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2.
Head Neck ; 46(7): E71-E74, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38606699

RESUMO

BACKGROUND: The concept of reserve flow perfusion for free flap reconstruction has been demonstrated in various applications in the literature. As it relates to the anterolateral thigh (ALT) free flap, the reserve flow principle has been primarily described to either augment or "supercharge" a large ALT to optimize skin perforator supply or lengthen the vascular pedicle. METHODS: We report a case of a 77-year old male with chronic renal failure who had extensive atherosclerosis of the proximal descending lateral circumflex femoral artery (LCFA) where arterial anastomosis was unable to be performed. RESULTS: We were able to circumvent this limitation by establishing reserve flow perfusion solely through the distal end of the descending LCFA. We describe our technique within the context of current literature on the topic of reverse flow perfusion in free flap reconstruction. CONCLUSION: This report uniquely describes applying the distally based, reverse arterial flow principle in an ALT flap to circumvent an atherosclerotic proximal pedicle.


Assuntos
Anastomose Cirúrgica , Aterosclerose , Artéria Femoral , Retalhos de Tecido Biológico , Coxa da Perna , Humanos , Masculino , Idoso , Retalhos de Tecido Biológico/irrigação sanguínea , Coxa da Perna/cirurgia , Coxa da Perna/irrigação sanguínea , Artéria Femoral/cirurgia , Anastomose Cirúrgica/métodos , Aterosclerose/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Falência Renal Crônica/cirurgia
3.
Khirurgiia (Mosk) ; (12): 95-102, 2023.
Artigo em Russo | MEDLINE | ID: mdl-38088846

RESUMO

Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.


Assuntos
Aterosclerose , Síndrome do Roubo Subclávio , Insuficiência Vertebrobasilar , Humanos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Qualidade de Vida , Síndrome do Roubo Subclávio/diagnóstico , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/cirurgia , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/cirurgia , Stents , Resultado do Tratamento
4.
Medicina (Kaunas) ; 59(11)2023 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-38003992

RESUMO

Background and Objectives: Surgical revascularisation of patients with atherosclerosis of the ascending aorta remains a challenge. Different surgical strategies have been described in coronary surgical patients to offer alternative revascularisation strategies other than the conventional surgical revascularisation in patients unsuitable for it. The aim of this study is to compare the real-world outcomes between two groups of patients who underwent off-pump surgery (left internal mammary artery graft to the left anterior descending artery) or a hybrid with a percutaneous revascularisation procedure at a later stage. Materials and Methods: This is a single-centre retrospective observational study. Between the years 2010 and 2021, 91/6863 patients (1.33%) were diagnosed with severe atherosclerosis of the ascending aorta. All the patients were treated with off-pump revascularisation (91 patients), and the cardiologist would decide at a later stage whether the rest of the vessels would be treated with percutaneous revascularisation (25 patients). Results: There was no statistical difference in the various preoperative characteristics, except for coronary artery left main disease (30.30% vs. 64%; p = 0.0043). The two groups had no statistical differences in the perioperative characteristics and postoperative complications. The 1-, 5-, and 10-year mortality rates in the two groups were 6.1% vs. 0%, 59% vs. 80%, and 93.9% vs. 100%, respectively (off-pump vs. hybrid with percutaneous revascularisation procedure, p = 0.1958). Conclusions: Both strategies have high long-term comparable mortality. The off-pump surgery and the HCR procedure at a later stage may be solutions for these high-risk patients, but the target treatment should be complete HCR revascularisation during the index hospitalization.


Assuntos
Aterosclerose , Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana , Humanos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/etiologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Aterosclerose/complicações , Aterosclerose/cirurgia , Aorta/cirurgia , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (9): 103-109, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37707339

RESUMO

Treatment of multilevel atherosclerotic lesions of the lower limb arteries is an acute problem in modern medicine. There is no a single treatment algorithm. Hybrid technologies are one of the possible treatment options. There are reasonable assumptions that these technologies can at least partially solve this problem. Minor trauma is an undoubted advantage of hybrid technologies. Therefore, these approaches are advisable in severe patients with various comorbidities and contraindications for traditional methods. Therefore, analysis of hybrid methods is of great interest for cardiovascular surgeons. Hybrid method is now recognized as one of the most effective and minimally traumatic treatment for patients with atherosclerotic lesions of the lower extremities.


