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2.
Khirurgiia (Mosk) ; (2): 13-20, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105251

RESUMO

OBJECTIVE: To evaluate the results of endoscopy-assisted surgical treatment of patients with 'high' tortuosity of the ICA. MATERIAL AND METHODS: Endoscopy-assisted surgical reconstruction of high tortuosity of the ICA was made in 11 patients. All procedures were carried out at the Sklifosofsky Research Institute for Emergency Medicine (Moscow) and Republican clinical hospital of Kabardino-Balkaria (Nalchik) for the period from 01.01.18 to 31.12.18. RESULTS: There were no intraoperative and postoperative complications (blood flow velocity increased by 66.2% after surgery). Neurological improvement after surgery was noted in all patients. Partial or complete regression of dizziness was observed in 5 (45.5%) patients. Tinnitus disappeared in 7 (63.6%) patients. CONCLUSION: Approach to the distal parts of ICA is traumatic, requires the use of additional techniques and considerable surgical experience. Endoscopic technique is valuable to reduce the risk of injury of soft tissues, neurovascular structures and improve functional outcomes.


Assuntos
Artéria Carótida Primitiva , Artéria Carótida Interna , Artéria Carótida Primitiva/cirurgia , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/cirurgia , Endoscopia , Humanos , Moscou , Complicações Pós-Operatórias
5.
Medicine (Baltimore) ; 99(4): e18998, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977916

RESUMO

The causes for falls in the elderly are varied, and visual spatial neglect could be 1 contributing factor. Further, the presence of a carotid artery plaque, especially on the right side, might influence the visual spatial attention of the elderly.Our aim was to identify the intrinsic association between carotid plaques and lateralization of spatial attention in the elderly. Further, we sought to understand and potentially prevent the consequences of unilateral spatial neglect such as injury from falls.Participants aged 64 to 93 years were divided into a group with carotid artery plaque(s) of the right side or both sides (BOTH, n = 38; and 9/ 38 were right side only) and a group without right-side carotid artery plaque(s) (LEFT, n = 53). Participants were asked to perform a line bisection task and undergo doppler ultrasonography examinations.Contrary to expectations, compared to LEFT, the mean index and net scores of the line bisection errors in BOTH were significantly less leftward, but the mean diameter of the right-side common carotid artery in BOTH was significantly larger.Our results indicate that the presence of carotid plaque(s) might be linked to increased risk of falls in the elderly. The attenuated spatial neglect in participants with right-side carotid artery plaque(s) might be due to compensatory carotid artery dilatation.


Assuntos
Acidentes por Quedas , Estenose das Carótidas/complicações , Transtornos da Percepção/complicações , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Primitiva/patologia , Artéria Carótida Interna/patologia , Estudos de Casos e Controles , Circulação Cerebrovascular/fisiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Fatores de Risco
6.
J Forensic Sci ; 65(1): 274-275, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31469426

RESUMO

A 29-year-old man died at the scene of an altercation from a stab wound to the left side of the neck. At autopsy, careful in situ examination of the common carotid artery did not reveal any evidence of hemorrhage or apparent vascular injury. However, applying pressure to the chest wall and underlying thoracic viscera (lungs and heart) resulted in filling of the collapsed vessel with blood causing hemorrhage from a small incision on the medial aspect of the common carotid artery. Release of pressure and drying of the dissection field enabled the artery to be opened and the small defect to be identified. This technique may be used to temporarily restore blood to a vessel to help identify a small bleeding point that may otherwise be difficult to detect.


