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Scientific Reports Jan 2021Quantitative measurement of lung perfusion is a promising tool to evaluate lung pathophysiology as well as to assess disease severity and monitor treatment. However,...
Quantitative measurement of lung perfusion is a promising tool to evaluate lung pathophysiology as well as to assess disease severity and monitor treatment. However, this novel technique has not been adopted clinically due to various technical and physiological challenges; and it is still in the early developmental phase where the correlation between lung pathophysiology and perfusion maps is being explored. The purpose of this research work is to quantify the impact of pulmonary artery occlusion on lung perfusion indices using lung dynamic perfusion CT (DPCT). We performed Lung DPCT in ten anesthetized, mechanically ventilated juvenile pigs (18.6-20.2 kg) with a range of reversible pulmonary artery occlusions (0%, 40-59%, 60-79%, 80-99%, and 100%) created with a balloon catheter. For each arterial occlusion, DPCT data was analyzed using first-pass kinetics to derive blood flow (BF), blood volume (BV) and mean transit time (MTT) perfusion maps. Two radiologists qualitatively assessed perfusion maps for the presence or absence of perfusion defects. Perfusion maps were also analyzed quantitatively using a linear segmented mixed model to determine the thresholds of arterial occlusion associated with perfusion derangement. Inter-observer agreement was assessed using Kappa statistics. Correlation between arterial occlusion and perfusion indices was evaluated using the Spearman-rank correlation coefficient. Our results determined that perfusion defects were detected qualitatively in BF, BV and MTT perfusion maps for occlusions larger than 55%, 80% and 55% respectively. Inter-observer agreement was very good with Kappa scores > 0.92. Quantitative analysis of the perfusion maps determined the arterial occlusion threshold for perfusion defects was 50%, 76% and 44% for BF, BV and MTT respectively. Spearman-rank correlation coefficients between arterial occlusion and normalized perfusion values were strong (- 0.92, - 0.72, and 0.78 for BF, BV and MTT, respectively) and were statically significant (p < 0.01). These findings demonstrate that lung DPCT enables quantification and stratification of pulmonary artery occlusion into three categories: mild, moderate and severe. Severe (occlusion ≥ 80%) alters all perfusion indices; mild (occlusion < 55%) has no detectable effect. Moderate (occlusion 55-80%) impacts BF and MTT but BV is preserved.
Topics: Animals; Animals, Newborn; Arterial Occlusive Diseases; Blood Volume; Perfusion; Pulmonary Artery; Swine; Tomography, X-Ray Computed
PubMed: 33436837
DOI: 10.1038/s41598-020-80177-5 -
Medicina (Kaunas, Lithuania) Dec 2022Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier...
Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with EVT or bridging therapy (BT) in anterior circulation stroke (ACS) versus PCS (middle cerebral artery occlusion (MCAO) and basilar artery occlusion (BAO), and establish the risk factors for poor outcome. Materials and Methods: we analyzed the data of 279 subjects treated with EVT due to LVO-caused stroke in a comprehensive stroke centre in 2015−2021. The primary outcome was hospital mortality, secondary outcomes were National Institutes of Health Stroke Scale (NIHSS) after 24 h, early neurological deterioration, futile recanalization (FR), the ambulatory outcome at discharge, and complications. Results: BAO presented with higher baseline NIHSS scores (19 vs. 14, p < 0.001), and longer door-to-puncture time (93 vs. 82 min, p = 0.034), compared to MCAO. Hospital mortality and the percentage of FR were the same in BAO and almost two times higher than in MCAO (20.0% vs. 10.3%, p = 0.048), other outcomes did not differ. In BAO, unsuccessful recanalization was the only significant predictor of the lethal outcome, though there were trends for PAD and RF predicting lethal outcome. A trend for higher risk of symptomatic intracranial hemorrhage (sICH) was observed in the BAO group when BT was applied. Nevertheless, neither BT nor sICH predicted lethal outcomes in the BAO group. Conclusions: Compared to the modern gold standard of EVT in the ACS, early outcomes in BAO remain poor, there is a substantial amount of FR. Nevertheless, unsuccessful recanalization remains the strongest predictor of lethal outcomes. BT in PCS might pose a higher risk for sICH, but not the lethal outcome, although this finding requires further investigation in larger trials.
Topics: Humans; Basilar Artery; Thrombectomy; Treatment Outcome; Endovascular Procedures; Stroke; Arterial Occlusive Diseases; Intracranial Hemorrhages; Ischemic Stroke; Retrospective Studies
PubMed: 36676720
DOI: 10.3390/medicina59010096 -
British Medical Journal Feb 1976If vertebral artery occlusion occurs in degenerative arterial disease it is almost invariably left-sided, but in vertebral artery deficiency syndromes associated with...