Assuntos
Artérias , Aterosclerose , Humanos , Extremidade Inferior/cirurgia , Algoritmos , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Contraindicações
6.
Eur J Vasc Endovasc Surg ; 66(5): 632-643, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37451604

RESUMO

OBJECTIVE: Chronic mesenteric ischaemia (CMI) treatment focuses on symptom relief and prevention of disease progression. Endovascular repair represents the main treatment modality, while data on the associated antiplatelet regimen are scarce. The aim of this meta-analysis was to assess the early and midterm outcomes of endovascular repair in patients with CMI. DATA SOURCES: Randomised controlled trials and observational studies (1990 - 2022) reporting on early and midterm endovascular repair outcomes in patients with atherosclerotic CMI. REVIEW METHODS: The PRISMA guidelines and PICO model were followed. The protocol was registered to PROSPERO (CRD42023401685). Medline, Embase (via Ovid), and Cochrane databases were searched (end date 21 February 2023). The Newcastle-Ottawa Scale was used for risk of bias assessment, and GRADE for evidence quality assessment. Primary outcomes were technical success, 30 day mortality, and symptom relief, assessed using prevalence meta-analysis. The role of dual antiplatelet therapy (DAPT) was investigated using meta-regression analysis. RESULTS: Sixteen retrospective studies (1 224 patients; mean age 69.8 ± 10.6 years; 60.3% female) reporting on 1 368 target vessels (57.8% superior mesenteric arteries) were included. Technical success was 95.0% (95% CI 93 - 97%, p = .28, I2 19%, low certainty), the 30 day mortality rate was 2.0% (95% CI 2 - 4%, p = .93, I2 36%, low certainty), and immediate symptom relief was 87.0% (95% CI 80 - 92%, p < .010, I2 85%, very low certainty). At mean follow up of 28 months, the mortality rate was 15.0% (95% CI 9 - 25%, p = .010, I2 86%, very low certainty), symptom recurrence 25.0% (95% CI 21 - 31%, p < .010, I2 68%, very low certainty) and re-intervention rate 26.0% (95% CI 17 - 37%, p < .010, I2 92%, very low certainty). Single antiplatelet therapy (SAPT) and DAPT performed similarly in the investigated outcomes. CONCLUSION: Endovascular repair for CMI appears to be safe as first line treatment, with a low peri-operative mortality rate and acceptable immediate symptom relief. During midterm follow up, symptom recurrence and need for re-intervention are not uncommon. SAPT appears to be equal to DAPT in post-operative outcomes.


Assuntos
Aterosclerose , Procedimentos Endovasculares , Isquemia Mesentérica , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Isquemia Mesentérica/etiologia , Estudos Retrospectivos , Inibidores da Agregação Plaquetária/uso terapêutico , Aterosclerose/complicações , Aterosclerose/cirurgia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos
7.
J Neurosurg ; 139(6): 1715-1721, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37310068

RESUMO

OBJECTIVE: Authors of this study aimed to evaluate the effects of collateral status on the prognostic value of endovascular treatment (EVT) in patients with basilar artery occlusion (BAO) due to large-artery atherosclerosis (LAA). METHODS: The study included 312 patients from the BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry who had undergone EVT for acute BAO due to LAA and whose composite collateral scores were available. The effects of collateral status on EVT were assessed based on the composite collateral score (0-2 vs 3-5). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. RESULTS: The composite collateral score was 0-2 in 130 patients and 3-5 in 182. A good collateral status (composite collateral score 3-5) was associated with a favorable outcome (66/182 [36.3%] vs 31/130 [23.8%], adjusted odds ratio [aOR] 2.21, 95% CI 1.18-4.14, p = 0.014). A lower baseline National Institutes of Health Stroke Scale (NIHSS) score was an independent predictor of a favorable outcome in the poor collateral status group (aOR 0.91, 95% CI 0.87-0.96, p = 0.001). In the good collateral status group, there was a significant correlation between favorable outcomes and a younger age (aOR 0.96, 95% CI 0.92-0.99, p = 0.016), lower baseline NIHSS score (aOR 0.89, 95% CI 0.85-0.93, p < 0.001), lower proportion of diabetes mellitus (aOR 0.31, 95% CI 0.13-0.75, p = 0.009), and shorter procedure time (aOR 0.99, 95% CI 0.98-1.00, p = 0.003). CONCLUSIONS: A good collateral status was a strong prognostic factor after EVT in patients with BAO underlying LAA. A shorter procedure time was associated with favorable outcomes in patients with a good collateral status.


