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1.
Behav Brain Res ; 437: 114104, 2023 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-36100011

RESUMO

Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke, which seriously affects the quality of life and prognosis of patients. Nevertheless, the pathogenesis of PSD remains unclear. In our study, a PSD rat model was established by chronic restraint stress (CRS) combined with middle cerebral artery occlusion (MCAO). Depressive and anxiety-like behaviors were tested, as well as Neuronal loss and Apoptosis. The expression of synapse and p38 MAPK signaling pathway -relevant proteins was detected. Our data indicated that CRS combined with MCAO could induce depression-like and anxiety-like behaviors, which led to neuronal damage, apoptosis, and cellular loss in the left parietal cortex and left hippocampus. Furthermore, CRS combined with MCAO decreased synaptic plasticity in the parietal cortex and left hippocampus. We found that CRS combined with MCAO had activated the p38 MAPK signaling pathway, and decreased the expression of pathway-related proteins MKK6 and MKK3. These results suggested that CRS combined with MCAO could lead to depression-like behavior via neuronal damage, apoptosis and reduced synaptic plasticity, which might be related to the activation of the p38 MAPK pathway. Therefore, it provides novel ideas for the research on the intervention and prevention mechanisms of PSD.


Assuntos
Arteriopatias Oclusivas , Depressão , Infarto da Artéria Cerebral Média , Estresse Psicológico , Acidente Vascular Cerebral , Proteínas Quinases p38 Ativadas por Mitógeno , Animais , Ratos , Depressão/etiologia , Depressão/metabolismo , Depressão/psicologia , Modelos Animais de Doenças , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/metabolismo , Infarto da Artéria Cerebral Média/patologia , Infarto da Artéria Cerebral Média/psicologia , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Qualidade de Vida , Ratos Sprague-Dawley , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/psicologia , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/metabolismo , Sinapses/metabolismo , Transdução de Sinais , Restrição Física/efeitos adversos , Restrição Física/fisiologia , Restrição Física/psicologia , Doença Crônica , Estresse Psicológico/etiologia , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Apoptose , Ansiedade/etiologia , Ansiedade/metabolismo , Ansiedade/psicologia , Córtex Cerebral/metabolismo , Córtex Cerebral/patologia , Hipocampo/metabolismo , Hipocampo/patologia , Neurônios/metabolismo , Neurônios/patologia , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo
2.
J Invasive Cardiol ; 34(11): E757-E762, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36121925

RESUMO

OBJECTIVE: We aim to investigate the safety and efficacy of a new technique, "RailTracking," in the management of challenging transradial routes during percutaneous coronary interventions (PCI). BACKGROUND: The transradial access (TRA) currently represents the access site of choice in PCI, but complex anatomy could lead to complications and access-site crossover. The assisted-tracking techniques described in the past (such as balloon-assisted tracking and pigtail-assisted tracking) are based on the concept of a "guiding tapered tip" to improve trackability. The RailTracking technique creates a tapered catheter tip using a dedicated device. METHODS: We collected patient data from January 2021 to January 2022 in 2 high-volume centers using the RailTracking technique as a bail-out solution. A prospective analysis of the anatomical characteristics and outcomes of the study population was performed. RESULTS: Seventy-seven patients were included in the study. All patients presented with challenging anatomies; 35.1% of the patients (n = 27) had small radial arteries, 19.5% (n = 15) had significant radial tortuosity, 2.6% (n = 2) had significant brachial tortuosity, 2.6% (n = 2) had subclavian tortuosity, and 1.29% (n = 1) had a critical subclavian lesion. In addition, 38.9% presented with severe radial spasm. The procedural success rate of the RailTracking technique was 98.7% (76/77 patients). The only case of failure presented with calcifications and a critical lesion in the subclavian artery. However, no periprocedural vascular complications occurred. This new technique appears safe, with a radial artery occlusion rate of 3.89% (n = 3) at 1-month follow-up. CONCLUSION: The new RailTracking technique improves catheter crossing in challenging anatomies and seems safe and effective in cases of failure with currently available approaches.


