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Medical Science Monitor : International... Oct 2015The value of percutaneous transluminal angioplasty and stenting (PTAS) in the context of aggressive medical treatment for severe intracranial artery stenosis (ICAS) is...
BACKGROUND
The value of percutaneous transluminal angioplasty and stenting (PTAS) in the context of aggressive medical treatment for severe intracranial artery stenosis (ICAS) is under debate. This study compared the effects of PTAS and aggressive medical treatment in patients with severe ICAS and transient ischemic attack or stroke.
MATERIAL AND METHODS
A retrospective cohort study was performed. Patients with severe ICAS were assigned to a PTAS group or aggressive medical treatment group, according to the angiographic features of the stenotic lesions. The primary outcome was defined as stroke or death within 30 days or cerebral ischemia occurring ipsilaterally to the qualifying artery beyond 30 days.
RESULTS
We included 220 patients: 48 in the PTAS group and 172 in the medical group. The median follow-up was 32 months. PTAS was not associated with an increased incidence of the primary outcomes (10/42 vs. 39/172, p=0.96) or increased risks of the secondary outcomes of stroke, cardiovascular events, major bleeding, or mortality. The results of log-rank tests did not support a significant difference in event-free survival as a primary outcome between the 2 groups (chi-square=0.07, p=0.79). Moreover, although not significantly greater, the mean survival of patients in the PTAS group appeared to be better than that among patients in the medical group, as indicated by the curve for cumulative survival.
CONCLUSIONS
A suitable PTAS procedure is safe for patients with severe ICAS, and no significant differences in incidence of recurrent stroke or death were found between PTAS and aggressive medication treatment.
Topics: Aged; Angiography; Angioplasty; Arteries; Brain Infarction; Brain Stem; China; Constriction, Pathologic; Disease-Free Survival; Female; Hemorrhage; Humans; Ischemic Attack, Transient; Kaplan-Meier Estimate; Male; Middle Aged; Pressure; Retrospective Studies; Stents; Stroke; Treatment Outcome
PubMed: 26517946
DOI: 10.12659/msm.894574 -
Postgraduate Medicine Jun 2016Pulmonary hypertension is the commonest condition leading to dilated pulmonary artery. We describe three different types of compression of adjacent anatomical structures... (Review)
Review
Pulmonary hypertension is the commonest condition leading to dilated pulmonary artery. We describe three different types of compression of adjacent anatomical structures by dilated pulmonary arteries. We included involvement of the left main coronary artery, left recurrent laryngeal nerve and tracheobronchial tree. Compression of these structures can cause major complications such as myocardial ischemia, hoarseness and major airway stenosis. We present a case for each scenario and review the literature for each of these complications, focusing on patients' characteristics and contemporary management.
Topics: Adult; Aged; Bronchial Diseases; Constriction, Pathologic; Coronary Angiography; Coronary Stenosis; Dilatation, Pathologic; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Nerve Compression Syndromes; Pulmonary Artery; Recurrent Laryngeal Nerve; Tomography, X-Ray Computed
PubMed: 26898826
DOI: 10.1080/00325481.2016.1157442 -
Stroke and Vascular Neurology Apr 2022The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown. The Clinical Registration Trial of...
INTRODUCTION
The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown. The Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis (CRTICAS) was a prospective, multicentre, real-world registry designed to assess these outcomes and the impact of centre experience.
METHODS
1140 severe, symptomatic intracranial arterial stenosis (ICAS) patients treated with endovascular therapy were included from 26 centres, further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years: (1) high volume for ≥25 cases/year; (2) moderate volume for 10-25 cases/year and (3) low volume for <10 cases/year.
RESULTS
The rate of 30-day stroke, transient ischaemic attack or death was 9.7% (111), with 5.4%, 21.1% and 9.7% in high-volume, moderate-volume and low-volume centres, respectively (p<0.05). Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres (OR=0.187, 95% CI: 0.056 to 0.627; p≤0.0001), while moderate-volume and low-volume centres showed no significant difference (p=0.8456).
CONCLUSION
Compared with the preceding randomised controlled trials, this real-world, prospective, multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ICAS. Non-uniform utilisation in endovascular technology, institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.
Topics: Angioplasty; Arteries; Constriction, Pathologic; Endovascular Procedures; Humans; Registries
PubMed: 34642253
DOI: 10.1136/svn-2021-000979 -
Brain and Behavior Sep 2020Vertigo and balance disorders are a significant clinical problem, especially in elderly patients. The narrowing of cranial vessels may be asymptomatic or produce...
