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1.
Int Heart J ; 61(2): 397-399, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173698

RESUMO

A 50-year-old man who suffered from dyspnea on effort with hearing loss was referred to our hospital. Computed tomography angiography revealed a giant 90-mm diameter ascending aortic aneurysm with severe calcification and neck vessel occlusion. Transthoracic echocardiography revealed moderate-to-severe aortic regurgitation. His condition was diagnosed as Takayasu arteritis and he underwent aortic valve reimplantation with total arch replacement. Postoperative computed tomography angiography showed complete aneurysm resection and the patient was discharged without any complications and his hearing loss improved. He is currently being followed up as an outpatient.


Assuntos
Aneurisma Aórtico/complicações , Arterite de Takayasu/complicações , Aneurisma Aórtico/cirurgia , Artérias Carótidas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade
3.
World Neurosurg ; 133: e739-e744, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606499

RESUMO

OBJECTIVE: To carry out surgery safely in vessels with stents, it is essential to have knowledge of what would happen if the stents were clamped or cut. Using all stents that are permitted in Japan, we recorded with a surgical microscope the behavior of stents when they were clamped or cut and discussed the morphologic changes along with image findings. METHODS: We classified carotid artery and intracranial stents as group 1A and 1B or group 2A and 2B according to the structure of stent eye: laser cut or blade. Each stent was clamped using a Yasargil aneurysm clip, bulldog forceps, and vascular forceps. Degree of closure and presence or absence of stent deformation after declamping were recorded using a surgical microscope. Furthermore, we performed morphologic evaluations using high-resolution cone-beam computed tomography. Lastly, each stent was cut; the behavior of the cut stent was recorded, and differences between stents were examined. RESULTS: Complete clamping was confirmed both visually and based on image evaluations with bulldog forceps and vascular forceps in the groups of carotid artery stents, with the Yasargil aneurysm clip in the intracranial stents. In the blade-type stents, we found that the stents elongated during clamping, and the component wire scattered at the time of stent cutting. Furthermore, the stents could be easily separated by holding with forceps. CONCLUSIONS: Knowing the properties of each stent is essential to conduct safe surgery in response to complications. Special care must be taken when clamping and cutting blade-type stents.


Assuntos
Procedimentos Endovasculares/instrumentação , Teste de Materiais , Stents , Artérias Carótidas/cirurgia , Humanos , Técnicas In Vitro , Aneurisma Intracraniano/cirurgia
4.
J Med Vasc ; 44(6): 426-431, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761309

RESUMO

We report here the management of an acquired left carotid-jugular fistula in a 29-year-old man. This patient was referred to us for a ballistic wound of the left cheek evolving since one month with the diagnosis of a carotid pseudo-aneurysm discovered on Doppler ultrasound. The clinical presentation was marked by cervical thrill in favor of an arteriovenous fistula confirmed by computed tomography angiography. The surgical exploration by cervicotomy revealed a communication between common carotid artery and internal jugular vein that were repaired using a saphenous vein patch and a lateral suture respectively without complication. The control at five months found an asymptomatic patient with good patency of the repaired vessels.


Assuntos
Fístula Arteriovenosa/cirurgia , Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/cirurgia , Veias Jugulares/cirurgia , Veia Safena/transplante , Técnicas de Sutura , Ferimentos por Arma de Fogo/cirurgia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/diagnóstico por imagem , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/lesões , Masculino , Resultado do Tratamento , Ferimentos por Arma de Fogo/diagnóstico por imagem
5.
Hand Surg Rehabil ; 38(6): 348-352, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31473335

RESUMO

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.


Assuntos
Anastomose Cirúrgica/educação , Competência Clínica , Educação Médica Continuada/métodos , Microcirurgia/educação , Cirurgiões , Suturas , Animais , Artérias Carótidas/cirurgia , Humanos , Ratos Sprague-Dawley , Grau de Desobstrução Vascular
6.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420432

RESUMO

Free-floating thrombus (FFT) in the carotid artery has been reported as a rare cause of acute ischaemic stroke. There are various treatment strategies, but higher risk of distal embolism may limit their applicability. A 77-year-old woman noticed right upper arm weakness. A CT angiogram revealed that a large floating thrombus had strayed across the carotid bifurcation, while another thrombus was present in the right axillary artery. As for the carotid FFT, in spite of anticoagulation therapy, the number of asymptomatic microthrombuses gradually increased on diffusion-weighted MRI. We performed endovascular therapy utilising two temporary occlusion balloon catheters and performed direct aspiration with a reperfusion catheter. The procedure was uneventful. We successfully performed a new endovascular technique for FFT in the carotid bifurcation. Our method is effective, minimally invasive and safe.


