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Neuroimaging Clinics of North America Aug 2007Atherosclerotic disease of the major intracranial arteries is a frequent cause of stroke. In addition, many patients who have symptomatic intracranial stenosis are at... (Review)
Review
Atherosclerotic disease of the major intracranial arteries is a frequent cause of stroke. In addition, many patients who have symptomatic intracranial stenosis are at very high risk for recurrent stroke. Preliminary studies suggest that angioplasty and stenting may reduce the risk of stroke in patients who have severe stenosis of intracranial arteries. Data for angioplasty and stenting, however, consist of case series; no randomized studies have been completed to date. This article reviews these data and discusses the rationale for a randomized trial of angioplasty and stenting versus best medical management for patients who have symptomatic intracranial stenosis.
Topics: Angioplasty; Anticoagulants; Brain; Carotid Arteries; Carotid Stenosis; Cerebral Arteries; Constriction, Pathologic; Humans; Intracranial Arteriosclerosis; Randomized Controlled Trials as Topic; Stents
PubMed: 17826637
DOI: 10.1016/j.nic.2007.05.001 -
Journal of Vascular Surgery Jun 2022Endurance athletes can develop intermittent claudication due to sports-related flow limitations of the iliac artery (FLIA) caused by arterial kinking. In the present...
OBJECTIVE
Endurance athletes can develop intermittent claudication due to sports-related flow limitations of the iliac artery (FLIA) caused by arterial kinking. In the present study, we investigated the short- and long-term efficacy of an operative release for iliac artery kinking.
METHODS
Between 1996 and 2015, all patients with a diagnosis of FLIA due to iliac artery kinking without substantial arterial stenosis (<15%) or an excessive arterial length (vessel length to straight ratio, <1.25) who had undergone surgery were included. The short-term follow-up protocol consisted of cycling tests, the ankle brachial index with a flexed hip, and Doppler echography examinations to determine the peak systolic velocity before and 6 to 18 months after surgery. Additionally, the short- and long-term efficacy were evaluated using questionnaires.
RESULTS
A total of 142 endurance athletes (155 legs; 88.4% male; median age, 26 years; interquartile range [IQR], 22-31 years) were available for analysis. In the short term, the symptoms had decreased in 83.9% of the patients, with an overall 80.3% satisfaction rate. Power during a maximal cycling test had improved from 420 W (IQR, 378-465 W) to 437 W (IQR, 392-485 W; P < .001). The symptom-free workload had increased from 300 W (IQR, 240-340 W) to 400 W (IQR, 330-448 W; P < .001). The postexercise ankle brachial index with a flexed hip had increased from 0.53 (IQR, 0.40-0.61) to 0.57 (IQR, 0.47-0.64; P = .002), and the peak systolic velocity with a flexed hip had decreased from 1.88 m/s (IQR, 1.45-2.50 m/s) to 1.52 m/s (IQR, 1.19-2.07 m/s; P < .001). Postoperative imaging studies revealed some degree kinking in 33.9%, mostly asymptomatic. The long-term results were evaluated after a median of 15.2 years (IQR, 10.9-19.5 years). The athletes had cycled an additional 125.500 km (IQR, 72.00-227.500 km), which was approximately equal to the 131.000 km (IQR, 98.250-220.000 km) cycled before the diagnosis of FLIA. On the long term, 63.9% of the athletes reported persistent reduction of complaints, with an overall 59.1% satisfaction rate. Eight patients had required reintervention, six because of treatment failure and two because of newly developed FLIA.
CONCLUSIONS
Operative iliac artery release for sports-related functional kinking in the absence of stenosis or an excessive vessel length was effective for most athletes in the short and long term.
Topics: Adult; Athletes; Constriction, Pathologic; Female; Humans; Iliac Artery; Intermittent Claudication; Male; Physical Endurance; Treatment Outcome; Young Adult
PubMed: 35085748
DOI: 10.1016/j.jvs.2021.12.082 -
European Journal of Vascular and... May 2021
Topics: Cardiovascular Abnormalities; Constriction, Pathologic; Humans; Mesenteric Artery, Inferior; Vascular Diseases
PubMed: 33773902
DOI: 10.1016/j.ejvs.2021.02.028 -
Journal of the American College of... Feb 1992
Topics: Angioplasty, Balloon, Coronary; Animals; Constriction, Pathologic; Coronary Angiography; Coronary Disease; Coronary Vessels; Humans; Recurrence
PubMed: 1732352
DOI: 10.1016/0735-1097(92)90477-5 -
Computers in Biology and Medicine Dec 2022Invasive coronary angiography imposes risks and high medical costs. Therefore, accurate, reliable, non-invasive, and cost-effective methods for diagnosing coronary...