INTRODUCTION
Vertigo and balance disorders are a significant clinical problem, especially in elderly patients. The narrowing of cranial vessels may be asymptomatic or produce neurological symptoms. Very often nonspecific signs of ischemia occur, such as headache, vertigo, or dizziness.
OBJECTIVE
The objective of the study was to assess the effect of carotid and vertebral arteries stenosis on the function of the equilibrium organ on the basis of electronystagmography and posturography.
MATERIAL
The study was conducted in 63 patients, presenting with carotid and vertebral arteries stenosis. The control group consisted of 32 healthy persons.
METHODS
All patients were subjected to precise audiological and otoneurological diagnostic examinations. Prior to being qualified for the study, patients were subjected to the assessment of arteries by means of Doppler ultrasonography. The vestibular organ was assessed by means of physical examination as well as by electronystagmography and posturography testing.
RESULTS AND CONCLUSIONS
The study revealed statistically significant reduction in the results of the equilibrium organ assessments in patients with carotid and vertebral arteries sclerosis as compared to the control group. Abnormal ENG records in the study group patients were observed particularly in the pendulum test, optokinetic test, and the assessment of positional nystagmus, possibly indicating disturbances within the central part of the equilibrium system. Disturbed blood flow in arteries had also an important impact on spinovestibular reflexes and resulted in disturbed postural stability control. On the basis of the conducted studies, it is concluded that diagnostic examinations for carotid and vertebral artery stenosis should be performed in patients with equilibrium system disorders.
Topics: Aged; Carotid Arteries; Constriction, Pathologic; Dizziness; Humans; Skull; Vertebral Artery; Vertigo
PubMed: 32691535
DOI: 10.1002/brb3.1695 -
PloS One 2023Long diseased vessel segments of peripheral arteries may display irregular shapes with different diameters. The aim of this study was to investigate inhibition of...
BACKGROUND
Long diseased vessel segments of peripheral arteries may display irregular shapes with different diameters. The aim of this study was to investigate inhibition of neointimal proliferation in porcine peripheral vessels with different diameters covered by one single hyper-compliant drug-coated balloon (HCDCB), compared to conventional drug-coated balloons (DCB), each selected according to the respective vessel diameter.
METHODS AND RESULTS
Neointimal proliferation was stimulated in proximal and distal segments of the peripheral arteries by balloon overstretch and stent implantation. Inhibition of neointimal proliferation by one single HCDCB was compared to two vessel diameter-adjusted DCB per artery and to one single uncoated hyper-compliant balloon (HCB). Sixteen HCB, 16 HCDCB, and 32 DCB were used in 16 arteries each. Quantitative angiography (QA), optical coherence tomography (OCT) and histology showed a similar anti-restenotic effect for one HCDCB compared to two vessel diameter-adjusted DCB in narrow distal and wider proximal segments (QA diameter stenosis: 18.7±12.3% vs. 22.8±15.5%, p = 0.535; OCT area stenosis: 21.4±11.6% vs. 23.6±12.3%, p = 0.850; histomorphometry diameter stenosis: 27.5±7.1% vs. 26.9±8.0%, p = 0.952) and indicated significant inhibition of neointimal proliferation by HCDCB vs. uncoated HCB (QA diameter stenosis: 18.7±12.3% vs. 30.3±16.7%, p = 0.008; OCT area stenosis: 21.4±11.6% vs. 34.7±16.0%, p = 0.004; histomorphometry diameter stenosis: 27.5±7.1% vs. 32.5±8.5%, p = 0.038).
CONCLUSIONS
HCDCB were found to be similar effective as DCB in inhibiting neointimal proliferation in vessel segments with different diameters. One single long HCDCB may allow for treatment of segments with variable diameters, and thus, replace the use of several vessel diameter-adjusted DCB.
Topics: Swine; Animals; Constriction, Pathologic; Paclitaxel; Coronary Vessels; Neointima; Cell Proliferation; Coated Materials, Biocompatible; Angioplasty, Balloon; Stents
PubMed: 36706120
DOI: 10.1371/journal.pone.0280206 -
Pediatric Radiology Jul 2014Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.
BACKGROUND
Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.
OBJECTIVE
To demonstrate the advantage of multi-slice CT in diagnosing tracheobronchial compression, its severity as related to the adjacent dilated pulmonary arteries, and associated lung and cardiac lesions.