Assuntos
Oclusão com Balão/métodos , Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Reperfusão/instrumentação , Trombose/terapia , Idoso , Braço/irrigação sanguínea , Braço/cirurgia , Feminino , Humanos , Reperfusão/métodos
7.
Artif Cells Nanomed Biotechnol ; 47(1): 3110-3115, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31352800

RESUMO

Objective: The randomized controlled trail was carried out to investigate the influence of statin pre-treatment on clinical efficacy of carotid artery stenting (CAS). Methods: 160 eligible patients were randomly divided into statin group (n = 82) and control group (n = 78). The patients in statin group received 40 mg atorvastatin daily 7 days before operation. Major endpoints included transient ischemic attack (TIA), stroke, death, myocardial infarction (MI), and other cardiac adverse events within 30 days after CAS. Results: Preoperative baseline information was similar between the statin and control groups (p > 0.05 for all). Within 48 h after operation, the occurrence rate of CIN (3.66% vs 8.97%, p = .019) and new infarction (4.88% vs. 14.10%, p = .045) were significantly lower in statin group than in control group. 30 days after CAS, the incidences of TIA (12.20% vs. 26.92%, p = .018), ischemic stroke (6.10% vs. 16.67%, p = .034), and other cardiac complications (7.32% vs. 19.23%, p = .026) were also significantly lower in statin group, than in the control group. Multiple analysis demonstrated that statin use exerted protective effect against ischemic stroke (OR = 0.038, 95% CI = 0.003-0.543, p = .016) and other cardiac complications (OR = 0.208, 95%CI = 0.063-0.694, p = .011). Conclusion: Pre-treatment with statin is an effective and safe strategy to prevent from perioperative complications and to improve postoperative outcomes in patients undergoing CAS.


Assuntos
Artérias Carótidas/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Segurança , Stents , Idoso , Artérias Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
8.
Med Sci Monit ; 25: 4933-4940, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269009

RESUMO

BACKGROUND We discuss the presentation and management of extracranial carotid artery aneurysms (ECAAs) and to develop a new type of classification. MATERIAL AND METHODS A retrospective review of 35 ECAAs patients who were admitted in our institution from January 2010 to June 2016 was conducted. The mean follow-up period was 25.58±22.13 months. RESULTS During the study period, 35 aneurysms were diagnosed and treated (mean age, 50.8±15.6 years; 15 men). There were 28 true aneurysms, 5 false aneurysms, and 2 dissecting aneurysms. A total of 16 patients with true aneurysms underwent open surgical treatment (group 1), whereas 15 received endovascular management, including all false and dissecting aneurysms (group 2). The remaining 4 true aneurysms were treated with hybrid operation (group 3). The patency rates of groups 1, 2, and 3 were 100%, 93.3%, and 100%, respectively. According to the Peking Union Medical College Hospital (PUMCH) Classification, all 24 cases of type Ia aneurysms were treated by either open surgery and/or endovascular treatment, whereas all 3 type Ib cases were treated solely by open surgery. All 5 type IIa patients were treated by endovascular treatment, with the exception of 1 failure that was transferred to hybrid operation. All 3 type IIb patients were treated by hybrid operation. CONCLUSIONS Open surgery was more frequently feasible in true aneurysms, and endovascular surgery was the first choice for false and dissecting aneurysms. Hybrid operation was available for complicated cases. The PUMCH classification may be helpful for selection of management strategies for ECAAs.


Assuntos
Aneurisma Dissecante/cirurgia , Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
9.
Ann Ital Chir ; 90: 106-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31182697