Invasive coronary angiography imposes risks and high medical costs. Therefore, accurate, reliable, non-invasive, and cost-effective methods for diagnosing coronary stenosis are required. We designed a machine learning-based risk-prediction system as an accurate, noninvasive, and cost-effective alternative method for evaluating suspected coronary heart disease (CHD) patients. Electronic medical record data were collected from suspected CHD patients undergoing coronary angiography between May 1, 2017, and December 31, 2019. Multi-Class XGBoost, LightGBM, Random Forest, NGBoost, logistic models and MLP were constructed to identify patients with normal coronary arteries (class 0: no coronary artery stenosis), minimum coronary artery stenosis (class 1: 0 < stenosis <50%), and CHD (class 2: stenosis ≥50%). Model stability was verified externally. A risk-assessment and management system was established for patient-specific intervention guidance. Of 1577 suspected CHD patients, 81 (5.14%) had normal coronary arteries. The XGBoost model demonstrated the best overall classification performance (micro-average receiver operating characteristic [ROC] curve: 0.92, macro-average ROC curve: 0.89, class 0 ROC curve: 0.88, class 1 ROC curve: 0.90, class 2 ROC curve: 0.89), with good external verification. In class-specific classification, the XGBoost model yielded F1 values of 0.636, 0.850, and 0.858, for Classes 0, 1, and 2, respectively. The visualization system allowed disease diagnosis and probability estimation, and identified the intervention focus for individual patients. Thus, the system distinguished coronary artery stenosis well in suspected CHD patients. Personalized probability curves provide individualized intervention guidance. This may reduce the number of invasive inspections in negative patients, while facilitating decision-making regarding appropriate medical intervention, improving patient prognosis.
Topics: Humans; Decision Support Systems, Clinical; Constriction, Pathologic; Coronary Stenosis; Heart; Arteries
PubMed: 36410096
DOI: 10.1016/j.compbiomed.2022.106300 -
Revista Da Associacao Medica Brasileira... 2011The aim of this study was to evaluate the prevalence of hemodynamically significant infrainguinal bypasses stenosis using reverse great saphenous vein graft.
OBJECTIVE
The aim of this study was to evaluate the prevalence of hemodynamically significant infrainguinal bypasses stenosis using reverse great saphenous vein graft.
METHODS
From March of 2008 to March of 2009, 56 infrainguinal bypasses were performed with reverse great saphenous vein graft in 56 patients. On the 30th post-operative day, 32 out of 56 patients were submitted to vascular ultrasonography. The prevalence of significant graft stenosis was determined. In addition, the diagnosis of stenosis was related to the clinical and surgical characteristics of the patients. The variables analyzed at the moment of diagnosis were the localization of the graft stenosis, the risk factors associated with stenosis and the association of vascular ultrasonography findings with ankle brachial pressure index (ABI).
RESULTS
The overall prevalence of significant graft stenosis was 48.4%. Out of the total number of observed stenosis, 19.4% were considered severe, and 29% mild or moderate. There was no significant association between the presence of significant stenosis and the following variables: gender, diabetes, hypertension, smoking, hipercholesterolemia, graft diameter, site of the distal anastomosis, and graft composition. There was a weak agreement between ABI and vascular ultrasonography in detecting stenosis in general (K = 0.30; CL95% 0.232 - 0.473; p = 0.018). However, there was a substantial agreement in detecting severe stenosis (K = 0.75; CL95% 0.655 - 0.811; p = 0.0001).
CONCLUSION
There was a high prevalence of stenosis on the 30th post-operative day, mostly localized in the proximal half of the vein graft. There was no significant association of stenosis with clinical and surgical factors analyzed. ABI and vascular ultrasonography had weak agreement with the diagnosis of stenosis in general and an important agreement for the diagnosis of severe stenosis.
Topics: Ankle Brachial Index; Arteries; Constriction, Pathologic; Female; Graft Occlusion, Vascular; Humans; Male; Prevalence; Risk Factors; Saphenous Vein; Ultrasonography, Doppler, Duplex
PubMed: 21537706
DOI: 10.1590/s0104-42302011000200017 -
European Review For Medical and... Jan 2023To detect the display rate and flow velocity of intracranial circle of Willis (anterior, middle, and posterior cerebral arteries) with transcranial contrast-enhanced...
OBJECTIVE
To detect the display rate and flow velocity of intracranial circle of Willis (anterior, middle, and posterior cerebral arteries) with transcranial contrast-enhanced transcranial color-coded sonography (CE-TCCS), using digital subtraction angiography (DSA) as the golden diagnostic standard.
