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1.
Rev. bras. cir. cardiovasc ; 34(6): 653-658, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057501

ABSTRACT

Abstract Objective: To evaluate the predictive accuracy of SYNTAX score (SS) I and II for detecting significant carotid artery stenosis (CAS) in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery. Methods: The study population consisted of 416 patients. Clinical, demographic, and radiological records were retrospectively reviewed. Characteristics of patients with CAS (n=66) and patients without CAS (n=350) were compared before and after propensity score matching analysis. Results: Patients with significant CAS were older compared to those without significant CAS [(60 (53-65) vs. 63 (59-67); P=0.01]. However, atherosclerotic risk factors and SS I were similar between groups. SS II CABG and percutaneous coronary intervention (PCI) were significantly higher in patients with CAS [37.4 (30.9-43.5) vs. 33.8 (29.9-38.9); P=0.02]. After propensity score matching analysis (66 vs. 66), age, SS II PCI and CABG were significantly higher in patients with CAS than those without CAS [37.4 (30.9-43.5) vs. 33 (29.3-36.9); P=0.03]. Age, SS II PCI and CABG were associated with CAS in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P<0.001; OR=1.054, 95% CI (1.010-1.101), P=0.02; OR=1.078, 95% CI (1.029-1.129), P<0.01]. In ROC curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P<0.01, 95% CI (0.583-0.749)] to predict CAS. Pairwise comparison of ROC curves revealed similar statistical accuracy for prediction of CAS (z statistic: 0.683, P=0.49) Conclusion: SS II is useful to predict asymptomatic CAS in patients with multivessel coronary artery disease.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/complications , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Coronary Artery Disease/surgery , Body Mass Index , Coronary Artery Bypass , Risk Factors , ROC Curve , Sensitivity and Specificity , Percutaneous Coronary Intervention
3.
ABC., imagem cardiovasc ; 32(1): 6-13, jan.-mar. 2019. graf
Article in Portuguese | LILACS | ID: biblio-969855

ABSTRACT

As doenças cardiovasculares são a maior causa de morbimortalidade no mundo. A prevenção primária, por meio do diagnóstico precoce, é necessária para possibilitar o tratamento adequado e controlar a evolução da doença, reduzindo a mortalidade e os gastos em saúde pública. Correlacionar aterosclerose em artéria carótida (avaliada pelo Eco Doppler) e disfunção ventricular esquerda (avaliada pelo ecocardiograma), além de correlacionar tais achados com o risco cardiovascular dos pacientes estudados. Método: Foram analisados 286 prontuários de pacientes que realizaram os exames Eco Doppler carotídeo e ecocardiograma transtorácico. Os dados analisados foram: presença de placa aterosclerótica e grau de estenose, fração de ejeção do ventrículo esquerdo e presença de alterações contráteis difusas ou segmentares do ventrículo esquerdo. Resultados: Dos 238 laudos de Eco Doppler carotídeo, 18 tinham estenose maior que 70% em artéria carótida e 14 destes apresentavam alteração contrátil do ventrículo esquerdo (p = 0,045). Dos pacientes que tinham risco cardiovascular muito alto, 61 apresentavam estenose em artéria carótida (p < 0,001); 51 pacientes com risco cardiovascular muito alto apresentavam alteração contrátil (p < 0,001). Dos 266 laudos de ecocardiograma, 37 registravam fração de ejeção do ventrículo esquerdo reduzida. Desses, 25 tinham risco cardiovascular muito alto (p < 0,001). Conclusão: Houve relação positiva entre estenose de artéria carótida, redução da fração de ejeção do ventrículo esquerdo e alteração contrátil do ventrículo esquerdo (difusa ou segmentar) com risco cardiovascular muito alto. Também foi possível correlacionar a estenose carotídea com alteração contrátil, apesar deste estudo não demonstrar correlação entre estenose carotídea e redução da fração de ejeção do ventrículo esquerdo


Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Primary prevention, through early diagnosis, is necessary to enable proper treatment and control disease progression, reducing mortality and public health expenditures. Objective: Correlate carotid artery atherosclerosis (evaluated by Doppler echocardiography) and left ventricular dysfunction (evaluated by echocardiography) and to correlate the findings with the patients' cardiovascular risk. Method: A total of 286 medical records of patients who underwent carotid Doppler echocardiography and transthoracic echocardiography were analyzed. The data analyzed were: presence of atherosclerotic plaque and degree of stenosis, left ventricular ejection fraction and presence of diffuse or segmental left ventricular contractile disorders. Results: Of the 238 reports of carotid Doppler echocardiography, 18 had stenosis greater than 70% in the carotid artery and 14 of those had left ventricular contractile disorders (p = 0.045). Of the patients with very high cardiovascular risk, 61 had carotid artery stenosis (p < 0.001); 51 patients with very high cardiovascular risk had contractile disorders (p < 0.001). Of the 266 echocardiography reports, 37 had reduced left ventricular ejection fraction. Of these, 25 had very high cardiovascular risk (p < 0.001). Conclusion: There was a positive relationship between carotid artery stenosis, reduced left ventricular ejection fraction and left ventricular (diffuse or segmental) contractile disorder with very high cardiovascular risk. It was also possible to correlate carotid stenosis with contractile disorder, although this study did not demonstrate any correlation between carotid stenosis and reduced left ventricular ejection fraction


Subject(s)
Humans , Male , Female , Echocardiography/methods , Carotid Arteries , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Ventricular Dysfunction, Left/complications , Primary Prevention/methods , Stroke Volume , Vertebral Artery , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Echocardiography, Doppler/methods , Retrospective Studies , Risk Factors , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Plaque, Atherosclerotic , Myocardial Revascularization/methods
4.
J. vasc. bras ; 14(3): 231-240, July-Sep. 2015. tab, graf
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-763077

ABSTRACT

A hidrocortisona pode reduzir a concentração dos biomarcadores inflamatórios séricos e teciduais.ObjetivoAnalisar a atividade inflamatória da proteína C-reativa ultrassensível (PCR-US), do fator de necrose tumoral (FNT)-alfa e do fator de crescimento do endotélio vascular (FCEV) séricos e teciduais, mediante administração intraoperatória de hidrocortisona, após endarterectomia de artéria carótida (EAC).MétodoVinte e dois pacientes foram divididos em Grupo Controle (5 assintomáticos e 6 sintomáticos) – não foi administrada hidrocortisona – e Grupo 1 (4 assintomáticos e 7 sintomáticos) – foram administrados 500 mg intravenoso de hidrocortisona. O PCR-US, o FNT-alfa e o FCEV séricos foram dosados no pré-operatório e em 1 hora, 6 horas e 24 horas após a EAC. Na placa carotídea, mensuramos os níveis de FNT-alfa e FCEV.ResultadosO grupo 1 exibiu menor concentração sérica de FNT-alfa em 1 hora (p=0,031), 6 horas (p=0,015) e 24 horas (p=0,017) após a EAC, e menor concentração de FCEV em 1 hora (p=0,006) e 6 horas (p=0,005) após a EAC, em relação ao grupo controle. Os pacientes sintomáticos do grupo 1 exibiram menor concentração de FNT-alfa em 1 hora e 6 horas após a EAC, e menor concentração de FCEV em 1 hora após a EAC, em relação ao grupo controle. Não houve diferença estatística entre as concentrações teciduais de FNT-alfa e FCEV entre o grupo controle e o grupo 1.ConclusãoA hidrocortisona reduz as concentrações séricas pós-operatórias de FNT-alfa e FCEV, em especial nos sintomáticos; porém, não reduz os níveis teciduais destes biomarcadores.


Hydrocortisone may reduce serum and tissue concentrations of inflammatory biomarkers.ObjectiveTo analyze the inflammatory activity of serum and tissue high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-á and vascular endothelial growth factor (VEGF) after intraoperative administration of hydrocortisone, after carotid endarterectomy (CEA).MethodTwenty-two patients were allocated to a Control Group (5 asymptomatic and 6 symptomatic patients) and were not administered hydrocortisone or to Group 1 (4 asymptomatic and 7 symptomatic patients) and were administered 500 mg intravenous hydrocortisone. Serum levels of hsCRP, TNF-á and VEGF were tested for the preoperative period and at 1 hour, 6 hours and 24 hours after CEA. Levels of TNF-á and VEGF were also measured in carotid plaques.ResultsGroup 1 exhibited lower concentrations of serum TNF-á at 1 hour (p=0.031), 6 hours (p=0.015) and 24 hours (p=0.017) after CEA and lower concentrations of serum VEGF at 1 hour (p=0.006) and 6 hours (p=0.005) after CEA, relative to controls. Symptomatic patients in group 1 exhibited lower concentrations than controls for serum TNF-á at 1 hour and 6 hours after CEA and lower concentrations than controls for serum VEGF at 1 hour after CEA. There were no statistical differences in tissue concentrations of TNF-á or VEGF between the control group and group 1.ConclusionHydrocortisone reduces postoperative concentrations of serum TNF-á and VEGF, especially in symptomatic patients; but does not reduce tissue levels of these biomarkers.