If vertebral artery occlusion occurs in degenerative arterial disease it is almost invariably left-sided, but in vertebral artery deficiency syndromes associated with oral contraceptives a striking preponderance of right-sided involvement has been shown. This observation adds support to the view that causes other than changes in the wall of the vessel at the site of occlusion must be sought as an explanation of the occlusion.
Topics: Age Factors; Arterial Occlusive Diseases; Contraceptives, Oral; Functional Laterality; Humans; Sex Factors; Vertebral Artery
PubMed: 1252812
DOI: 10.1136/bmj.1.6008.487 -
Contrast Media & Molecular Imaging 2022To investigate the risk factors of radial artery obstruction after repeated right radial coronary interventions.
OBJECTIVE
To investigate the risk factors of radial artery obstruction after repeated right radial coronary interventions.
METHODS
497 patients who underwent repeated coronary intervention via the right radial artery in our hospital from January 2017 to January 2021 were selected and followed up for 28.07 ± 6.07 months. According to whether the right radial artery was obstructed or not, they were divided into radial artery occlusion group ( = 48) and nonradial artery occlusion group ( = 449).
RESULTS
The proportion of patients with diabetes mellitus, elevated D-dimer, and elevated LDL cholesterol was higher in the radial artery occlusion group than in the nonradial artery occlusion group ( < 0.05). The radial artery occlusion group had more passage through the right radial artery often and had a longer cumulative sheath retention time than the radial artery occlusion group ( < 0.05). Cumulative sheath retention time (hours) had a high predictive value for radial artery occlusion. The optimal diagnostic limit for radial artery occlusion was 2.75 h, with a sensitivity of 77.1% and a specificity of 79.5% ( < 0.05).
CONCLUSION
Diabetes mellitus, elevated D-dimer, elevated LDL cholesterol, and long retention sheath time predispose to radial artery occlusion. Cumulative duration of sheath retention is a predictor of radial artery occlusion.
Topics: Arterial Occlusive Diseases; Cholesterol, LDL; Humans; Radial Artery; Risk Factors; Treatment Outcome
PubMed: 35924069
DOI: 10.1155/2022/9624339 -
BMC Neurology Jan 2024Radial artery occlusion (RAO) remains a significant limitation of neuroendovascular procedures peformed through transradial access (TRA) when radial artery needs to be...
BACKGROUND
Radial artery occlusion (RAO) remains a significant limitation of neuroendovascular procedures peformed through transradial access (TRA) when radial artery needs to be reused. Instances of early RAO recanalization to successfully complete neuroendovascular procedures have been rarely documented.
MATERIALS AND METHODS
Documents and imaging data were extracted retrospectively for all patients who underwent TRA diagnostic angiography and neuroendovascular procedures in our center from June 2022 to February 2023. The patients with early RAO who required repeat TRA were included.
RESULTS
A total of 46 patients underwent repeat TRA, and 13 consecutive patients who experienced early RAO after angiography as confirmed by ultrasonography were enrolled in this study. The occluded radial arteries were successfully recanalized, and subsequent neuroendovascular procedures were carried out successful. During an average follow-up time of 7.1 months, no patients exhibited symptomatic RAO, dissection, hematoma or pseudoaneurysm.
CONCLUSIONS
Early RAO recanalization and reused for neuroendovascular procedures through TRA is feasible. A visually guided and stable puncture process plays a crucial role in successfully recanalizing early RAO.
Topics: Humans; Radial Artery; Retrospective Studies; Feasibility Studies; Cardiac Catheterization; Ultrasonography; Arterial Occlusive Diseases
PubMed: 38297227
DOI: 10.1186/s12883-024-03549-8 -
Neuroradiology May 2022We present the first nationwide study on endovascular therapy for basilar artery occlusion (BAO) from early hospital management to 3-month outcome.
PURPOSE
We present the first nationwide study on endovascular therapy for basilar artery occlusion (BAO) from early hospital management to 3-month outcome.
METHODS
Data were collected on all acute ischaemic stroke patients registered 2016-2019 in the two national quality registers for stroke care and endovascular therapy (EVT), receiving EVT for BAO and subclassified into proximal, middle and distal.
