History of Carotid Occlusions: The Contribution of Egas Moniz.

OBJECTIVE: To describe the first cases of carotid occlusions identified by the Portuguese neurologist Egas Moniz while performing the cerebral angiography he invented. METHODS: We reviewed the publications of Egas Moniz on the subject of cerebral angiography and ischemic stroke. RESULTS: We identified the first description of carotid occlusion a situation unknown until then. Also, some of the carotid occlusions he described were suggestive of dissection an unknown situation. Nevertheless, he admitted the role of trauma in such cases by lesioning the intimal layer and he also described the characteristic post-bulbar "bezel-like" image of dissection. CONCLUSIONS: In 1936 Egas Moniz described, for the first time, one case of carotid occlusion a situation unknown until then. He also described some of the characteristic aspects of carotid dissections. Carotid occlusions were only thoroughly described in English literature more than a decade later with the well-known work of Miller Fisher, in 1951.

The history of basilar artery occlusion: when art aids science.

Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.

The history of basilar artery occlusion: when art aids science / História da oclusão da artéria basilar: quando a arte auxilia a ciência

ABSTRACT Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.

RESUMO O acidente vascular cerebral isquêmico secundário à oclusão aguda da basilar (OAB) é uma condição relativamente rara, que cursa com elevada morbimortalidade. Até o momento atual, a melhor estratégia de recanalização arterial na fase aguda da OAB não está definida, principalmente pela carência de ensaios clínicos randomizados e controlados neste contexto. Neste artigo, revisamos aspectos históricos do diagnóstico e do tratamento desta condição, assim como o impacto do avanço tecnológico na evolução clínica e prognóstico desta condição. Ademais, descrevemos fatos históricos e a literatura fictícia relacionados à OAB. Concluímos que a OAB é um exemplo peculiar de como a arte pode auxiliar a medicina na descrição acurada de condições médicas.

Karl Viktor Hall: From In Situ Vein Bypass to the Tilting Disc Heart Valve Prosthesis.

In 1977, Karl Viktor Hall implanted a novel tilting disc heart valve prosthesis at Rikshospitalet in Oslo, Norway. The Medtronic-Hall valve was known for its excellent durability and low thrombogenicity. Hall popularized the use of the great saphenous vein in situ as an arterial shunt in the 1960s, made a metal stripper to lyse vein valves, and introduced electromagnetic flowmeters in vascular surgery. He performed the first coronary artery bypass graft in Scandinavia in 1969. Under his leadership the first heart transplantation and the first heart-lung transplantation were performed in Scandinavia by his successor Tor Frøysaker in 1983 and 1986, respectively.

Experimento de Harvey: caso clínico, diagnóstico y cirugía vascular / Harvey's experiment: clinical case, diagnosis and vascular surgery

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La aterosclerosis: ¿una enfermedad reciente? / Atheroscelorosis: A modern disease?

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Contemporary relevancy of carotid-subclavian bypass defined by an experience spanning five decades.

BACKGROUND: The contemporary impact of and indications for carotid-subclavian bypass (CSB) are essential considerations in decision making for brachiocephalic reconstruction. METHODS: We analyzed operative outcomes, long-term graft patency, and the extended epidemiological impact of the primary disease process in 287 consecutive patients (mean age, 60.6 years; 43.2% male) who received CSB for symptomatic brachiocephalic disease. RESULTS: Technical success was achieved in each patient. Operative mortality was 1.0% (3/287) and total (ipsilateral [1.4%, 4/287] plus contralateral [0.7%, 2/287]) stroke rate was 2.1% (6/287). Primary patency rates at 5, 10, and 15 years were 94.2 ± 1.9%, 88.6 ± 3.2%, and 86.5 ± 3.8%, respectively. Kaplan-Meier freedom from specific events at 15 years was as follows: restenosis, 86.5 ± 3.8%; death, 67.5 ± 5.2%; coronary revascularization, 59.6 ± 6.3%; myocardial infarction, 82.8 ± 3.9%; stroke, 85.6 ± 4.9%; other vascular procedure, 60.0 ± 5.5%; adverse cardiac outcome (death, myocardial infarction, or coronary revascularization), 44.5 ± 5.5%; and adverse vascular outcome (restenosis, stroke, or other vascular procedure), 48.7 ± 5.3%. CONCLUSIONS: CSB produces excellent long-term patency and extended symptom relief, with acceptably low operative morbidity and mortality. Despite the durability and success of CSB, the primary disease process has an adverse impact on long-term prognosis and significantly influences decision making with regard to management. The proven durability may offer extended symptom relief to the relatively younger patient, a survival advantage associated with preservation of internal mammary artery perfusion in patients at risk for myocardial revascularization, optimal durability in patients requiring a concomitant open procedure, and preservation of limb function in patients who require aortic endovascular graft placement.

