one of the most common perioperative complications in symptomatic intracranial atherosclerotic stenosis (ICAS) patients after percutaneous transluminal angioplasty and/or stenting (PTAS). This study aimed to investigate the correlations between the relevant serum biochemical indicators of carbohydrate metabolism and the occurrence of contrast extravasation. METHODS: Patients' demographic characteristics, vascular risk factors and laboratory examination data were collected. Blood routine test, blood biochemical examination and hormone level test within 1 week before surgery were measured in all enrolled subjects. Patients underwent non-contrast CT scans immediately after the endovascular procedure. Follow-up non-contrast CT scans were performed in the next 24 h and repeated as per clinical condition. RESULTS: 104 patients who have undergone effective PTAS were involved in this study. 18 patients have identified as contrast extravasation and there was no obvious abnormality in another 86 cases. There were significant differences in the pre-operative HbA1c, fasting blood sugar and cortisol levels in the subjects regardless of gender between two groups (p < 0.001, p < 0.001 and p = 0.001, respectively). Furthermore, there were statistical differences in E2 and testosterone levels between two groups in both male population (p = 0.035 and p = 0.028, respectively) and female population (p = 0.036 and p = 0.003, respectively). Besides, the AUC value of HbA1c, fasting blood sugar and cortisol levels were all over 0.7 (0.858, 0.780 and 0.752, respectively). The highest AUC value of various combinations was obtained from the combination of HbA1c and cortisol level, which was 0.898. CONCLUSIONS: Patient with chronic hyperglycemia is closely related to contrast extravasation after PTAS. Specific mechanisms might be explored and regarded as promising candidates to prevent contrast extravasation.


Assuntos
Angioplastia/efeitos adversos , Constrição Patológica/terapia , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Hiperglicemia/epidemiologia , Adulto , Idoso , Biomarcadores/sangue , Metabolismo dos Carboidratos , Feminino , Humanos , Hiperglicemia/sangue , Masculino , Pessoa de Meia-Idade
20.
Oper Neurosurg (Hagerstown) ; 21(3): E242-E243, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34017988

RESUMO

Embolic protection devices (EPDs) have become a standard of care during internal carotid artery revascularization.1,2 This video is about a 57-yr-old-male who presented with a wake-up stroke with a left hemispheric syndrome. Head computed tomography angiography (CTA) revealed tandem occlusions of the proximal left internal carotid artery (ICA) and of the distal left middle cerebral artery (MCA) with an ASPECT (Alberta Stroke Program Early CT Score) score of 6. The patient underwent a cerebral angiogram and was treated with balloon angioplasty with a distal EPD and mechanical thrombectomy. The EPD became occluded with thrombus from the ICA and was retrieved through a 6-Fr Sofia (MicroVention) under continuous aspiration. Successful revascularization of the proximal ICA and distal MCA was achieved. No procedure-related complications occurred, and the patient's neurological exam improved. Tandem occlusions can occur in up to 15% of strokes. The optimal treatment can be controversial, but mechanical thrombectomy and ICA revascularization with a distal EPD appear to be safe and effective in selected patients.3 Consent was obtained for the procedure and for the video production.


Assuntos
Acidente Vascular Cerebral , Trombose , Angioplastia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Humanos , Masculino , Artéria Cerebral Média
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