Assuntos
Lesões das Artérias Carótidas/patologia , Hemorragia/patologia , Pressão , Tórax , Ferimentos Perfurantes/patologia , Adulto , Autopsia/métodos , Artéria Carótida Primitiva/patologia , Exsanguinação/etiologia , Humanos , Masculino
7.
Angiol Sosud Khir ; 25(4): 124-130, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855209

RESUMO

AIM: The purpose of this study was to investigate the natural course of stenosis of the common carotid artery (CCA) after carotid endarterectomy, as well as the long-term outcomes of various methods of reconstruction of the internal carotid artery (ICA) in patients with extended atherosclerotic lesions. PATIENTS AND METHODS: Presented herein are the remote retrospective and prospective results of carotid endarterectomy in a total of 78 patients with concomitant atherosclerotic lesions of carotid arteries. Depending on the degree of CCA stenosis, the patients were divided into 2 groups. Group One (n=25): stenosis of the internal carotid artery (ICA) of more than 70% and haemodynamically insignificant (30-35% stenosis) but extended (from 3.0 to 5.0 cm (Q1, Me, Q3); 3.5 cm, 4.0 cm, 5.0 cm) stenosis of the CCA. These patients underwent carotid endarterectomy (CEA) from the ostium of the ICA, during which an atherosclerotic plaque was not completely removed from the CCA because the stenosis was extended but haemodynamically insignificant. Group Two (n=53): stenosis of the ICA of more than 70% and haemodynamically significant, extended (from 7.0 to 10.0 cm (Q1, Me, Q3); 7.5 cm, 8.0 cm, 9.0 cm) stenosis of the CCA. The patients of this group were subjected to various methods of operative intervention on the ICA and CCA: carotid endarterectomy (ECA) combined with open endarterectomy from the CCA with plasty using the primary suture (n=23); carotid endarterectomy and alloreconstruction of the CCA (n=10); simultaneous eversion endarterectomy from the ICA and CCA (n=20). The remote period of follow up of patients ranged from 14 to 24 months ((Q1, Me, Q3; 19 months, 22 months, 24 months). The differences were statistically insignificant (Mann-Whitney U-test, p=0.881). RESULTS: In the remote postoperative period, 32% of Group One patients after previously performed carotid endarterectomy were found to have an increase in the degree of stenosis of the CCA up to a haemodynamically significant one (70% and more), thus suggesting progression of the atherosclerotic process. In Group Two patients, after plasty of the CCA with the primary suture, 21.7% of patients were diagnosed as having restenosis of the reconstruction zone up to 30%, with no neurological deficit. 20% of patients after carotid endarterectomy and alloreconstruction of the CCA were diagnosed as having restenosis of the reconstruction zone more than 70% and acute impairment of cerebral circulation with a lethal outcome. The patients after simultaneous eversion endarterectomy form the ICA and CCA in the intraoperative and postoperative periods had neither restenosis of the reconstruction zone nor neurological deficit. CONCLUSION: 32% of patients after previously performed carotid endarterectomy with the presence of extended, but haemodynamically insignificant stenosis of the CCA (30-35% stenosis) in the postoperative period were found to have progression of the atherosclerotic lesion in the form of an increased degree of stenosis up to haemodynamically significant (more than 70%), thus requiring repeat reconstructive operation. Therefore, in patients presenting with concomitant atherosclerotic lesions of the carotid arteries it is appropriate to carry out operative intervention simultaneously on the ICA and CCA, which would make it possible to considerably improve the remote postoperative results of reconstructive interventions on the carotid basin in this cohort of patients. A comparative study of the outcomes of various methods of reconstruction of carotid arteries in patients with concomitant atherosclerotic lesions of the ICA and CCA demonstrated that simultaneous eversion endarterectomy from the ICA and CCA resulted in good postoperative parameters: absence of restenosis and neurological deficit in the remote period of follow up.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Artéria Carótida Interna/cirurgia , Endarterectomia das Carótidas/métodos , Artéria Carótida Primitiva/patologia , Artéria Carótida Interna/patologia , Estenose das Carótidas/cirurgia , Progressão da Doença , Humanos , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
8.
No Shinkei Geka ; 47(12): 1239-1246, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874944