MATERIALS AND METHODS
We included children with absent pulmonary valve who were reviewed by multi-slice CT during a 17-year period. The number and locations of stenoses and lung lesions were noted and the severity of stenosis was categorized. The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated.
RESULTS
Thirty-one children (14 girls and 17 boys) were included. Of these, 29 had ventricular septal defect and 2 had an intact ventricular septum. Twenty-nine children (94%) had tracheobronchial compression, judged to be mild in nine children (31%), moderate in 10 (34%) and severe in 10 (34%). The different locations of the stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. And the number and location of lung lesions demonstrated that the right middle and left upper and lower lobes were often affected. The diameter of the pulmonary artery in these children was well above normal published values, and Spearman rank correlation analysis showed a correlation between the size of the pulmonary artery and the severity of the tracheobronchial stenosis. Nineteen children (61%) underwent surgery and 4 of these children had a multi-slice CT post-operative follow-up study.
CONCLUSION
Absent pulmonary valve can cause significant morbidity and mortality in children. Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.
Topics: Bronchial Diseases; Child; Child, Preschool; Constriction, Pathologic; Female; Heart Defects, Congenital; Humans; Image Processing, Computer-Assisted; Infant; Infant, Newborn; Male; Multidetector Computed Tomography; Pulmonary Artery; Pulmonary Valve; Retrospective Studies; Severity of Illness Index; Tracheal Stenosis
PubMed: 24706163
DOI: 10.1007/s00247-014-2898-z -
Science Progress 2021The electro-osmotically modulated hemodynamic across an artery with multiple stenosis is mathematically evaluated. The non-Newtonian behaviour of blood flow is tackled...
The electro-osmotically modulated hemodynamic across an artery with multiple stenosis is mathematically evaluated. The non-Newtonian behaviour of blood flow is tackled by utilizing Casson fluid model for this flow problem. The blood flow is confined in such arteries due to the presence of stenosis and this theoretical analysis provides the electro-osmotic effects for blood flow through such arteries. The mathematical equations that govern this flow problem are converted into their dimensionless form by using appropriate transformations and then exact mathematical computations are performed by utilizing Mathematica software. The range of the considered parameters is given as . The graphical results involve combine study of symmetric and non-symmetric structure for multiple stenosis. Joule heating effects are also incorporated in energy equation together with viscous effects. Streamlines are plotted for electro-kinetic parameter and flow rate . The trapping declines in size with incrementing , for symmetric shape of stenosis. But the size of trapping increases for the non-symmetric case.
Topics: Arteries; Constriction, Pathologic; Electroosmosis; Hemodynamics; Humans; Viscosity
PubMed: 34296626
DOI: 10.1177/00368504211031693 -
Computer Methods and Programs in... Jun 2022The role of red blood cell dynamics is emphasised in certain cardiovascular diseases, and thus needs to be closely studied. A multiphase model of blood flow allows the...
BACKGROUND AND OBJECTIVE
The role of red blood cell dynamics is emphasised in certain cardiovascular diseases, and thus needs to be closely studied. A multiphase model of blood flow allows the resolution of locally varying density of red blood cells within a complex vessel geometrical domain, and haemodynamic consequences of such build up.
METHODS
A novel computational fluid dynamics solver for simulating multiphase flows is used for modelling blood flow using level set for a sharp interface representation. Single-phase simulations and reduced order models are used for pressure comparisons. The new solver is used for numerically studying AHA type B lesions. The impact of hematocrit and degree of stenosis on the haemodynamics of coronary arteries is investigated.
RESULTS
The comparisons with single-phase flow simulations indicate differences in pressure when considering red blood cell aggregation. Multiphase simulations provide slightly lower pressure drop for the same stenosis severity compared to the single-phase simulations. Secondary flow patterns and the interactions between the two phases leads to the red blood cell aggregation at the end of the diastole cycle, which significantly changes the red blood cell distribution, the shear stresses and velocity in tubular lesions.
CONCLUSIONS
Neither pressure drop nor mean velocity are not strongly changed in the multiphase modelling, but particle buildup significantly changes which is only revealed by the multiphase approach.
Topics: Blood Flow Velocity; Computer Simulation; Constriction, Pathologic; Coronary Vessels; Hemodynamics; Humans; Models, Cardiovascular; Stress, Mechanical
PubMed: 35483270
DOI: 10.1016/j.cmpb.2022.106780 -
European Review For Medical and... 2015To evaluate the recurrent ischemic events and risk factors in patients with symptomatic intracranial artery stenosis.
