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1.
J Assoc Physicians India ; 67(11): 71-73, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31793276

RESUMO

Cerebral Hyperperfusion syndrome is a relatively rare event following carotid revascularization. It can occur after both carotid endarterectomy and carotid artery stenting. It is characterized by focal neurodeficit, seizures and headache in the absence of ischemia. It occurs due to ipsilateral cerebral edema secondary to hyperperfusion. CT and MRI of the brain are the main modalities used for diagnosis and to rule out infarct. Prompt recognition and treatment can prevent permanent injury to the brain. We present a case of cerebral hyperperfusion syndrome in an elderly gentleman after a staged bilateral internal carotid artery stenting.


Assuntos
Isquemia Encefálica , Estenose das Carótidas , Circulação Cerebrovascular , Endarterectomia das Carótidas , Stents , Idoso , Isquemia Encefálica/etiologia , Artéria Carótida Interna , Estenose das Carótidas/cirurgia , Humanos , Stents/efeitos adversos , Síndrome
3.
Angiol Sosud Khir ; 25(4): 83-90, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855204

RESUMO

The authors carried out a prospective study aimed at revealing predictors of acute embolic lesions of cerebral vessels during angioplasty with stenting of the internal carotid artery. The study enrolled a total of 54 patients who between May 2015 and December 2018 underwent carotid angioplasty with stenting performed at the Department of Vascular and Endovascular Surgery of the Research Centre of Neurology. The procedure of internal carotid artery stenting may be accompanied by intraoperative acute embolic lesions. In order to reveal intraoperative acute embolic lesions of cerebral vessels all patients before and 24 hours after the intervention were subjected to diffusion-weighted magnetic resonance imaging. Thirty-six patients received classical carotid stents (Xact and Acculink) and 18 patients received Casper stents. The patients of both groups were comparable by 24 characteristics studied, including the incidence of intraoperative acute cerebral embolic lesions (18/36 for the classical stents and 10/18 for the Casper stent), which made it possible to unite them into one group in order to increase the power of the study. All acute embolic lesions detected by the diffusion-weighted magnetic resonance imaging (prior to stenting and 24 hours thereafter) were clinically, asymptomatic with no perioperative stroke observed. In order to reveal predictors of intraoperative acute embolic lesions of cerebral vessels we analysed 22 characteristics of the patients, with the obtained findings demonstrating the following signs: a low-intensity (below 20 dB) ultrasonographic signal reflected from fragments of an atherosclerotic plaque during ultrasound examination prior to stenting (p=0.001) - a sign strongly associated with acute embolic lesions (sensitivity - 75%, specificity - 92%); symptomatic stenosis according to the anamnestic data (p=0.02) - a sign significantly associated with acute embolic lesions; female gender (p=0.06) - a sign moderately associated with acute embolic lesions; a history previously endured (according to the anamnestic data) operations on coronary and/or carotid arteries (p=0.09) - a sign weakly associated with acute embolic lesions. Based on the obtained findings we proposed a prognostic scale to assess the risk of acute embolic lesions of cerebral vessels during internal carotid artery stenting. Knowing the factors associated with intraoperative acute embolic lesions will allow the endovascular surgeon to single out the patients at increased risk of acute embolic lesions.


Assuntos
Angioplastia/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Embolia Intracraniana/etiologia , Stents/efeitos adversos , Doença Aguda , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Dispositivos de Proteção Embólica , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Prognóstico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(51): e18303, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860979

RESUMO

RATIONALE: Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS: A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES: Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS: Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS: TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.


Assuntos
Doenças da Aorta/complicações , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/etiologia , Implantação de Prótese/efeitos adversos , Stents/efeitos adversos , Fístula Vascular/complicações , Idoso , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Evolução Fatal , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
5.
Medicine (Baltimore) ; 98(47): e17829, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764776