RESULTS
In all, 251 patients were included: 69 proximal, 73 middle and 109 distal BAO. Patients with proximal BAO were younger (66, middle 71, distal 76, p < 0.0001), less often female (27.5%, middle 47.9%, distal 47.7%, p = 0.015), more often smokers (28.6%, middle 20.3%, distal 11.5%, p < 0.0001), and fewer had atrial fibrillation (13.2%, middle 24.7%, distal 48.6%, p < 0.0001). Level of consciousness and NIHSS score did not differ by BAO subtype and 52.2% were alert on admission. Time from groin puncture to revascularization was significantly longer in patients with proximal BAO (71, middle 46, distal 42 min, p < 0.0001), and angioplasty and/or stenting was more often performed in patients with proximal (43.4%) and middle (27.4%) than distal (6.4%) BAO (p < 0.0001). Cumulative 90-day mortality was 38.6% (proximal 50.7%, middle 32.9%, distal 34.9%, p = 0.02). Older and pre-stroke dependent patients had higher mortality, as did patients in whom angioplasty/stenting was performed.
CONCLUSION
We confirm a serious outcome in BAO despite endovascular therapies, and demonstrate important differences relating to occlusion location in baseline characteristics, procedural time, therapeutic measures and outcome. Further in-depth analyses of factors affecting outcome in BAO are warranted.
Topics: Arterial Occlusive Diseases; Basilar Artery; Brain Ischemia; Endovascular Procedures; Female; Humans; Registries; Retrospective Studies; Stroke; Sweden; Thrombectomy; Treatment Outcome; Vertebrobasilar Insufficiency
PubMed: 34716767
DOI: 10.1007/s00234-021-02843-3 -
Journal of Vascular Surgery Dec 2009Occlusion of the ulnar artery is found in a substantial proportion of elderly patients. The aim of this study was to estimate the prevalence of ulnar artery occlusion in...
BACKGROUND
Occlusion of the ulnar artery is found in a substantial proportion of elderly patients. The aim of this study was to estimate the prevalence of ulnar artery occlusion in a sample of the general population of France, look for its risk factors, and evaluate its clinical correlates.
METHODS
This study was an offshoot of a cross-sectional epidemiologic study in the general population of four locations in France (Tarentaise, Grenoble, Nyons, and Toulon). In phase I, random samples of 2000 individuals per location aged >or=18 years old were interviewed by phone for screening of Raynaud phenomenon. In phase II, subsamples of individuals were invited to a medical interview and physical examination where the presence of Raynaud phenomenon and occupational risk factors were recorded and a bilateral clinical Allen test was performed for the detection of ulnar artery occlusion. Phase II comprised 688 women and 335 men.
RESULTS
In 36 men and seven women, at least one occluded ulnar artery was found. The estimated prevalence was 9.6% in men and 1.0% in women (P < .001). The occluded artery was more often in the dominant hand of both men (8.1% vs 2.4%; P < .001) and women (0.9% vs 0.4%; P = .34). Ulnar artery occlusion was found more often in men aged >50 years (16.4%) than in younger men (1.4%; P < .001). Besides age, male sex, and dominant side, the only independent risk factor was an occupational exposure in men to repeated palmar trauma, with a significant quantitative relationship in the frequency of the impacts (P < .001) and the duration of the exposure (P < .001). Exposures to hand-held vibrating tools and cigarette smoking did not show a significant relationship in the multivariate analysis. Most individuals with ulnar artery occlusion did not have associated complaints; however, the diagnostic criteria for Raynaud phenomenon was validated in 13 of the 36 affected men. The association remained significant after adjusting for occupational exposure to vibrating tools. One individual reported a previous episode consistent with an attack of permanent digital ischemia.
CONCLUSION
This study confirms a substantial prevalence of ulnar artery occlusions in the general population, mostly in middle-aged and elderly men, which appears to be principally related to an occupational exposure to repeated occupational palmar trauma. Although there is a significant association with Raynaud phenomenon, most often the consequences of this occlusion remain subclinical.
Topics: Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Arterial Occlusive Diseases; Constriction, Pathologic; Cross-Sectional Studies; Female; France; Functional Laterality; Humans; Logistic Models; Male; Middle Aged; Occupational Diseases; Occupational Exposure; Odds Ratio; Population Surveillance; Prevalence; Raynaud Disease; Regional Blood Flow; Risk Assessment; Risk Factors; Sex Distribution; Sex Factors; Ulnar Artery; Vibration
PubMed: 19837535
DOI: 10.1016/j.jvs.2009.07.076 -
The Journal of Invasive Cardiology Apr 2020The aim of this study was to compare two hemostatic techniques, minimum pressure technique and patent hemostasis, on radial artery occlusion (RAO) after transradial... (Comparative Study)
Comparative Study
OBJECTIVES
The aim of this study was to compare two hemostatic techniques, minimum pressure technique and patent hemostasis, on radial artery occlusion (RAO) after transradial catheterization.
BACKGROUND
RAO is an infrequent complication of transradial procedures. One of the strategies used to reduce this complication is the patent hemostasis technique. Use of minimum pressure in hemostatic wristband, without monitoring patency, might have the same efficacy for preventing RAO.
