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1.
Rev Assoc Med Bras (1992) ; 65(11): 1368-1373, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31800899

RESUMO

OBJECTIVE: We aimed to investigate cardiac and extra-cardiac pathologies in patients who were operated for acute arterial occlusion. METHODS: Between March 2010 and March 2018, a total of 120 patients who underwent surgical treatment for acute arterial occlusion were included in this retrospective study. RESULTS: 84 (70%) and 27 (22. 5%) of the patients had cardiac and extra-cardiac pathologies, respectively. In 9 (7. 5%) of the cases, no reason for arterial occlusion could be found. Pure atrial fibrillation was found in 39 (32. 5%) patients. Atrial fibrillation and cardiac valvular pathologies were detected in 45 patients (37. 5%). Among those with a cardiac valvular pathology, 9 patients (7. 5%) had pure mitral stenosis, 21 patients (17. 5%) had moderate to advanced mitral stenosis with tricuspid regurgitation, 9 patients (7. 5%) had 20-30 mitral regurgitation with 30 tricuspid regurgitation, 3 patients (2. 5%) had moderate mitral stenosis, 30-40 tricuspid regurgitation and 20-30 aortic stenosis, and 3 patients (2. 5%) had 30 mitral regurgitation, 10- 20 tricuspid regurgitation, calcific moderate aortic stenosis, and coronary artery disease. Among those 27 patients with an extra-cardiac pathology, 21 patients (22. 5%) had peripheral artery disease, 3 patients (2.5%) had an abdominal aortic aneurysm, and 3 patients (2. 5%) had Behçet's Disease. CONCLUSION: Cardiac and extra-cardiac pathologies should be kept in mind in patients with acute arterial occlusion. Thus, detected pathologies could be treated, and the development of additional peripheral emboli could be prevented.


Assuntos
Arteriopatias Oclusivas/complicações , Doença Aguda , Adulto , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
2.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471366

RESUMO

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.


Assuntos
Arteriopatias Oclusivas/cirurgia , Artéria Basilar/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombose/cirurgia , Artéria Vertebral/cirurgia , Adulto , Arteriopatias Oclusivas/complicações , Procedimentos Endovasculares/métodos , Humanos , Masculino , Punções , Stents , Acidente Vascular Cerebral/etiologia , Trombose/complicações , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 28(11): 104291, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31445856

RESUMO

We report 2 patients with acute occlusion of middle cerebral artery successfully treated by mechanical thrombectomy performed via transbrachial access. Both patients had floating aortic arch thrombi precluding safe transfemoral access due to risk of further iatrogenic embolization. Moreover both patients were diagnosed with hypercoagulopathy secondary to lung malignancy (paraneoplastic etiology, Trousseau's syndrome) as the cause of both aortic thrombi and acute ischemic stroke. Mechanical thrombectomy in the setting of a floating aortic thrombus has been mentioned only once as part of general management of floating aortic thrombi in the whole body. To the best of our knowledge, it has never been described previously in the literature in the context of cerebral mechanical thrombectomy technique. However, the diagnosis of this entity bears clinical importance for it can modify the treatment approach. A modified transbrachial approach allowed us to treat both patients without neurologic complications and resulted in modified Rankin scores of 1 on follow-up. We advise that the cross-sectional imaging of acute stroke patients should include an evaluation of the aortic arch and should be scrutinized in detail especially in patients with possible hypercoagulable state. Flat panel computed tomography technology allowed us to obtain such an imaging study in the angiography suite.


Assuntos
Doenças da Aorta/complicações , Arteriopatias Oclusivas/complicações , Isquemia Encefálica/terapia , Trombose Intracraniana/terapia , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Doenças da Aorta/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
4.
J Vasc Res ; 56(5): 217-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31272099