Assuntos
Arteriopatias Oclusivas , Aterosclerose , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Resultado do Tratamento , Procedimentos Endovasculares/métodos , Estudos Retrospectivos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Aterosclerose/complicações , Aterosclerose/cirurgia , Trombectomia/métodos , Acidente Vascular Cerebral/etiologia
8.
PLoS One ; 18(5): e0285982, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37205640

RESUMO

OBJECTIVE: Despite advances in the nonsurgical management of cerebrovascular atherosclerotic steno-occlusive disease, approximately 15-20% of patients remain at high risk for recurrent ischemia. The benefit of revascularization with flow augmentation bypass has been demonstrated in studies of Moyamoya vasculopathy. Unfortunately, there are mixed results for the use of flow augmentation in atherosclerotic cerebrovascular disease. We conducted a study to examine the efficacy and long term outcomes of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in patients with recurrent ischemia despite optimal medical management. METHODS: A single-institution retrospective review of patients receiving flow augmentation bypass from 2013-2021 was conducted. Patients with non-Moyamoya vaso-occlusive disease (VOD) who had continued ischemic symptoms or strokes despite best medical management were included. The primary outcome was time to post-operative stroke. Time from cerebrovascular accident to surgery, complications, imaging results, and modified Rankin Scale (mRS) scores were aggregated. RESULTS: Twenty patients met inclusion criteria. The median time from cerebrovascular accident to surgery was 87 (28-105.0) days. Only one patient (5%) had a stroke at 66 days post-op. One (5%) patient had a post-operative scalp infection, while 3 (15%) developed post-operative seizures. All 20 (100%) bypasses remained patent at follow-up. The median mRS score at follow up was significantly improved from presentation from 2.5 (1-3) to 1 (0-2), P = .013. CONCLUSIONS: For patients with high-risk non-Moyamoya VOD who have failed optimal medical therapy, contemporary approaches to flow augmentation with STA-MCA bypass may prevent future ischemic events with a low complication rate.


Assuntos
Aterosclerose , Revascularização Cerebral , Doença de Moyamoya , Acidente Vascular Cerebral , Cirurgiões , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Doença de Moyamoya/complicações , Doença de Moyamoya/cirurgia , Aterosclerose/complicações , Aterosclerose/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Artéria Cerebral Média/cirurgia , Artérias Temporais , Revascularização Cerebral/métodos , Resultado do Tratamento , Circulação Cerebrovascular
9.
Eur J Vasc Endovasc Surg ; 66(2): 245-251, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37201719