Assuntos
Arteriopatias Oclusivas , Intervenção Coronária Percutânea , Humanos , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Artéria Radial , Arteriopatias Oclusivas/etiologia , Artéria Subclávia , Resultado do Tratamento
3.
J Invasive Cardiol ; 34(8): E627-E632, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35920732

RESUMO

OBJECTIVES: Although a distal radial artery (DRA) approach has recently been used in patients undergoing cardiac catheterization, no studies have so far investigated the safety and feasibility of DRA in patients undergoing hemodialysis (HD). We aimed to investigate the incidence of conventional radial artery (CRA) occlusion and puncture site complications after DRA puncture in patients undergoing HD. METHODS: We retrospectively analyzed the data of 117 consecutive patients with HD who underwent coronary angiography or percutaneous coronary intervention via a DRA approach at our institution from September 2017 to December 2019. The primary endpoint was the incidence of CRA occlusion after DRA puncture, as assessed via vascular ultrasonography. Secondary endpoints included difficulty achieving hemostasis, DRA occlusion, aneurysm, arteriovenous shunt, and acute ischemia. RESULTS: The DRA puncture was successful in 106 patients (success rate: 90.5%). Because 21 patients lacked postprocedural vascular ultrasonography data, the primary endpoint was evaluated in 85 patients. CRA occlusion occurred in three patients (3.5%) following DRA puncture. DRA occlusion and aneurysm occurred in five patients (5.9%) and one patient (1.2%), respectively. CONCLUSIONS: Catheterization through DRA is feasible in patients undergoing HD, with a clinically acceptable incidence of CRA and complications.


Assuntos
Arteriopatias Oclusivas , Cateterismo Periférico , Intervenção Coronária Percutânea , Arteriopatias Oclusivas/etiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Angiografia Coronária/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial , Diálise Renal/efeitos adversos , Estudos Retrospectivos
4.
Folia Med (Plovdiv) ; 64(4): 682-687, 2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36045462

RESUMO

Aortoiliac occlusive disease (AIOD) is non-inflammatory obstructive vasculopathy commonly affecting patients with advanced atherosclerosis, diabetes mellitus, or elevated cholesterol levels, and subjects with other risk factors such as cigarette smoking.Two Caucasian patients (a 55-year-old woman and a 56-year-old man), with ulcerous cutaneous lesions of AIOD are reported. In both cases, medical history comprises initial lower limb claudication, multiple painful ulcers along the legs and absence of superficial femoral artery pulse. Severe obstruction of both infrarenal aorta and iliac arteries on the left side was demonstrated by contrast angiography and Doppler ultrasonography.The evolution of the disease showed some characteristic findings, including pyoderma gangrenosum-like ulcerations as the initial cutaneous manifestation of AIOD, multiple painful ulcers along the lower extremities, and aorto-iliac occlusive disease due to atherosclerosis.Early diagnosis and surgical reconstruction of vessels in patients with AIOD improved quality of life and limb salvage rates.


Assuntos
Arteriopatias Oclusivas , Aterosclerose , Dermatopatias , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/cirurgia , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Úlcera
5.
Contrast Media Mol Imaging ; 2022: 9624339, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35924069

RESUMO

Objective: To investigate the risk factors of radial artery obstruction after repeated right radial coronary interventions. Methods: 497 patients who underwent repeated coronary intervention via the right radial artery in our hospital from January 2017 to January 2021 were selected and followed up for 28.07 ± 6.07 months. According to whether the right radial artery was obstructed or not, they were divided into radial artery occlusion group (n = 48) and nonradial artery occlusion group (n = 449). Results: The proportion of patients with diabetes mellitus, elevated D-dimer, and elevated LDL cholesterol was higher in the radial artery occlusion group than in the nonradial artery occlusion group (p < 0.05). The radial artery occlusion group had more passage through the right radial artery often and had a longer cumulative sheath retention time than the radial artery occlusion group (p < 0.05). Cumulative sheath retention time (hours) had a high predictive value for radial artery occlusion. The optimal diagnostic limit for radial artery occlusion was 2.75 h, with a sensitivity of 77.1% and a specificity of 79.5% (p < 0.05). Conclusion: Diabetes mellitus, elevated D-dimer, elevated LDL cholesterol, and long retention sheath time predispose to radial artery occlusion. Cumulative duration of sheath retention is a predictor of radial artery occlusion.