RESUMO

RATIONALE: Venous thoracic outlet syndrome (VTOS) secondary to subclavian arterial stent implantation is extremely rare. Here, we firstly report this disease and the endovascular intervention using covered-stents. PATIENT CONCERNS: An 80-year-old man who had received an acceptable stent implantation for the treatment of a right subclavian arteriovenous malformation (AVM), presented with a gradually increasing swelling and pain in his right upper extremity. DIAGNOSIS: The patient was diagnosed with right VTOS and recurrent subclavian AVM following ultrasonography and computed tomographic angiography. INTERVENTIONS: We positioned a covered-stent in the subclavian artery to block the feeding arteries and successfully embolized the remaining branches with coils. Next, we performed successful dilation 3 times, followed by the positioning of another covered-stent in the right subclavian vein. OUTCOMES: The patient was free of all symptoms and the imaging procedures confirmed an acceptable thrombosis of the AVM with patent stents in the right subclavian artery and vein during the 6-month follow-up. LESSONS: Venous stent implantation is an alternative to treat VTOS caused by subclavian arterial stents and it is essential to pay more attention to the incidence of VTOS following arterial stent implantation in the subclavian artery.


Assuntos
Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Artéria Subclávia , Síndrome do Desfiladeiro Torácico/etiologia , Idoso de 80 Anos ou mais , Humanos , Masculino
6.
Medicine (Baltimore) ; 98(47): e18092, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764846

RESUMO

RATIONALE: Pipeline embolization device pipeline embolization device (PLED) is one of the most preferred flow-diverting devices used in treating giant and complex intercranial aneurysms. The occurrence of in-stent stenosis (ISS), which is a partially reversible complication, has been associated with PLED. Trauma around the neck of the aneurysm during our attempts to implant the PLED across the aneurysm resulted into inflammatory reactions, endotheliazation, granular tissue formation, and subsequent ISS. PATIENT CONCERNS: We present an 11-year-old girl with dizziness of 6 days duration on account of which she was admitted at our institution. Physical as well as neurological examinations did not yield much. DIAGNOSES: Cerebral angiography revealed a right cavernous segment giant aneurysm. INTERVENTIONS: We initially implanted Pipeline embolization devices (PLEDs) (ev3, Irvine, California, USA) across the neck of the aneurysm which resulted into ISS 6 months after the operation. OUTCOMES: We also attempted balloon angioplasty which failed during our second operation. She was finally treated with Neuroform stent (Stryker Neurovascular, USA) with no further complication and two years follow-up revealed no ISS. LESSONS SUBSECTIONS AS PER STYLE: A combination of multiple kinds of flow diverting devices could reduce the incidence of ISS in selected patients with complex aneurysms. Minimal trauma caused by PLED at aneurysm site could also reduce incidence of ISS.


Assuntos
Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Criança , Constrição Patológica/etiologia , Feminino , Humanos
7.
Presse Med ; 48(12): 1416-1421, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679898

RESUMO

Antiplatelet therapy is the cornerstone of coronary artery disease treatment and prevention. Combination of aspirin and P2Y12 inhibitor is recommended after acute coronary syndrome and after elective percutaneous coronary intervention. The optimal duration of dual antiplatelet therapy depends on the individual ischemic and bleeding risk of the patient. Bleeding on dual anti platelet therapy remains the most frequent complication of antiplatelet therapy even is mostly minimal or moderate. Beyond individualized evaluation of patients' bleeding risk, management of patients with severe bleeding complications is a challenging situation and requires general and specific recommendations with interruption of the dual antiplatelet therapy in the vast majority of the cases.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/terapia , Inibidores da Agregação de Plaquetas/efeitos adversos , Anticoagulantes/administração & dosagem , Quimioterapia Combinada , Hemorragia/epidemiologia , Hemorragia/patologia , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem , Índice de Gravidade de Doença , Stents/efeitos adversos , Trombose/tratamento farmacológico , Trombose/epidemiologia , Trombose/etiologia
8.
Khirurgiia (Mosk) ; (11): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714523