RESUMO

OBJECTIVE: Patients with chronic limb threatening ischaemia (CLTI) suffer from pain and non-healing ulcers, which impact negatively on both their physical and mental health. While maintaining and improving quality of life is a principal aim with all treatments, little is known about the health related quality of life (HRQoL) of CLTI patients and how revascularisation procedures impact on HRQoL endpoints. The aim of this study was to investigate disease specific HRQoL before and after revascularisation in patients with CLTI undergoing femoropopliteal revascularisation. METHODS: HRQoL was prospectively analysed in 190 CLTI patients with main atherosclerotic target lesions in the femoropopliteal segment, who were planned for endovascular or open revascularisation. The choice of revascularisation method was made by the vascular team, represented by both open and endovascular expertise. The Vascular Quality of Life (VascuQoL) questionnaire was used to assess disease specific HRQoL before revascularisation and one month, one year, and two years after the procedure. Main endpoints were mean VascuQoL score changes, effect sizes of observed changes and the proportion reaching a minimally important difference (half a standard deviation change from baseline) during two years after revascularisation. RESULTS: Patient reported VascuQoL scores were low at baseline (mean 2.68, 95% CI 1.18 - 4.17). After revascularisation, the mean VascuQoL score improved statistically significantly over time, with the largest improvement observed after one year (difference from baseline 2.02, 95% CI 1.75 - 2.29; p < .001). No differences in HRQoL change over time were observed between patients treated with endovascular approaches compared with bypass surgery. Approximately half the patients reached the minimally important threshold at one year (53%), which was largely maintained also at two years (41%). CONCLUSION: While CLTI profoundly affected HRQoL, a large and clinically meaningful HRQoL increase was observed after revascularisation. This confirms the value of CLTI revascularisation on HRQoL and underlines the importance of including patient reported outcomes when evaluating revascularisation procedures in CLTI patients.


Assuntos
Aterosclerose , Procedimentos Endovasculares , Doença Arterial Periférica , Humanos , Isquemia Crônica Crítica de Membro , Qualidade de Vida , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/patologia , Isquemia/cirurgia , Procedimentos Cirúrgicos Vasculares , Aterosclerose/cirurgia , Salvamento de Membro/métodos , Resultado do Tratamento , Fatores de Risco , Estudos Retrospectivos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Doença Crônica
10.
Heart Vessels ; 38(9): 1117-1129, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37217811

RESUMO

Isolated atherosclerotic popliteal lesions (IAPLs) have been considered challenging. This study aimed to investigate the efficacy of endovascular therapy (EVT) using the newer devices for IAPLs. This retrospective multicenter registry analyzed patients with lower extremity artery disease having IAPLs who underwent EVT using the newer devices between 2018 and 2021. The primary outcome was primary patency 1 year after EVT. A total of 392 consecutive patients undergoing EVT for IAPLs were enrolled. The Kaplan-Meier analysis showed that the primary patency and the freedom from target lesion revascularization were 80.9% and 87.8% 1 year after EVT, respectively. The multivariate Cox proportional hazards regression analysis showed that the clinical features that were independently associated with restenosis risk were drug-coated balloon (DCB) use for younger age (< 75 years old; adjusted hazard ratio, 3.08 [95% confidence interval 1.08-8.74]; P = 0.035), non-ambulatory status (2.74 [95% confidence interval 1.56-4.81]; P < 0.001), cilostazol use (0.51 [95% confidence interval 0.29-0.88]; P = 0.015), severe calcification (1.86 [95% confidence interval 1.18-2.94]; P = 0.007), and small external elastic membrane (EEM) area measured by intravascular ultrasound (IVUS) (< 30 mm2) (2.07 [95% confidence interval 1.19-3.60]; P = 0.010). From the univariate analysis, among patients treated with DCB, younger patients (n = 141) were associated with more comorbidities including smoking (P < 0.001), diabetes mellitus (P < 0.001), end-stage renal disease (P < 0.001), history of revascularization (P = 0.046) and small EEM area (P = 0.036), compared to older patients (n = 140). Moreover, smaller post-procedural minimum lumen area measured by IVUS after DCB dilatation was observed in younger patients (12 ± 4 vs. 14 ± 4 mm2, P = 0.033). This retrospective study demonstrated that the current EVT provided an acceptable 1-year primary patency rate in patients with IAPLs. The primary patency was lower following DCB in younger patients, likely due to the higher rates of comorbidities in this patient population.


