Unprotected carotid artery stenting in symptomatic patients with high-grade stenosis: results and long-term follow-up in a single-center experience.

BACKGROUND AND PURPOSE: The use of cerebral protection during CAS is an extended practice. Paradoxically it is open to question because it can lead to potential embolic complications. The aim of this study was to evaluate the safety and efficacy of CASWPD in patients with severe symptomatic carotid artery stenosis. MATERIALS AND METHODS: A prospective study was performed including 210 consecutive patients (201 symptomatic and 9 asymptomatic) with carotid artery stenosis >70%. All patients were treated by CASWPD. Angiographic results and neurologic complications were recorded during the procedure and within 30 days after it. All patients underwent clinical evaluation and Doppler sonography follow-up at 3, 6, and 12 months after the procedure. RESULTS: Two hundred twenty carotid arteries were treated. The average degree of stenosis was 88.9%. The procedure was successfully completed in 212 (96.4%) arteries. After stent placement, 98.6% of arteries showed no residual stenosis or <30%. Balloon angioplasty dilation before stent placement was performed in 16% of cases. During the 30-day periprocedural period, there were 3 major complications (1.4%), including 1 disabling ischemic stroke, 1 acute stent thrombosis, and 1 MI. The last 2 patients died from these complications. At 1-year follow-up 24 (12.8%) restenoses, 2 new ipsilateral strokes, 1 contralateral stroke, and 5 deaths (2.7%) had occurred. None of these deaths were related to the initial stroke. CONCLUSIONS: In our study, unprotected stent placement in symptomatic patients with severe carotid artery stenosis has demonstrated a low incidence of complications. We believe that this is due to the reduction of maneuvering and manipulation through the stenosis and to the protective effect of the stent placement before angioplasty balloon dilation.

Fracaso renal agudo en paciente hipertenso / Acute renal failure and hypertension

Los pacientes hipertensos con nefropatía isquémica pueden presentar deterioroagudo de función renal por varias razones, entre ellas tratamiento con IECAs oARAII, deshidratación y oclusión de las arterias renales. Presentamos un caso de hipertensiónarterial secundaria a estenosis bilateral de arterias renales, tratada conARAII (valsartán), que presenta un deterioro agudo de función renal que precisadiálisis. La revascularización mediante angioplastia y colocación de «stent», junto ahidratación y supresión de este fármaco consigue la mejoría y estabilización prolongadade la función renal

Ischemic nephropathy could be complicated with hypertension and acute worseningof chronic renal failure secondary to ACE inhibitors or AT1 receptor antagonisttreatments and arterial occlusion. We describe a patient with bilateral renal arterystenosis and hypertension treated with AT1 receptor antagonist (valsartan) that developedrapid worsening of renal function that required dialysis. Percutaneous transluminalrenal artery angioplasty and stenting, complemented with hydratation andvalsartan suppression achieves rapid and sustained recovery of renal function

[Acute renal failure and hypertension]. / Fracaso renal agudo en paciente hipertenso.

Ischemic nephropathy could be complicated with hypertension and acute worsening of chronic renal failure secondary to ACE inhibitors or AT receptor antagonist treatments and arterial occlusion. We describe a patient with bilateral renal artery stenosis and hypertension treated with ATI receptor antagonist (valsartan) that developed rapid worsening of renal function that required dialysis. Percutaneous transluminal renal artery angioplasty and stenting, complemented with hydratation and valsartan suppression achieves rapid and sustained recovery of renal function.

[Antioxidative state and lipid peroxidation in erectile dysfunction: preliminary study]. / Estado antioxidante y peroxidación lipídica en la disfunción eréctil: estudio preliminar.

OBJECTIVE: The aims of this study were to analyze the cavernosal tissue metabolic status of patients with vascular and psychogenic impotence and attempt to establish metabolic differences between these types of erectile dysfunction. METHODS: 103 patients were classified according to the type of erectile dysfunction into group A (vascular) and group B (psychogenic). Diagnosis was based on clinical history, physical examination, intracavernosal injection test, penile echo-doppler assessment, cavernosography-cavernosometry and nocturnal penile test. Cavernosal and peripheral venous blood samples were obtained from each patient and the lipoperoxide (LPO) levels and total antioxidant status (TAS) were determined. SPSS V9.0 was used for the statistical analysis. RESULTS: The mean age was 62 years (range 32-73). Cavernosal blood lipoperoxide levels were statistically higher (p < 0.05) in patients with vascular impotence (2.45 mumol/L) than in those with psychogenic impotence (1.47 mumol/L). Cavernosal blood total antioxidant status was statistically higher (p < 0.05) in patients with psychogenic (1.40 mmol/L) than those with vascular impotence (1.10 mmol/L). The lipoperoxide levels and total antioxidant status for peripheral blood were 1.68 mumol/L vs 1.60 mumol/L and 1.29 mmol/L vs 1.35 mmol/L, respectively, with no statistically significant differences between both groups. CONCLUSIONS: Cavernosal blood lipoperoxide levels and total antioxidant status can be an indicator of cavernosal tissue metabolic status and function.

Percutaneous embolization for erectile dysfunction due to venous leakage: prognostic factors for a good therapeutic result.

OBJECTIVES: To identify prognostic parameters for patient outcome after embolization for erectile dysfunction (ED) due to venous leakage (VL). METHODS: 23 patients presenting with ED due to pure venous leakage were selected. Intracavernous pharmacological testing, Doppler ultrasound, dynamic cavernosography-cavernosometry and cavernous oxygen tension were done. All patients underwent embolization of the leakage areas visualized. The results were assessed in terms of the response: good, partial or absent. Mean values were calculated for diastolic flow, oxygen tension, maintenance flow and pressure decay, and were compared between the group of patients who responded and the group which did not respond using Student's t test. RESULTS: 26% had a good response, with a mean follow-up of 22 months, if we include partial response and adjuvant therapy this rate rises to 44%. A statistically significant relationship was found between the intracavernous oxygen tension and maintenance flow with a good response to treatment; patients with cavernosography types I and II showed a better response to treatment than those with cavernosography type III. CONCLUSIONS: Maintenance flow, intracavernous oxygen tension, and cavernosography types can be prognostic factors of success in the treatment of ED due to pure VL with embolization.