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(1) Study purpose: The aim of our prospective single-center, matched case-control study was to compare the number and volume of acute ischemic brain lesions following carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software on CT angiography (CTA) images. The number and volume of acute and chronic ischemic brain lesions were assessed on MRI scans taken 12-48 h after the procedures. Propensity score-based matching was performed at a 1:1 ratio to compare the ischemic lesions on postinterventional MR. (3) Results: A total of 107 patients (CAS, N = 33; CEA, N = 74) were included in the study. There were significant differences in smoking (p = 0.003), total calcification plaque volume (p = 0.004), and lengths of the lesion (p = 0.045) between the CAS and CEA groups. Propensity score matching resulted in 21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients (47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA group (p = 0.02). The volume of acute ischemic brain lesions was significantly larger (p = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched CAS group.
ABSTRACT
Összefoglaló. Bevezetés: Az aortabetegségek kezelése során az orvos által módosított sztentgraftok alkalmazása vitatott. Döntoen sürgosségi esetben, nagy rizikójú nyitott mutét alternatívájaként vagy nehéz anatómiai konfigurációk esetén alkalmazzák oket. Módszer: Cikkünkben három eseten keresztül klinikánk kezdeti tapasztalatait mutatjuk be az orvos által a mutét során módosított sztentgraftokkal kapcsolatosan. Eredmények: Elso esetünkben egy 75 éves férfi beteg 50 mm-es saccularis infrarenalis aortaaneurysma miatt került felvételre. A rövid infrarenalis tágulat proximalis rögzítési zónájának átméroje lényegesen nagyobb volt, mint a terminális aortaszakasz. A kaliberdiszkrepancia megoldására a legalkalmasabb egy reverz helyzetu iliacagraftszár volt, így egy graftszárat a felvezetorendszerérol eltávolítottunk, majd megfordítva az aorta tágulatába deponáltuk. Hasonló megoldást választottunk egy 67 éves férfi beteg jobb oldali, 65 mm-es arteria iliaca communis aneurysmájának kezelése során. Egy 81 éves nobeteg hasi aortaaneurysma tartott rupturája miatt korábban behelyezett unilateralis graft proximalis endoleakjének megoldása miatt érkezett. Az ectaticus aorta, valamint az arteria mesenterica superior és a primer intervenció során bekerült unilateralis graft elkeskenyedo része közti rövid távolság miatt konvencionális sztentgraft beültetése nem volt lehetséges. A szituáció egy rövid thoracalis sztentgrafttal volt megoldható: egy thoracalis sztentgraft distalis végébol 3 cm-t kauter segítségével levágtunk, majd az eszközt a felvezetorendszerbe visszatöltöttük. A módosított sztentgraftot az arteria mesenterica superior alá pozicionáltuk, egy 'chimney' sztentgraft segítségével biztosítottuk a jobb vese perfúzióját. Technikailag mindhárom beavatkozásunk sikeres volt. Következtetés: Az endovascularis aortamutétek azonnal elérheto eszközparkja a típusos anatómiájú betegek megoldására általában alkalmas. A szokatlan anatómiával rendelkezo elektív esetek, illetve a sürgeto beavatkozást igénylo komplex endovascularis mutétek során az orvos által módosított sztentgraftok hatékonyan alkalmazhatók. Alkalmazásuk nagy forgalmú aortacentrumokban javasolt. Orv Hetil. 2022; 163(3): 109-115. INTRODUCTION: Physician-modified endografts are mainly used in urgent cases of aortic disease as an alternative to high-risk open surgical repair or in difficult anatomical configurations. METHOD: We present our initial experiences with physician-modified stent graft implantation. RESULTS: A 75-year-old male patient was admitted with a 50 mm saccular infrarenal aortic aneurysm. However, the diameter of the proximal sealing zone was significantly larger than that of the distal sealing zone, so we decided to use an iliac limb stent graft with reverse mounting resulting in an upside-down configuration to accommodate this diameter mismatch. A similar approach was used to treat a 67-year-old male patient with a 65 mm right common iliac artery aneurysm. An 81-year-old female patient was admitted with a type I endoleak associated with an aorto-uni-iliac endograft. The wide juxtarenal aortic diameter together with the short distance between the superior mesenteric artery and the proximal end of the previously deployed uni-iliac graft made the patient unsuitable for conventional endovascular repair, thus the distal 3 cm was cut from a standard thoracic stent graft and the device was reloaded. The modified graft was positioned below the superior mesenteric artery, while renal perfusion was secured by a chimney graft. Technical success was obtained in all three cases. CONCLUSION: The available toolkit of endovascular aortic surgery is generally suitable for the treatment of patients with typical anatomy. In elective cases of patients with unusual anatomy, or in urgent cases with complex aortic pathologies, physician-modified endovascular graft implantation can be used effectively. Orv Hetil. 2022; 163(3): 109-115.
