RESUMO
BACKGROUND: This meta-analysis aimed to evaluate randomized trials (RTs) that compare outcomes among asymptomatic patients with significant carotid stenosis undergoing carotid endarterectomy (CEA) versus carotid stenting (CAS) or best medical treatment (BMT). MATERIAL AND METHODS: The Pubmed, Embase, Scopus and Cochrane Library databases were systematically searched to identify eligible studies. Data were analyzed by using the StatsDirect Statistical software (Version 2.8.0, StatsDirect Ltd). Odds ratios (OR) were used to determine effect size, along with 95% confidence interval (CI). PRISMA guidelines for conducting meta-analyses were utilized. RESULTS: Overall, 10 RTs including 8771 asymptomatic patients were evaluated. Compared to CAS, 30-day all stroke risk was found to be lower after CEA (pooled ORâ¯=â¯0.56; CI 95% [0.312-0.989]; Pâ¯=â¯0.046). However, other early and late outcomes were not different between CEA and CAS. Furthermore, 30-day all stroke (pooled ORâ¯=â¯3.43; CI 95% [1.810-6.510]; Pâ¯=â¯0.0002), death (pooled ORâ¯=â¯4.75; CI 95% [1.548-14.581]; Pâ¯=â¯0.007) and myocardial infarction (MI) (pooled ORâ¯=â¯9.18; CI 95% [1.668-50.524]; Pâ¯=â¯0.011) risks were higher after CEA compared to BMT, as expected. Additionally, 30-day all stroke/death and all stroke/death/MI risks were higher after CEA compared to BMT as well. Regarding long-term results, ipsilateral stroke risk was lower after CEA compared to BMT (pooled ORâ¯=â¯0.46; CI 95% [0.361-0.596]; Pâ¯<â¯0.0001) although death due to stroke risk was not different (pooled ORâ¯=â¯0.57; CI 95% [0.223-1.457]; Pâ¯=â¯0.240). Unfortunately, no study comparing CAS to BMT was found. CONCLUSIONS: CEA is associated with a lower early all stroke risk compared to CAS although other early or late outcomes did not show any difference between the two methods. Additionally, CEA seems to have a benefit over BMT against long-term ipsilateral stroke, although early outcomes are worse after CEA. No studies are available comparing CAS to BMT alone.
Assuntos
Fármacos Cardiovasculares/uso terapêutico , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Doenças Assintomáticas , Fármacos Cardiovasculares/efeitos adversos , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
We report an unusual case of an 83-year-old man who was admitted with dizziness and repeated drop attacks. He was diagnosed with bilateral carotid artery occlusion and he underwent a left subclavian to left carotid bypass with ringed polytetrafluoroethylene graft. The patient's postoperative course was uneventful and no symptoms presented during a 6-month follow-up. Finally, we discuss on proper management of such patients.
RESUMO
The incidence of combined neurovascular injuries among patients with high-energy shoulder trauma ranges from 27% to 44%. However, the presentation of an axillary artery pseudoaneurysm (PSA) due to shoulder dislocation without an associated osseous fracture is a very rare condition. Moreover, treatment of combined neurologic and vascular injuries of the shoulder remains controversial. Additionally, minimally invasive treatments such as thrombin injection have been mainly evaluated in patients with iatrogenic femoral artery PSAs. Therefore, we aim to report a rare case of axillary artery PSA associated with brachial plexus injury after shoulder dislocation treated with percutaneous thrombin injection.
Assuntos
Falso Aneurisma/tratamento farmacológico , Artéria Axilar/lesões , Luxação do Ombro/complicações , Trombina/administração & dosagem , Lesões do Sistema Vascular/tratamento farmacológico , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artéria Axilar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Injeções Intralesionais , Luxação do Ombro/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaRESUMO
BACKGROUND: Proper management of patients with thromboangiitis obliterans (TAO) or cannabis-associated arteritis (CAA), presenting with critical lower limb ischaemia (CLI) remains controversial, and data are limited. PATIENTS AND METHODS: Patients with TAO or CAA presenting with CLI between 2011 and 2016 were retrospectively evaluated. Patients requiring primary intervention were excluded. Conservative treatment included: (a) weight-adjusted bemiparin plus six hours/day intravenous iloprost for 28 days, (b) aspirin (100 mg/day) plus cilostazol (100 mg twice/day) after discharge, and (c) strict recommendations/monitoring for smoking cessation. Main outcomes included symptom recession, ankle-brachial index (ABI) improvement, and healing of lesions at the time of discharge as well as amputation, revascularization, and abstinence rate during follow-up. RESULTS: Overall, 23 patients (TAO: 15; CAA: 8) were included within six years, none of the patients reported any other factor than smoking. All patients presented with rest pain and 12 patients with ulcer or necrotic lesions. Mean ABI measurement at presentation was 0.46 ± 0.2, after 28 days of treatment, all patients showed improvement regarding clinical picture and ABI measurement (0.54 ± 0.1; p < 0.05). During follow-up, only three patients underwent bypass surgery and two patients underwent major amputation, although the smoking abstinence rate was very low (13 %). CONCLUSIONS: Intravenous iloprost plus bemiparin for 28 days together with per os aspirin plus cilostazol seem to produce promising results in patients with TAO/CAA, treated for CLI, even with a low smoking abstinence rate. However, larger series are needed to further evaluate inter-group differences and potential prognostic factors.
Assuntos
Arterite/tratamento farmacológico , Fármacos Cardiovasculares/administração & dosagem , Isquemia/tratamento farmacológico , Extremidade Inferior/irrigação sanguínea , Abuso de Maconha/complicações , Fumar Maconha/efeitos adversos , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Tromboangiite Obliterante/tratamento farmacológico , Adulto , Amputação Cirúrgica , Índice Tornozelo-Braço , Anticoagulantes/administração & dosagem , Arterite/diagnóstico , Arterite/etiologia , Aspirina/administração & dosagem , Fármacos Cardiovasculares/efeitos adversos , Cilostazol , Estado Terminal , Quimioterapia Combinada , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Iloprosta/administração & dosagem , Infusões Intravenosas , Isquemia/diagnóstico , Isquemia/etiologia , Salvamento de Membro , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/terapia , Fumar Maconha/prevenção & controle , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Recidiva , Indução de Remissão , Estudos Retrospectivos , Fatores de Risco , Tetrazóis/administração & dosagem , Tromboangiite Obliterante/diagnóstico , Tromboangiite Obliterante/etiologia , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
Peripheral artery disease (PAD) has been associated with severe morbidity and mortality worldwide, affecting the quality of life for millions of patients. Acute thrombosis has been identified as a major complication of PAD, with proper management including both open as well as endovascular techniques. Thrombolysis has emerged as a reasonable option in the last decades to treat such patients although data produced by randomized trials have been limited. This review aims to present major aspects of thrombolysis in PAD regarding its indications and contraindications, technique tips as well as to review literature data in order to produce useful conclusions for everyday clinical practice.