Assuntos
Arteriopatias Oclusivas , Artéria Radial , Arteriopatias Oclusivas/etiologia , LDL-Colesterol , Humanos , Fatores de Risco , Resultado do Tratamento
6.
Catheter Cardiovasc Interv ; 100(3): 387-391, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35842777

RESUMO

BACKGROUND: Radial artery occlusion (RAO) remains one of the most important complications of transradial access (TRA). Despite the identification of multiple predictors, the interaction between these predictors on the occurrence of RAO has not been evaluated. METHODS: Consecutive patients undergoing TRA coronary angiography (CA) or percutaneous coronary intervention (PCI), were retrospectively analyzed to compare the effect of standard patent hemostasis using a one-bladder band versus two-bladder band with simultaneous ipsilateral ulnar artery compression and two introducer sizes on the primary endpoint of RAO. Access was obtained using 6-Fr slender introducer sheath or 7-Fr slender introducer sheath and hemostasis with either a one-bladder band or a two-bladder band. The radial artery was evaluated using ultrasound. RESULTS: Total of 2019 patients undergoing CA or PCI were included in the analysis. In the one-bladder band group, the incidence of RAO with a 6-Fr slender introducer sheath was 4.2%. In those receiving hemostasis with a two-bladder band, RAO occurred in 1% of patients receiving a 6-Fr slender introducer sheath versus 0.9% in those receiving a 7-Fr slender introducer sheath (p = 0.68). Larger radial artery diameter, larger body weight, and a two-bladder hemostasis band with ipsilateral ulnar compression were independently associated with a lower incidence of RAO. CONCLUSION: A two-bladder band with simultaneous ipsilateral ulnar artery compression when used for radial artery hemostasis, is associated with a lower incidence of RAO, and can mitigate the penalty for a larger catheter with reassuring implications for use of a 7-Fr capable system for complex transradial PCI.


Assuntos
Arteriopatias Oclusivas , Intervenção Coronária Percutânea , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/etiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Hemostasia , Humanos , Incidência , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Artéria Radial/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
7.
Rev Neurol (Paris) ; 178(8): 771-779, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35871014

RESUMO

BACKGROUND AND PURPOSE: Acute basilar artery occlusions (BAO) are associated with poor outcome despite modern endovascular treatment (EVT). The best anesthetic management during EVT is not known and may affect the procedure and clinical outcome. We compared the efficacy and safety of general anesthesia (GA) and conscious sedation/local anesthesia (CS/LA) in a large cohort of stroke patients with BAO treated with EVT in current clinical practice. METHODS: Data from the ongoing prospective multicenter Endovascular Treatment In Ischemic Stroke Registry of consecutive acute BAO patients who had EVT indication from January 1st, 2015, to December 31st, 2021, were retrospectively analyzed. Two groups were compared: patients treated with CS/LA versus GA (both types of anesthesia being performed in the angiosuite). Good outcome was defined as modified Rankin Scale (mRS) score 0-3 at 90 days. RESULTS: Among the 524 included patients, 266 had GA and 246 had CS/LA (67 LA). Fifty-three patients finally did not undergo EVT: 15 patients (5.9%) in the GA group and 38 patients (16.1%) in the CS/LA group (P < 0.001). After matching, two groups of 129 patients each were retained for primary analysis. The two groups were well balanced in terms of baseline characteristics. After adjustment, CS/LA compared to GA was not associated with good outcome (OR=0.90 [95%CI 0.46-1.77] P=0.769) or mortality (OR=0.75 [0.37-1.49] P=0.420) or modified thrombolysis in cerebral infarction score 2b-3 (OR=0.43 [0.16-1.16] P=0.098). On mixed ordinal logistic regression, the modality of anesthesia was not associated with any significant change in the overall distribution of the 90-day mRS (adjusted OR=1.08 [0.62-1.88] P=0.767). CONCLUSIONS: Safety, outcome and quality of EVT under either CS/LA or GA for stroke due to acute BAO appear similar. Further randomized trials are warranted.