Subject(s)
Humans , Endarterectomy, Carotid/rehabilitation , Carotid Stenosis/diagnosis , Carotid Stenosis/therapy , Heparin/administration & dosage , Hydrocortisone/administration & dosage , Hydrocortisone , Angiography , Risk Factors , Ultrasonography, Doppler/methods
5.
Rev. bras. cardiol. invasiva ; 21(2): 159-164, abr.-jun. 2013. ilus, graf, tab
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: lil-681950

ABSTRACT

INTRODUÇÃO: O tipo de proteção cerebral utilizado durante o implante de stent carotídeo é controverso em idosos. Nosso objetivo foi avaliar os resultados dos dispositivos de proteção embólica cerebral (PEC), proximal e distal, em pacientes > 70 anos de idade, por meio da ressonância magnética ponderada de difusão (RM-PD). MÉTODOS: Entre 2008 e 2011, 60 pacientes com indicação de stent carotídeo foram randomizados para PEC com Mo.Ma® ou Angioguard®, dos quais 26 tinham > 70 anos de idade. Os resultados da RM-PD realizada antes e 48 horas após o procedimento foram avaliados por neuro­logista independente e cego para o tipo de PEC utilizado. Foram analisados o número de novos focos isquêmicos, sua localização e o tamanho. RESULTADOS: Novos focos isquêmicos cerebrais foram encontrados em 8/12 (66,7%) pacientes do grupo Mo.Ma® e em 12/14 (85,7%) pacientes do grupo Angioguard® (P = 0,37). A maioria das lesões (> 90%) era ipsilateral à artéria tratada em ambos os grupos, e o tamanho das lesões foi < 0,5 cm na maioria dos casos. O número de lesões por paciente foi menor com o dispositivo Mo.Ma® (mediana [variação]: 3 [1 a 8] lesões vs. 15 [2 a 76] lesões; P < 0,001). Todos os pacientes que tiveram mais de 40 lesões pertenciam ao grupo Angioguard®. CONCLUSÕES: Mesmo utilizando PEC (proximal ou distal), novas lesões isquêmicas foram observadas em ambos os grupos em pacientes idosos. Proporcionalmente maior número de pacientes com Angioguard® teve novos focos isquêmicos se comparados aos pacientes do grupo Mo.Ma®. O dispositivo de PEC Mo.Ma® parece diminuir o número de lesões por paciente.


BACKGROUND: The type of cerebral protection used during carotid stenting in the elderly is controversial. Our objective was to evaluate the results of proximal and distal cerebral embolic protection devices (EPDs), in patients > 70 years through diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS: Between 2008 and 2011, 60 patients with indication for carotid stenting were randomized to EPD with Mo.Ma® or Angioguard®, of which 26 patients were > 70 years of age. Results of DW-MRI performed before and 48 hours after the procedure were evaluated by an independent neurologist blinded to the type of EPD used. New ischemic lesions, their localization and size were analyzed. RESULTS: New cerebral ischemic lesions were found in 8/12 (66.7%) patients in the Mo.Ma® group and 12/14 (85.7%) patients in the Angioguard® group (P = 0.37). The vast majority of the lesions (> 90%) were ipsilateral to the treated artery in both groups and the size of the lesions was < 0.5 cm in most cases. The number of lesions per patient was lower with the Mo.Ma® device (median [variation]: 3 [1 to 8] lesions vs 15 [2 to 76] lesions; P < 0.001). All of the patients with more than 40 lesions were in the Angioguard® group. CONCLUSIONS: Despite the use of EPDs (proximal or distal), new ischemic lesions were observed in both groups in elderly patients. A proportionately larger number of patients with Angioguard® had new ischemic lesions when compared to those with Mo.Ma®. The Mo.Ma® device seems to decrease the number of lesions per patient.