RESUMO

INTRODUCTION: We reviewed our experience of carotid artery stenting (CAS) in patients older than 75 years treated with open or closed cell stents. The aim of our paper is to evaluate if there are differences between the two groups in term of clinical outcomes, neurological impairment and survival. MATERIAL AND METHODS: CAS consecutively performed from March 2000 and December 2016 in elderly patients were rectrospectively collected. We classified them into two groups: closed cells (group A) and open cells stent (group B). Perioperative and long term events were observed (death, major cerebrovascular and cardiovascular events, in-stent restenosis). RESULTS: We collected 429 CAS, 259 (60.37%) male with median age of 79 years (range 77-82). Group A collects 247 (57.98%) patients, 142 (33.3%) in group B. The other 40 patients were treated with hybrid stents or just ballooning. In perioperative period we had not death but 2 patients (0.8%) in group A had a transient ischemic attack (TIA) due to immediate stent thrombosis, 2 patients (1 per group) had an ipsilateral major stroke and 8 patients had a TIA (3 in group A and 5 in group B). Median follow up was 686 days (IQR 267-1299 days). Freedom from complications at 12, 36 and 60 months was 99.4 ± 0.5%, 97 ± 1.5% and 90.08 ± 4.3% respectively. Survival at 12, 36 and 60 months was 77.4 ± 7.5%, 51.6 ± 8.9% and 16.1± 6.6% respectively. CONCLUSION: Our data show CAS as a safe procedure also for people older than 75 years in terms of perioperative and long term complications and cerebral events without any significant difference between the different type of stent. Further studies are requested to better clarify its role in symptomatic patients. KEY WORDS: Carotid stenting, Carotid treatment, Old people.


Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desenho de Prótese
10.
Physiol Res ; 68(4): 603-610, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31177797

RESUMO

We compared graft outcome between two types of a novel composite three-layer carp-collagen-coated vascular graft in low-flow conditions in a sheep model. Collagen in group A underwent more cycles of purification than in group B in order to increase the ratio between collagen and residual fat. The grafts were implanted end-to-side in both carotid arteries in sheep (14 grafts in 7 sheep in group A, 18 grafts in 9 sheep in group B) and artificially stenosed on the right side. The flow in the grafts in group A decreased from 297±118 ml/min to 158±159 ml/min (p=0.041) after placement of the artificial stenosis in group A, and from 330±164ml/min to 97±29 ml/min (p=0.0052) in group B (p=0.27 between the groups). From the five surviving animals in group A, both grafts occluded in one animal 3 and 14 days after implantation. In group B, from the six surviving animals, only one graft on the left side remained patent (p=0.0017). Histology showed degradation of the intimal layer in the center with endothelization from the periphery in group A and formation of thick fibrous intimal layer in group B. We conclude that the ratio between collagen and lipid content in the novel three-layer graft plays a critical role in its patency and structural changes in vivo.


Assuntos
Prótese Vascular/tendências , Artérias Carótidas/cirurgia , Colágeno/administração & dosagem , Colágeno/isolamento & purificação , Desenho de Prótese/tendências , Grau de Desobstrução Vascular/fisiologia , Animais , Artérias Carótidas/fisiologia , Carpas , Desenho de Prótese/métodos , Ovinos
11.
Stroke ; 50(7): 1898-1901, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31177981

RESUMO

Background and Purpose- Novel double layer micromesh stents have recently been introduced for treatment of patients with significant carotid stenosis. Strict evaluation of safety and patency of such novel devices is required both in elective and in emergency interventions. We report a single center experience with double layer mesh stents for carotid artery revascularization. Methods- Consecutive patients who underwent carotid artery stenting with a double layer mesh stent between June 2015 and September 2018 in our tertiary vascular referral center were included. Treatment indications were emergent carotid artery stenting for intracranial or extracranial carotid stenosis in patients undergoing intraarterial thrombectomy for acute ischemic stroke in the anterior circulation, or elective carotid artery stenting for significant symptomatic or asymptomatic stenosis. End points were postprocedural thrombotic stent occlusion and procedural stroke or death. Results- Fifty-four patients were included; 27 were treated for acute stroke with intracranial and extracranial (tandem) lesions and 27 for elective stenting. Follow-up imaging was available for 9/27 (33%) patients with acute stroke, and 19/27 (70%) electively treated patients. Five stent occlusions occurred, of which 2 were symptomatic with clinical deterioration within one day. Another patient deteriorated on postprocedural day one, but imaging of the carotids was not performed, and the stent turned out occluded on the 30-day duplex. All stent occlusions occurred in patients treated for acute stroke. Conclusions- This study suggests that occlusion of novel double layer mesh stents occurs in a considerable proportion of carotid artery stenting procedures performed in the emergency setting for acute stroke, with occlusion-related symptoms in half the cases. Future prospective studies should clarify the role of double layer mesh stents in this high-risk patient population.


Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Stents , Telas Cirúrgicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Estenose das Carótidas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
12.
PLoS One ; 14(6): e0217271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170183

RESUMO

Wall shear stress (WSS), the frictional force exerted on endothelial cells by blood flow, is hypothesised to influence atherosclerotic plaque growth and composition. We developed a methodology for image registration of MR and histology images of advanced human carotid plaques and corresponding WSS data, obtained by MRI and computational fluid dynamics. The image registration method requires four types of input images, in vivo MRI, ex vivo MRI, photographs of transversally sectioned plaque tissue and histology images. These images are transformed to a shared 3D image domain by applying a combination of rigid and non-rigid registration algorithms. Transformation matrices obtained from registration of these images are used to transform subject-specific WSS data to the shared 3D image domain as well. WSS values originating from the 3D WSS map are visualised in 2D on the corresponding lumen locations in the histological sections and divided into eight radial segments. In each radial segment, the correlation between WSS values and plaque composition based on histological parameters can be assessed. The registration method was successfully applied to two carotid endarterectomy specimens. The resulting matched contours from the imaging modalities had Hausdorff distances between 0.57 and 0.70 mm, which is in the order of magnitude of the in vivo MRI resolution. We simulated the effect of a mismatch in the rigid registration of imaging modalities on WSS results by relocating the WSS data with respect to the stack of histology images. A 0.6 mm relocation altered the mean WSS values projected on radial bins on average by 0.59 Pa, compared to the output of original registration. This mismatch of one image slice did not change the correlation between WSS and plaque thickness. In conclusion, we created a method to investigate correlations between WSS and plaque composition.


Assuntos
Artérias Carótidas , Doenças das Artérias Carótidas , Endarterectomia , Hemorreologia , Angiografia por Ressonância Magnética , Placa Aterosclerótica , Resistência ao Cisalhamento , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , Feminino , Humanos , Masculino , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/fisiopatologia , Placa Aterosclerótica/cirurgia
13.
J Card Surg ; 34(7): 645-646, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212383

RESUMO

Spontaneous rupture of the left subclavian artery is a rare condition that requires immediate surgical intervention. A 21-year-old man with a history of membranoproliferative glomerulonephritis, failed kidney transplant, and history of a type A aortic dissection that was surgically repaired was admitted with altered mental status and hypotension. He was found to have a left subclavian artery rupture. This was successfully managed with emergent thoracic endovascular aortic repair and carotid-subclavian bypass.


Assuntos
Procedimentos Endovasculares/métodos , Artéria Subclávia/cirurgia , Adulto , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Artérias Carótidas/cirurgia , Humanos , Masculino , Ruptura Espontânea/cirurgia , Resultado do Tratamento , Adulto Jovem
14.
J Cardiovasc Surg (Torino) ; 60(5): 599-611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31089086

RESUMO

BACKGROUND: Synthetic vascular material use, particularly polytetrafluoroethylene- (PTFE) -based, can be associated with bleeding, which may increase operative time and blood loss. None of the commercially available sealants designed to ensure hemostasis combine bioresorption, high viscosity, hydrophobicity, and compliance with the underlying tissue and on-demand activation. METHODS: A study was designed to assess the biocompatibility and in-vivo performance and bioresorption of a new synthetic on-demand light-activated poly(glycerol-sebacate) acrylate- (PGSA) -based SETALIUM™ Vascular Sealant (TISSIUM, Paris, France) in three large animal studies of open vascular carotid and aortic surgery. The pre-clinical results were then translated into a clinical setting in a prospective, single-arm multicenter study in patients requiring carotid endarterectomy using an ePTFE patch. RESULTS: The biocompatibility testing showed that the PGSA-based SETALIUM™ Vascular Sealant did not induce any significant toxic reaction at a standard clinical dose nor at doses up to 40 times the equivalent intended clinical dose. The PGSA-based sealant was shown to be non-pyrogenic, non-sensitizing, non-irritant, non-clastogenic, and non-mutagenic. The animal studies showed excellent performance and safety results, with clinically significant hemostasis achieved in 100% of the animals in both carotid and aorta studies and excellent local tolerance. Histopathology and morphometric analyses showed surface-based gradual and sustained bioresorption of the PGSA-based sealant up to 86% at 12 months. In the clinical study, the application of the PGSA-based sealant resulted in good performance and safety, with immediate hemostasis achieved in 84% of the cases and no adverse event related to the sealant reported through the one-year follow-up. CONCLUSIONS: The new synthetic on-demand light activated PGSA-based SETALIUM™ Vascular Sealant investigated in our studies demonstrated good biocompatibility, sustained and gradual surface based bioresorption, and acceptable safety profile in animal studies. In addition, the first in-human use showed that the sealant is a safe and effective alternative to achieve fast and controlled hemostasis in vascular carotid reconstructions. A larger randomized controlled study will allow further validation of these encouraging preliminary results.


