1,721,161 research outputs found
Commentary: The ENABLER-P Balloon Catheter System: a new and exciting tool for recanalization of femoropopliteal CTOs
No full textEndografts for the treatment of aortic infection
No full textAortic infection is an uncommon but life-threatening condition. Conservative medical treatment is insufficient in many cases because of the high risk of persistent infection, aortic rupture, and death. Conventional open surgical treatment consists of extensive tissue debridement, complete removal of the infected prosthetic material, and arterial reconstruction with anatomical or extra-anatomical bypass. This treatment is associated with significant morbidity and mortality; in order to avoid these, minimally invasive options with endovascular aneurysm repair have been attempted. Endovascular repair is minimally invasive and provides rapid aneurysm exclusion and prompt control of bleeding in the face of hemodynamic instability. Despite this, a major concern is the risk associated with endograft placement in an infected bed, leading to controversy about the wisdom of using endovascular aneurysm repair in this setting for mid- and long-term periods. The rate of recurrent infection is unclear because the majority of information exists in exceptional single cases or short-term series, while unsuccessful results with this approach are less likely to be reported. This review aims to assess the role of endovascular therapy for aortic infections, including its applicability as definitive or bridge repair in mycotic aneurysm, aortobronchial, aortoesophageal, and aortoenteric fistulas, in terms of both primary and secondary outcomes (ie, after previous open or endovascular aneurysm repair)
A case of contrast-induced encephalopathy using iodixanol
No full textPURPOSE:
To document a heretofore unreported complication of the contrast agent iodixanol during an endovascular procedure.
CASE REPORT:
A 76-year-old woman with a history of coronary artery disease was admitted to the emergency department for recurrent transient ischemic attacks. Before combined percutaneous transluminal coronary angioplasty and carotid artery stenting (CAS) using iodixanol, the patient suffered from concomitant unstable angina and recurrent transient ischemic attacks. The total amount of iodixanol used during the CAS procedure was 300 mL. Contrast-induced encephalopathy, which manifested as aphasia, stupor, and full hemiparesis immediately after the combined procedure, was diagnosed by urgent computed tomography. Treatment was based on anti-edema drugs, and the patient made a complete recovery within 48 hours, without any neurological sequelae.
CONCLUSION:
Although previously reported in relation to other types of contrast media, contrast-induced encephalopathy has never been described as a complication of an endovascular procedure using iodixanol
Experimental study of a new open stent for vessel banding in a swine model: long-term results
No full textAims. A new stent was designed, conceived for being placed externally around blood vessels to perform vessel banding in a much simple and fast way. In fact it requires the dissection of a single segment of the aortic wall, as its mechanical features allow it to slide on the tunica adventitia. After previous tests (ex vivo and in vivo test), the new stent has been evaluated in vivo long-term study. Methods. In female pig of average weight of 60 kg, after placement of endoprosthesis in infrarenal abdominal aorta, immediately below renal arteries, aortic banding was performed with new stent at the level of each end of endoprosthesis, identified under fluoroscopic guidance. Pigs were followed up for six months, and acetylsalicylic acid was administrated: 100 mg once a day. After six months, histological evaluation of explanted abdominal aorta was performed. Results. New stent made the aortic banding simple and fast. Postoperative course was uneventful. Histological results were similar to previous 10-week survival tests and not damages of aortic wall were observed. Conclusion. Positive outcome of three last long-term survival tests, as of all those ex vitro and in vivo tests previously performed, makes conceivable further scientific investigation and trials
Carotid artery stenting in recently symptomatic patients: a single center experience
No full textBACKGROUND:
The effective and early management of patients with acute symptoms due to carotid stenosis remains the subject of debate. The inability to predict who is at higher early risk of a recurrent stroke after a cerebrovascular event (transient ischemic attack [TIA] or stroke) may explain the variation in management of acute strokes from physician to physician and institution to institution. The aim of this study is to evaluate the clinical outcome of recently symptomatic patients with carotid stenosis treated with urgent or deferred carotid artery stenting (CAS) on the basis of a preidentified protocol in a single center.
