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1.
Br J Radiol ; 93(1107): 20190516, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31647306

RESUMO

Re-irradiation can offer a potentially curative solution in case of progression after initial therapy; however, a second course of radiotherapy can be associated with an increased risk of severe side-effects. Particle therapy with protons and especially carbon ions spares surrounding tissue better than most photon techniques, thus it is of high potential for re-irradiation. Irradiation of tumors of the brain, head and neck and skull base involves several delicate risk organs, e.g. optic system, brainstem, salivary gland or swallowing muscles. Adequate local control rates with tolerable side-effects have been described for several tumors of these locations as meningioma, adenoid cystic carcinoma, chordoma or chondrosarcoma and head and neck tumors. High life time doses nonetheless lead to a different scope of side-effects, e.g. an enhanced rate of carotid blow outs has been reported. This review summarizes the current data on particle irradiation of the aforementioned locations and malignancies.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia com Íons Pesados/métodos , Terapia com Prótons/métodos , Reirradiação/métodos , Neoplasias da Base do Crânio/radioterapia , Carcinoma Adenoide Cístico/radioterapia , Artérias Carótidas/efeitos da radiação , Lesões das Artérias Carótidas/etiologia , Sistema Nervoso Central/patologia , Sistema Nervoso Central/efeitos da radiação , Condrossarcoma/radioterapia , Cordoma/radioterapia , Ependimoma/radioterapia , Glioma/radioterapia , Humanos , Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Necrose , Órgãos em Risco , Sarcoma/radioterapia
2.
Braz J Med Biol Res ; 53(1): e9085, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859914

RESUMO

Total Panax notoginseng saponin (TPNS) is the main bioactivity compound derived from the roots and rhizomes of Panax notoginseng (Burk.) F.H. Chen. The aim of this study was to investigate the effectiveness of TPNS in treating vascular neointimal hyperplasia in rats and its mechanisms. Male Sprague-Dawley rats were randomly divided into five groups, sham (control), injury, and low, medium, and high dose TPNS (5, 10, and 20 mg/kg). An in vivo 2F Fogarty balloon-induced carotid artery injury model was established in rats. TPNS significantly and dose-dependently reduced balloon injury-induced neointimal area (NIA) (P<0.001, for all doses) and NIA/media area (MA) (P<0.030, for all doses) in the carotid artery of rats, and PCNA expression (P<0.001, all). The mRNA expression of smooth muscle (SM) α-actin was significantly increased in all TPNS groups (P<0.005, for all doses) and the protein expression was significantly increased in the medium (P=0.006) and high dose TPNS (P=0.002) groups compared to the injury group. All the TPNS doses significantly decreased the mRNA expression of c-fos (P<0.001). The medium and high dose TPNS groups significantly suppressed the upregulation of pERK1/2 protein in the NIA (P<0.025) and MA (P<0.004). TPNS dose-dependently inhibited balloon injury-induced activation of pERK/p38MAPK signaling in the carotid artery. TPNS could be a promising agent in inhibiting cell proliferation following vascular injuries.


Assuntos
Lesões das Artérias Carótidas/prevenção & controle , Neointima/patologia , Panax notoginseng/efeitos dos fármacos , Saponinas/farmacologia , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Animais , Lesões das Artérias Carótidas/etiologia , Hiperplasia , Imuno-Histoquímica , Masculino , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase em Tempo Real , Transdução de Sinais , Regulação para Cima
3.
Medicine (Baltimore) ; 98(44): e17785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689850

RESUMO

INTRODUCTION: Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS: A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. DIAGNOSIS: Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. INTERVENTIONS: After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. OUTCOMES: Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. CONCLUSIONS: Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.


Assuntos
Aneurisma Roto/etiologia , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/etiologia
4.
Khirurgiia (Mosk) ; (9): 86-89, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532172

RESUMO

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


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Aneurisma/etiologia , Lesões das Artérias Carótidas/etiologia , Humanos , Procedimentos Cirúrgicos Vasculares/métodos
5.
World Neurosurg ; 131: e128-e135, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31319187