Assuntos
Acrilatos/administração & dosagem , Angioplastia/efeitos adversos , Aorta Torácica/cirurgia , Artérias Carótidas/cirurgia , Decanoatos/administração & dosagem , Endarterectomia das Carótidas/efeitos adversos , Glicerol/análogos & derivados , Hemorragia/prevenção & controle , Técnicas Hemostáticas , Polímeros/administração & dosagem , Adesivos Teciduais/administração & dosagem , Acrilatos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Angioplastia/instrumentação , Animais , Decanoatos/efeitos adversos , Endarterectomia das Carótidas/instrumentação , Feminino , Glicerol/administração & dosagem , Glicerol/efeitos adversos , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Modelos Animais , Polímeros/efeitos adversos , Estudos Prospectivos , Carneiro Doméstico , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
15.
Biomed Mater Eng ; 30(3): 309-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127751

RESUMO

The utilization of Asymmetric stent for recovering atherosclerotic diseases, particularly non-symmetric obstruction, is a quite challenging breakthrough treatment. In terms of eccentric plaque, the non-uniform stiffness of arterial layer causes the increasingly complex issues of vulnerability. This study investigated the vulnerability of the interaction between the Asymmetric stent and the surrounding arterial layer using structural transient dynamic analysis in ANSYS. Four combinations of stent deployment, i.e. the Sinusoidal stent expanded by the offset balloon, the Sinusoidal stent expanded by the ordinary cylindrical balloon, the Asymmetric stent expanded by the offset balloon, and the Asymmetric stent expanded by the ordinary cylindrical balloon, are generated for this comparative study. Multilayer material properties from recent in vitro experiments are adopted for the surrounding arterial layer, such as a fibrous cap, lipid core, diseased-healthy intima, and diseased-healthy media. In order to address plaque vulnerability, the Cauchy stresses and Hencky strains are used for stress measure because of convenience in comparison with the uniaxial/biaxial tension test data. The location-specific threshold value from the diseased human carotid artery is adopted for rupture criteria. The simulation indicated that as regards the eccentric plaque, the plaque vulnerability is caused by the plaque shape and components rather than caused by the geometrical structure of the stent or balloon expansion method. Nevertheless, the non-symmetric inflation of balloon, which leads against the plaque, contributed to an increase in the vulnerability of fibrous cap of fibroatheroma plaque.


Assuntos
Artérias Carótidas/cirurgia , Placa Aterosclerótica/terapia , Stents , Artérias Carótidas/patologia , Simulação por Computador , Análise de Elementos Finitos , Humanos , Teste de Materiais , Modelos Cardiovasculares , Placa Aterosclerótica/patologia , Desenho de Prótese , Estresse Mecânico
16.
World Neurosurg ; 128: e513-e521, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048049

RESUMO

BACKGROUND: Various studies have suggested that age ≥80 years is associated with a higher rate of complications after carotid artery stenting (CAS). The Buffalo Risk Assessment Scale (BRASS) predicts complications in symptomatic patients undergoing CAS. Application of the BRASS has shown the ability to improve patient selection. We used the BRASS system to evaluate whether the higher rate of complications associated with CAS in the elderly is related to vascular anatomy. METHODS: A retrospective review of CAS was performed at our institution over 7 years. Demographic information, anatomic characteristics, BRASS categorization, and outcome measures were compared between elderly (≥80 years) and younger patients (<80 years). RESULTS: The study included 447 patients: 335 patients (75%) <80 years and 112 patients (25%) ≥80 years. There were significantly more elderly patients in the high-risk BRASS category (P < 0.01), and more young patients in the low-risk BRASS category (P = 0.04). The complication rates in the 2 groups were similar. Older patients were more likely to harbor complex vascular anatomy: they had significantly higher rates of types II and III aortic arches (P = 0.01 and P < 0.01, respectively), higher percentage of tortuous carotid vessels (P < 0.01), and higher rates of hostile anatomy for deployment of distal embolic protection devices (P = 0.02). CONCLUSIONS: Complex vascular anatomy, rather than age, is the key factor behind the higher CAS-associated complication rate in the elderly. Complications can be avoided through proper patient selection and stratifying patients based on anatomic characteristics, which can be achieved through the BRASS scoring system.