RESUMO

OBJECTIVE: To analyze early and delayed results of various variants of circular tracheal resection (CTR) with anastomosis, to determine the safest approach, dates and conditions of correction, features of postoperative period in patients after previous tracheal surgery. MATERIAL AND METHODS: There were 831 patients with cicatricial tracheal stenosis. CTR was made in 330 (39.7%) patients. Most patients had previous prolonged ICU-stay. The patients were divided into 4 groups. Group 1 consisted of 61 (18.5%) patients after previous prolonged tracheal stenting. Group 2 included 45 (13.6%) patients who underwent circular tracheal resection with a functioning tracheostomy. Tracheostomy tube served as a stent in these patients. Group 3 enrolled 32 (9.7%) patients with previous staged reconstructive plastic surgeries on cranial segment of the respiratory tract. Tracheostomy or stent were absent in 192 (58.2%) patients who underwent circular tracheal resection at the first hospitalization. These patients were enrolled into the fourth (control) group. Favorable outcomes (without complications and mortality) were achieved in 85.5% (n=282) of patients. Postoperative complications occurred in 48 (14.5%) patients. Mortality rate was 0.6% (n=2). The greatest number of complications including anastomositis and restenosis was noted in patients after CTR and previous tracheoplasty with T-tube (n=8, 25%). The most common complication in patients after tracheal resection and previous stenting was anastomositis (14.7%). Long-term results depended on postoperative complications and methods of their correction. Recurrent stenosis occurred in 5 (1.5%) patients within the period of 3 months - 8 years. CTR after previous tracheoplasty with T-tube was carried out in 4 of these patients. CONCLUSION: Tracheal resection after preliminary stenting or tracheostomy is quite safe and technically feasible. Stenting allows postponing radical surgery for correction of concomitant diseases and closure of tracheostomy as a focus of infection within the surgical approach and further tracheal anastomosis. Tracheal resection with simultaneous closure of tracheostomy results a higher rate of postoperative complications compared with preliminary stenting.


Assuntos
Constrição Patológica/cirurgia , Stents/efeitos adversos , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Constrição Patológica/etiologia , Humanos , Estudos Retrospectivos , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/etiologia
9.
Medicine (Baltimore) ; 98(48): e17789, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770196

RESUMO

INTRODUCTION: Riolan arch thickening is usually caused by the occlusion of the superior mesenteric artery (SMA), inferior mesenteric artery, or abdominal aortic artery, by colon cancer, or by ulcerative colitis in the active phase. PATIENT CONCERNS: A 61-years-old female was admitted due to left lower abdominal pain, nausea, and vomiting for more than 4 days. She had received an endovascular covered stent-graft exclusion due to abdominal aortic aneurysm 18 months earlier. Computed tomographic angiography (CTA) showed a local rupture of 1 of the branch artery of the SMA, and a pseudoaneurysm was formed around it. It was feared that performing Riolan atrial arch pseudoaneurysm embolization may cause ischemia of the inferior mesenteric artery (IMA) and could lead to avascular necrosis of the descending colon and sigmoid colon, intestinal perforation, and peritonitis. DIAGNOSIS: Riolan arch collateral circulation associated with pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm. INTERVENTIONS: Riolan arterial arch pseudoaneurysm embolization was performed near the distal end. OUTCOMES: The symptoms, signs, and biochemistry returned to normal. CONCLUSION: Riolan arch collateral circulation can be caused by pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm.


Assuntos
Falso Aneurisma/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Falso Aneurisma/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Artéria Mesentérica Inferior/cirurgia , Artéria Mesentérica Superior/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/cirurgia , Stents/efeitos adversos
10.
Expert Rev Med Devices ; 16(11): 955-963, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31648562

RESUMO

Introduction: Endovascular therapy is the standard of care for acute ischemic stroke due to large vessel occlusions. The ultimate goal is to achieve fast first pass complete reperfusion, since delayed and/or incomplete reperfusion increases complication rates and costs and deteriorates patient outcome. Achieving optimal results can sometimes be challenging, particularly in patients with tortuous vessels. Several techniques have been described lately to optimize recanalization, including first line aspiration and various stent-retriever assisted techniques. In our experience, mechanical thrombectomy with a BAlloon guide catheter, large bore Distal access catheter, Dual Aspiration and Stent-retriever as Standard approach (BADDASS) is the most efficient technique to succeed, since it combines the advantages of stent-retrievers and distal aspiration.Areas covered: The purpose of this review is to enable neurointerventionalists to achieve fast first pass complete reperfusion by outlining the BADDASS approach step-by-step and sharing additional tips for navigating through challenging internal carotid artery segments.Expert opinion: In our experience, the BADDASS approach is the safest and most effective way to achieve fast first pass complete reperfusion.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/terapia , Cateterismo Cardíaco , Reperfusão , Stents , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Humanos , Stents/efeitos adversos , Sucção
11.
Expert Rev Med Devices ; 16(11): 965-980, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31648573