Assuntos
Anestesia Geral , Sedação Consciente , Procedimentos Endovasculares , Acidente Vascular Cerebral , Arteriopatias Oclusivas/etiologia , Artéria Basilar , Isquemia Encefálica/terapia , Sedação Consciente/métodos , Procedimentos Endovasculares/métodos , Humanos , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
8.
Vasc Endovascular Surg ; 56(5): 480-494, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35503434

RESUMO

OBJECTIVES: Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI). METHODS: We conducted a retrospective cohort study within the National Inpatient Sample (2006-2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology. RESULTS: We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 P=.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay. CONCLUSIONS: Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Abuso de Maconha , Isquemia Mesentérica , Doença Arterial Periférica , Amputação , Arteriopatias Oclusivas/etiologia , Isquemia Crônica Crítica de Membro , Procedimentos Endovasculares/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/epidemiologia , Isquemia/etiologia , Salvamento de Membro , Abuso de Maconha/complicações , Abuso de Maconha/epidemiologia , Isquemia Mesentérica/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Cardiovasc Revasc Med ; 43: 87-96, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35469761

RESUMO

BACKGROUND: Paclitaxel-eluting technologies improve the clinical outcome of femoropopliteal (FP) occlusive disease. Several studies reported efficacy of the high-dose (nominal paclitaxel density of 3.5 µg/mm2) drug-coated balloon (DCB) for complex FP lesions. However, previous studies of DCB have shown a high rate of bailout stents, and few studies have compared the high-dose DCB with successful lesion pre-dilation without bailout stent and drug-eluting stent (DES) in chronic total occlusion (CTO) of the superficial femoral artery (SFA). This study aimed to compare the clinical outcome of high-dose DCB with successful lesion preparation and DES in CTO of the SFA. METHODS: This was a single-center, retrospective study. From June 2018 to November 2020, we compared 41 patients (43 lesions) treated with high-dose DCB and 36 patients (37 lesions) treated with DES. The study period was defined as the period after DCB and DES became available simultaneously at our hospital, when all surviving patients had at least 1 year of follow-up. The primary endpoint was 12-month primary patency. The secondary endpoints were 12-month freedom from: (1) clinically driven target lesion revascularization (CD-TLR), and (2) re-occlusion. RESULTS: Baseline clinical data were comparable between the two groups. Reference vessel diameter was smaller in the DCB group. The mean lesion and occlusion lengths were about the same in both groups. The subintimal angioplasty and bailout stent rate was 0% in the DCB group. The Kaplan-Meier estimate for 12-month primary patency was 92.0% in the DCB group and 87.2% in the DES group (p = 0.47). Freedom from CD-TLR also did not differ significantly between the two groups. The 12-month freedom from re-occlusion rate tended to be higher in the DCB group than in the DES group. CONCLUSIONS: High-dose DCB with successful lesion preparation showed 12-month clinical outcomes comparable with DES for CTO of the SFA, even without bailout stents.


Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas , Stents Farmacológicos , Doença Arterial Periférica , Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/etiologia , Materiais Revestidos Biocompatíveis , Artéria Femoral/diagnóstico por imagem , Humanos , Paclitaxel/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
BMJ Case Rep ; 15(4)2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410945

RESUMO

We describe a girl in middle childhood with newly diagnosed Crohn's disease, who presented with seizures and altered mental status. MRI showed an abnormal vascular signal at the basilar artery, but no evidence of acute ischaemia. Her weakness worsened over the next 8 hours to dense quadriplegia. CT angiography of the brain, approximately 24 hours after the initial onset of symptoms, identified an acute basilar artery occlusion with infarction. She received endovascular thromboembolectomy emergently. She showed significant improvement over 8-month period from quadriplegia to walking unassisted. This case highlights the importance of recognising stroke in patients with inflammatory bowel disease and the need for emergent radiological assessment and potential intervention.