Assuntos
Aorta Torácica/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Stents , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/anatomia & histologia , Artérias Carótidas/anatomia & histologia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Calcificação Vascular/epidemiologia
17.
Neurology ; 92(22): e2514-e2521, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31053663

RESUMO

OBJECTIVE: We investigated whether mental illness is associated with lower rates of carotid endarterectomy (CEA)/carotid artery stenting (CAS) after stroke due to carotid stenosis. METHODS: In this retrospective cross-sectional study, ischemic stroke cases due to carotid stenosis were identified in the 2007-2014 Nationwide (National) Inpatient Sample. Psychiatric conditions were identified by secondary ICD-9-CM diagnosis codes for schizophrenia/psychoses, bipolar disorder, depression, anxiety, or substance use disorders. Using logistic regression, we tested the association between psychiatric conditions and CEA/CAS, controlling for demographic, clinical, and hospital factors. RESULTS: Among 37,474 included stroke cases, 6,922 (18.5%) had a psychiatric comorbidity. The presence of any psychiatric condition was associated with lower odds of CEA/CAS (adjusted odds ratio [OR] 0.84, 95% confidence interval [CI] 0.78-0.90). Schizophrenia/psychoses (OR 0.72, 95% CI 0.55-0.93), depression (OR 0.83, 95% CI 0.75-0.91), and substance use disorders (OR 0.73, 95% CI 0.65-0.83) were each associated with lower odds of CEA/CAS. The association of mental illness and CEA/CAS was dose-dependent: compared to patients without mental illness, patients with multiple psychiatric comorbidities (OR 0.74, 95% CI 0.62-0.87) had lower odds of CEA/CAS than those with only one psychiatric comorbidity (OR 0.86, 95% CI 0.79-0.92; p value for trend <0.001). CONCLUSION: The odds of carotid revascularization after stroke is lower in patients with mental illness, particularly those with schizophrenia/psychoses, depression, substance use disorders, and multiple psychiatric diagnoses.


Assuntos
Endarterectomia das Carótidas , Transtornos Mentais/epidemiologia , Stents , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/cirurgia , Artérias Carótidas/cirurgia , Revascularização Cerebral , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
18.
PLoS One ; 14(4): e0212235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943188

RESUMO

Neointimal hyperplasia, stimulated by injury and certain vascular diseases, promotes artery obstruction and tissue ischemia. In vascular smooth muscle cell (VSMCs), multiple modulators of protein handling machinery regulate intimal hyperplasia. These include elements of the VSMC unfolded protein response to endoplasmic reticulum stress (UPRER), and transglutaminase 2 (TG2), which catalyzes post-translational protein modification. Previous results for deficiency of UPRER-specific mediator XBP1, and of TG2, have been significant, but in multiple instances contradictory, for effects on cultured VSMC function, and, using multiple models, for neointimal hyperplasia in vivo. Here, we engineered VSMC-specific deficiency of XBP1, and studied cultured VSMCs, and neointimal hyperplasia in response to carotid artery ligation in vivo. Intimal area almost doubled in Xbp1fl/fl SM22α-CRE+ mice 21 days post-ligation. Cultured murine Xbp1 deficient VSMCs migrated more in response to platelet derived growth factor (PDGF) than control VSMCs, and had an increased level of inositol-requiring enzyme 1α (Ire1α), a PDGF receptor-binding UPRER transmembrane endonuclease whose substrates include XBP1. Cultured XBP1-deficient VSMCs demonstrated decreased levels of TG2 protein, in association with increased TG2 polyubiquitination, but with increased TG transamidation catalytic activity. Moreover, IRE1α, and TG2-specific transamidation cross-links were increased in carotid artery neointima in Xbp1fl/fl SM22α-CRE+ mice. Cultured TG2-deficient VSMCs had decreased XBP1 associated with increased IRE1α, and increased migration in response to PDGF. Neointimal hyperplasia also was significantly increased in Tgm2fl/fl SM22α-CRE+ mice at 21 days after carotid ligation. In conclusion, a VSMC regulatory circuit between XBP1 and TG2 limits neointimal hyperplasia in response to carotid ligation.