PATIENTS AND METHODS
We collected data from 104 patients with suspected stroke treated in our hospital between December 2019 and October 2021. The detection rate of the intracranial circle of Willis, anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were analyzed based on routine TCCS and CE-TCCS data. Based on digital subtraction angiography (DSA) data, the degree of MCA stenosis was divided into mild stenosis (<50%), moderate stenosis (50-69%), severe stenosis (70-99%), and bilateral middle cerebral artery CE-TCCS examinations were performed. We evaluated MCA color blood flow on CE-TCCS, and recorded the peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MFV).
RESULTS
The display rates of ACA, MCA, and PCA were significantly improved on the CE-TCCS, and the PSV, EDV and MFV of the MCA stenosis group were higher than those of the normal group. The flow velocity of each stenosis subgroup was increased compared to the normal group. The optimal cutoff values of normal and stenosis under the receiver operating characteristic (ROC) curve were PSV = 168.5 cm/s, EDV = 61.5 cm/s, and MFV = 110.5 cm/s. The optimal cutoff values for mild and moderate stenosis and for moderate and severe stenosis were PSV = 201.5 cm/s and 249.5 m/s, EDV = 95.2 cm/s and 141.5 cm/s, and MFV = 137.6 cm/s and 160.5 cm/s, respectively. PSV and MFV had the most significant sensitivity, specificity, and accuracy.
CONCLUSIONS
Transcranial contrast-enhanced ultrasonography can improve the display rate of intracranial blood vessels and can accurately diagnose MCA stenosis.
Topics: Humans; Middle Cerebral Artery; Constriction, Pathologic; Sensitivity and Specificity; Ultrasonography, Doppler, Transcranial; Blood Flow Velocity; Ultrasonography; Cerebrovascular Disorders
PubMed: 36647872
DOI: 10.26355/eurrev_202301_30875 -
The Annals of Thoracic Surgery Nov 2006
Topics: Constriction, Pathologic; Coronary Angiography; Humans; Radial Artery; Ultrasonography
PubMed: 17062232
DOI: 10.1016/j.athoracsur.2006.07.004 -
British Medical Journal Jul 1960
Topics: Constriction, Pathologic; Disease; Humans; Renal Artery; Renal Artery Obstruction; Vascular Diseases
PubMed: 13856754
DOI: No ID Found -
Brain and Behavior Sep 2020High-resolution magnetic resonance imaging (HR-MRI) has high spatial resolution and can simultaneously perform wall and lumen imaging. Dynamic contrast-enhanced magnetic...
PURPOSE
High-resolution magnetic resonance imaging (HR-MRI) has high spatial resolution and can simultaneously perform wall and lumen imaging. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can evaluate the integrity of the blood-brain barrier. In this paper, the result of 3.0T HR-MRI and 3.0T DCE-MRI has been evaluated to explore the application value of unilateral middle cerebral artery inflammatory stenosis and changes in vascular permeability parameters of stroke events.
METHODS
Thirty-six cases of neurological suspicion of central nervous system vasculitis of our hospital were selected from 20 January 2018 to 1 January 2019, who were diagnosed as unilateral middle cerebral artery M1 stenosis/occlusion by 3D TOF MRA. 3.0T HR-MRI and 3.0T DCE-MRI has been applied.
RESULTS
Among the 36 patients who met the inclusion criteria, 23 patients with central nervous system vasculitis were diagnosed. The 23 patients with HR-MRI showed diffuse thickening and enhanced stenosis. The K value of 10/23 patients with acute-subacute cerebral infarction and 3/23 patients in chronic phase were significantly higher than that of the mirror side, and the K value of these patients remeasured in the same region of interest is lower than before after 6 months treatment. The K value in the target area of 10 patients without cerebrovascular events was not statistically significant compared with the mirror side. The K value of patients with acute-subacute cerebral infarction was significantly higher than that without cerebrovascular events (0.098 ± 0.038 vs. 0.007 ± 0.001, p = .000), and there was no significant difference between K in the chronic infarction group and the other two groups (0.098 ± 0.038 vs. 0.044 ± 0.012, p = .058; 0.044 ± 0.012 vs. 0.007 ± 0.001, p = .057).
CONCLUSION
HR-MRI is an accurate direct imaging method and has a high value for the etiological diagnosis of central nervous system vasculitis. DCE-MRI could be an effective way to evaluate and monitor blood-brain barrier to prevent clinical ischemic stroke.
Topics: Blood-Brain Barrier; Constriction, Pathologic; Contrast Media; Humans; Magnetic Resonance Imaging; Middle Cerebral Artery
PubMed: 32767660
DOI: 10.1002/brb3.1732