RESUMO

BACKGROUND: As the endoscopic endonasal approach (EEA) has gained popularity as an alternative to microsurgery (MS) for transsphenoidal resection (TSR), numerous studies have attempted to assess the differential risk of internal carotid artery (ICA) injury between the techniques, yet results have been equivocal and contradictory. The aim of this study was to evaluate ICA injury in MS versus EEA among highly experienced neurosurgeons. METHODS: We performed a systematic literature review of publications from 2002-2017 reporting ICA injury outcomes in ≥250 cases using MS or EEA. RESULTS: Seventeen series reporting 11,149 patients were included: 3 MS series, 13 EEA series, and 1 series with adequate samples for each. ICA injury incidences were 0.0%-1.6% in cohorts of 275-3000. MS series documented 5 ICA injuries in 2672 operations, for an overall incidence of 0.2% (range, 0.0%-0.4%), and EEA series reported 30 ICA injuries in 8477 operations, for a 0.4% injury rate (range, 0.0%-1.6%); the difference was nonsignificant (P = 0.25). Increased operative experience was associated with decreased incidence of ICA injury, a finding preserved in the overall study cohort and within discretely examined MS and EEA subgroups (overall r2 = 0.08, MS r2 = 0.23, EEA r2 = 0.07). CONCLUSIONS: ICA injury is the most serious complication of TSR of pituitary neoplasms. Operator inexperience may be a more important risk factor than choice of surgical technique, given the comparably low rates of injury obtained by highly experienced surgeons independent of technique. This emphasizes the need for consolidated care in pituitary centers of excellence, improvement of high-fidelity simulators, and skull base mentorship between senior and junior staff.


Assuntos
Adenoma/cirurgia , Lesões das Artérias Carótidas/epidemiologia , Artéria Carótida Interna , Microcirurgia/efeitos adversos , Neuroendoscopia/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Lesões das Artérias Carótidas/etiologia , Humanos , Incidência , Curva de Aprendizado , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos
8.
Mol Med Rep ; 20(2): 1436-1442, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173198

RESUMO

Neointimal hyperplasia could be one of the most important complications after balloon angioplasty. Since calcium signaling has several physiologic effects on the regulation of the proliferation and migration of vascular smooth muscle cells (VSMCs), it was hypothesized that transmembrane protein 66 (TMEM66), a store operated calcium entry (SOCE)­associated regulatory factor, possesses vascular protection against balloon injury. The rat balloon­induced carotid artery injury model was performed. Histological analysis was used to check neointimal hyperplasia. TMEM66 expression was measured by PCR and immunoblotting. The results revealed that TMEM66 was expressed in the medial and neointimal layers of the injured artery, and the expression of TMEM66 was markedly decreased. TMEM66 overexpression attenuated neointimal hyperplasia via VSMC proliferation/migration inhibition, and restored expression of VSMC phenotypic markers. Moreover, TMEM66 overexpression reduced the increased expression of Stim1 and Orai1 and PDGF­BB treatment­enhanced [Ca2+]i. In conclusion, TMEM66 protects against balloon injury­induced neointimal hyperplasia, and may be a pharmacological target for the treatment of restenosis.


Assuntos
Proteínas de Ligação ao Cálcio/metabolismo , Cálcio/metabolismo , Lesões das Artérias Carótidas/genética , Hiperplasia/genética , Proteínas Sensoras de Cálcio Intracelular/genética , Proteínas de Membrana/metabolismo , Neointima/genética , Angioplastia com Balão/efeitos adversos , Animais , Becaplermina/farmacologia , Sinalização do Cálcio , Proteínas de Ligação ao Cálcio/genética , Artérias Carótidas/metabolismo , Artérias Carótidas/patologia , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/patologia , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Regulação da Expressão Gênica , Hiperplasia/etiologia , Hiperplasia/metabolismo , Hiperplasia/patologia , Proteínas Sensoras de Cálcio Intracelular/metabolismo , Transporte de Íons , Masculino , Proteínas de Membrana/genética , Músculo Liso Vascular/efeitos dos fármacos , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Neointima/etiologia , Neointima/metabolismo , Neointima/patologia , Proteína ORAI1/genética , Proteína ORAI1/metabolismo , Cultura Primária de Células , Ratos , Ratos Sprague-Dawley , Molécula 1 de Interação Estromal/genética , Molécula 1 de Interação Estromal/metabolismo
9.
World Neurosurg ; 129: 130-132, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154100