RESUMO

BACKGROUND AND PURPOSE: Various studies have addressed risk factors for recurrence of ischemic stroke in patients with symptomatic carotid artery stenosis. However, no investigations have compared common localized carotid artery lesions and internal carotid artery lesions, including carotid bifurcation. This retrospective study investigated risk factors for ischemic stroke recurrence in patients with symptomatic carotid artery stenosis, including a comparison of lesion sites. METHODS: Of 61 consecutive patients admitted to the authors' hospital due to a diagnosis of symptomatic carotid artery stenosis between April 2015 and March 2018, data from 59 were retrospectively reviewed(2 patients diagnosed with arterial dissection were excluded). The primary end point was recurrence of ischemic stroke caused by symptomatic carotid artery stenosis, the cause of the first event. Patients were censored at the time of surgical intervention;events occurring during and after surgical intervention were not included. In the ischemic stroke recurrence and non-recurrence groups, each item was analyzed using the Kaplan-Meier method, and a log-rank test was performed with a significance level set to 5%. RESULTS: Ischemic stroke recurrence before surgical intervention was observed in 5(8.5%)patients. In comparing the recurrence and non-recurrence groups, a significant difference was observed in age(p=0.027)and lesion site(p <0.001). CONCLUSION: A localized lesion in the carotid artery was a risk factor for recurrence of ischemic stroke in patients with symptomatic carotid artery stenosis. For individuals with symptomatic localized lesions in the common carotid artery, surgical intervention should be considered-in addition to medical treatment-regardless of the degree of stenosis.


Assuntos
Isquemia Encefálica , Estenose das Carótidas , Endarterectomia das Carótidas , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Artérias Carótidas , Artéria Carótida Primitiva , Humanos , Recidiva , Estudos Retrospectivos , Fatores de Risco
9.
Medicine (Baltimore) ; 98(50): e18234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852087

RESUMO

The aim of this prospective observational single-centre pilot study was to evaluate the association between alterations in carotid artery blood flow velocities during cardiac surgery and postoperative delirium.Carotid artery blood flow velocity was determined perioperatively at 5 different timepoints by duplex sonography in 36 adult cardiac surgical patients. Delirium was assessed using the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Additionally, blood flow velocities in the middle cerebral arteries, differences in regional cerebral tissue oxygenation and quantity and quality of microemboli were measured.Delirium was detected in 7 of 36 patients. After cardiopulmonary bypass carotid artery blood flow velocities increased by +23 cm/second (95% confidence interval (CI) 9-36 cm/second) in non-delirious patients compared to preoperative values (P = .002), but not in delirious patients (+3 cm/second [95% CI -25 to 32 cm/second], P = .5781). Middle cerebral artery blood flow velocities were higher at aortic de-cannulation in non-delirious patients (29 cm/second [inter-quartile range (IQR), 24-36 cm/second] vs 12 cm/second [IQR, 10-19 cm/second]; P = .017). Furthermore, brain tissue oxygenation was higher in non-delirious patients during surgery.Our results suggest that higher cerebral blood flow velocities after aortic de-clamping and probably also improved brain oxygenation might be beneficial to prevent postoperative delirium.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Artéria Carótida Primitiva/fisiopatologia , Delírio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Ultrassonografia Doppler Dupla/métodos , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Artéria Carótida Primitiva/diagnóstico por imagem , Delírio/etiologia , Delírio/fisiopatologia , Feminino , Seguimentos , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos
11.
Medicine (Baltimore) ; 98(40): e17477, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577781

RESUMO

The objective of this study was to compare clinical outcomes in patients who with unfavorable vascular anatomy underwent mechanical thrombectomy (MT) by common carotid artery access versus transfemoral approach.A retrospective review was performed in our hospital database to identify patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion (LVO) between August 2015 and November 2018. Transcarotid and transfemoral cohorts were compared. Patient characteristics, procedural techniques, clinical outcomes were recorded.A total of 52 patients were included, 16 (31%) underwent MT via transcarotid access. There were no significant differences in patient characteristics, intravenously recombinant tissue plasminogen activator therapy, clot location, or carotid tortuosity and presence of aortic arch type. There were significant differences in clinical outcomes between the 2 cohorts, including mean access-to-reperfusion time (84 vs 44 minutes; P = .000), poor clinical outcome (modified Rankin scale >2) at 90 days follow-up (37.5% vs 63.9%; P = .034). But there were no significant differences in successful revascularization rates (thrombolysis in cerebral infarction score ≥2b 87.5% vs 80.6%; P = .541), post-thrombectomy symptomatic intracranial hemorrhage (12.5% vs 13.9%; P = .892), and mortality (12.5% vs 22.2%; P = .412) were similar between transcarotid and transfemoral cohorts.Our results demonstrate that transcarotid access for MT of anterior circulation LVO in patients with unfavorable vascular anatomy may be considerable. Transcarotid access may be better than transfemoral access in well-selected unfavorable vascular anatomy patients undergoing MT.