Subject(s)
Humans , Male , Female , Aged , Cerebral Angiography/methods , Cerebral Angiography , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Aged , Stents , Angioplasty/methods , Risk Factors
6.
J. vasc. bras ; 12(2): 129-132, jun. 2013. graf
Article in English | LILACS | ID: lil-687317

ABSTRACT

This article describes the VascMorph 1a prototype software and reports first results obtained with postoperative determination of the degree of stenosis in the carotid artery.


Este artigo descreve o programa protótipo VascMorph 1a e apresenta os primeiros resultados obtidos com a determinação pós-operatória do grau de estenose na artéria carótida.


Subject(s)
Humans , Carotid Stenosis/diagnosis , Carotid Stenosis/therapy , Magnetic Resonance Angiography/methods , Postoperative Care
7.
Med. interna (Caracas) ; 26(3): 153-162, 2010. tab, graf
Article in Spanish | LILACS | ID: lil-772242

ABSTRACT

Existe evidencia que en pacientes con enfermedad de hígado graso no alcohólica (EHGNA) hay aumento del estrés oxidativo hepático y que esta entidad puede también ser un marcador temprano de ateroesclerosis en personas sanas. Establecer la relación entre el espesor de íntima media carotídea (EIMC) y la placa de ateroma, con la EHGNA, como un marcador precoz de ateroesclerosis subclínica independiente de los factores de riesgo cardiometabólicos clásicos. Estudio clínico no experimental, transversal, analítico. 40 sujetos distribuidos en 2 grupos: sin EHGNA y con EHGNA, diagnosticados por ultrasonido hepático, a quienes se les determinó el EIMC. Para el análisis de los resultados se calculó la media y la desviación estándar, U de Mann-Whitney y la prueba chi-cuadrado (p <0,05). Prevalencia de EHGNA 64, %. En el grupo con EHGNA 80% grado I, 20% grado II, y ninguno grado III. La media del EIMC fue mayor en el grupo con EHGNA. Se encontraron 14 individuos (35%) con EIMC > 0,8 mm; 17 individuos (40%) con placa ateromatosa carotídea, y 20 individuos (50%) con una o ambas características, en su mayoría, se encontraron en el grupo con EHGNA (p=0,004). Los pacientes con EHGNA tienen un incremento en el EIMC, y por consiguiente, del riesgo de enfermedad cardiovascular. Así, la detección de EHGNA por ultrasonido podría ser un marcador temprano de ateroesclerosis


There is evidence that in patients who have Nonalcoholic Fatty Liver Disease (NFLD), there is an increase of hepatic oxidative stress, and this entity could be an early marker of atherosclerosis in healthy people. To establish the relationship between carotid intimamedia thickness (CMT), atheroma plaque and NFLD as a possible early marker of subclinic atherosclerosis independently of the classical cardiometabolic factors. Our sample consisted of 40 subjects, divided in two groups: with and without NFLD diagnosed by hepatic ultrasound. CIMT was done in all. For statistical analysis we applied median, standard deviation, U de Mann-Whitney and chi-square. Prevalence of NFLD was 64%. In the group with NFLD 80% had stage I. 20% stage II. Median of CMT was higher in the group with NFLD. 14 subjects (40 %) had a CMT > 0,8 mm; 17 (40%) had atheromatous plaque and 20 (50%) both. (p=0,004). Patients with NFLD have a higher CMT, and, thereforea higher risk of CVD. Hepatic Ultrasound could help as an early marker of atherosclerosis


Subject(s)
Humans , Male , Female , Atherosclerosis/pathology , Cardiovascular Diseases/pathology , Carotid Stenosis/diagnosis , Fatty Liver/complications , Fatty Liver/diagnosis , Internal Medicine
8.
J. vasc. bras ; 8(4): 307-312, dez. 2009. ilus
Article in Portuguese | LILACS | ID: lil-543397

