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Anesthesiology Apr 2020
Topics: Animals; Arterial Occlusive Diseases; Lung; Pulmonary Artery; Swine; Thorax
PubMed: 31996554
DOI: 10.1097/ALN.0000000000003138 -
Journal of Cerebral Blood Flow and... Jun 2021The long-term functional outcome of acute basilar artery occlusion (BAO) patients who received modern endovascular therapy (EVT) is unclear. We sought to assess the... (Observational Study)
Observational Study
The long-term functional outcome of acute basilar artery occlusion (BAO) patients who received modern endovascular therapy (EVT) is unclear. We sought to assess the long-term functional outcome of BAO patients treated with EVT and determine the prognostic factors associated with favorable outcome. We enrolled consecutive BAO patients who received EVT between December 2012 and December 2018 in this observational study. Baseline characteristics and outcomes were presented. Multivariable logistic regression analysis was performed to identify the prognostic factors associated with long-term outcome. Among the 177 BAO patients included in this study, 80 patients (45.2%) obtained favorable outcome and 97 patients (54.8%) had unfavorable outcome at long-term follow-up with a median observation time of 12 months (interquartile range, 3-19). A total of 67 patients (37.9%) died. National Institutes of Health Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), time from stroke onset to recanalization, and recanalization condition were identified as independent predictors for long-term outcome. Over 40% of BAO patients who were treated with modern EVT achieved favorable outcome at long-term follow-up. NIHSS, pc-ASPECTS, time from stroke onset to recanalization, and recanalization condition were identified as independent prognostic factors of long-term outcome.
Topics: Aged; Arterial Occlusive Diseases; Basilar Artery; Endovascular Procedures; Female; Humans; Male; Middle Aged; Stroke; Time; Treatment Outcome; Vertebrobasilar Insufficiency
PubMed: 32955959
DOI: 10.1177/0271678X20958587 -
Orthopaedic Surgery Jun 2019Knee arthroplasty, including total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), is an effective procedure for patients with severe knee joint... (Review)
Review
Knee arthroplasty, including total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), is an effective procedure for patients with severe knee joint diseases. Arterial occlusion after knee arthroplasty is a rare but severe complication. However, there are few comprehensive reviews or analyses focusing on it. In this study, we presented a case of successful treatment of acute arterial occlusion of the popliteal artery after TKA by emergent balloon angioplasty, and conducted a review and analysis of published cases with this complication. After search and screening, 36 studies with 47 cases of arterial occlusion after knee arthroplasty in the past 35 years (1984-2018) were included. Among the 47 patients, there were 22 men and 25 women. The mean age was 68 years old. A total of 43 patients had primary TKA while 2 had revision surgery for TKA and 2 for UKA. For arterial occlusions, 66% presented symptoms in less than 1 day after knee surgery and 95% of the occlusion sites were around the popliteal artery. For treatment, 89% chose surgical treatment. Compared with conservative treatment, surgical treatment was more effective (P < 0.01). The patients who underwent surgical treatment less than 1 day after diagnosis had less sequelae (P < 0.05). For arterial occlusion after knee arthroplasty, we should pay attention to the perioperative risk factors and presentations, and diagnose and treat surgically at an early stage.
Topics: Aged; Angioplasty, Balloon; Anticoagulants; Arterial Occlusive Diseases; Arthroplasty, Replacement, Knee; Combined Modality Therapy; Early Diagnosis; Female; Heparin; Humans; Osteoarthritis, Knee; Popliteal Artery; Postoperative Complications
PubMed: 31243922
DOI: 10.1111/os.12494 -
Pediatrics and Neonatology Aug 2014Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal complication that can cause strokes in both adults and children. Traumatic vertebral artery...
Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal complication that can cause strokes in both adults and children. Traumatic vertebral artery dissection (VAD) is one of the most common causes of ABAO in young patients. We present a case of an 11-year-old boy with VAD complicated by basilar artery occlusion 2 days after a fight with classmates that caused severe neurological deficits. He did not have any direct head trauma or concomitant risk factors. Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments. A history of such subtle precipitating events should be noted when diagnosing young patients with brainstem strokes. A delay in the diagnosis of ABAO is frequently due to misleading symptoms and signs and the lack of awareness of this rare condition.