Assuntos
Artéria Carótida Primitiva/cirurgia , Procedimentos Endovasculares/métodos , Trombose Intracraniana/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Artéria Femoral , Humanos , Trombose Intracraniana/complicações , Trombose Intracraniana/patologia , Masculino , Punções , Estudos Retrospectivos , Resultado do Tratamento
13.
Sheng Li Xue Bao ; 71(5): 705-716, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31646324

RESUMO

The aim of the present study was to investigate the differences of the pathological changes and cognitive function after bilateral common carotid artery occlusion (BCCAO) between Sprague-Dawley (SD) and Wistar rats. Male SD and Wistar rats were randomly divided into 2 groups, respectively: sham operated (S-sham and W-sham) and operated (S-BCCAO and W-BCCAO) groups. The survival rate and the rate of loss of pupillary light reflex (PLR) were observed on day 1, 3, 7, 14 and 28 after the operation, and the light-dark box, Y-maze and odor recognition tests were performed to detect cognitive function on day 28 after the operation. HE and Luxol fast blue staining were used to observe the pathological changes of gray matter (hippocampus), white matter (optical tract), optic nerve, and retina. The results showed that the survival rate of the W-BCCAO group was 62.5%, and PLR loss rate was 100%; whereas the survival rate of the S-BCCAO group was 100%, and PLR loss rate was 58.3%. In the W-BCCAO group, percentages of time spent and distance traveled in the light box were more than those in the W-sham group, but there was no statistical significance between the S-BCCAO and S-sham groups. In the S-BCCAO group, the percentages of time spent and distance traveled in the III arm (labyrinth arm) of the Y-maze were less than those in the S-sham group, but no statistical significance was found between the W-BCCAO group and W-sham group. In the S-BCCAO group, the discrimination ratio of the odor recognition task was less than that in the S-sham group, but no statistical significance could be seen between the W-BCCAO and W-sham groups. Ischemic injury was observed in the CA1 area of the hippocampus in the S-BCCAO group, but no readily visible damage was observed in the W-BCCAO group. Ischemic injury of the visual beam and optic nerve was observed in both the S-BCCAO and W-BCCAO groups. Compared with the corresponding sham groups, the S-BCCAO and W-BCCAO groups showed serious retinal damage with significant thinner retina. The ganglion cell layer (GCL), inner plexiform layer (IPL), and outer plexiform layer (OPL) were thinner in the S-BCCAO group, but no statistical significances were shown in the other layers. All the layers, except the outer nuclear layer (ONL), were significantly thinner in the W-BCCAO group. The results indicate that there are differences of the pathological changes in the hippocampus and visual conduction pathway after BCCAO between SD and Wistar rats, and the degree of learning and memory injury was also different, which suggests that the vascular dementia model of different rat strains should be selected according to research purpose.


Assuntos
Encéfalo/patologia , Doenças das Artérias Carótidas/patologia , Artéria Carótida Primitiva/patologia , Cognição , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley , Ratos Wistar
14.
Khirurgiia (Mosk) ; (9): 86-89, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532172

RESUMO

Surgical repair of common carotid artery aneurysm as an extremely rare complication of carotid endarterectomy in long-term period is described. Aneurysmectomywasfollowed by patch repair of the artery. It was concluded that this intervention is effective approach for this complication. The main causes of this adverse event are identified.