Assuntos
Proteínas de Ligação ao GTP/metabolismo , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Neointima/patologia , Transglutaminases/metabolismo , Proteína 1 de Ligação a X-Box/metabolismo , Animais , Artérias Carótidas/citologia , Artérias Carótidas/patologia , Artérias Carótidas/cirurgia , Movimento Celular , Proliferação de Células , Modelos Animais de Doenças , Endorribonucleases/metabolismo , Proteínas de Ligação ao GTP/genética , Humanos , Hiperplasia/etiologia , Hiperplasia/patologia , Ligadura/efeitos adversos , Masculino , Camundongos , Camundongos Knockout , Músculo Liso Vascular/citologia , Processamento de Proteína Pós-Traducional , Proteínas Serina-Treonina Quinases/metabolismo , Transdução de Sinais , Transglutaminases/genética , Ubiquitinação , Resposta a Proteínas não Dobradas , Proteína 1 de Ligação a X-Box/genética
19.
World Neurosurg ; 127: e722-e726, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30951917

RESUMO

BACKGROUND: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well-established treatments that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease. We assessed clinical outcome, safety, and restenosis rates for patients who underwent standardized CEA or CAS at our tertiary care center using patient selection criteria based on available scientific evidence. METHODS: Retrospective chart review of patients who underwent CEA or CAS between 2009 and 2016. RESULTS: In total, 314 cases (204 with CEA and 110 with CAS) were analyzed. Patients were predominantly white (84.4%), men (61.1%) with hypertension (86.9%) and hyperlipidemia (81.8%). Most patients (84.5%) had symptomatic carotid disease. No significant differences were observed in median postoperative National Institutes of Health Stroke Scale and modified Rankin scale (mRS) scores based on pretreatment symptomatic status or treatment modality (CEA vs. CAS). Most patients (85.9%) had favorable outcomes (mRS score 0-2) at a median follow-up of 11.7 months (interquartile range, 1.8-28.8). The perioperative complication rate was low (3.2%), and permanent neurologic deficit was seen in only 3 patients (1%). Restenosis was found in 7.3%, without significant difference between CEA and CAS at last follow-up. Restenosis was asymptomatic in most patients. CONCLUSIONS: Our findings in a real-world predominantly symptomatic cohort demonstrate that favorable patient outcomes and low restenosis and complication rates can be achieved with both CEA and CAS by the utilization of a consistent institutional patient selection and treatment process.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Stents , Idoso , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Eur J Pharm Biopharm ; 139: 272-278, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31004790

RESUMO

OBJECTIVE: Vascular prostheses for small caliber bypass grafts in cardiac and vascular diseases or for access surgery are still missing. Poly (Ɛ-caprolactone) (PCL) has been previously investigated by our group and showed good biocompatibility and mechanical properties in vitro and rapid endothelialisation, cellular infiltration and vascularisation in vivo yielding optimal patency in the abdominal aortic position. The aim of the present study is to evaluate our PCL graft in the carotid position and to compare its outcome to the grafts implanted in the abdominal aortic position. METHODS: PCL grafts (1 mm ID/10 mm long) were implanted into the left common carotid artery in 20 Sprague-Dawley rats and compared to our previously published series of abdominal aortic implants. The animals were followed up to 3, 6, 12 and 24 weeks. At each time point, in vivo compliance, angiography and histological examination with morphology were performed. RESULTS: PCL grafts showed good mechanical properties and ease of handling. The average graft compliance was 14.5 ±â€¯1.7%/ mmHg compared to 7.8 ±â€¯0.9% for the abdominal position and 45.1 ±â€¯3.2%/ mmHg for the native carotid artery. The overall patency for the carotid position was 65% as compared to 100% in the abdominal position. Complete endothelialisation was achieved at 3 weeks and cell invasion was more rapid than in the aortic position. In contrast, intimal hyperplasia (IH) and vascular density were less pronounced than in the aortic position. CONCLUSION: Our PCL grafts in the carotid position were well endothelialised with early cellular infiltration, higher compliance, lower IH and calcification compared to the similar grafts implanted in the aortic position. However, there was a higher occlusion rate compared to our abdominal aorta series. Anatomical position, compliance mismatch, flow conditions may answer the difference in patency seen.


Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular/efeitos adversos , Artérias Carótidas/cirurgia , Animais , Aorta Abdominal/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Caproatos/química , Artérias Carótidas/fisiopatologia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Lactonas/química , Modelos Animais , Poliésteres/química , Ratos , Ratos Sprague-Dawley , Grau de Desobstrução Vascular
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