Topics: Arterial Occlusive Diseases; Basilar Artery; Child; Craniocerebral Trauma; Humans; Magnetic Resonance Angiography; Male; Vertebral Artery Dissection
PubMed: 23597537
DOI: 10.1016/j.pedneo.2012.12.014 -
Stroke and Vascular Neurology Dec 2018Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke. No prognostic tool has yet gained any widespread use. We compared the... (Comparative Study)
Comparative Study Observational Study
BACKGROUND AND PURPOSE
Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke. No prognostic tool has yet gained any widespread use. We compared the predictive value of various models based on National Institutes of Health Stroke Scale (NIHSS) subitems, ranging from simple to more complex models, for predicting large artery occlusion (LAO) in anterior circulation stroke.
METHODS
Patients registered in the SITS international Stroke Register with available NIHSS and radiological arterial occlusion data were analysed. We compared 2042 patients harbouring an LAO with 2881 patients having no/distal occlusions. Using binary logistic regression, we developed models ranging from simple 1 NIHSS-subitem to full NIHSS-subitems models. Sensitivities and specificities of the models for predicting LAO were examined.
RESULTS
The model with highest predictive value included all NIHSS subitems for predicting LAO (area under the curve (AUC) 0.77), yielding a sensitivity and specificity of 69% and 76%, respectively. The second most predictive model (AUC 0.76) included 4-NIHSS-subitems (level of consciousness commands, gaze, facial and arm motor function) yielding a sensitivity and specificity of 67% and 75%, respectively. The simplest model included only deficits in arm motor-function (AUC 0.72) for predicting LAO, yielding a sensitivity and specificity of 67% and 72%, respectively.
CONCLUSIONS
Although increasingly more complex models yield a higher discriminative performance for predicting LAO, differences between models are not large. Assessing grade of arm dysfunction along with an established stroke-diagnosis model may serve as a surrogate measure of arterial occlusion-status, thereby assisting in triage decisions.
Topics: Aged; Arm; Arterial Occlusive Diseases; Clinical Decision Rules; Clinical Decision-Making; Disability Evaluation; Europe; Female; Functional Status; Humans; Ischemic Stroke; Male; Motor Activity; Predictive Value of Tests; Prospective Studies; Registries; Reproducibility of Results; Thrombectomy; Triage
PubMed: 30637127
DOI: 10.1136/svn-2018-000165 -
Interventional Neuroradiology : Journal... Oct 2022Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The...
BACKGROUND
Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.
METHODS
Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed.
RESULTS
Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale <2. Twelve presented with acute basilar artery occlusion and were submitted to mechanical thrombectomy before percutaneous transluminal angioplasty and stenting, while the remaining had severe basilar artery stenosis. Successful stent placement was achieved in 22 (88%). Procedure-related complications included new small ischemic lesions (16%), basilar artery dissection (8%), vertebral artery dissection (12%) and death (12%). At 3 months post-percutaneous transluminal angioplasty and stenting, 10 out of 23 patients (43.5%) were independent (mRS ≤ 2) and six died. Fourteen patients underwent transcranial Doppler ultrasound 3 months post-percutaneous transluminal angioplasty and stenting: 12 showed residual stenosis, one significant stent restenosis and one presented stent occlusion.
CONCLUSIONS
Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.
Topics: Aged; Angioplasty; Arterial Occlusive Diseases; Basilar Artery; Constriction, Pathologic; Female; Humans; Male; Stents; Stroke; Treatment Outcome; Vertebrobasilar Insufficiency
PubMed: 34704502
DOI: 10.1177/15910199211051830 -
Journal of Vascular Surgery Dec 2008Most current animal models of hindlimb ischemia use acute arterial occlusion that does not accurately reflect the pathogenesis of gradual arterial occlusion in humans.... (Comparative Study)
Comparative Study
BACKGROUND
Most current animal models of hindlimb ischemia use acute arterial occlusion that does not accurately reflect the pathogenesis of gradual arterial occlusion in humans. We, therefore, developed the first mouse model of gradual arterial occlusion and tested the hypothesis that the mechanisms regulating blood flow recovery are critically dependent on the rate of arterial occlusion.
METHODS
Gradual arterial occlusion was induced by placing ameroid constrictors on the proximal and distal left femoral artery, and ligating the femoral arterial branches (n = 36). Acute arterial occlusion was accomplished by excising the left femoral artery (n = 36). The blood flow recovery was studied by laser Doppler imaging. Differential gene expression between these two models was assessed by quantitative real-time polymerase chain reactions (PCR). Inflammatory and progenitor cells recruitment were determined by immunohistochemistry.