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Aneurisma/etiologia , Lesões das Artérias Carótidas/etiologia , Humanos , Procedimentos Cirúrgicos Vasculares/métodos
15.
Angiol Sosud Khir ; 25(3): 17-22, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503243

RESUMO

OBJECTIVE: The study was aimed at determining cognitive impairments, vascular endothelial dysfunction and morphofunctional alterations of neurons in brain structures (neocortex and hippocampus) in unilateral occlusion of the common carotid artery in albino rats. MATERIAL AND METHODS: The experiments were carried out on Wistar albino rats. The animals were divided into two groups: group 1 - the control group composed of sham-operated rats and group 2 - the study group consisting of rats with cerebral ischaemia. The model of cerebral ischaemia was reproduced by occlusion of the left common carotid artery. Cognitive functions in rats were assessed by means of the object recognition test and conditioned passive avoidance response (CPAR). The degree of vascular endothelial dysfunction was evaluated by the number of circulating endotheliocytes and concentration of end products of nitric oxide - nitrites in blood plasma. Pathomorphological studies of the brain and morphometric analysis of the number of damaged neurons after ischaemic exposure were carried out by means of light microscopy. RESULTS: It was determined that unilateral occlusion of the common carotid artery in rats resulted in memory impairment revealed by the object recognition test and CPAR (p≤0.05). Cerebral ischaemia induced an elevated level of circulating endotheliocytes and a decrease in end products of nitric oxide - nitrates as compared with the controls (p≤0.05). Morphological study demonstrated signs of vasoconstrictive reactions, microvascular endothelial oedema, as well as an increase in the proportion of damaged neurons localized in the fronto-bregmatic region of the cortex of the cerebral hemispheres and hippocampus on the ipsilateral side (p≤0.05). CONCLUSION: Unilateral occlusion of the common carotid artery in albino rats resulted in cognitive impairments, damage of neurons in the most vulnerable areas of the cortex of the cerebral hemispheres and hippocampus predominantly on the ipsilateral side. Cognitive impairments and ischaemic lesions of the brain structures are induced by endothelial dysfunction, enhanced desquamation of endotheliocytes and prevalence of vasoconstrictive reactions resulting from decreased production of the major vasorelaxing factor - nitric oxide.


Assuntos
Isquemia Encefálica , Disfunção Cognitiva , Animais , Isquemia Encefálica/complicações , Artérias Carótidas/patologia , Artéria Carótida Primitiva , Disfunção Cognitiva/etiologia , Ratos , Ratos Wistar
16.
J Vasc Res ; 56(5): 241-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536996

RESUMO

PURPOSE: Atherosclerosis in the carotid arteries is a common cause of ischemic stroke. We examined atherogenesis in the left carotid artery with and without interrupted blood flow of C57BL/6 (B6) and C3H-Apoe-deficient (Apoe-/-) mouse strains. METHODS: Blood flow was interrupted by ligating the common carotid artery near its bifurcation in one group of mice and another group was not interrupted. RESULTS: Without interference with blood flow, C3H-Apoe-/- mice developed no atherosclerosis in the carotid artery, while B6-Apoe-/- mice formed advanced atherosclerotic lesions (98,019 ± 10,594 µm2/section) after 12 weeks of a Western diet. When blood flow was interrupted by ligating the common carotid artery near its bifurcation, C3H-Apoe-/- mice showed fatty streak lesions 2 weeks after ligation, and by 4 weeks fibrous lesions had formed, although they were smaller than in B6-Apoe-/- mice. Neutrophil adhesion to endothelium and infiltration in lesions was observed in ligated arteries of both strains. Treatment of B6-Apoe-/- mice with antibody against neutrophils had little effect on lesion size. CONCLUSIONS: These findings demonstrate the dramatic influences of genetic backgrounds and blood flow on atherogenesis in the carotid artery of hyperlipidemic mice.