RESUMO

Introduction: Abdominal Aortic Aneurysm (AAA) is a potentially life-threatening condition caused by the ballooning of the patient's aortic wall. One treatment for this condition, Endovascular Aneurysm Repair (EVAR), has demonstrated a greater degree of safety in the short term and has the potential to be more cost-effective than its open surgical counterpart.Areas covered: EVAR comes with the added risks of late-term failure, however, as the endografts are subject to displacement, loss of seal against the aortic wall, or failure to serve as a means of bypassing the aneurysm. Device manufacturers have made constant iterations to the endoprostheses available on the market to reduce these complications, expand the pool of suitable patients, and reduce cost of endovascular repair while ensuring patient safety and strong clinical outcomes.Expert opinion: Short and midterm clinical outcomes have improved markedly over 20 years and the number of patients who qualify for EVAR has increased dramatically. Late-term failures and the need for life-long monitoring for complications remain the Achille's heel for this treatment paradigm. Differences in short- and long-term outcomes, as well as overall costs related to lifelong monitoring and late-term complications and reinterventions, still require continuous comparison to previous devices and the historically proven open surgical repair.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Aneurisma da Aorta Abdominal/economia , Prótese Vascular/economia , Procedimentos Endovasculares/economia , Desenho de Equipamento , Humanos , Stents/efeitos adversos , Resultado do Tratamento
12.
Niger J Clin Pract ; 22(10): 1459-1461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607740

RESUMO

Tracheobronchomalacia is a rare condition in the pediatric age group which may be life-threatening when it occurs. The common form of tracheomalacia is congenital, presenting with wheezing and cough. We report a case of a 65-day-old baby who was treated with non-invasive mechanical ventilation due to respiratory distress since the day of birth. Tracheomalacia was diagnosed based on the physical examination and the thorax computerized tomography (CT) findings. Patient was initially treated with noninvasive positive pressure ventilation and thereafter, fitted with a tracheobronchial conical fully-covered self-expandable nitinol stent. After stent insertion and the respiratory situation of the patient improved, ventilatory weaning and extubation were possible. A careful selection of suitable patients, appropriate stent type and the site, where it has to be placed is mandatory for successful airway stenting. Also, children must be adequately followed-up to prevent the possible life-threatening complications after stent insertion.


Assuntos
Obstrução das Vias Respiratórias/terapia , Stents , Traqueomalácia/terapia , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/diagnóstico , Ligas , Feminino , Humanos , Lactente , Stents/efeitos adversos , Tomografia Computadorizada por Raios X , Traqueomalácia/congênito , Traqueomalácia/diagnóstico , Resultado do Tratamento
13.
Nepal J Ophthalmol ; 11(21): 24-28, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31523063

RESUMO

INTRODUCTION: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. METHODS: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. RESULTS: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. CONCLUSION: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.


Assuntos
Anestesia Local/métodos , Dacriocistorinostomia/efeitos adversos , Remoção de Dispositivo/métodos , Endoscopia/métodos , Obstrução dos Ductos Lacrimais/terapia , Silicones/efeitos adversos , Stents/efeitos adversos , Dacriocistorinostomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/cirurgia , Projetos Piloto , Falha de Prótese , Fatores de Tempo , Resultado do Tratamento
14.
Jpn J Radiol ; 37(10): 719-726, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31486969