Historical reflections on the management of acute limb ischemia.

The history of clot removal consists primarily of efforts at procedures, techniques, and instruments that had suboptimal performance. In the 1960s, the amputation and death rates following attempts at removal were as high as 50%. A wide variety of instruments were used but none were specifically designed for embolus and thrombus removal. The need was obvious but the problem was unresolved.

[The history of intermittent claudication due to arterial disease]. / Histoire de la claudication intermittente d'origine artérielle.

The clinical description of intermittent claudication due to arterial occlusive disease was made by two French precursors: a veterinary surgeon, Jean-François Bouley, and a neurologist, Jean-Martin Charcot. The subsequent works clarified the aetiology, the investigations and the treatment of this trouble but did not add anything to the initial description.

From Hippocrates to Palmaz-Schatz, the history of carotid surgery.

The extracranial carotid artery is the most common site for peripheral vascular procedures. Although the association of carotid disease and neurologic dysfunction was understood by the ancient Greeks, over 1700 years would pass before the relevant anatomy was described. In the 16th and 17th centuries, attempts at treatment of carotid injury and aneurysm by ligation were met with extremely high rates of stroke and death. It is not until the mid 20th century, with the introduction of carotid angiography and improved vascular surgical techniques, that the era of reconstructive carotid surgery begins. We present a synopsis of the history of carotid surgery from ancient times to present day.

The neglected research of Egas Moniz of internal carotid artery (ICA) occlusion.

Egas Moniz is generally remembered for having discovered cerebral angiography in 1927, and having introduced lobotomy as a form of treatment for mental illness in 1935. Less well known is his pioneering research on occlusive cerebrovascular disease, namely internal carotid artery (ICA) occlusion, as documented by cerebral angiography. It is our contention that the medical community has, until recently, largely overlooked this research. His neglected observations on ICA occlusion and the important diagnostic role played by angiography are reviewed. We propose to show how our paper differs from previous publications regarding Moniz's ICA occlusion contributions. Whereas most previous reviews have focused on either the role played by cerebral angiography in the diagnosis of ICA occlusion, or on the importance of Moniz's internal carotid occlusion observations, our review attempts to integrate both topics. We will tie Moniz's ICA occlusion research to his documented use of angiography.

The Allen test.

There has been renewed interest in radial artery bypass conduits for coronary artery revascularization, and surgeons should be familiar with methods of assessing circulation of the hand to determine which patients are candidates for this procedure. The Allen test originally was described in 1929, and this report reviews its initial description and contribution to our surgical heritage.

Andreas Grüntzig's balloon catheter for angioplasty of peripheral arteries (PTA) is 25 years old.

History of Andreas Grüntzig's time spent in Angiology and Radiology of the Zürich University Hospital (1969-1975). First, the pioneer of catheter therapy discovered that the Achilles tendon reflex is significantly prolonged during claudication pain. Furthermore, he participated actively in the clinical evaluation of Doppler ultrasound. After a stay in the Aggertalklinik (Engelskirchen near Köln, Germany), where he learnt Charles Dotter's original procedure with Eberhard Zeitler, he introduced catheter therapy of peripheral arteries in Zürich. In the same period he developed a new, rigid, sausage-shaped balloon catheter (polyvinylchloride), manufactured the device on his kitchen table together with his wife Michaela, Maria and Walter Schlumpf, and used it first on February 12, 1974 in a patient with intermittent claudication due to subtotal stenosis of the superficial femoral artery. The first successful dilatation of an iliac artery stenosis by his double-lumen catheter, which was modified later on into the famous coronary catheter, followed on January 23, 1975. Soon, the innovative catheter became commercially available (Cook and Schneider Companies). Andreas Grüntzig not only excelled in pioneering novel techniques, but also in patient care, in a prospective follow-up study of his own 242 patients lasting 15 years (results summarized in this article), in the teaching of Swiss scholars like Felix Mahler, Ernst Schneider and Bernhard Meier and many more in the world, and in organizing life demonstrations for large numbers of participants. His career in Cardiology, his work in Atlanta Georgia, USA, and his early tragic death in an airplane accident are briefly mentioned.