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Ahmed JA, Ahmed KA, Ahmed MH. Surprising Resolution of Life-Long Severe Generalized Hyperhidrosis Post- angioplasty and Stenting. Cureus 2024; 16:e52451. [PMID: 38371051 PMCID: PMC10871155 DOI: 10.7759/cureus.52451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond thermoregulation needs. HH can be primary with no known etiology or secondary, as a symptom of underlying medical disease or a side effect of certain medications. Furthermore, HH can be focal, affecting one or a few body parts, or generalized, affecting the entire body. We present the case of a 49-year-old male with a history of primary generalized HH as well as coronary artery disease whose HH symptoms surprisingly resolved following coronary angioplasty and stenting. This unprecedented outcome of the procedure points to a potential association between HH and coronary artery disease, proposing potential management of HH through cardiovascular workup. In light of this result, we suggest that patients exhibiting generalized primary HH undergo a thorough comprehensive cardiovascular workup.
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Shukla A, Dwivedi SK, Chandra S, Chaudhary G, Sharma A, Sethi R, Pradhan A, Vishwakarma P, Bhandari M, Singh A. Reliability of Fractional Flow Reserve in Non-Infarct-Related Arteries in ST-Segment Elevation Myocardial Infarction Patients Undergoing a Pharmaco-Invasive Approach. Cureus 2024; 16:e52668. [PMID: 38260108 PMCID: PMC10801342 DOI: 10.7759/cureus.52668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 01/24/2024] Open
Abstract
Objectives We investigated the reproducibility of fractional flow reserve (FFR) of significant stenoses (≥70% narrowing) in the non-infarct related artery (NIRA) during the pharmaco-invasive percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) within 24 hours of thrombolysis and at a follow up of 2-3 weeks. Background STEMI with multivessel disease has worse outcomes. The benefits of FFR-directed PCI of NIRA at the time of primary PCI are yet controversial. Assessing the hemodynamic severity of the NIRA may help in deciding the management strategy of these lesions, save time, and avoid complications. Methods Thirty-one patients undergoing PCI for STEMI under a pharmaco-invasive approach were prospectively recruited. The FFR measurements in 34 stenoses (≥70% diameter stenosis) were obtained immediately after PCI of the culprit stenosis and were repeated at a mean follow-up of 17.6 ± 3.55 (14-21) days. In addition, time to thrombolysis, time from symptom onset to PCI, left ventricular ejection fraction (LVEF), quantitative coronary angiographic measurements of the non-culprit stenoses, and thrombolysis in myocardial infarction (TIMI) flow were recorded. Results There was a significant change in FFR values at follow-up as compared to baseline (0.78 ± 0.08 (0.68-0.93) to 0.77 ± 0.08 (0.67-0.93)) (p = 0.014). In four of the lesions, the FFR values differed by >0.05 at follow-up. The follow-up FFR values led to a change in the management strategy in 5 out of 31 patients (15%) of the lesions. The TIMI flow, percentage diameter stenosis, minimum lumen diameter, and LVEF did not change. There were no predictors of this change in FFR values. Conclusions During the acute phase of STEMI, the severity of non-culprit coronary artery stenoses can not be reliably assessed by FFR. The prolonged jeopardized state of myocardium in pharmaco-invasive PCI as compared to primary PCI seems to be responsible.
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Affiliation(s)
- Ayush Shukla
- Cardiology, King George's Medical University, Lucknow, IND
| | | | - Sharad Chandra
- Cardiology, King George's Medical University, Lucknow, IND
| | | | - Akhil Sharma
- Cardiology, King George's Medical University, Lucknow, IND
| | - Rishi Sethi
- Cardiology, King George's Medical University, Lucknow, IND
| | | | | | | | - Abhishek Singh
- Cardiology, King George's Medical University, Lucknow, IND
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Borhani-Haghighi A, Hooshmandi E, Zahediasl F, Molavi Vardanjani H, Rezaei M, Rahimi-Jaberi A, Ashjazadeh N, Petramfar P, Ostovan VR, Fadakar N, Poursadeghfard M, Izadi S, Nazeri M, Zafarmand SS, Bayat M, Salehi MS, Owjfard M, Sedighi B, Iranmanesh F, Shafiei K, Vakilian A, Moghadam Ahmadi A, Nemati R, Rezaeian Jahromi F, Jalalijahromi M, Kashani K, Razmeh S, Bahrehbar M, Basir M, Qureshi AI. Early and mid-term outcomes of carotid angioplasty and stent placement in 579 patients. J Neuroimaging 2022; 32:1161-1169. [PMID: 35969379 DOI: 10.1111/jon.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid-term complications associated with CAS. METHODS This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All-cause mortality, vascular mortality, and stroke were investigated during mid-term follow-up. RESULTS A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all-cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All-cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014). CONCLUSION CAS provides acceptable short-term and mid-term outcomes in a unique population of high- and standard-surgical-risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.