RESUMO

PURPOSE: To evaluate and compare the clinical outcomes between percutaneous gallbladder drainage (PGBD) and percutaneous gallbladder aspiration (PGBA) for acute cholecystitis after biliary stenting for malignant biliary obstruction. MATERIALS AND METHODS: Twenty-six and 14 patients underwent PGBD and PGBA, respectively, for acute cholecystitis after biliary stenting for malignant obstruction. The technical success rate, clinical effectiveness, and safety were compared between the 2 groups. RESULTS: Technical success was achieved in all patients. Clinical effectiveness rate was significantly higher in the PGBD group than in the PGBA group [100% (26/26) vs. 57% (8/14), p < 0.01]. In the PGBA group, clinical effectiveness rate was significantly lower in patients with tumor involvement of the cystic duct [13% (1/8) with involvement vs. 83% (5/6) without involvement, p = 0.03]. There were no deaths related to the procedure or acute cholecystitis aggravation. Pleural effusion and biliary peritonitis occurred in 1 patient each after PGBD and intra-abdominal bleeding occurred in 1 patient after PGBA as complications requiring treatment. CONCLUSION: Although PGBD was a more effective treatment for acute cholecystitis after biliary stenting for malignant obstruction, PGBA may be a less invasive option for high-risk patients without tumor involvement of the cystic duct.


Assuntos
Colecistite Aguda/terapia , Colestase/cirurgia , Stents/efeitos adversos , Idoso , Colecistite Aguda/etiologia , Drenagem , Feminino , Vesícula Biliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sucção , Resultado do Tratamento
15.
Urology ; 134: 72-78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487513

RESUMO

OBJECTIVE: To assess the symptoms associated with long-term Double-J ureteral stenting including the influence of biofilms on ureteral stents. METHODS: Patients with long-term (>8 weeks) uni- or bilateral ureteral stents completed the Ureteral Stent Symptoms Questionnaire (USSQ) at the day of stent exchange. Repeated assessment of patients was possible to allow for analysis of intraindividual changes. Assessment of biofilm mass on the stents was performed according to a validated method, its correlation with the USSQ total score was defined as primary outcome. Secondary outcomes included further analyses of stent-associated symptoms and their temporal course. RESULTS: A total of 87 stent indwelling periods in 35 patients were investigated. Median USSQ total score did not differ significantly between unilateral and bilateral stenting (42 vs 39 points; P = .17). An increasing total stent treatment time up to study inclusion did not correlate with the USSQ total score, but was significantly correlated with less urinary symptoms and a better quality of life. USSQ total score and subscores within individual patients did not significantly increase or decrease over the sequence of stent indwelling periods. Higher total biofilm masses were not associated with higher USSQ total scores or subscores. CONCLUSION: Long-term Double-J stenting provides a valuable treatment option, if stent-associated symptoms are low during the initial indwelling period. Thus, symptoms remain stable over the long-term course and the majority of patients are satisfied with the treatment. Furthermore, biofilm formation on ureteral stents does not seem to be the relevant driver of symptoms.


Assuntos
Bactérias , Biofilmes , Efeitos Adversos de Longa Duração , Implantação de Prótese , Infecções Relacionadas à Prótese , Qualidade de Vida , Stents , Obstrução Ureteral/cirurgia , Idoso , Bactérias/classificação , Bactérias/isolamento & purificação , Correlação de Dados , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/microbiologia , Efeitos Adversos de Longa Duração/psicologia , Masculino , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/psicologia , Stents/efeitos adversos , Stents/microbiologia , Inquéritos e Questionários , Suíça , Avaliação de Sintomas/métodos
16.
Int Heart J ; 60(5): 1154-1160, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484855

RESUMO

In-stent neoatherosclerosis is an important problem after percutaneous coronary intervention. To explore the mechanisms and treatment of in-stent neoatherosclerosis, an animal model is needed. To avoid the disadvantages of current animal models, such as excessive use of X-rays and a high mortality rate, we attempted to develop an improved animal model. We explored a method that uses a short time interval to establish a rabbit model of in-stent neoatherosclerosis with a high survival rate and to evaluate its indicators. Sixty rabbits were divided into three equal groups: group A, the traditional method; group B, the standard intervention method; and group C, the improved method. In group C, we made two small incisions in each rabbit's neck, separated the common carotid, punctured it, and implanted a stent. The incision was then sutured. Four weeks later, we used optical coherence tomography (OCT) to scan all rabbits for neoatherosclerosis. We found no significant differences in OCT data between our new animal model and the traditional and interventional groups (P > 0.05). The technological success rate was higher in the new animal model (P < 0.001). We developed a new method to establish an animal model of neoatherosclerosis, which had similar results to the traditional and interventional methods.