METHODS
This is a multicenter study encompassing patients submitted to transradial catheterization. After pneumatic wristband application, the band was deflated to the lowest allowable volume while preserving hemostasis. Radial artery patency was subsequently evaluated. The group with no return of plethysmographic curve was labeled "minimum pressure," and the group in which the signal returned was labeled "patent hemostasis." RAO was verified by Doppler evaluation within the first 24 hours of the procedure.
RESULTS
A total of 1082 patients were enrolled, with mean age of 61.4 ± 10.4 years. The majority (61.0%) were male and 34.5% had diabetes. Patent hemostasis was achieved in only 213 cases (20%). Early RAO occurred in 16 patients (1.8%) in the minimum pressure group and in 4 patients (1.9%) in the patent hemostasis group (P=.97). No major bleeding was observed among the entire cohort. EASY scale for hematoma grade was similar between the cohorts (EASY grades 1-3: 7.0% in the minimum pressure group vs 7.5% in the patent hemostasis group; P=.96).
CONCLUSION
Checking radial patency during hemostatic compression may not be necessary after the procedure when adopting a mild and short hemostatic compression.
Topics: Aged; Arterial Occlusive Diseases; Cardiac Catheterization; Catheterization, Peripheral; Female; Hemostasis; Hemostatic Techniques; Humans; Male; Middle Aged; Punctures; Radial Artery; Vascular Patency
PubMed: 32160152
DOI: No ID Found -
Journal of Interventional Cardiology Dec 2018Radial artery occlusions (RAOs) impose an important problem that limit transradial interventions. In this study, we represent that it is possible to perform...
It is both possible and safe to perform coronary angiography through the same radial artery, after retrograde recanalization of radial artery occlusion, following a previous coronary angiography.
INTRODUCTION
Radial artery occlusions (RAOs) impose an important problem that limit transradial interventions. In this study, we represent that it is possible to perform interventions through occluded radial arteries.
METHOD
Twenty-five patients with RAO who had retrograde flow shown by doppler ultrasonography were enrolled into our study. After preparing the radial region, the radial artery was accessed with a puncture needle. A 0.014″ guidewire was introduced into the brachial artery via the radial artery with the aid of balloon back up. Lesion was predilated with a drug coated peripheral balloon, and a sheath was placed at the end.
RESULTS
Radial artery recanalization could be established in 22 of 25 cases and coronary angiography could be performed from those occluded radial arteries. Neither the occlusion duration nor the caliber of the radial artery had any effect on the success rate of recanalization attempts. Two patients had a hematoma because of the intervention and there were no other complications.The patency rates at 1 month follow up have been only 33.4%, too much lower than we expected.
DISCUSSION AND CONCLUSION
In patients with RAO because of a previous angiographic intervention via their radial arteries may be reintervened from their occluded radial artery safely and effectively. So, our procedure is not intended for neither the recanalization nor keeping the patency of the radial artery, but suitable for those patients in whom other routes of intervention are not wanted.
Topics: Aged; Arterial Occlusive Diseases; Coronary Angiography; Female; Humans; Male; Middle Aged; Postoperative Complications; Punctures; Radial Artery; Vascular Surgical Procedures
PubMed: 29855079
DOI: 10.1111/joic.12524 -
Biomedical Papers of the Medical... Dec 2014Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality... (Review)
Review
BACKGROUND
Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality rate (to 86%). Early recanalization is essential for good clinical outcome but the most effective treatment approach remains unestablished. Several treatment strategies are currently available but their safety and efficacy have only been tested in retrospective/prospective case series. Randomized controlled trials (RCTs) are lacking.
METHODS AND RESULTS
We searched the PubMed database for assessments of recanalization rate and clinical outcome in BAO patients treated with various treatment methods. The results show that antithrombotics are least effective while specific reperfusion therapies including intravenous thrombolysis (IVT) and various types of intra-arterial therapy (IAT) are more so. Less than half of BAO patients reach independent outcome following IVT with a recanalization rate 52-78%. Even though IAT recanalizes BAO more frequently (in up to 100%), the higher recanalization rate is not necessarily associated with better outcome.
CONCLUSIONS
Good clinical outcome is strongly dependent on recanalization time. Thus, the concept of bridging therapy, combining widely available IVT with IAT, was introduced and is usually considered a rescue strategy in non-responders to IV alteplase. A trend to better outcome in patients treated with bridging therapy in some studies, has to be confirmed by large RCTs.
Topics: Acute Disease; Arterial Occlusive Diseases; Basilar Artery; Humans; Stroke; Thrombolytic Therapy; Treatment Outcome
PubMed: 24085313
DOI: 10.5507/bp.2013.075