Assuntos
Angioplastia com Balão , Aterosclerose , Procedimentos Endovasculares , Doença Arterial Periférica , Humanos , Idoso , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Artéria Femoral , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/terapia , Doença Arterial Periférica/etiologia , Angioplastia com Balão/efeitos adversos , Resultado do Tratamento , Aterosclerose/cirurgia , Aterosclerose/etiologia , Procedimentos Endovasculares/efeitos adversos , Sistema de Registros , Grau de Desobstrução Vascular , Materiais Revestidos Biocompatíveis
11.
Updates Surg ; 75(4): 1037-1039, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36799920

RESUMO

The chronic organ shortage and the increased number of patients on the waiting list for liver transplantation have led to a progressive increase in the use of extended criteria donors. Nowadays more and more overweight donors with several comorbidities are selected for donation providing acceptable patient and liver graft survival. These donors have often aortic atherosclerosis which can spare the hepatic artery making suitable the liver for procurement. Massive aortic atherosclerosis localized to infrarenal aorta can challenge aortic cannulation for organ cooling. We herein describe in a stepwise approach the aortic cannulation realized at the ascending aorta level in case of massive infrarenal aortic atherosclerosis in ECD donors. This technique represents a safe option when abdominal aorta is not suitable for cannulation and it should be included into the surgical armamentarium of liver transplant surgeon.


Assuntos
Aorta Abdominal , Aterosclerose , Humanos , Aorta Torácica , Doadores de Tecidos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Cateterismo , Aterosclerose/cirurgia
12.
World Neurosurg ; 173: 199-207.e8, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36758795

RESUMO

BACKGROUND: Atherosclerotic steno-occlusive cerebrovascular disease includes extracranial carotid occlusive and intracranial atherosclerotic disease. Despite the negative findings in Carotid Occlusion Surgery Study (COSS), many large centers continue to report favorable results for revascularization surgery in select groups of patients. The aim of our study was to perform an updated systematic review to investigate the role of revascularization surgery for atherosclerotic steno-occlusive patients in the modern era. METHODS: Five independent reviewers performed Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature searches in October 2022 to identify articles reporting clinical outcomes in adult patients undergoing bypass for atherosclerotic steno-occlusive disease. Primary endpoints used were perioperative and long-term ischemic strokes, intracerebral hemorrhage, bypass patency, and favorable clinical outcomes. Study quality was evaluated with Newcastle-Ottawa, JADAD, and the Oxford Center for Evidence-Based Medicine scales. RESULTS: A total of 6709 articles were identified in the initial search. Of these articles, 50 met the inclusion criteria and were included in the systematic review. A notable increase in the proportion of articles published over the past 10 years was observed. There were 6046 total patients with 4447 bypasses performed over the period from 1978 to 2022. The average length of follow-up was 2.75 ± 2.71 years. The average Newcastle-Ottawa was 6.23 out of 9 stars. There was a significant difference in perioperative stroke (odds ratio [OR], 0.65 [0.48-0.87]; P = 0.004), long-term ischemia (OR, 0.32 [0.23-0.44]; P < 0.0001), overall ischemia (OR, 0.36 [0.28-0.44]; P < 0.0001), and favorable outcomes (OR, 3.63 [2.84-4.64]; P < 0.0001) when comparing pre-COSS to post-COSS time frames in favor of post-COSS. CONCLUSIONS: Based on a systematic review of 50 articles, the existing literature indicates that long-term stroke rates and favorable outcomes for surgical revascularization for steno-occlusive disease have improved over time and are lower than previously reported. Improved patient selection, perioperative care, and surgical techniques may contribute to improved outcomes.


Assuntos
Aterosclerose , Doenças das Artérias Carótidas , Revascularização Cerebral , Arteriosclerose Intracraniana , Acidente Vascular Cerebral , Adulto , Humanos , Revascularização Cerebral/métodos , Resultado do Tratamento , Acidente Vascular Cerebral/cirurgia , Hemorragia Cerebral , Aterosclerose/cirurgia , Arteriosclerose Intracraniana/cirurgia
13.
Oper Neurosurg (Hagerstown) ; 24(2): 145-153, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637299