OBJECTIVE
To evaluate the recurrent ischemic events and risk factors in patients with symptomatic intracranial artery stenosis.
PATIENTS AND METHODS
Patients with acute cerebral infarction or transient ischemia attach (TIA) and intracranial arterial stenosis confirmed through CTA examination, were enrolled from the Department of Neurology. All cases were followed-up regularly and divided into recurrent group and non-recurrent group according to occurrence of cerebrovascular events. Major observation index: (1) the occurrence of endpoint; (2) new stroke in responsible artery; (3) drug therapy compliance was used.
RESULTS
A total of 142 cases fulfilled the inclusion criteria, among them 121 cases (85.2%) completed the follow-up, and in 16 cases (13.2%) ischemic cerebrovascular stroke events occurred within one year, while among these vascular lesions recurred on the ipsilateral side in 12 cases (75%). Single factor analysis showed that difference between recurrent group and non-recurrent group on irregular use of statins (p = 0.017), diabetes mellitus (p = 0.017) and severe arterial stenosis (p = 0.030) were statistically significant. Logistic regression analysis showed that irregular use of statins (OR=3.719, p = 0.005), diabetes (OR=1.842. p = 029) and severe arterial stenosis (OR=1.503. p = 0.045) were correlated with the recurrence of symptomatic intracranial artery stenosis.
CONCLUSIONS
Patients with symptomatic intracranial artery stenosis had a higher recurrence rate of stroke; whereas patients with irregular use of statins, diabetes and severe arterial stenosis had a higher recurrence risk of stroke.
Topics: Aged; Antihypertensive Agents; Brain Ischemia; Cerebral Arteries; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Recurrence; Risk Factors; Stroke
PubMed: 26221890
DOI: No ID Found -
Medicine Dec 2015The aim of the study was to assess the capacity of dynamic cerebral autoregulation (dCA) in asymptomatic patients with unilateral middle cerebral artery (MCA)... (Observational Study)
Observational Study
The aim of the study was to assess the capacity of dynamic cerebral autoregulation (dCA) in asymptomatic patients with unilateral middle cerebral artery (MCA) stenosis.Fifty-seven patients with asymptomatic mild, moderate, and severe unilateral MCA stenosis and 8 patients with symptomatic severe unilateral MCA stenosis diagnosed by transcranial Doppler were enrolled. Twenty-four healthy volunteers served as controls. The noninvasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each subject in the supine position. Transfer function analysis was applied to determine the autoregulatory parameters (phase difference [PD] and gain).The PD values in the severe stenosis groups were significantly lower than those of the control group (60.71 ± 18.63°), the asymptomatic severe stenosis group was impaired ipsilaterally (28.94 ± 27.43°, P < 0.001), and the symptomatic severe stenosis group was impaired bilaterally (13.74 ± 19.21°, P < 0.001; 19.68 ± 14.50°, P = 0.006, respectively). The PD values in the mild and moderate stenosis groups were not significantly different than the controls (44.49 ± 27.93°; 48.65 ± 25.49°, respectively). The gain values in the mild and moderate groups were higher than in the controls (1.00 ± 0.58 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, and 1.20 ± 0.59 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, respectively). The gain values in the severe stenosis groups were significantly lower than that in the control group: the asymptomatic severe stenosis group was lower bilaterally (0.56 ± 0.32 cm/s/mm Hg, P = 0.003; 0.60 ± 0.32 cm/s/mm Hg, P < 0.05, respectively), whereas the symptomatic severe group was lower unilaterally (on the contralateral side) (0.53 ± 0.43 cm/s/mm Hg, P < 0.05).In asymptomatic patients with unilateral MCA stenosis, only the dCA of the severe stenosis was ipsilaterally impaired. Acute stroke may aggravate the impaired dCA and even spread contralaterally.
Topics: Adult; Asymptomatic Diseases; Cerebrovascular Circulation; Constriction, Pathologic; Female; Homeostasis; Humans; Intracranial Arteriosclerosis; Magnetic Resonance Angiography; Male; Middle Aged; Middle Cerebral Artery; Reproducibility of Results; Severity of Illness Index; Stroke; Ultrasonography, Doppler, Transcranial
PubMed: 26717363
DOI: 10.1097/MD.0000000000002234