Assuntos
Reestenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Stents/efeitos adversos , Tomografia de Coerência Óptica/métodos , Animais , Reestenose Coronária/mortalidade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Modelos Animais de Doenças , Humanos , Masculino , Neointima/diagnóstico por imagem , Neointima/patologia , Variações Dependentes do Observador , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/mortalidade , Falha de Prótese , Coelhos , Distribuição Aleatória , Fatores de Risco , Estatísticas não Paramétricas , Taxa de Sobrevida
18.
World Neurosurg ; 131: 209-212, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31442658

RESUMO

BACKGROUND: Antiplatelet agents are typically administered before and after treatment using flow-diverter stents (FDS) to prevent thrombotic complications, but the effects of anticoagulants are unclear. We present a patient with a giant aneurysm treated with an FDS. The thrombus within the aneurysm was dissolved when a direct factor Xa inhibitor was administered to treat lower limb venous thrombosis that occurred secondary to steroid use. CASE DESCRIPTION: A 60-year-old woman with a 30-mm giant thrombosed aneurysm in the cavernous segment of the right internal carotid artery presenting with headache and right abducens nerve palsy was treated by placing an FDS. Diplopia and increased pain in her right eye appeared on postoperative day 7, and both were alleviated by continuous oral administration of prednisolone. Angiography 3 months postoperatively revealed that the aneurysm thrombosis had progressed, and there were signs of healing. However, at the same time, lower limb venous thrombosis occurred, which was treated by continuous edoxaban. Six months after surgery, her headaches worsened and angiography showed that the aneurysm was again contrast enhanced and that the thrombus within the aneurysm had dissolved. After discontinuing edoxaban 9 months after surgery, the aneurysmal thrombosis had again rapidly progressed. CONCLUSIONS: Administration of a direct factor Xa inhibitor during healing after placing an FDS may cause dissolution of an existing thrombus; therefore factor Xa inhibitors must be used with caution.


Assuntos
Doenças das Artérias Carótidas/etiologia , Inibidores do Fator Xa/uso terapêutico , Aneurisma Intracraniano/etiologia , Trombose Intracraniana/tratamento farmacológico , Piridinas/uso terapêutico , Stents/efeitos adversos , Tiazóis/uso terapêutico , Doenças do Nervo Abducente/cirurgia , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Trombose Venosa/tratamento farmacológico
19.
Medicine (Baltimore) ; 98(35): e16612, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464896

RESUMO

RATIONALE: Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, and nowadays poorly understood. The overall incidence of SCAD ranges from 0.28% to 1.1% in angiographic studies. Therefore, the true incidence of SCAD is most likely underestimated due to asymptomatic or sudden cardiac death before diagnosis. Stent fracture (SF) is a multifactorial issue. Longer vessel remodeled by 2 stents can be more prone to have SF due to higher radial force. PATIENT CONCERNS: In this paper we report a 48-year-old man with chest pain for 2 years. DIAGNOSES: Elective coronary angiography revealed a linear dissection in obtuse marginal branch (OM). INTERVENTIONS: He underwent percutaneous coronary intervention (PCI) with the guidance of intravascular ultrasound (IVUS). OUTCOMES: Then SF was revealed 9 months later. LESSONS: This is the first case report of SF after coronary intervention therapy in SCAD patients.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Stents/efeitos adversos , Doenças Vasculares/congênito , Dor no Peito/etiologia , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Resultado do Tratamento , Ultrassonografia de Intervenção , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
20.
Zhonghua Nei Ke Za Zhi ; 58(8): 599-601, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365983

RESUMO

Carotid web is a rare risk factor of ischemic stroke. A total of 32 (0.54%) patients with carotid web were finally diagnosed in 5 943 patients who underwent carotid computerized tomography angiography (CTA) in two hospitals. Only one patient received carotid endarterectomy that pathological findings were fibrous tissue hyperplasia of vascular wall with mucinous degeneration. Stent implantation was administrated in two cases. Among 13 asymptomatic patients, the observational follow-up period was (20.9±12.4) months without strokes. Carotid web is a rare aberration. Asymptomatic patients with carotid web are usually silent. Large sized cohort and long-term follow-up are further needed.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Stents/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Estudos de Coortes , Endarterectomia das Carótidas/métodos , Displasia Fibromuscular/complicações , Seguimentos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
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