RESULTS
We found that hypoxia-related genes increased significantly in the calf, but not in the thigh, after gradual and acute femoral arterial occlusion (P < .05). Shear-stress dependent genes and inflammatory genes were upregulated immediately in the thigh only after acute femoral arterial occlusion (P < .05). These differences in gene expression were consistent with increased SDF-1alpha expression, recruitment of macrophages and hemangiocytes, and higher blood flow recovery after acute arterial occlusion than after gradual arterial occlusion (P < .05).
CONCLUSION
This is the first study to show the mechanisms that regulate blood flow recovery are critically dependent on the rate of arterial occlusion. This novel model of gradual arterial occlusion may more closely resemble the human diseases, and may provide more accurate mechanistic insights for creating novel molecular therapies.
Topics: Acute Disease; Animals; Arterial Occlusive Diseases; Blood Flow Velocity; Chemokine CXCL12; Chronic Disease; Disease Models, Animal; Disease Progression; Endothelium, Vascular; Femoral Artery; Gene Expression; Immunohistochemistry; Laser-Doppler Flowmetry; Mice; Mice, Inbred C57BL; Muscle, Skeletal; Polymerase Chain Reaction; RNA, Messenger; Recovery of Function
PubMed: 19118738
DOI: 10.1016/j.jvs.2008.07.063 -
The Journal of Invasive Cardiology Jun 2015
Topics: Arterial Occlusive Diseases; Humans; Radial Artery; Vascular Patency
PubMed: 26028660
DOI: No ID Found -
BMJ Case Reports Dec 2020This report describes the case of a 45-year-old woman with a history of Behçet's disease and complex regional pain syndrome of her legs who presented with severe pain...
This report describes the case of a 45-year-old woman with a history of Behçet's disease and complex regional pain syndrome of her legs who presented with severe pain and swelling in her left lower extremity. The patient was initially diagnosed with exacerbation of complex regional pain syndrome, which fit the symptom complex of hyperalgesia, oedema and skin temperature changes. However, after unsuccessful attempts at significant pain relief during admission, CT angiography demonstrated occlusion of the left common and external iliac arteries, a limb-threatening emergency. This case describes an example of anchoring bias, a type of cognitive bias in which there is a tendency to rely too heavily on an initial piece of information, the 'anchor', when making decisions. This report emphasises that clinicians should be aware of biases when making decisions and avoid anchoring bias by asking themselves if their diagnosis is influenced by any leading pieces of information.
Topics: Arterial Occlusive Diseases; Behcet Syndrome; Computed Tomography Angiography; Female; Humans; Iliac Artery; Middle Aged
PubMed: 33298479
DOI: 10.1136/bcr-2020-236554 -
Anatolian Journal of Cardiology Feb 2022Radial artery occlusion (RAO) is a common complication during transradial coronary intervention. Its incidence is variably reported in literature and its predictors are...
OBJECTIVE
Radial artery occlusion (RAO) is a common complication during transradial coronary intervention. Its incidence is variably reported in literature and its predictors are not completely understood. In this study, we aimed to define the incidence and factors influencing RAO in patients undergoing transradial coronary intervention.
METHODS
This was a single-center prospective study (October 2018 to September 2019) that enrolled 1,754 patients who were evaluated for RAO 24 hours after transradial coronary intervention. Univariate as well as multivariate analyses were done to identify patient and procedure related factors predicting the occurrence of RAO.
RESULTS
A total of 1,374 patients (78.3%) underwent angioplasty, whereas 380 (21.7%) underwent angiography alone. RAO was diagnosed in 11.97% patients. Lower glomerular filtration rate, multiple puncture attempts for radial artery access, larger sheath size, complex nature of interventional procedure, longer homeostasis time, and forearm hematoma formation were independent predictors for RAO.
CONCLUSION
RAO was not an uncommon complication in transradial coronary interventions, especially in the Indian population; and the knowledge of predictors may be helpful in its prevention.
Topics: Arterial Occlusive Diseases; Cardiac Catheterization; Coronary Angiography; Heart; Humans; Incidence; Prospective Studies; Radial Artery
PubMed: 35190358
DOI: 10.5152/AnatolJCardiol.2021.163