Neurovascular in-stent stenoses: treatment with conventional and drug-eluting balloons.

BACKGROUND AND PURPOSE: ISRs remain a major issue in the endovascular management of ICAD, requiring retreatment by reangioplasty. The aim of the present study was to evaluate the technical feasibility, safety, and efficiency of the novel DEBs for neurovascular ISRs. MATERIALS AND METHODS: Fifty-one patients (median age, 67 years; age range, 34-82 years; male/female ratio, 37:14) underwent 63 balloon dilation procedures for ISRs in intracranial stented arterial segments between November 2007 and August 2010 in a single center. Of the 63 procedures, 20 (32%) were performed by using a conventional balloon and 43 (68%), by using a paclitaxel-eluting balloon (SeQuent Please). Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of a recurrent ISR after reangioplasty were analyzed. RESULTS: Technical success, defined as <50% residual stenosis was achieved in all cases (100%), with failure of the DEB treatment in 6% of the attempts; those lesions were finally successfully treated with a conventional balloon. The combined permanent neurologic morbidity and mortality rate (stroke, ICH, and SAH) at 30 days was 1.6%. Substantial difference was found in the rate of recurrent stenosis when comparing conventional balloons and DEBs, with recurrent stenosis rates of 50% and 9%, respectively. CONCLUSIONS: The initial results of reangioplasty of intracranial ISRs with DEBs are encouraging; further technical developments are, nevertheless, mandatory.

Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results.

BACKGROUND AND PURPOSE: Recent studies on stent placement of significant stenoses at the origin of the vertebral artery reported excellent immediate results. Long-term outcomes, however, were disappointing due to high restenosis rates and stent breakage. In the present study, we evaluated the application of a short drug-eluting balloon-expandable coronary stent for the endovascular treatment of these frequent lesions. MATERIALS AND METHODS: In a period of 23 months, 48 patients (12 women, 36 men) with a mean age of 68 years (range, 46-82 years) harboring 52 significant ostial vertebral artery stenoses underwent treatment with short (8 mm) balloon-expandable paclitaxel-eluting coronary stents. Stents were deployed as closely as possible so that the proximal end was just at the origin of the vertebral artery, with high inflation pressure applied. Patients were under continuous medication with acetylsalicylic acid and clopidogrel before and after the treatment. Follow-up clinical assessment and angiography were performed in all patients. RESULTS: Periprocedural complications were not encountered. Stenosis severity was reduced from 62 +/- 2% (mean +/- standard error of the mean) preprocedurally to 15 +/- 2% postprocedurally. Follow-up angiography at 7.7 +/- 0.6 months revealed a mean stenosis degree of 24 +/- 3%. None of the patients developed posterior circulation symptoms related to the treated segment during the follow-up period. Recurrent stenosis (>50%) at follow-up was found in 6 (12%) lesions. CONCLUSIONS: Stent placement of significant ostial vertebral artery stenosis by using short drug-eluting stents is safe and yields good midterm patency rates and excellent protection from posterior circulation ischemia.

[Blood pressure elevation among industrial workers exposed to stress]. / Blodtrykksstigning hos stresseksponerte industriarbeidere.

A standardized, annual medical examination of a group of heat workers exposed to, and another group not exposed to heat in a Norwegian ferro-alloy plant over a period of six years showed no statistically significant difference in blood pressure between the two groups. However, following three years of stable blood pressure and heart rates, both parameters increased markedly in both groups. The occurrence of this sudden increase in blood pressure coincided with the plant being threatened with the possibility of closure due to inability to operate at a profit. This threat persisted for more than two years, but even afterwards, when it was quite clear that jobs at the plant were no longer threatened, the blood pressure remained markedly elevated. These findings emphasize the importance of being aware of the possible relationship between prolonged mental stress and hypertension.

Methods for the surveillance of endemic treponematoses and sero-immunological investigations of "disappearing" disease.

Although the treatment of whole communities with long-acting penicillin for the control of endemic treponematoses of childhood during the past twenty years has led to a remarkable initial regression of disease, early clinical yaws has not yet been eliminated in large endemic areas and the elimination of early childhood syphilis has been observed in favourable environmental conditions in a single instance only. In most areas, transmission of infection continues at varying levels and recrudescence or periodic focal outbreaks continue to occur.Mass penicillin campaigns have been undertaken in 46 countries and up to the end of 1970 some 160 million people had been examined and some 50 million clinical cases, latent cases, and contacts had been treated. In the past few years, sero-epidemiological studies of the changing pattern of disease and infection have become possible and methods for long-term surveillance of endemic treponematoses have been developed. The application of these methods to the study of "disappearing" disease is described, particularly with regard to yaws but also to childhood syphilis and pinta.