Assuntos
Arteriopatias Oclusivas , Doença de Crohn , Acidente Vascular Cerebral , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/cirurgia , Artéria Basilar , Criança , Doença de Crohn/complicações , Feminino , Humanos , Quadriplegia
12.
Ann Neurol ; 92(1): 97-106, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35438200

RESUMO

OBJECTIVE: We aimed to investigate the effectiveness of endovascular therapy (EVT) versus intravenous thrombolysis (IVT) in patients with basilar artery occlusion (BAO), based on the information of advanced imaging. METHODS: We analyzed data of stroke patients with radiologically confirmed BAO within 24 hours. BAO subjects were categorized into "top-of-the-basilar" syndrome (TOBS) and other types. An initial infarct size of <70ml and a ratio of ischemic tissue to infarct volume of ≥1.8 was defined as "target mismatch." The primary outcome was a good outcome, defined as a modified Rankin Scale score of 0 to 3 at 3 months. Propensity score adjustment and inverse probability of treatment weighting (IPTW) propensity score methods were used. RESULTS: Among 474 BAO patients, 93 (19.6%) were treated with IVT prior to EVT, 91 (19.2%) were treated with IVT alone, 95 (20.0%) were treated with EVT alone, and 195 (41.1%) were treated with antithrombotic therapy. In IPTW analyses, we found no benefit of EVT over IVT for good outcome in either TOBS patients (odds ratio = 1.08, 95% confidence interval [CI] = 0.88-1.31) or those with other types (odds ratio = 1.13, 95% CI = 0.94-1.36). However, in patients with other types, if there existed a target mismatch, EVT was independently related to good outcome (odds ratio = 1.46, 95% CI = 1.17-1.81). INTERPRETATION: The "target mismatch profile" seems to be a possible candidate selection standard of EVT for those with other types of BAO. Future studies should separate TOBS from other types of BAO, and try to use advanced imaging. ANN NEUROL 2022;92:97-106.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/terapia , Artéria Basilar/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Humanos , Infarto , Reperfusão , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Resultado do Tratamento
13.
JACC Cardiovasc Interv ; 15(8): 810-819, 2022 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-35450681

RESUMO

OBJECTIVES: The aim of this trial was to test whether the potassium ferrate hemostatic patch (PFHP) as an adjunct to the TR Band (TRB) facilitated an early deflation protocol. BACKGROUND: Shorter TRB compression times may reduce the rate of radial artery occlusion (RAO) and reduce observation time after transradial access. METHODS: A total of 443 patients were randomized to the TRB or PFHP + TRB, with complete TRB deflation attempted 60 minutes postprocedure. The primary outcome was the time to successful full deflation of the TRB without bleeding, with secondary outcomes of time to discharge and complications including hematoma, RAO, or bleeding requiring intervention beyond TRB reinflation. RESULTS: Time to complete TRB deflation was 66 ± 14 minutes with the PFHP vs 113 ± 56 minutes for the TRB alone (P < 0.001). Minor rebleeding requiring TRB reinflation was much more frequent without the PFHP (0% vs 67.7%; P < 0.001) with 2.3 ± 1.3 additional reinflation and deflation attempts needed for hemostasis. Hematomas developed in 4.0% of the PFHP group and 6.8% of the TRB group (P = 0.20). RAO was rare (<1%), although 41% of patients received <5,000 U heparin. Among percutaneous coronary intervention patients, time to TRB deflation (68 ± 15 minutes vs 138 ± 62 minutes; P < 0.001) and composite complications (10.0% vs 24.2%; P = 0.04) were reduced with the PFHP. CONCLUSIONS: Compared with the TRB alone, the PFHP facilitated early 60-minute TRB deflation following transradial catheterization, with a numeric reduction in vascular complications. RAO occurs rarely with early deflation regardless of heparin dose. (Comparing TR Band to StatSeal in Conjunction With TR Band II [StatSeal II]; NCT04046952).