RESUMO

BACKGROUND: Indications for reconstruction of the common carotid artery (CCA) include trauma, iatrogenic injury, neoplastic growth (such as invasive neck carcinomas), postoperative infection, and cervical carotid aneurysm. Although various techniques and conduits have been described, the clinical scenario may preclude the use of the most commonly used grafts. We describe a case using a superficial femoral artery (SFA) interposition graft to repair the CCA and review the available literature, highlighting the feasibility of this technique for carotid artery reconstruction. CASE DESCRIPTION: A patient aged 51 years presented with a ruptured mycotic CCA pseudoaneurysm that developed in the setting of a pharyngeal-carotid fistula. Because of the presence of a pharyngeal-carotid fistula and active infection within the vessel wall, endovascular treatment of the pseudoaneurysm was not feasible, and open surgical correction was required to repair the fistulous connection. Furthermore, owing to the extensive soft tissue infection, the use of a synthetic or venous autograft conduit for repair of the artery was contraindicated. Therefore, we harvested a segment of the SFA and used it as an interposition graft to reconstruct the diseased CCA, achieving an excellent anatomic and clinical result. CONCLUSIONS: This case highlights the feasibility of using an SFA interposition graft for short-segment CCA reconstruction, which can provide significant utility in the setting of a hostile operative field due to prior infection or radiation.


Assuntos
Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Artéria Femoral/transplante , Enxerto Vascular/métodos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/etiologia , Quimiorradioterapia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/complicações , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia
10.
Khirurgiia (Mosk) ; (5): 68-70, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169822

RESUMO

The patient 58-year-old with nodular goiter grade 2 was hospitalized to the surgical clinic. Thyroidectomy was performed. Postoperative period was complicated by hiccups and pulsation in the right half of the neck. According to angiography and CT data, there were a hematoma within thyroid bed and arteriovenous fistula between superior thyroid artery and right facial vein. Surgical repair of the fistula and false aneurysm drainage were carried out. This case report demonstrates a rare complication of thyroidectomy - arteriovenous fistula between superior thyroid artery and facial vein followed by pulsatile false aneurysm.


Assuntos
Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Bócio Nodular/cirurgia , Tireoidectomia/efeitos adversos , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Angiografia , Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/diagnóstico , Lesões das Artérias Carótidas/etiologia , Face/irrigação sanguínea , Humanos , Pessoa de Meia-Idade , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/cirurgia
11.
Medicine (Baltimore) ; 98(22): e15750, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145290

RESUMO

RATIONALE: Penetrating neck traumas are dangerous and have a high mortality rate, particularly in patients with common carotid artery injuries. Advances in diagnostic imaging technology have shifted management of penetrating neck injuries from mandatory exploration to selective management. The question is now regarding optimal selection of auxiliary examinations to assess "stability" rapidly and guide clinics in managing such patients. PATIENT CONCERNS: A 56-year-old man suffered neck trauma with the right common carotid artery caused by a percussive drill. The carotid artery could not be clearly displayed in computed tomography (CT) angiography imaging. DIAGNOSES: Penetrating neck trauma due to percussive drill bit with common carotid artery injury. INTERVENTIONS: X-ray and bedside duplex ultrasound with color Doppler flow imaging were used to assess the state of trauma and the foreign body was removed under general anesthesia. OUTCOMES: The patient was discharged at postoperative day 10 with no complication. The patient had no sequelae from this injury at 6-month follow up. LESSONS: X-ray provides a comprehensive assessment of damage, and can efficiently detect foreign bodies in the skull and cervical vertebrae. Duplex ultrasound to be a viable method to exclude macrovascular injury in unstable patients who are not eligible for computed tomography angiography (CTA) or catheter angiography imaging. Widely available duplex ultrasound and x-ray should be considered in emergency situations.


Assuntos
Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Corpos Estranhos/cirurgia , Lesões do Pescoço/cirurgia , Ferimentos Penetrantes/cirurgia , Lesões das Artérias Carótidas/etiologia , Indústria da Construção/instrumentação , Corpos Estranhos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Ferimentos Penetrantes/etiologia
13.
J Clin Neurosci ; 64: 27-29, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30987808

RESUMO

Embolic stroke of undetermined source (ESUS) is not uncommon in young patients. Here, we describe two cases of stroke from an unusual aetiology; cerebral embolization from carotid artery injury presumed secondary to hyoid bone impingement. Both patients demonstrated angiographic evidence of hyoid bone impingement. Following resection of the greater cornu of the hyoid bone, neither patient had further strokes.