RESUMO

Reduced lower-limb blood flow has been shown to lead to asymmetrical abdominal aortic aneurysms (AAAs) but the mechanism of action is not fully understood. Therefore, small animal ultrasound (Vevo2100, FUJIFILM VisualSonics) was used to longitudinally study mice that underwent standard porcine pancreatic elastase (PPE) infusion (n = 5), and PPE infusion with modified 20% iliac artery stenosis in the left (n = 4) and right (n = 5) iliac arteries. Human AAA computed tomography images were obtained from patients with normal (n = 9) or stenosed left (n = 2), right (n = 1), and bilateral (n = 1) iliac arteries. We observed rapid early growth and rightward expansion (8/9 mice) in the modified PPE groups (p < 0.05), leading to slightly larger and asymmetric AAAs compared to the standard PPE group. Further examination showed a significant increase in TGFß1 (p < 0.05) and cellular infiltration (p < 0.05) in the modified PPE group versus standard PPE mice. Congruent, yet variable, observations were made in human AAA patients with reduced iliac outflow compared to those with normal iliac outflow. Our results suggest that arterial stenosis at the time of aneurysm induction leads to faster AAA growth with aneurysm asymmetry and increased vascular inflammation after 8 weeks, indicating that moderate iliac stenosis may have upstream effects on AAA progression.


Assuntos
Aneurisma da Aorta Abdominal/etiologia , Arteriopatias Oclusivas/complicações , Artéria Ilíaca , Animais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Constrição Patológica , Modelos Animais de Doenças , Progressão da Doença , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Interleucina-6/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Elastase Pancreática , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Fator de Crescimento Transformador beta1/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
5.
Cardiovasc Intervent Radiol ; 42(10): 1398-1404, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342098

RESUMO

OBJECTIVE: Percutaneous transluminal balloon angioplasty (PTA) is the main treatment option for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction. However, IVC rupture caused by PTA has never been reported. MATERIALS AND METHODS: Between August 2004 and December 2016, a consecutive cohort of 617 BCS patients with obstructed IVC who underwent PTA with or without stent placement were reviewed retrospectively to identify IVC rupture. Pre- and post-procedural imaging data, clinical and procedural technical data were analyzed. RESULTS: Of the 617 BCS patients, five patients had IVC rupture caused by PTA (0.81%). Four of these patients had retroperitoneal, intra-hepatic IVC rupture without extravasation into abdominal cavity which was successfully managed conservatively. One patient had supra-hepatic IVC rupture into the pericardial cavity which was surgically treated. CONCLUSION: IVC rupture is a rare complication of PTA treatment of BCS and most commonly located at the intra-hepatic IVC caused by oversized balloons which does not require additional treatment.


Assuntos
Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/complicações , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/terapia , Ruptura/etiologia , Veia Cava Inferior/lesões , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 28(9): e135-e138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31253482

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH. She developed right hemiplegia without dyspnea or edema. Brain magnetic resonance imaging revealed multiple fresh infarctions, while transesophageal echocardiography revealed a patent foramen ovale. Based on these findings, she was diagnosed as having paradoxical cerebral embolism. During the search for the embolic source, right heart catheterization showed significant pulmonary hypertension and pulmonary angiography revealed chronic thrombi in the peripheral pulmonary arteries, consistent with a diagnosis of CTEPH. To our knowledge, this is the first case of CTEPH to be diagnosed with the onset of paradoxical cerebral embolism. Because CTEPH is the only potentially curable form of pulmonary hypertension, clinicians should consider paradoxical cerebral embolism as a possible initial manifestation of CTEPH.


Assuntos
Arteriopatias Oclusivas/complicações , Embolia Paradoxal/etiologia , Hipertensão Pulmonar/etiologia , Embolia Intracraniana/etiologia , Trombose/complicações , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Doença Crônica , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Trombose/diagnóstico por imagem
8.
BMJ Case Rep ; 12(6)2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31196972

RESUMO

We present a previously unreported case of endovascular therapy in the acute setting of ischaemic stroke in a patient with bilateral carotid occlusion (BCO). A 54-year-old man presents with sudden onset of right-sided weakness, difficulty speaking and left-sided gaze, with National Institute of Health Stroke Scale of 22 and no abnormalities on plain CT head. CT angiography showed BCO and CT perfusion demonstrated extensive area of penumbra in both hemispheres. The patient was sent for cerebral angiography that confirmed BCO. Since symptomatology was a left middle cerebral arteries syndrome, decision was made to angioplasty and stent the left internal carotid artery emergently, which was performed successfully and the patient had complete resolution of symptoms. Acute stroke with BCO represents a challenge in decision making regarding acute management and individual assessment must be made.