Assuntos
Arteriopatias Oclusivas , Cateterismo Periférico , Hemostáticos , Arteriopatias Oclusivas/etiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Hemostasia , Técnicas Hemostáticas , Hemostáticos/efeitos adversos , Heparina/efeitos adversos , Humanos , Compostos de Ferro , Compostos de Potássio , Artéria Radial/diagnóstico por imagem , Fator de Transcrição STAT2 , Resultado do Tratamento
14.
J Neurointerv Surg ; 14(12): 1173-1179, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35387858

RESUMO

BACKGROUND: Whether endovascular thrombectomy (EVT) is superior to standard medical treatment (SMT) for stroke patients with acute basilar artery occlusion (BAO) is uncertain. This systematic review and meta-analysis aimed to compare the safety and efficacy of EVT with SMT for treating BAO patients. METHODS: Papers were retrieved from PubMed, Embase, and the Cochrane Library databases. The primary outcome of this meta-analysis was favorable functional outcomes at 3 months (defined as a modified Rankin Scale (mRS) score of ≤3). A random effect model was used to calculate risk ratios (RR) with 95% confidence intervals (CIs) per outcome. RESULTS: Five articles, including two randomized controlled trials (RCTs) and four observational cohort studies, comprising 1484 patients (1024 in the EVT group and 460 in the SMT group), were included in the meta-analysis. The pooled results demonstrated no significant differences between the EVT and SMT groups in achieving favorable functional outcomes at 3 months (RR=1.63, 95% CI 0.90, 2.96; p=0.11). However, patients in the EVT group had higher rates for symptomatic intracerebral hemorrhage (RR=6.22, 95% CI 2.06 to 18.76; p=0.001) but lower mortality at 3 months (RR=0.72, 95% CI 0.56 to 0.91; p=0.007) than patients in the SMT group. CONCLUSION: Among patients with BAO, EVT and SMT did not differ significantly in achieving favorable functional outcomes at 3 months, but BAO patients treated with EVT might have lower mortality at 3 months. RCTs are warranted to further assess the efficacy and safety of EVT for BAO patients.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Humanos , Arteriopatias Oclusivas/etiologia , Artéria Basilar , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Trombectomia/métodos , Resultado do Tratamento
15.
Vasc Endovascular Surg ; 56(5): 509-513, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35404719

RESUMO

Objective: Persistence of the sciatic artery is a rare phenomenon in vascular surgery. It results from abnormal embryologic development, and where present in the absence of a femoral arterial system, it can have significant clinical implications for patients and can even be limb threatening. We present the case of a 69-year-old man with left-sided, short-distance claudication and rest pain, which caused concern for critical limb ischaemia. Methods: Computed tomography angiography revealed a persistent sciatic artery arising from the common iliac artery and resulting in an occluded popliteal artery. The patient underwent a double-bypass procedure to restore the arterial supply to the symptomatic limb. A left iliopopliteal Dacron graft bypass was performed, followed by a left iliopopliteal Dacron to posterior tibial bypass using the patient's great saphenous vein. The left sciatic artery was ligated proximally. Results:This allowed for restoration of arterial supply to the patient's left lower limb, relieving his claudication and rest pain. Conclusion: The key finding was the aneurysmal nature of the sciatic artery, reflecting the likely thromboembolic nature of the distal popliteal disease. Thus, our patient required not only a bypass procedure but also ligation of the native sciatic artery. Timely management is critical due to severity of consequences.