ABSTRACT

Contexto: A qualidade e a quantidade de partículas coletadas em filtros de proteção cerebral (FPC) durante angioplastia transluminal percutânea com stent (ATPS) podem esclarecer a importância desses dispositivos no tratamento de estenoses carotídeas. Objetivos: Analisar o conteúdo retido por FPC em pacientes submetidos a ATPS de artéria carótida interna com nova técnica de análise qualiquantitativa. Métodos: O material coletado em 10 FPC durante ATPS da bifurcação da carótida em pacientes com alto risco cirúrgico foi submetido a análise microscópica qualiquantitativa. Fotografias digitais das lâminas com material corado com hematoxilina e eosina foram analisadas com o programa Axio Vision LE Release 4.1, que calculou a área das partículas em micrômetros/metro quadrado (µm²). Resultados: O exame histopatológico evidenciou material em 100 por cento dos filtros consistindo predominantemente de restos hemáticos, cristais de colesterol e cálcio. A área média de fragmentos coletados foi expressiva (1.570.310 µm²), e houve ampla variância desses valores. Conclusões: Os FPC coletam quantidade importante de fragmentos de placas de ateroma, e a grande variância nas quantidades de material coletado pode estar associada com a gravidade da lesão, motivo pelo qual se tornam relevantes estudos que utilizem técnica padronizada para a quantificação desses fragmentos e para a compreensão de seu real significado clínico.


Background: Quality and quantity of the content retained in embolic protection filters (EPFs) used in percutaneous transluminal angioplasty and stenting may possibly indicate the importance of EPFs in the management of carotid stenosis. Objectives: To analyze the content retained by EPFs in patients undergoing percutaneous transluminal angioplasty and stenting of the internal carotid artery using a new technique for qualitative and quantitative analysis. Methods: Material captured in 10 EPFs during percutaneous transluminal angioplasty and stenting in high-surgical-risk patients was examined to determine a qualitative and quantitative microscopic analysis. Digital photographs of the hematoxylin-eosin stained slides were analyzed using the Axio Vision LE Release 4.1 software in order to calculate the particles area in micra/square meter (µm²). Results: Histopathological examination identified particulate debris in 100 percent of the filters including predominantly blood residues, cholesterol crystals, and calcium Quantity of captured fragments was significant (mean of 1,570,310 µm²) with a wide range of these values. Conclusions: Significant quantity of fragments of atheromatous plaques is retained by EPFs and the wide range in the quantity of the retained debris can be associated with the lesion severity; therefore new studies using standardized technique for quantifying these fragments and for better understanding their real clinical meaning are necessary.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Carotid Arteries , Endarterectomy/methods , Endarterectomy , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Stents
9.
Rev. Méd. Clín. Condes ; 20(3): 382-385, mayo 2009. ilus
Article in Spanish | LILACS | ID: lil-525318

ABSTRACT

Presentamos un caso clínico radiológico de un paciente joven, de 47 años, con una estenosis carotidea hipercrítica precoz, con una carótida única ya que previamente había ocluido su carótida contralateral. Revisamos imágenes de su evaluación diagnóstica radiológica y también de su tratamiento endovascular, haciendo una breve reseña del marco teórico diagnóstico de este caso.


We present a clinical radiological case report of a young patient 47 years of age with an early onset of a critical carotid artery stenosis, and a contralateral carotid occlusion. We review images of the different diagnostic radiological different diagnostic imaging tools available in the evaluation of such a patient.


Subject(s)
Humans , Male , Adult , Carotid Stenosis/surgery , Carotid Stenosis/diagnosis , Stents , Angioplasty , Cerebral Angiography , Carotid Stenosis/etiology , Cerebral Infarction/complications , Magnetic Resonance Imaging , Tomography, Emission-Computed, Single-Photon
10.
Article in English | WPRIM | ID: wpr-93517

ABSTRACT

Distal protection devices such as FilterWire EX have been widely used in carotid artery stenting, however, the large amount of atherothrombotic debris entrapped in the filter could reduce or stop antegrade flow. We present a case of pseudo-no-reflow phenomenon after postdilatation of the stent in a patient with asymptomatic carotid artery stenosis. After several passes using an Export Aspiration catheter, normal flow in the internal carotid artery was restored. Aspiration thrombectomy can successfully recover pseudo-no-reflow phenomenon.


Subject(s)
Aged , Blood Vessel Prosthesis Implantation , Carotid Arteries/diagnostic imaging , Carotid Stenosis/diagnosis , Humans , Male , No-Reflow Phenomenon , Stents , Thrombectomy/instrumentation
11.
ACM arq. catarin. med ; 37(4): 64-68, set.-dez. 2008. tab, graf
Article in Portuguese | LILACS | ID: lil-512812