Assuntos
Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/anormalidades , Osso Hioide/anormalidades , Embolia Intracraniana/etiologia , Adulto , Feminino , Humanos , Acidente Vascular Cerebral/etiologia
15.
Redox Biol ; 22: 101137, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30771750

RESUMO

Injury-induced stenosis is a serious vascular complication. We previously reported that p38α (MAPK14), a redox-regulated p38MAPK family member was a negative regulator of the VSMC contractile phenotype in vitro. Here we evaluated the function of VSMC-MAPK14 in vivo in injury-induced neointima hyperplasia and the underlying mechanism using an inducible SMC-MAPK14 knockout mouse line (iSMC-MAPK14-/-). We show that MAPK14 expression and activity were induced in VSMCs after carotid artery ligation injury in mice and ex vivo cultured human saphenous veins. While the vasculature from iSMC-MAPK14-/- mice was indistinguishable from wildtype littermate controls at baseline, these mice exhibited reduced neointima formation following carotid artery ligation injury. Concomitantly, there was an increased VSMC contractile protein expression in the injured vessels and a decrease in proliferating cells. Blockade of MAPK14 through a selective inhibitor suppressed, while activation of MAPK14 by forced expression of an upstream MAPK14 kinase promoted VSMC proliferation in cultured VSMCs. Genome wide RNA array combined with VSMC lineage tracing studies uncovered that vascular injury evoked robust inflammatory responses including the activation of proinflammatory gene expression and accumulation of CD45 positive inflammatory cells, which were attenuated in iSMC-MAPK14-/- mice. Using multiple pharmacological and molecular approaches to manipulate MAPK14 pathway, we further confirmed the critical role of MAPK14 in activating proinflammatory gene expression in cultured VSMCs, which occurs in a p65/NFkB-dependent pathway. Finally, we found that NOX4 contributes to MAPK14 suppression of the VSMC contractile phenotype. Our results revealed that VSMC-MAPK14 is required for injury-induced neointima formation, likely through suppressing VSMC differentiation and promoting VSMC proliferation and inflammation. Our study will provide mechanistic insights into therapeutic strategies for mitigation of vascular stenosis.


Assuntos
Proteína Quinase 14 Ativada por Mitógeno/metabolismo , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Neointima/metabolismo , Neointima/patologia , Animais , Biomarcadores , Artérias Carótidas/metabolismo , Artérias Carótidas/patologia , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/patologia , Diferenciação Celular , Proliferação de Células , Imunofluorescência , Expressão Gênica , Humanos , Hiperplasia , Imuno-Histoquímica , Inflamação/etiologia , Inflamação/metabolismo , Inflamação/patologia , Mediadores da Inflamação , Camundongos , Proteína Quinase 14 Ativada por Mitógeno/genética , Miócitos de Músculo Liso/citologia , NADPH Oxidase 4/metabolismo , RNA Interferente Pequeno/genética , Fator de Transcrição RelA/metabolismo
16.
Med Sci Law ; 59(1): 17-19, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30674223

RESUMO

Traumatic dissection of the carotid arteries is a rare cause of delayed death due to hanging. We report a case of delayed death two and a half months following attempted suicide by hanging where the patient was able to talk after being released from neck compression. The cause of death was aspiration pneumonia due to cerebral infarction secondary to traumatic dissection of the left common carotid artery due to attempted suicide by hanging. Carotid artery injuries should be examined in patients who were able to talk after an unsuccessful suicide attempt by hanging but who later died.


Assuntos
Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/patologia , Lesões do Pescoço/complicações , Pneumonia Aspirativa/etiologia , Tentativa de Suicídio , Idoso , Lesões das Artérias Carótidas/patologia , Infarto Cerebral/complicações , Infarto Cerebral/patologia , Humanos , Masculino , Fatores de Tempo
18.
Interv Neuroradiol ; 25(2): 139-143, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30296867

RESUMO

Internal carotid artery (ICA) injury is a rare but potentially life-threatening complication of skull base and neck surgery. Although usually manifested by massive intraoperative haemorrhage, impairment of the ICA might go unnoticed and result in formation of a pseudoaneurysm, causing delayed bleeding. Often additional complications are observed such as thrombosis, spasm, embolism or carotico-cavernous fistula formation. The risk of carotid artery injury in aggressive endonasal skull base surgical interventions ranges from 1% to 9%. Digital subtracted angiography remains the gold standard for evaluation of patients with iatrogenic carotid artery injury as it allows for endovascular treatment at the time of the procedure. Endovascular embolization is currently the preferred method for treating ICA pseudoaneurysms and a successful alternative to the surgical approach. Even though endovascular approaches are considered the safer option, delayed complications have been registered, such as endovascular coil extrusion and migration, which increases the risk of further episodes of bleeding. We present our experience with late coil extrusion in a patient who was previously treated with flow diverter stent and coiling for iatrogenic ICA pseudoaneurysm.