Assuntos
Arteriopatias Oclusivas , Doença Arterial Periférica , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/cirurgia , Artéria Femoral/cirurgia , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/etiologia , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Masculino , Dor , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Polietilenotereftalatos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Veia Safena/diagnóstico por imagem , Veia Safena/transplante , Resultado do Tratamento
16.
Am J Case Rep ; 23: e936295, 2022 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-35462393

RESUMO

BACKGROUND Acute arterial occlusion after total knee arthroplasty (TKA) is a rare but occasionally limb-threatening complication. Successful outcomes of surgical treatment for acute arterial occlusion after TKA have been frequently reported in the literature; however, few reports have described conservative treatment. This case report describes the successful conservative treatment of popliteal artery occlusion after TKA. CASE REPORT We report 2 cases of popliteal artery occlusion after TKA that were managed with conservative treatment. In Case 1, a 68-year-old woman presented with a weak dorsalis pedis pulse in the foot and weakness to dorsiflexion of the toe on the operative side immediately after TKA. The operative lower extremity arterial ultrasonography and computed tomography angiography demonstrated the popliteal artery occlusion. In Case 2, a 79-year-old woman presented a cold right foot and lack of popliteal and dorsalis pedis pulse in the operated extremity immediately after TKA, and Doppler ultrasound did not reveal a flow for the dorsalis pedis artery. In both patients, urgent angiographies showed popliteal artery occlusion, and blood flow was observable in the anterior tibial, peroneal, and foot arteries collateral perfusion. Thus, conservative treatments were chosen, and anticoagulant and vasodilator therapies were undergone in both patients. At 6 months after surgery, they were able to walk without intermittent claudication. CONCLUSIONS Conservative treatment can be a good option for popliteal artery occlusion after TKA in cases of rich collateral circulation.


Assuntos
Arteriopatias Oclusivas , Artroplastia do Joelho , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/cirurgia , Artroplastia do Joelho/efeitos adversos , Tratamento Conservador , Feminino , Humanos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/cirurgia
17.
World J Gastroenterol ; 28(8): 868-877, 2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35317096

RESUMO

BACKGROUND: During pancreaticoduodenectomy in patients with celiac axis (CA) stenosis due to compression by the median arcuate ligament (MAL), the MAL has to be divided to maintain hepatic blood flow in many cases. However, MAL division often fails, and success can only be determined intraoperatively. To overcome this problem, we performed endovascular CA stenting preoperatively, and thereafter safely performed pancreaticoduodenectomy. We present this case as a new preoperative treatment strategy that was successful. CASE SUMMARY: A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery. Preoperative assessment revealed CA stenosis caused by MAL. We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications. Double-antiplatelet therapy (DAPT) - which is needed when a stent is inserted - was then administered in parallel with neoadjuvant chemotherapy (NAC). This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC. Subtotal stomach-preserving pancreaticoduodenectomy was then performed. The operation did not require any unusual techniques and was performed safely. Postoperatively, the patient progressed well, without any ischemic complications. Histopathologically, curative resection was confirmed, and the patient had no recurrence or complications due to ischemia up to six months postoperatively. CONCLUSION: Preoperative endovascular stenting, with NAC and DAPT, is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer.


Assuntos
Arteriopatias Oclusivas , Neoplasias Pancreáticas , Idoso , Arteriopatias Oclusivas/etiologia , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Constrição Patológica/etiologia , Humanos , Masculino , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos
18.
Circ Cardiovasc Interv ; 15(4): e011555, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35317614

RESUMO

BACKGROUND: Adequate procedural anticoagulation is crucial for radial artery occlusion (RAO) prevention in patients undergoing transradial access coronary catheterization, although the effect of postprocedural anticoagulation lack thorough investigation. The aim of this study was to evaluate the clinical value of short-term postoperative anticoagulation with rivaroxaban for 24 hours and 1-month RAO prevention in patients who received transradial coronary procedures. METHODS: A total of 382 patients were randomized to receive either placebo (control group) or rivaroxaban 10 mg once daily for a period of 7 days (rivaroxaban group) to evaluate the effect of the rivaroxaban in the prevention of 24 hours and 1-month RAO assessed by Doppler ultrasound. RESULTS: There was no significant difference in the incidence of 24-hour RAO (8.9% versus 11.5%; P=0.398) between the rivaroxaban group and control group (odds ratio, 0.75 [95% CI, 0.39-1.46]; P=0.399). In contrast, the 1-month RAO (3.8% versus 11.5%; P=0.011) was significantly reduced in patients who received rivaroxaban as compared with those who did placebo (odds ratio, 0.22 [95% CI, 0.08-0.65]; P=0.006). For patients with 24-hour RAO, the rivaroxaban group was associated with higher recanalization rate of the radial artery (69.2% versus 30.0%; P=0.027) compared with the control group. No significant differences can be observed between the 2 groups for access-site complications or bleeding events. CONCLUSIONS: Short-term postoperative anticoagulation with rivaroxaban did not reduce the rate of 24-hour RAO but improved 1-month RAO, because of higher recanalization of the radial artery. However, larger clinical trials are needed to prove our results. REGISTRATION: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900026974.