Assuntos
Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Infarto da Artéria Cerebral Média/cirurgia , Acidente Vascular Cerebral/cirurgia , Angioplastia/métodos , Arteriopatias Oclusivas/complicações , Doenças das Artérias Carótidas/complicações , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Humanos , Infarto da Artéria Cerebral Média/complicações , Masculino , Pessoa de Meia-Idade , Stents , Acidente Vascular Cerebral/etiologia
9.
Future Cardiol ; 15(3): 169-173, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148471

RESUMO

Radial artery access is associated with lower bleeding risks and higher patient satisfactions compared with femoral access. It is currently the preferred access for coronary catheterization and interventions, and increasingly used for peripheral and cranial vascular interventions. Herein, we present a patient who had a recent procedures included right transradial right vertebral artery and peripheral vascular interventions. She was admitted for abdominal aortic bifemoral artery bypass, and was complicated with ST elevation myocardial infarction that required immediate cardiac catheterization. Patient did not have palpable radial access and ultrasonography confirmed a total occlusion of right radial artery with thrombus. Although distal right radial artery - at the anatomical snuff box - was not palpable, artery was patent and could be accessed successfully with ultrasonography guidance.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Arteriopatias Oclusivas/complicações , Cateterismo Periférico/métodos , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Angiografia , Arteriopatias Oclusivas/diagnóstico , Angiografia Coronária/métodos , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Radial
10.
World Neurosurg ; 129: e429-e435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150855

RESUMO

OBJECTIVE: To evaluate the 30-day outcomes of using the Enterprise stent to treat patients with hypoperfusion of symptomatic severe intracranial stenosis. METHODS: Patients with symptomatic severe intracranial stenosis (70%-99%) who underwent Enterprise stent intervention between August 2014 and November 2018 were retrospectively analyzed. The 30-day primary outcomes included the success rate of stenting and the incidence of complications, including ischemic stroke, cerebral hemorrhage, and death. The 30-day complication rates of patients with different lesion locations and classifications of Mori morphology were compared. RESULTS: Sixty-eight patients were treated using 70 Enterprise stents. The success rate was 100%. The 30-day complication rate was 4.4%. The rates of ischemic stroke, cerebral hemorrhage, and death were 1.5%, 2.9%, and 0%, respectively. No significant difference was found in the 30-day complication rate between patients with different lesion locations and classifications of Mori morphology (P > 0.05). CONCLUSION: Enterprise stents were relatively safe in treating patients with hypoperfusion of symptomatic severe intracranial stenosis.


Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/etiologia , Hemorragia Cerebral/etiologia , Procedimentos Endovasculares/métodos , Stents , Acidente Vascular Cerebral/etiologia , Idoso , Arteriopatias Oclusivas/complicações , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
Int J Mol Sci ; 20(12)2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31208079

RESUMO

Background: Observational studies support an association between periodontitis (PD) and atherosclerotic vascular disease, but little is known specifically about peripheral arterial occlusive disease (PAOD). OBJECTIVES: To systematically review the evidence for an association between PD and PAOD. DATA SOURCES: Medline via PubMed. REVIEW METHODS: We searched the Pubmed database for original studies, case reports, case series, meta-analyses and systematic reviews that assessed whether there is an association between PD (all degrees of severity) and PAOD (all degrees of severity). The reporting of this systematic review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement following the Population, Intervention, Control, and Outcome (PICO) format. RESULTS: 17 out of 755 detected studies were included in the qualitative synthesis. Nine studies demonstrated associations between PD and PAOD, and two studies reported associations between tooth loss and PAOD. Six studies addressed the pathomechanism regarding PD as a possible trigger for PAOD. No study that dismissed an association could be detected. Odds ratios or hazard ratios ranged from 1.3 to 3.9 in four large cohort studies after adjusting for established cardiovascular risk factors. CONCLUSIONS: The presented evidence supports a link between PD and PAOD. Further studies which address the temporality of PD and PAOD and randomized controlled intervention trials examining the causal impact of PD on PAOD are needed. Although our results cannot confirm a causal role of PD in the development of PAOD, it is likely that PD is associated with PAOD and plays a contributing role.