RESUMO

BACKGROUND: Extracranial-intracranial bypass is an effective treatment option for moyamoya disease and in well-selected cases of anterior circulation intracranial atherosclerotic disease; however, the effectiveness of bypass is less evident in posterior circulation atherosclerosis. Updated surgical techniques and clinical guidelines necessitate modern appraisal of arterial bypass for symptomatic patients with posterior circulation atherosclerotic disease who are refractory to medical management. OBJECTIVE: To evaluate the complications, graft patency, and postoperative outcomes of arterial bypass for posterior circulation intracranial atherosclerotic disease. METHODS: Perioperative records of consecutive bypass patients were retrospectively evaluated to determine the clinical course and surgical outcomes. RESULTS: Arterial bypass was performed in 8 cases with a median age of 62 years. All 8 patients underwent direct bypass with an autologous occipital artery donor vessel. Recipient vessel selection varied on a case-by-case basis, with the superior cerebellar artery used in 4 cases, the posterior inferior cerebellar artery in 3 cases, and the anterior inferior cerebellar artery in 1 case. There were no significant intraoperative or postoperative complications. Postoperatively, all 8 patients displayed clinical improvement of their preoperative symptoms, with a significant decrease of 2.5 points on the modified Rankin Scale (P < .001). Postoperative imaging confirmed full graft patency in 7 patients and partial patency in 1 patient. CONCLUSION: Excellent postoperative outcomes and no major complications after posterior circulation arterial bypass for intracranial atherosclerotic disease highlight the utility of this intervention for the treatment of medically refractory or symptomatic posterior circulation intracranial atherosclerotic disease. Larger studies may be valuable to validate these findings.


Assuntos
Aterosclerose , Revascularização Cerebral , Arteriosclerose Intracraniana , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Revascularização Cerebral/métodos , Artéria Vertebral/cirurgia , Aterosclerose/diagnóstico por imagem , Aterosclerose/cirurgia , Aterosclerose/etiologia , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/cirurgia
15.
Eur Rev Med Pharmacol Sci ; 26(19): 7007-7014, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36263548

RESUMO

OBJECTIVE: This study investigates whether medication therapy alone is as effective and safe as percutaneous revascularization (PR) in patients with atherosclerotic renal artery stenosis (ARAS). MATERIALS AND METHODS: The Embase, PubMed, and Cochrane Library databases were searched from their inception to July 31, 2021, for randomized controlled trials (RCTs) reporting PR for ARAS. RevMan 5.3 was employed to analyze the retrieved articles. RESULTS: Eight studies with a total of 2,225 ARAS patients were included in this analysis, demonstrating that PR and medication therapy alone had a similar effect on both systolic [mean difference (MD)= 0.19, 95% CI: -1.64- 2.02] and diastolic blood pressure (MD= -0.44, 95% CI: -1.68-0.80). Meanwhile, there were no differences in all-cause mortality [Odds ratio (OR) = 0.89, 95% CI: 0.70-1.14], stroke (OR = 0.84, 95% CI: 0.55-1.31), congestive heart failure (OR = 0.89, 95% CI: 0.67-1.19), and perioperative complications (OR = 0.87, 95% CI: 0.68-1.12). CONCLUSIONS: Medication therapy alone is as effective and safe as PR.


Assuntos
Aterosclerose , Obstrução da Artéria Renal , Acidente Vascular Cerebral , Humanos , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/complicações , Aterosclerose/tratamento farmacológico , Aterosclerose/cirurgia , Aterosclerose/complicações , Pressão Sanguínea , Acidente Vascular Cerebral/complicações
17.
Clin Cardiol ; 45(12): 1264-1271, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36124340

RESUMO

BACKGROUND: Severe atherosclerosis of the ascending aorta (SAA) in patients undergoing surgical revascularization by coronary artery bypass grafting (CABG) is becoming an increasing problem as more elderly patients are diagnosed with coronary artery disease. Strokes and other neurologic insults are common complications in this group, with devastating impacts on outcomes and prognoses. HYPOTHESIS: Early detection of the atherosclerotic aorta and the application of a stroke prevention protocol will reduce the risk of stroke in patients with SAA. METHODS: In 2012, we adopted a protocol devised to preemptively detect and manage patients suspected of having SAA. From the time of the application of the protocol, we compared the immediate and late outcomes of CABG in SAA in the 8 years preceding the protocol in a "control" group (30 patients) and in the 8 years following the protocol in a "brain" group (69 patients). RESULTS: More patients with SAA were detected after the initiation of the protocol. They had significantly more history of stroke, renal dysfunction, and left main coronary disease. The percutaneous coronary intervention was utilized more after the protocol (26% vs. 7%) and there was far less utilization of replacement of the ascending aorta (12% vs. 37%). Postoperative stroke rates were significantly less after the protocol (2% vs. 18%), with an almost twofold reduction in stroke associated with SAA even after risk adjustment. The composite endpoints of cardiac death, nonfatal myocardial infarction, and stroke were significantly reduced after initiating the protocol at a median of 2.3 years from the time of revascularization. CONCLUSION: Early detection of SAA and individualized therapeutic strategies for revascularization is effective in reducing athero-embolic brain injury and are associated with better prognosis.


