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2.
J Cardiovasc Med (Hagerstown) ; 16 Suppl 1: S49-50, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21157367

RESUMO

A 29-year-old woman with two mechanical valve prostheses was referred to our institution for sudden and self-resolved diplopia 2 weeks after childbirth. From the beginning of pregnancy, nadroparin was started instead of warfarin. The echocardiogram performed at hospital admission revealed a severe aortic prosthesis regurgitation due to incomplete leaflet apposition with a prosthetic aortic transvalvular gradient increase. Three-dimensional transoesophageal echocardiography revealed a thrombus located between the two prostheses, causing intermittent aortic valve malfunction. Intravenous heparin was started. Three days later, a second transoesophageal echocardiogram revealed a decreased aortic transvalvular gradient, but an oval thrombus adhered to the mitral prosthesis and fluctuating through the prosthetic valve was detected. Tissue plasminogen activator infusion was started. To reduce cerebral embolization, carotid filters used during artery angioplasty were placed in common carotid arteries, left and right. No complication occurred during and after the procedure. With thrombus absence at 30-min transoesophageal echocardiography, filters were removed. The patient continued intravenous heparin until achievement of a therapeutic international normalized ratio range and she was asymptomatic on discharge.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Próteses Valvulares Cardíacas/efeitos adversos , Heparina/uso terapêutico , Trombose/tratamento farmacológico , Trombose/etiologia , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Insuficiência da Valva Aórtica/etiologia , Feminino , Heparina/administração & dosagem , Humanos , Período Pós-Parto , Gravidez , Trombose/diagnóstico por imagem , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
3.
J Endovasc Ther ; 19(5): 599-610, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23046324

RESUMO

PURPOSE: To assess the efficacy of the Cardiatis multilayer flow modulator (CMFM), a bare cobalt alloy self-expanding stent, in the treatment of peripheral and visceral artery aneurysms. METHODS: In this multicenter (n=22), prospective, voluntary registry, 54 patients (47 men; mean age 68 years, range 19-87) who underwent CMFM deployment for peripheral (n=35) or visceral aneurysms (n=19) in a variety of target arteries were enrolled between June 2009 and June 2010. Among the 54 lesions, 44 had a total of 53 side branches. The main effectiveness endpoint was stent and side branch patency with no aneurysm rupture or reperfusion at 1, 6, and 12 months after stent implantation. Outcome measures were complete aneurysm thrombosis and sac shrinkage. The safety endpoint was freedom of complications (death, aneurysm rupture, endoleak, need for reintervention, stent foreshortening, stent occlusion, and access-site sequelae). Aneurysms were categorized as saccular (type I) or fusiform (type II) without a side branch or with branch(es) in the sac (subtype A), neck (subtype X), or both (subtype AX). Kaplan-Meier estimates were calculated for primary and secondary endpoints. Sac shrinkage was correlated to aneurysm morphology subtypes and presence/absence of mural thrombus. RESULTS: Technical success was achieved in all patients. Mortality at 1 year was 5.5% (n=3), including 1 perioperative death. Six patients were lost to follow-up. There was no aneurysm rupture. Six (11.1%) stents occluded over the 1-year period; 3 asymptomatic patients were not treated, 2 symptomatic patients had successful stent dilation to restore patency, and 1 symptomatic patient required bypass (the only side branch lost). Cumulative primary and secondary patency estimates were 86.9% and 90.7% at 1 year. The cumulative side branch patency was 96.1% and the freedom from all complications was 83.0% at 1 year. Complete aneurysm thrombosis was recorded in 42 (93.3%) of 45 patients at 1 year. Percent diameter reduction was 15.5%, 3.8%, and 11.0% at 1, 6, and 12 months (p<0.05), respectively. Presence of mural thrombus did not influence the time course of shrinkage (p>0.05), while complex lesion anatomy (presence of side branches) delayed shrinkage (p<0.05). CONCLUSION: Results at 1 year show that CMFM can be safely used in the treatment of PAA and VAA, with good results in terms of freedom from rupture, patency of the stents and side branches, complete aneurysm thrombosis, shrinkage, and acceptable freedom from morbidity and mortality.


Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Vísceras/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Aneurisma/diagnóstico por imagem , Aneurisma/mortalidade , Aneurisma/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Cobalto , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fluxo Sanguíneo Regional , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução Vascular , Adulto Jovem
4.
Radiology ; 261(2): 634-42, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22012905

RESUMO

PURPOSE: To determine the clinical outcome and the success of stent application for high-grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty (PTA) in critical limb ischemia (CLI). MATERIALS AND METHODS: In this ethics board-approved randomized prospective study, PTA or stent application was performed on 131 lesions in 88 patients with CLI. The primary end points were clinical improvement after endovascular treatment and limb salvage rate. Secondary end points were defined by the minimal lumen diameter (MLD) before and after the revascularization procedure, percentage of residual diameter stenosis (DS), binary restenosis rate (>50% DS and >70% DS), and incidence of target lesion revascularization at 9-month follow-up. RESULTS: At 3 months, the clinical status in the PTA group was less improved than that in the stent group (P = .008). At 9 months, there had been five minor and two major amputations in the PTA group and five major and five minor amputations in the stent group. MLD was significantly larger and the percentage of DS was significantly less in the stent group at completion angiography. At 9 months, the angiographic control showed better trends for the stent group in comparison to the PTA group despite that no significant differences were detected (MLD, 1.19 mm ± 0.92 vs 1.02 mm ± 1.02; DS, 38.68% ± 25.47 vs 43.31% ± 28.37). CONCLUSION: Infrapopliteal stent application is an effective treatment modality in CLI. The PTA and stent groups were essentially equal at 3 and 9 months except for the difference in clinical improvement in the stent group at 3 months.


Assuntos
Angioplastia/métodos , Isquemia/terapia , Perna (Membro)/irrigação sanguínea , Artéria Poplítea , Stents , Idoso , Idoso de 80 Anos ou mais , Carbono , Distribuição de Qui-Quadrado , Materiais Revestidos Biocompatíveis , Europa (Continente) , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
5.
Stereotact Funct Neurosurg ; 88(2): 94-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20134208

RESUMO

BACKGROUND/AIMS: Patients with advanced Parkinson disease (PD) are at increased risk for asymptomatic leg deep venous thrombosis (DVT) because of severe motor fluctuations. Protracted immobility in the absence of antiparkinsonian therapy during stereotactic surgery may further increase the risk for venous thrombosis. Our aim was to determine the incidence of asymptomatic DVT of leg veins in PD patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS). METHODS: 41 consecutive PD patients undergoing stereotactic surgery for STN-DBS were investigated by ultrasound compression sonography of leg veins and D-dimer measurement in the week preceding surgery. After surgery, D-dimer measurements were repeated and when the value exceeded the normal range, ultrasound compression sonography was repeated to confirm or exclude DVT. RESULTS: Doppler ultrasonographic examinations demonstrated that 2 patients (4.9%) developed asymptomatic DVT shortly after surgery (8.5 days) despite the fact that none of the 41 patients submitted to STN-DBS had DVT before surgery and that a specific prophylaxis was applied during surgery. CONCLUSIONS: Our data show that advanced PD patients are at risk for developing asymptomatic leg DVT following stereotactic surgery performed for STN-DBS. A strict clinical monitoring in the perioperative period is advisable in order to ensure early detection of DVT and prevent further thrombo-embolic complications.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Doença de Parkinson/terapia , Complicações Pós-Operatórias/etiologia , Trombose Venosa/etiologia , Idoso , Eletrodos Implantados/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia , Trombose Venosa/diagnóstico por imagem
7.
J Endovasc Ther ; 14(4): 460-8, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17696619

RESUMO

PURPOSE: To evaluate the patency of sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) in the treatment of atherosclerotic renal artery stenosis (RAS). METHODS: Between November 2001 to June 2003, 105 consecutive symptomatic patients (53 men; mean age 65.7 years) with RAS were treated with either a bare-metal (n=52) or a drug-eluting (n=53) low-profile Palmaz-Genesis peripheral stent at 11 centers in a prospective nonrandomized trial. The primary endpoint was the angiographic result at 6 months measured with quantitative vessel analysis by an independent core laboratory. Secondary endpoints were technical and procedural success, clinical patency [no target lesion revascularization (TLR)], blood pressure and antihypertensive drug use, worsening of renal function, and no major adverse events at 1, 6, 12, and 24 months. RESULTS: At 6 months, the overall in-stent diameter stenosis for BMS was 23.9%+/-22.9% versus 18.7%+/-15.6% for SES (p=0.39). The binary restenosis rate was 6.7% for SES versus 14.6% for the BMS (p=0.30). After 6 months and 1 year, TLR rate was 7.7% and 11.5%, respectively, in the BMS group versus 1.9% at both time points in the SES group (p=0.21). This rate remained stable up to the 2-year follow-up but did not reach significance due to the small sample. Even as early as 6 months, both types of stents significantly improved blood pressure and reduced antihypertensive medication compared to baseline (p<0.01). After 6 months, renal function worsened in 4.6% of the BMS patients and in 6.9% of the SES group. The rate of major adverse events was 23.7% for the BMS group and 26.8% for the SES at 2 years (p=0.80). CONCLUSION: The angiographic outcome at 6 months did not show a significant difference between BMS and SES. Renal artery stenting with both stents significantly improved blood pressure. Future studies with a larger patient population and longer angiographic follow-up are warranted to determine if there is a significant benefit of drug-eluting stents in treating ostial renal artery stenosis.