Assuntos
Arteriopatias Oclusivas/complicações , Periodontite/complicações , Doença Arterial Periférica/complicações , Animais , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/metabolismo , Ensaios Clínicos como Assunto , Humanos , Razão de Chances , Periodontite/epidemiologia , Periodontite/metabolismo , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/metabolismo , Modelos de Riscos Proporcionais , Perda de Dente/complicações , Perda de Dente/epidemiologia , Perda de Dente/metabolismo
12.
Int J Stroke ; 14(6): 603-612, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31096871

RESUMO

In major ischemic stroke caused by a large artery occlusion, neuronal loss varies considerably across individuals without revascularization. This study aims to identify which patient characteristics are most highly associated with this variability. Demographic and clinical information were retrospectively collected on a registry of 878 patients. Imaging biomarkers including Alberta Stroke Program Early CT score, noncontrast head computed tomography infarct volume, perfusion computed tomography infarct core and penumbra, occlusion site, collateral score, and recanalization status were evaluated on the baseline and early follow-up computed tomography images. Infarct growth rates were calculated by dividing infarct volumes by the time elapsed between the computed tomography scan and the symptom onset. Collateral score was graded into four levels (0, 1, 2, and 3) in comparison with the normal side. Correlation of perfusion computed tomography and noncontrast head computed tomography infarct volumes and infarct growth rates were estimated with the nonparametric Spearman's rank correlation. Conditional inference trees were used to identify the clinical and imaging biomarkers that were most highly associated with the infarct growth rate and modified Rankin Scale at 90 days. Two hundred and thirty-two patients met the inclusion criteria for this study. The median infarct growth rates for perfusion computed tomography and noncontrast head computed tomography were 11.2 and 6.2 ml/log(min) in logarithmic model, and 18.9 and 10.4 ml/h in linear model, respectively. Noncontrast head computed tomography and perfusion computed tomography infarct volumes and infarct growth rates were significantly correlated (rho=0.53; P < 0.001). Collateral status was the strongest predictor for infarct growth rates. For collateral=0, the perfusion computed tomography and noncontrast head computed tomography infarct growth rate were 31.56 and 16.86 ml/log(min), respectively. Patients who had collateral >0 and penumbra volumes>92 ml had the lowest predicted perfusion computed tomography infarct growth rates (6.61 ml/log(min)). Collateral status was closely related to the diversity of infarct growth rates, poor collaterals were associated with a faster infarct growth rates and vice versa.


Assuntos
Arteriopatias Oclusivas/patologia , Infarto/patologia , Acidente Vascular Cerebral/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Biomarcadores , Angiografia Cerebral , Angiografia por Tomografia Computadorizada/métodos , Feminino , Humanos , Infarto/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
13.
Cardiovasc Intervent Radiol ; 42(8): 1117-1127, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062068

RESUMO

OBJECTIVES: To propose a scale of severity for post-thrombotic venous lesions (PTVLs) after ilio-femoral deep venous thrombosis and to compare the grade with the results of endovascular treatment of ilio-femoral PTVLs. METHODS: In this retrospective monocentric observational study, we included 95 patients treated for ilio-femoral PTVLs. We proposed a four-grade scale evaluating the severity of PTVLS caudal to the common femoral vein based on CT phlebography and per-operative phlebography. For most patients, venous patency was assessed with color duplex ultrasonography and the clinical efficacy of the intervention using the Villalta and CIVIQ scores. RESULTS: Recanalization was successful in 100% of patients with a morbidity rate of 4%. After a mean follow-up of 21 months, the overall primary patency was 75%, the assisted primary patency 82%, and the secondary patency 93%. Secondary patency was 100% for grade 0-1, 90% for grade 2, and 63% for grade 3 (p < 0.002). There was no correlation between the extension of stenting caudally of the common femoral vein and venous patency. The mean improvements in the Villalta and CIVIQ-20 scores were, respectively, 4.6 (p < 0.0001) and 18 (p < 0.0001); scores were not correlated with the grade of PTVLs in the thigh. CONCLUSION: Venous patency after endovascular treatment of ilio-femoral PTVLs was strongly linked to the severity of PTVLs caudal to the common femoral vein but not to the extent of stenting.