Assuntos
Doenças das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/fisiopatologia , Hiperlipidemias/complicações , Placa Aterosclerótica , Animais , Doenças das Artérias Carótidas/genética , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Primitiva/patologia , Artéria Carótida Primitiva/cirurgia , Modelos Animais de Doenças , Feminino , Predisposição Genética para Doença , Hiperlipidemias/genética , Ligadura , Masculino , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , Fluxo Sanguíneo Regional , Especificidade da Espécie , Fatores de Tempo
17.
Nepal J Ophthalmol ; 11(21): 86-90, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31523073

RESUMO

BACKGROUND: Ocular ischemic syndrome is not a common condition so most of these cases are often misdiagnosed or treated as a different entity. Therefore, it is very important for the ophthalmologists to have this condition in mind as a differential so that the patients can be diagnosed and treated as early as possible. A 42 years female presented with painless, progressive diminution of vision in right eye over the period of 1 month. She doesn't give any history of redness of eyes, fever or trauma. There is no history of diabetes mellitus or hypertension as well. On examination, vision in right and left eyes was 1.78 and 0.30 Log Mar Units respectively. On anterior segment examination, revascularization of iris (1o 4 'o'clock hrs) in right eye was noted. On dilated fund us copy, revascularization of disc (1/3rd) was present in right eye. Cotton wool spots blot hemorrhages and micro aneurysms were also noted in right eye. Likewise, attenuation of arteries were noted on both sides. Fund us fluorescent angiography revealed delayed artery covetous and venous phase. Carotid Doppler was done which showed complete occlusion of right common carotid and bilateral internal carotid artery. These findings lead to the diagnosis as ocular ischemic syndrome so she was then referred to the cardiologist who further confirmed that no active intervention was required at present. The patient was planned for right eye pan retinal photocoagulation (PRP) and was completed in 2 sittings and was asked to follow up regularly. CONCLUSION: Early diagnosis and management is very important for uncommon conditions such as ocular ischemic syndrome to prevent further complications.


Assuntos
Artéria Carótida Primitiva , Estenose das Carótidas/complicações , Oftalmopatias/diagnóstico , Olho/irrigação sanguínea , Isquemia/diagnóstico , Retina/diagnóstico por imagem , Adulto , Estenose das Carótidas/diagnóstico , Oftalmopatias/etiologia , Oftalmopatias/cirurgia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Fotocoagulação/métodos , Retina/cirurgia , Síndrome , Ultrassonografia Doppler
18.
Vasa ; 48(6): 509-515, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31414617

RESUMO

Background: Fibromuscular dysplasia (FMD) primarily involves medium-sized arteries, though the entire spectrum of vascular involvement is not fully understood. We hypothesized that larger arteries may also be affected, albeit sub-clinically. Patients and methods: We measured the cross-sectional diameter of the thoracic aorta, abdominal aorta, common iliac arteries (CIA) and common carotid arteries (CCA) in FMD subjects and compared them to matched controls. We retrospectively analyzed records of FMD subjects (n = 74) and of age- and sex- matched controls (n = 74) that underwent computed tomography of the neck, chest or abdomen. Cross-sectional diameters of the thoracic and abdominal aorta, CIA and CCA were measured in a standardized manner by two trained physicians. Results: The FMD group had a significantly greater diameter of the CIA and CCA bilaterally. The measurements (mm) in FMD and control groups were as follows: Right CIA: 10.85 + 1.75 vs. 10.23 + 1.36, p = 0.04, left CIA: 11.01 + 1.93 vs. 10.15 + 1.38, p = 0.007, right CCA: 7.70 + 0.81 vs. 6.80 + 1.10, p < 0.001 and left CCA: 7.70 + 1.10 vs. 6.80 + 1.0, p < 0.001). There was no difference in the diameter between the two groups in the ascending aorta, descending and the abdominal aorta. After adjusting for baseline differences, common carotid arteries (but not common iliac) were significantly larger in FMD group compared with controls. Conclusions: There is sub-clinical involvement of the common carotid arteries in patients with FMD and this manifests as a greater diameter of these arteries compared to age and sex matched controls.


Assuntos
Displasia Fibromuscular , Artérias Carótidas , Artéria Carótida Primitiva , Estudos de Casos e Controles , Estudos Transversais , Humanos , Estudos Retrospectivos
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 733-736, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420631

RESUMO

OBJECTIVE: To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS). METHODS: From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively.Five of them developed HPS after CAS.The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed. RESULTS: In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately. CONCLUSION: HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.


Assuntos
Estenose das Carótidas , Stents , Idoso , Artérias Carótidas , Artéria Carótida Primitiva , Estenose das Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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