Subject(s)
Endometriosis , Physicians , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Iliac Artery , Kidney , MaleABSTRACT
BACKGROUND AND PURPOSE: There is relatively few data regarding the usage of dopaminagonists for the treatment of Parkinson's disease; furthermore, there are no publications regarding Central- and Eastern-European countries. The aim of the study was to evaluate the use of dopamine agonists as a therapeutic option amongst Parkinson's disease patients admitted to the Neurological Clinics of Tîrgu Mures during the last 15 years. METHODS: In our study we investigated the data of all Parkinson's patients treated at our clinics between the 1st of January 2003 and the 31st of December 2017. We analyzed the particularities of dopamine agonists' usage based on the therapeutic recommendations from the final report of these patients. Regarding time since the diagnosis, we divided the patients in two groups: less than or equal to 5 years and more than 5 years. RESULTS: During the studied period a total of 2379 patients with Parkinson's disease were treated at the Clinics. From the 1237 patients with disease duration under 5 years 665 received dopamine agonists: 120 as monotherapy, 83 together with monoamine oxidase inhibitors and in 234 cases associated with levodopa. The remaining 228 patients were treated with a triple combination of levodopa, dopamine agonists and monoamine oxidase inhibitors. In patients suffering from Parkinson's disease for more than 5 years, in 364 cases out of 653 a dopamine agonist was part of the therapy. CONCLUSION: The usage of dopamine agonists was similar to the data presented in other studies. We consider that clinicians treating the disease should, with the necessary prudence, use the available and recommended dopamine agonist with the utmost courage to their maximum therapeutic potential.
Subject(s)
Antiparkinson Agents/therapeutic use , Dopamine Agonists/therapeutic use , Levodopa/therapeutic use , Monoamine Oxidase Inhibitors/therapeutic use , Parkinson Disease/drug therapy , Cross-Sectional Studies , Humans , Treatment OutcomeABSTRACT
INTRODUCTION: In patients older than 70 years there is no valid alternative to progressively introduced substitution therapy. The antiparkinsonian drugs introduced in the last decade to treat Parkinson's disease, especially in its early phases, promised a comparable efficacy in reducing symptoms to levodopa. In younger patients and/or patients with mild symptoms we hoped to delay the motor complications by postponing the start of levodopa therapy. While these assumptions may not be true for all patients, probably the most important current challenge is the optimal starting moment of levodopa therapy. The aim of the study was to analyze the therapeutical choices during the early phase of Parkinson's disease in the Neurological Departments of Târgu Mures¸ County Hospital. MATERIALS AND METHODS: We examined data obtained from hospitalized Parkinson's disease patients during a 15-year period. According to the duration of the disease we split the patients into two groups, patients with Parkinson's disease for less than or equal to 5 years and patients with disease duration longer than 5 years, and then analyzed only the former group. RESULTS: During the examined period, 2,379 patients with Parkinson's disease were hospitalized, and 1,237 patients had a disease duration shorter than 5 years. In this group, 18 patients had monoamine oxidase inhibitor monotherapy. Also, 665 patients received dopamine agonists, in 120 cases as monotherapy and in 83 patients associated with monoamine oxidase inhibitors. In 521 patients we found only levodopa treatment. A further 481 patients received combined therapy (levodopa with dopamine agonists and/or monoamine oxidase inhibitors). CONCLUSION: Treatment strategies for the early stages of Parkinson's disease in our group were comparable to results from other studies. However, the authors feel that neurologists should use levodopa-sparing drugs with greater courage. Furthermore, if the clinical context is appropriate, physicians should combine substitution therapy with other antiparkinsonian drugs in order to reduce levodopa doses.