Assuntos
Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/métodos , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Síndrome Pós-Trombótica/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/complicações , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
17.
J Chin Med Assoc ; 82(1): 44-49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30839403

RESUMO

BACKGROUND: To compare the efficacy, safety, and results of Viabahn versus bare-metal stents (BMS) in chronic total occluded (CTO) long femoropopliteal lesions. METHODS: From April 2009 to August 2014, a total 97 patients (71.2 ± 9.7, 45-90 years old, 70 males) with occluded femo-ropopliteal lesions underwent Viabahn (55 patients) or BMS (42 patients) implantation. The clinical findings, procedural factors, and overall outcomes were collected and analyzed. RESULTS: The average lesion length was 22.1 ± 4.8 cm in the Viabahn group and 17.8 ± 3.3 cm in the BMS group. Both groups had a 100% technical success rate. Although there was no difference between the groups in complication, mortality, and major amputation rates, the Viabahn group had a significantly better average post-operative ankle brachial index (ABI) at 1-year and 2-year follow-ups. The Viabahn group also had significantly less in-stent restenosis (ISR) and target lesion revascularization (TLR) compared with the BMS group. Nevertheless, the two groups shared similar 2-year primary patency rates (63.6% vs. 50.0%, p = .178) and 2-year secondary patency rates (85.5% vs. 81.0%, p = .554). CONCLUSION: Both Viabahn and BMS were efficient treatments for long femoropopliteal CTO lesions. However, the Viabahn group had significantly improved results compared with the BMS group in TLR and ISR, but the difference was not sufficient enough to result in different primary and secondary patency rates.


Assuntos
Arteriopatias Oclusivas/terapia , Artéria Femoral/patologia , Artéria Poplítea/patologia , Stents , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/mortalidade , Doença Crônica , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade
19.
Ultrasound Med Biol ; 45(5): 1103-1111, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30773376

RESUMO

Early information on vascular status in acute stroke is essential. We analyzed whether duplex ultrasound (DUS) using a fast-track protocol provides this information without relevant delay. One hundred forty-six patients were prospectively enrolled. DUS was performed by sonographers with two levels of experience. The carotid and vertebral arteries, as well as all basal cerebral arteries, were bilaterally analyzed. Criteria for vessel analysis were (i) normal or stenosis <50%, (ii) stenosis ≥50% and (iii) occlusion. The mean duration of the ultrasound investigation was 6:07 ± 2:06 min with a significant difference between more and less experienced investigators (p < 0.0001). Insonation times decreased during the study in both groups. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound findings in comparison with computed tomography angiography were 73%, 99%, 84% and 98%, respectively. Our data suggest that "fast track" DUS is feasible and reliable. The time required for DUS assessment depends on the sonographer´s experience.


Assuntos
Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Serviços Médicos de Emergência/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Dupla/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/fisiopatologia , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Protocolos Clínicos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Acidente Vascular Cerebral/fisiopatologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Adulto Jovem
20.
Rinsho Shinkeigaku ; 59(2): 84-92, 2019 Feb 23.
Artigo em Japonês | MEDLINE | ID: mdl-30700691

RESUMO

A significant number of patients with minor or mild stroke symptoms on initial presentation subsequently develop neurological deterioration and poor clinical outcomes at hospital discharge. The presence of an underlying large vessel occlusion is a strong predictor of both clinical worsening and poor outcome. Although patients with a low baseline National Institutes of Health Stroke Scale (NIHSS) could have been included in some randomized controlled trials, the benefits of the mechanical thrombectomy for patients with a low NIHSS score are unknown. The causes of neurological deterioration in patients with underlying large vessel occlusion are heterogeneous, but include collateral failure, and no straightforward mechanisms are found in the majority of cases. Patients with internal carotid artery occlusion, but with a patent middle cerebral artery (MCA), can occasionally have good collateral circulation and develop only minor or mild stroke. These patients exhibit collateral MCA flow via the circle of Willis despite ipsilateral internal carotid artery occlusion. However, thrombus migration may cause occlusion of collateral MCA flow, leading to dramatic neurological deterioration. Careful observation and detailed assessment are required for the management of these patients. Recent studies have examined the efficacy and optimal timing of thrombolysis or mechanical thrombectomy for patients with minor or mild stroke. Herein, we review the mechanisms of neurological deterioration, and the efficacy of reperfusion therapy, for patients with minor or mild stroke.


Assuntos
Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Arteriopatias Oclusivas/complicações , Artéria Carótida Interna , Circulação Colateral , Humanos , Artéria Cerebral Média , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia
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