Assuntos
Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Obstrução da Artéria Renal/terapia , Artéria Renal/diagnóstico por imagem , Sirolimo/administração & dosagem , Stents , Idoso , Angioplastia com Balão/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Europa (Continente) , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Hipertensão/fisiopatologia , Testes de Função Renal , Masculino , Metais , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Radiografia , Recidiva , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/fisiopatologia , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
10.
J Vasc Interv Radiol ; 16(9): 1195-202, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16151060

RESUMO

PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly analyzed by a Core Lab. MATERIALS AND METHODS: Fifty-two consecutive patients (mean age, 63.7 years) were successfully treated with the Palmaz Genesis Peripheral Stent (Cordis, Miami, FL) on the Slalom 0.018-inch Delivery System (Cordis Europe N.V., Oosteinde 8, NLO-9301 LJ Roden, The Netherlands) at 11 investigational centers. Patients with severe renal failure and > 8-mm renal artery were excluded. Primary endpoint was angiographic determination of in-stent percent diameter stenosis at 6 months. Fifty-one patients were treated with one stent, one patient was treated with two stents to cover the complete lesion. RESULTS: Mean percentage diameter stenosis before renal angioplasty was 68.2% +/- 12.0%. No stent implantation failure, displacement, need for additional stent implantation, or procedural complication was observed. Six-month angiography was performed in 41 of 52 patients (79%) resulting in a mean in-stent percent diameter stenosis or Quantitative Vessel analysis (QVA) at 6 months of 23.9%. The in-stent binary (percent diameter stenosis > 50%) restenosis rate at 6 months was 14.3%. No fatal events occurred up to 6 months after implantation. Major adverse events occurred in five patients: four patients (7.7%) required a revascularization and one patient (1.9%) experienced a cerebrovascular event, which regressed spontaneously. CONCLUSIONS: The Palmaz Genesis stent (Cordis) provides good results for renal artery stent placement, with an in-stent binary restenosis rate (percent diameter stenosis > 50%) at 6 months of 14.3% as determined with angiography.


Assuntos
Obstrução da Artéria Renal/terapia , Stents , Idoso , Angioplastia com Balão , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Implante de Prótese Vascular , Creatinina/metabolismo , Remoção de Dispositivo , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Rim/metabolismo , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Contração Miocárdica/fisiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Radiografia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular/efeitos dos fármacos , Grau de Desobstrução Vascular/fisiologia
13.
J Nucl Med ; 44(10): 1574-81, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14530469

RESUMO

UNLABELLED: Captopril renography is a reliable, widely used test for the functional diagnosis of renovascular hypertension. Well-recognized drawbacks of the procedure include reduced accuracy in patients with bilateral disease or renal impairment as well as the possible interference from concurrent antihypertensive medication (diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers). Currently, no data exist regarding the reliability of captopril renography in patients with renovascular hypertension evaluated while they are under chronic treatment with angiotensin II (AT1) receptor antagonists (Sartans). Moreover, the renographic response of the kidney with renal artery stenosis to prolonged therapy with angiotensin II receptor antagonists has not yet been evaluated. METHODS: We investigated the diagnostic effectiveness of (99m)Tc-mercaptoacetyltriglycine captopril renography performed after acute addition of 25 mg of captopril to the daily dose of AT1 receptor antagonist in 13 patients with unilateral renal artery stenosis and subsequent evidence of renovascular hypertension, based on short-term (3 mo) blood pressure outcome after revascularization. The renographic evaluation was first performed after ingestion of the daily therapy of angiotensin II receptor antagonist alone (Sartan renography) and was repeated within 7 d after the acute addition of 25 mg of captopril to chronic treatment with angiotensin II receptor antagonist (captopril-Sartan renography). A cohort of 13 patients with a final diagnosis of essential hypertension was chosen as the control subjects. RESULTS: Twelve of 13 patients were correctly detected by captopril-Sartan renography (92% sensitivity), and 3 subjects were also identified without the addition of captopril. Adding captopril to Sartan therapy resulted in a slight reduction in mean arterial blood pressure, while significant side effects were never observed. No false-positive results were found in the 13 patients with essential hypertension. CONCLUSION: We conclude that performing captopril renography with the acute addition of 25 mg of captopril to the chronic monotherapy with Sartans has the same diagnostic effectiveness as performing captopril renography alone. Interrupting the vasoactive action of angiotensin II alone on the efferent glomerular arteries, which can also be selectively achieved by chronic administration of angiotensin II receptor antagonists, does not fully explain the effectiveness of captopril renography in detecting renovascular hypertensive patients.


Assuntos
Anti-Hipertensivos/uso terapêutico , Captopril/uso terapêutico , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/tratamento farmacológico , Renografia por Radioisótopo/métodos , Adulto , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Renografia por Radioisótopo/efeitos dos fármacos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
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