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Common carotid agenesis and internai carotid stenting.
No full textAgenesis of common carotid artery is rare and no report of stenting procedures (carotid artery stenting) for associated stenosis of the internal carotid have been published. We report a case of internal carotid stenosis associated with this anomaly. A 73-year-old male with left internal carotid artery originating from the arch, with significant stenosis, was referred to us. Wallstent was deployed with success. Carotid artery stenting should be reserved to uncomplicated arch anatomy and plaques with low fragmentation risk
Regarding the brachiocephalic elbow fistula: a useful alternative angioaccess for permanent hemodialisys
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Right-sided hemothorax after endovascular exclusion of descending thoracic aortic aneurysms with contained rupture
No full textEndovascular treatment of descending thoracic aortic (DTA) aneurysms seems to offer satisfactory early and midterm results with lower mortality and morbidity compared to open repair. The authors report three cases of right-sided hemothorax which is an uncommon complication after DTA endografting for a contained rupture. Three patients presented right hemothorax after endografting for DTA aneurysm with contained rupture. The patients were treated by means of right pleural cavity evacuation, which was associated in two patients to re-endografting for a type I and III endoleak. One patient, because of the absence of endoleaks, was treated only with chest tube drainage. The patients had good early outcome with complete recovery. The right-sided hemothorax after endovascular treatment of DTA aneurysm is an uncommon but life-threatening complication. The mechanisms responsible for the aneurysm rupture in the right pleural cavity after its exclusion are not completely clear. Nevertheless the persistent pressurization of the aneurysm caused by an high-flow endoleaks should be quickly resolve
FIRST 100 CAROTID STENTING PROCEDURES IN A VASCULAR SURGERY DEPARTMENT: SELECTION CRITERIA AND RESULTS
No full textA series of 214 carotid stenting procedures: Selection criteria, results and potential predictors of success
No full textAim. Treatment of carotid stenosis by carotid stenting (CAS) is gaining popularity over standard carotid endarterectomy (CEA). However, no definitive conclusions on CAS efficacy have been drawn, especially on low risk patients. This study was aimed at evaluating CAS efficacy in patients with no morphological selection criteria and to examine potential determinants of CAS efficacy. Methods. From December 2004 to July 2005, 214 patients with symptomatic >50% or asymptomatic carotid stenosis >80% were selected for CAS if they had creatinine <2.0 mg/dL, tolerance to aspirin and clopidogrel, absence of significant cardiac arrhythmias, bilateral iliac occlusion and coagulative disorders. Supraortic trunks and brain vascular state were evaluated using angio magnetic resonance imaging; duplex scanning was used for plaque characterization. No exclusion criteria were set according to plaque morphology or carotid anatomy. The outcomes of CAS efficacy were the rate of technical success and neurological complications, whose relationship with selected demographic and clinical factors was analysed using logistic regression. Results. Overall, technical success was achieved in 87.4% of the patients. The main reason for technical failure was tortuosity of vessels proximal to carotid stenosis. Perioperative mortality was 0%; 7% of the patients had temporary perioperative neurological complications. At bivariate and multivariate analysis, neither technical failure nor complications were significantly associated with gender, preoperative neurological symptoms, plaque morphology, grade of stenosis, contralateral stenosis or occlusion, and type of protection device and stent. The presence of aortic arch anomaly and type III arch were significantly associated with both technical failure and complications. Older age was significantly associated with an increased risk of technical failure only. Conclusion. CAS can been performed with low complication rates o a broad category of patients. While several anatomical characteristics do not influence results, the anatomy of the aortic arch is an independent predictor of CAS failure and neurological complications
Vascular MSCs govern the atherosclerotic plaque calcification under inflammatory conditions
No full textIntroduction. The vascular calcification, recruiting osteo-progenitors under inflammatory stimulation, recapitulates the normal bone-biogenesis process. We recently identified a population of Mesenchymal Stem Cells (MSCs) within abdominal aortic aneurysm (AAA) tissues, hypothesizing their contribution to the atherosclerotic plaque calcification.
Aim. The present study aimed at exploring the impact of inflammation, a feature of atherosclerosis, on osteogenic differentiation of vascular MSCs.
Methods. The extent of calcification within AAA tissues was detected by Alizarin Red stain. MSCs were enzymatically isolated from human healthy cryopreserved thoracic aortas (hMSCs) and from AAA (AAA-MSCs) biopsies. hMSCs and AAA-MSCs were characterized by flow cytometry and compared in terms of osteogenic potential. In order to investigate the effect of the inflammatory milieu on plaque calcification, hMSCs were primed with a cytokine cocktail (TNF-a/IL-1b) for 24 h before osteogenic induction. The osteogenic differentiation was induced by a specific growth media for 21 days, followed by Alizarin Red stain of calcium deposits and osteogenic factors analysis.
Results. Alizarin Red confirmed the presence of large calcified areas within the AAA wall. Healthy- and AAA-MSCs both expressed the typical MSC markers CD90, CD73, CD105 and CD44. AAA-MSCs had an higher degree of mineralization activity in comparison to the healthy MSC population, confirmed by the up-regulation of the osteogenic factors BMP-2 and OPN transcriptional levels (1.5 and 15 folds increase when compared to hMSCs, respectively). The inflammatory priming induced the expression of osteogenic factors BMP-2 and OPN genes and proteins in hMSCs. Accordingly, hMSCs pre-cultured under inflammatory conditions also had increased mineralization activity.
Conclusion. Vascular MSCs actively regulates the atherosclerosis progression, becoming a crucial source of osteoprogenitors. This process is sharpened by the local inflammatory milieu, supporting a tight association among inflammation, osteogenic differentiation and plaque calcification
A series of 214 carotid stenting procedures: selection criteria, results and potential predictors of success.
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