Assuntos
Arteriopatias Oclusivas , Rivaroxabana , Anticoagulantes/efeitos adversos , Arteriopatias Oclusivas/etiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Humanos , Artéria Radial/diagnóstico por imagem , Rivaroxabana/efeitos adversos , Resultado do Tratamento
19.
JACC Cardiovasc Interv ; 15(10): 1009-1018, 2022 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-35331684

RESUMO

OBJECTIVES: The aim of this study was to evaluate whether administration of nitroglycerin at the beginning or end of a transradial approach (TRA) procedure would preserve radial patency. BACKGROUND: The TRA is becoming the preferred vascular access route in coronary interventions. Radial artery occlusion (RAO) is the most frequent complication. Routine vasodilator treatment aims to reduce spasm and possibly prevent RAO. METHODS: The authors designed a prospective, multicenter, randomized, double-blind, 2-by-2 factorial, placebo-controlled trial encompassing patients undergoing the TRA. Patients were randomized to either 500 µg nitroglycerin or placebo; each arm was also subrandomized to early (upon sheath insertion) or late (right before sheath removal) nitroglycerin administration to evaluate the superiority of nitroglycerin in the prevention of RAO with 24 hours on Doppler ultrasound. RESULTS: A total of 2,040 patients were enrolled. RAO occurred in 49 patients (2.4%). Fifteen of these patients (30.6%) showed re-establishment of flow at 30 days. Nitroglycerin, compared with placebo, did not reduce the risk for RAO at either of the 2 time points (early, 2.5% vs 2.3% [P = 0.66]; late, 2.3% vs 2.5% [P = 0.66]). By multivariable analysis, the presence of spasm (OR: 3.53; 95% CI: 1.87-6.65; P < 0.001) and access achieved with more than 1 puncture attempt (OR: 2.58; 95% CI: 1.43-4.66; P = 0.002) were independent predictors of RAO. CONCLUSIONS: The routine use of nitroglycerin was not associated with a reduction in the rate of RAO, regardless of the time of administration (at the beginning or end of the TRA procedure).


Assuntos
Arteriopatias Oclusivas , Artéria Radial , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/prevenção & controle , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Humanos , Nitroglicerina/efeitos adversos , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Espasmo/complicações , Espasmo/prevenção & controle , Resultado do Tratamento
20.
J Cardiovasc Transl Res ; 15(5): 1203-1211, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35334079

RESUMO

Radial artery occlusion (RAO) is still a major complication of coronary catheterization (CC) via transradial access (TRA). Recently, coronary angiography (CAG) and percutaneous coronary intervention (PCI) through distal transradial access (dTRA) have been proven to be safe and feasible, but RAO recanalization and complete CC via dTRA have been rarely reported. Twenty-nine consecutive patients with RAO were enrolled in the present study. RAO was first confirmed by ultrasonography and after puncture of the distal radial artery (RA) in the anatomical snuffbox; cannula angiography was conducted to confirm total RAO. With the exception of two patients, we successfully recanalized the occluded RA in 27 patients. After RAO recanalization, subsequent CAG and PCI were successful, and no complications occurred. RAO recanalization and complete coronary catheterization via dTRA are safe and feasible.


Assuntos
Arteriopatias Oclusivas , Intervenção Coronária Percutânea , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Angiografia Coronária/efeitos adversos , Arteriopatias Oclusivas/etiologia
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