METHODS:
From January 2006 to October 2008, 43 patients with symptomatic carotid stenosis greater than 70% underwent urgent or deferred CAS (26 TIA, 17 minor stroke). The exclusion criteria were major stroke, cerebral ischemic lesion greater than 2.5 cm as documented by a computed tomography scan, loss of consciousness, and signs of intracranial hemorrhage. Patients who had a TIA underwent urgent CAS within 24 hours of the cerebral event, while patients who had had a minor stroke underwent deferred CAS, performed within a short space of time from the event (treatment within 1 to 30 days from the onset of symptoms, according to the stabilization of cerebral symptoms: mean time, 6.5 days; range, 2 to 28 days).
RESULTS:
Successful stent implantation was achieved in all cases (100%), respecting the use of a cerebral protection device (filter device: 76%, proximal occlusion device: 24%). The new adverse events in the TIA patients at 1 month were 1 non-neurological death (3.8%) and 1 TIA (3.8%). In the minor stroke group, at 1 month, 10 of 17 patients (58.8%) experienced an improvement in their initial neurological deficit (decrease in National Institutes of Health Stroke Scale less than 2), while in 35.3% of patients (6 of 17), the deficit remained stable, and only one patient had a neurological impairment.
CONCLUSION:
Our study demonstrated that early treatment with protected carotid stenting is both feasible and safe in selected patients with first episode or recurrent TIA or minor stroke. This preliminary study in a limited series of patients revealed that an urgent endovascular approach is associated with a satisfactory outcome considering the very high-risk profile of the patient population
Diabetic patients: epidemiology and global impact
No full textDefinition of the exact epidemiology and the global impact of diabetes is not easy, being strictly related to the availability of data in developing countries and to the use in the existing population-based investigations of common criteria for the diagnosis and definition of diabetes. According to the World Health Organization (WHO) the total number of people with diabetes was 171 million in 2000, and is projected to rise up to 366 million in 2030. The true prevalence of peripheral arterial disease (PAD) in people with diabetes has been difficult to determine, as most patients are asymptomatic, many do not report their symptoms, screening modalities have not been uniformly agreed upon, and pain perception may be blunted by the presence of peripheral neuropathy. Population-based studies, using a validated and reproducible test, have revealed a prevalence of PAD in people with diabetes to be up to 30%. Among people with diabetes, the annual incidence of developing a foot ulcer ranges from 1% to 4.1% and the prevalence ranges from 4% to 10%, which suggests that the lifetime incidence may be as high as 25%. Foot ulcer associated to PAD requires revascularization, although it is generally considered that the outcome in those people is inferior to that in non-diabetic patients. In summary, the increasing worldwide diabetes prevalence will inevitably result in increasing proportions of deaths from cardiovascular disease, as well as in increased prevalence and associated consequences of other complications of diabetes. As suggested by WHO, a concerted, global initiative is required to address the diabetes epidemic
Rationale and design of emergent/urgent carotid artery stenting (EUCAS) registry
No full textEUCAS is a multicenter Registry of carotid artery stenting (CAS) in patients with acute cerebral ischemia (TIA or minor stroke), designed to determine the role of early endovascular intervention in a selected population with a vulnerable lesion of carotid bifurcation. The aim of the registry is to study the safety and efficacy of emergent/urgent CAS and to improve patient selection and consequently reduce the time loss between the index event and the intervention. Secondary aim is to study the plasma levels of plaque vulnerability biomarkers before and after carotid intervention in high risk patients to compare these value with a control group of patients with asymptomatic severe carotid stenosis, and to test the hypothesis that carotid stenting stabilizes the plaque at 1 month. The Registry is open to expert interventionists performing carotid stenting with a documented experience of at least 100 CAS, and the participants are free to apply the preferred endovascular techniques and devices, remembering to include the use of the cerebral protection device. All changes in the neurological status and all new cerebral ischemic events following the procedure will be reported. Follow-up surveillance to 1 month will include Duplex scanning, neurological examinations and blood collections for inflammatory biomarkers determination
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