Assuntos
Falso Aneurisma/terapia , Lesões das Artérias Carótidas/terapia , Artéria Carótida Interna , Embolização Terapêutica/métodos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angiografia Digital , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Humanos , Doença Iatrogênica , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Stents
19.
World Neurosurg ; 122: 376-379, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30439523

RESUMO

BACKGROUND: Internal carotid artery (ICA) injury is 1 of the most feared complications in endoscopic pituitary surgery. Different endovascular techniques are available for the management of early and delayed ICA injuries. CASE REPORT: We report a case of emergency endovascular treatment with a flow diverter stent for an ICA injury that occurred during endoscopic transphenoidal surgery for pituitary macroadenoma in a 66-year-old man. Effective intraoperative hemostasis was achieved by direct packing of the sphenoid sinus. Digital subtraction angiography demonstrated extravasation of the contrast agent into the sphenoidal sinus from the anterior genu of the intracavernous portion of the right ICA. Balloon test occlusion resulted in a prominent delay in the venous phase in the right hemisphere during occlusion of the right ICA. Taking into account the hemodynamic stability and the absence of intracranial bleeding, we considered the ICA injury as if it were a pseudoaneurysm. Therefore, an emergency release of a flow diverter stent was performed, in association with antiplatelet therapy. No periprocedural complications occurred. The patient was discharged without neurologic deficits. The last follow-up studies at 6 months (digital subtraction angiography and magnetic resonance imaging) confirmed the regular placement of the stent and vessel reconstruction. CONCLUSIONS: Despite the presence of acute hemorrhage and the need for antiplatelet therapy, a flow diverter stent can be used as emergency treatment of ICA injury in selected circumstances.


Assuntos
Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/cirurgia , Tratamento de Emergência , Procedimentos Neurocirúrgicos , Hipófise/cirurgia , Stents , Adenoma/cirurgia , Idoso , Lesões das Artérias Carótidas/diagnóstico por imagem , Humanos , Doença Iatrogênica , Masculino , Neoplasias Hipofisárias/cirurgia
20.
Exp Anim ; 68(1): 81-90, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30369549

RESUMO

Percutaneous coronary intervention (PCI) is main treatment for acute coronary syndrome (ACS). However, restenosis caused by PCI-induced injury influences the outcome of patients. Linagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, has been reported to ameliorate intimal hyperplasia post vascular injury. The underlying mechanisms by which linagliptin protects against balloon injury are unclear and require to be explored. Herein, Wistar rats with carotid artery balloon injury were given 1, 2 or 3 mg/kg/day linagliprin for 6 weeks. We found that linagliptin attenuated vascular injury-mediated neointima formation in rats without affecting body weight and blood glucose levels. ELISA results indicated that linagliptin significantly reduced overproduction of cytokines including tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and IL-6 post balloon injury. By detecting the level of malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), we found that linagliptin prevented balloon injury-induced oxidative stress. Additionally, linagliptin decreased the level of Kelch ECH-associating protein 1 (KEAP1) compared with injury group. Results of Western blots and electrophoretic mobility shift assay (EMSA) demonstrated that linagliptin augmented nuclear accumulation of nuclear factor-E2-related factor 2 (NRF2) and its binding ability to target genes in rats with balloon injury. Moreover, heme oxygenase-1 (HO-1) and NAD (P) H quinine oxidoreductase 1 (NQO1), two downstream targets of NRF2, were further up-regulated after linagliptin treatment compared with injury group. In conclusion, our data suggest that linagliptin protects carotid artery from balloon injury-induced neointima formation and activates the NRF2 antioxidant pathway.


Assuntos
Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão/efeitos adversos , Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/prevenção & controle , Reestenose Coronária/prevenção & controle , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Linagliptina/administração & dosagem , Fator 2 Relacionado a NF-E2/metabolismo , Neointima/etiologia , Neointima/prevenção & controle , Estresse Oxidativo/efeitos dos fármacos , Animais , Lesões das Artérias Carótidas/dietoterapia , Lesões das Artérias Carótidas/metabolismo , Reestenose Coronária/tratamento farmacológico , Reestenose Coronária/etiologia , Citocinas/metabolismo , Glutationa Peroxidase/metabolismo , Mediadores da Inflamação/metabolismo , Masculino , Malondialdeído/metabolismo , Neointima/tratamento farmacológico , Neointima/metabolismo , Estresse Oxidativo/genética , Ratos Wistar , Superóxido Dismutase/metabolismo , Regulação para Cima/efeitos dos fármacos
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