[Short- and long-term outcomes of angioplasty and stenting for high-risk extracranial carotid stenosis in carotid endarterectomy]

Carotid endarterectomy [CEA] is a standard method for patient with significant carotid stenosis but direct surgical repair via carotid endarterectomy may not be a good option in some patients because of the overall health status that may make the surgery too risky. Carotid angioplasty and stenting [CAS], is a relatively new procedure for the treatment of carotid artery disease in patients who may not be fit enough to undergo surgery. In this investigation, we determined short- and long-term outcomes of stent angioplasty in high-risk patients for whom the risk of perioperative morbidity and mortality is high. We have followed 82 consecutive symptomatic patients with a >/= 50% and asymptomatic patients with a >/= 70%- 80% carotid stenosis within 15.9 months of angioplasty and stenting in Baqiyatallah and Jamaran hospitals from 2008-2010. All the patients were considered poor surgical candidates by experienced surgeons and anesthesiologists upon pre-surgical consultation. This descriptive cross-sectional study was performed on 28 women and 54 men with a mean age of 69.7_9.2 years. The procedure was technically successful in 79 [96.3%] cases. There were 6 [7.3%] deaths, 5 [6.1%] strokes, 4 [4.9%] MIs and 4 [4.9%] TIAs during the follow-up period. The clinical results during the short available follow-up period suggested stent angioplasty to be useful, effective, reliable and safe in the treatment of significant cervical carotid stenosis in high-risk patients. Further analytical investigations with longer follow-up periods for predicting risk factors are recommended

[Alzheimer's disease: yesterday, today, tomorrow]

Alzheimer's disease is the most common and well - known cause of dementia, as a progressive, irreversible brain disorder that affects cognitive function, personality, thought, perception and behaviour. Alzheimer's disease is the fourth leading cause of death in western countries. Interesting to know that this disease was unknown in medical community till 100 years ago and had no name. Dr. Alois Alzheimer, a German psychiatrist was the person who suspected the presence of this new illness and by succinct clinical, neuroanatomic, and neuropathologic examination of some cases, including the first known case of this disease - a woman named Auguste Deter - documented it. In further Emil Kraepelin by knowing about the cases that Dr. Alzheimer reported, and another reports of this disease that were published in the first decade of the twentieth century, set the name of Alzheimer on this new disease. Descriptions of Dr. Alzheimer and Kraepelin are the same as the present day descriptions of this disease. Electron microscopy, quantitative morphology and modern biochemistry emerging in the second half of the twentieth century opened a new era in dementia research with description of the ultra structure and biochemistry of senile plaques and neuronfibrillary tangles, the major disease markers of Alzheimer's disease. Basic research gave insight into the molecular genetics and pathophysiology of Alzheimer's disease and based on the biochemical findings, new pharmacological treatment options were opened. The future attempts will probably be concentrated on the prevention of this disease. Oxidative stress, excessive transition metal ions, and misfolded / aggregated proteins and inflammation are among the probable causes of Alzheimer's disease and the future research will focus on their better understanding and prevention of their occurrence. As the last word, stem cells grafts that in animals have led to remarkable improvement of brain function, may also be a promising course in the cure of Alzheimer's disease in the future