ABSTRACT

Objetivo: Conhecer a prevalência e severidade da doença aterosclerótica da artéria carótida em pacientes com estenose significativa do tronco da artéria coronária esquerda (TCE) submetidos à cirurgia de revascularização do miocárdio.Métodos: A população estudada consistiu em 18 pacientes submetidos à cirurgia de revascularização do miocárdio no Hospital São José de Criciúma (SC) de fevereiro de 2002 a novembro de 2006 devido à estenose no TCE. A ultra-sonografia (US) foi o exame de eleição para detectar estenose de artérias carótidas, e o cateterismo para detectar estenose do TCE. Resultados: O sexo masculino foi o mais prevalente (77,8%) e a idade média foi de 63,1 anos. O grau de estenose do TCE mais prevalente foi o de 90% em 27,8% dos pacientes. O segmento do TCE predominantemente lesado foi o terço distal em 72,2% dos casos. A US mostrou estenose em 33,3% das carótidas, independente de sua gravidade. Destes, 66,6% tinham, concomitantemente, lesão de carótida direita. Dentre os casos com aterosclerose de carótidas, metade possuía lesão bilateral e significativa (grau de estenose ≥70%). Os segmentos carotídeos mais acometidos foram o bulbo e a carótida interna em 66,6% dos casos. Conclusões: A literatura médica realça uma relação importante da doença aterosclerótica de carótidas com a lesão significativa do TCE. O rastreamento de estenose de carótidas é recomendado a todos os pacientes com aterosclerose de artérias coronárias.


Objectives: Know prevalence and severity of atherosclerotic disease of carotid artery in patients with significative stenosis of left coronary artery (LCA) submitted to myocadial revascularization surgery. Methods: The sample was composed by 18 patients submitted to myocadial evascularization surgery in São José Hospital from Criciúma, South Brazil, between February 2002 to November 2006 due to LCA stenosis. Ultrasonography (US) was the exam of choice to detect stenosis of carotid arteries and the Hearth Catheterization to detect stenosis of LCA. Results: Male sex was the most prevalent (77.8%) and the mean age was 63.1 years old. The LCA stenosis degree most prevalent was of 90% in 27.8% of patients. The LCA segment mainly lesioned was the distal third in 72.2% of the cases. US shows stenosis in 33.3% of carotids, independent of its gravity. Among this patients, 66,6% also had right carotid lesion. Between the cases with carotid atherosclerosis, half had bilateral and significative lesion (stenosis degree ≥70%). The carotid segments most affected was the bulb and internal carotid in 66.6% of the cases.Conclusions: The medical literature enhalces an important relation of carotid atherosclerotic disease with significative lesion of LCA. Screening of carotide stenosis is recommended to all patients with atherosclerosis in coronary arteries.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Disease Progression , Carotid Artery Diseases , Carotid Stenosis , Myocardial Revascularization , Carotid Artery Diseases/surgery , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/metabolism , Carotid Artery Diseases/mortality , Carotid Artery Diseases/pathology , Carotid Stenosis/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/pathology , Myocardial Revascularization/statistics & numerical data , Myocardial Revascularization/methods , Myocardial Revascularization
13.
Rev. méd. Chile ; 135(3): 399-402, mar. 2007. ilus
Article in Spanish | LILACS | ID: lil-456628

ABSTRACT

Georg Friedrich Hãndel, a musical genius, was affected since his middle age by several attacks, during a period of 20 years, of upper right limb palsies, abnormal speech followed by amaurosis in his contralateral eye and then is both eyes. He underwent three unsuccessful operations due to a wrong diagnosis of cataracts. We discuss the possible differential diagnoses. Considering his clear vascular profile, the most plausible hypothesis is cerebrovascular disease with embolic infarcts from stenotic left internal carotid artery to the left middle cerebral and retinal arteries.


Subject(s)
History, 18th Century , Humans , Male , Blindness/history , Carotid Stenosis/diagnosis , Famous Persons , Infarction, Middle Cerebral Artery/history , Music , Blindness/etiology , Carotid Stenosis/complications , Cataract/history , Germany , Infarction, Middle Cerebral Artery/complications , Intracranial Embolism/history , Retinal Artery
15.
Prensa méd. argent ; 93(5): 275-280, jul. 2006. ilus
Article in Spanish | LILACS | ID: lil-482530

ABSTRACT

La ateroesclerosis carotídea es un fuerte predictor de accidente cerebro-vascular e infarto de miocardio. La relación entre la morfología carotídea y la patogénesis del ACV no es exactamente conocida. Es por ello que las placas carotídeas removidas quirúrgicamente a través de endarterectomías representan una oportunidad muy importante para obtener información sobre los mecanismos patogénicos. El objetivo de este trabajo es resumir nuestra experiencia de 10 años en el estudio de placas ateroescleróticas carotídeas.