Assuntos
Doenças da Aorta , Aterosclerose , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Acidente Vascular Cerebral , Humanos , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Intervenção Coronária Percutânea/efeitos adversos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/diagnóstico , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Resultado do Tratamento
18.
J Vasc Res ; 59(4): 221-228, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35760040

RESUMO

Animal models have significantly advanced our understanding of the mechanisms of atherosclerosis formation and the evaluation of therapeutic options. The current focus of research is on preventive strategies and includes pharmacologic and biologic interventions directed primarily against smooth-muscle cell proliferation, endovascular devices for recanalization and/or drug delivery, and an integrated approach using both devices and pharmacobiologic agents. The experience over many decades with animal models in vascular research has established that a single, ideal, naturally available model for atherosclerosis does not exist. The spectrum ranges from large animals such as pigs to small animal experiments with genetically modified rodents such as the ApoE-/- mouse with correspondingly differently pronounced changes in their lipid and lipoprotein levels. The development of transgenic variants of currently available models, e.g., an ApoE-deficient rabbit line, has widened our options. Nevertheless, an appreciation of the individual features of natural or stimulated disease in each species is of importance for the proper design and execution of relevant experiments.


Assuntos
Aterosclerose , Procedimentos Cirúrgicos Vasculares , Animais , Aterosclerose/cirurgia , Modelos Animais de Doenças , Camundongos , Camundongos Knockout para ApoE , Coelhos , Suínos
20.
J Cardiothorac Vasc Anesth ; 36(8 Pt B): 2954-2960, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35288024

RESUMO

OBJECTIVES: The introduction and use of a preincision safety check were associated with lower mortality after mixed adult cardiac surgery; however, an explanatory mechanism is lacking. Stroke, one of the most severe complications after cardiac surgery, with high mortality, may be reduced by adapting the surgical handling of the ascending aorta. This study assessed the prevalence and predictors of this adaptation after a preincision safety check and the subsequent effect on outcome. DESIGN: A prospective, single-center, observational study comparing adaptation with no-adaptation. The primary outcome measure was 30-day mortality. Multivariate analyses were performed to determine independent predictors of adaptation. To study the effect of adaptation on outcome, a propensity score-matched cohort was constructed in a 1:3 intervention:control ratio. SETTING: At Isala Zwolle (NL), a large, nonacademic teaching hospital. PARTICIPANTS: All consecutive cardiac surgery procedures from 2012 until 2015, including 4,752 surgeries. INTERVENTIONS: The adaptation of surgical handling of the ascending aorta. MEASUREMENTS AND MAIN RESULTS: In 283 cardiac surgeries (5.9%), adaptation was indicated. The most important independent predictors for adaptation were extracardiac atherosclerosis, current smoking, and increasing age. In the propensity score-matched cohort consisting of 1,069 procedures, there were no significant differences in outcome. After correction for propensity score, the hazard ratio of adaptation for 30-day mortality was 1.8 (0.85-3.79). CONCLUSIONS: The adaptation of aortic surgical handling after a preincision safety check was necessary for 5.9% of cardiac surgeries, with extracardiac atherosclerosis as the strongest predictor. Outcome was not significantly different between patients with and without adaptation. Although promising, it remains unclear whether adaptation may fully explain mortality reduction after the use of a preincision safety check.


Assuntos
Aterosclerose , Procedimentos Cirúrgicos Cardíacos , Procedimentos de Cirurgia Plástica , Adulto , Aorta/cirurgia , Aterosclerose/complicações , Aterosclerose/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco
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