Subject(s)
Humans , Carotid Stenosis/surgery , Carotid Stenosis/diagnosis , Myocardial Infarction , Stroke
16.
Prensa méd. argent ; 93(5): 287-292, jul. 2006.
Article in Spanish | LILACS | ID: lil-482532

ABSTRACT

Las indicaciones tradicionales de la cirugía en la insuficiencia mitral (IM) son los síntomas y las indicaciones avanzadas se extienden a los pacientes asintomáticos con disfunción del ventrículo izquierdo (VI), hipertensión pulmonar (HTP) o fibrilación auricular (FA). Recientemente algunos grupos preconizan la plástica precoz aún en pacientes sin síntomas, disfunción del VI, HTP, ni FA, a condición de que la válvula sea reparable y que el riesgo de mortalidad quirúrgica no supere el 1 por ciento...Se concluye que la plástica mitral debería realizarse en los pacientes que no refieren síntomas sólo si existen evidencias objetivas de que se trata de una IM realmente grave asociada a deterioro de la función del VI, HTP o FA.


Subject(s)
Humans , Carotid Stenosis/surgery , Carotid Stenosis/diagnosis , Myocardial Infarction , Stroke
18.
Rev. bras. ecocardiogr ; 19(1): 37-44, jan.-mar. 2006. ilus, tab
Article in Portuguese | LILACS | ID: lil-427571

ABSTRACT

A ruptura de placas carotideas e embolização de material atero-trombótico é o mecanismo patogênico mais comum causador de isquemia cerebral devido à estenose de artéria carótida. Vários trabalhos multicêntricos e randomizados demostraram o benefício da cirúrgia de endarterectomia da artéria carótida (CEAC) em prevenir acidente vascular cerebral(AVC) tanto em pacientes sintomáticos quanto assintomáticos. Entretanto, estes mesmos trabalhos também notaram que a maioria dos pacientes portadores de estenoses significativas das artérias carótidas permaneceram livres de eventos neurológicos apenas com a terapia medicamentosa e que um grande número e pacientes pode ser operado desnecessariamente. Assim, é necessário identificar pacientes com alto risco, em que a CEAC deve ser considerada, e pacientes com baixo risco os quais devem ser poupados deste procedimento frequentementee custoso e não isento de riscos. Estudos histológicos têm demonstrado que um núcleo lipídico grande, localizado próximo ao lúmen, com ruptura da capa fibrosa, hemorragia intraplaca e ulceração da superfície ocorrem mais frequemtemente em placas sintomáticas. A caracterização quantitativa desses achados histológicos através de métodos não invasivos permitirá que a CEAC seja realizada em pacientes portadores de placas de alto risco. O método videodensitométrico é uma técnica promissora que pode identificar placas carotídeas e potencialmente instáveis.


Subject(s)
Male , Female , Humans , Stroke/diagnosis , Endarterectomy/methods , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Brain Ischemia/complications , Brain Ischemia/diagnosis
19.
Journal of Tehran Heart Center [The]. 2006; 1 (1): 29-32
in English | IMEMR | ID: emr-78216

ABSTRACT

The incidence of stroke is 2.1-5.2% in bypass surgery patients with a mortality of 0-38%. This study was designed to evaluate the incidence of significant carotid artery stenosis and its related risk factors in c and idates for coronary artery bypass graft [CABG] surgery. 1045 consecutive c and idates for CABG underwent carotid artery Doppler examination in a prospective study. The relation of age, sex, smoking and diabetes as well as lipid profile and carotid stenosis was evaluated In 1045 CABG c and idates with the mean age of 60 years, the prevalence of significant carotid stenosis [>60%] was 6.9%. In the patients who aged 65 years and older, significant stenosis was 12.5%. Age of 50 years and above, female gender hypercholesterolemia and diabetes mellitus are independent risk factors for significant carotid stenosis. Significant carotid stenosis has an earlier beginning in our study. Cost effectiveness studies are recommended for revising the previous screening protocols


Subject(s)
Humans , Male , Female , Coronary Artery Bypass/adverse effects , Stroke/etiology , Carotid Stenosis/diagnosis , Carotid Stenosis/surgery
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