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Affiliation(s)
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Zahediasl
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdiyeh Rezaei
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi-Jaberi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Reza Ostovan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Fadakar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Nazeri
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahnaz Bayat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Saied Salehi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Owjfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnaz Sedighi
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Farhad Iranmanesh
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Kaveh Shafiei
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - Alireza Vakilian
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Moghadam Ahmadi
- Neuro-immunology Research Scholar, Thomas Jefferson University, Philadelphia, PA, USA
| | - Reza Nemati
- Department of Neurology, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | | | - Kaveh Kashani
- Department of Neurology, Fasa University of Medical Sciences, Fasa, Iran
| | - Saeed Razmeh
- Department of Neurology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mansour Bahrehbar
- Department of Neurology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Marzieh Basir
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and University of Missouri, Columbia, Missouri, USA
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Wang Y, Wang T, Dmytriw AA, Yang K, Jiao L, Shi H, Lu J, Li T, Huang Y, Zhao Z, Wu W, Wan J, Sun Q, Hong B, Li Y, Zhang L, Chu J, Cheng Q, Cai Y, Wang P, Luo Q, Yang H, Dong B, Zhang Y, Zhao J, Chen Z, Li W, Bai X, He W, Cai X, Ti M, Zaidat OO. Safety of endovascular therapy for symptomatic intracranial artery stenosis: a national prospective registry. Stroke Vasc Neurol 2021; 7:166-171. [PMID: 34642253 PMCID: PMC9067260 DOI: 10.1136/svn-2021-000979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/04/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown. The Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis (CRTICAS) was a prospective, multicentre, real-world registry designed to assess these outcomes and the impact of centre experience. METHODS 1140 severe, symptomatic intracranial arterial stenosis (ICAS) patients treated with endovascular therapy were included from 26 centres, further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years: (1) high volume for ≥25 cases/year; (2) moderate volume for 10-25 cases/year and (3) low volume for <10 cases/year. RESULTS The rate of 30-day stroke, transient ischaemic attack or death was 9.7% (111), with 5.4%, 21.1% and 9.7% in high-volume, moderate-volume and low-volume centres, respectively (p<0.05). Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres (OR=0.187, 95% CI: 0.056 to 0.627; p≤0.0001), while moderate-volume and low-volume centres showed no significant difference (p=0.8456). CONCLUSION Compared with the preceding randomised controlled trials, this real-world, prospective, multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ICAS. Non-uniform utilisation in endovascular technology, institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.
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Affiliation(s)
- Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Adam Andrew Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Huaizhang Shi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Tianxiao Li
- Center of Neurointerventional Therapy, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yujie Huang
- Department of Neurology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wu
- Department of Neurology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Jieqing Wan
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Shanghai, China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Bo Hong
- Neusurgery, Changhai Hospital, Shanghai, China
| | - Yongli Li
- Department of Neurosurgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng City, Shandong, China
| | - Jianfeng Chu
- Department of Neurosurgery, Jining First People's Hospital, Jining, Shandong, China
| | - Qiong Cheng
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yiling Cai
- Department of Neurology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Pengfei Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, Tianjin, China
| | - Qi Luo
- Department of Neurosurgery, Jilin University First Hospital, Changchun, Jilin, China
| | - Hua Yang
- Department of Neurology, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou, China
| | - Baijing Dong
- Department of Neurosurgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yang Zhang
- Department of Neurosurgery, Peking University First Hospital, Beijing, Beijing, China
| | - Jun Zhao
- Department of Neurology, Liaocheng Second People's Hospital, Liaocheng, China
| | - Zuoquan Chen
- Department of Neurology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Wei Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, Tianjin, China
| | - Xiaoxin Bai
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weiwen He
- Department of Neurosurgery, Guangzhou Medical University Second Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Maimai Ti
- Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
| | - Osama O Zaidat
- Neurology Program, North East Ohio Medical School, Mercy St Vincent Mercy Medical Center, Toledo, Ohio, USA
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Vemmou E, Alaswad K, Khatri JJ, Khelimskii D, Krestyaninov O, Poommipanit P, Karacsonyi J, Nikolakopoulos I, Garcia S, Brilakis ES. Chronic total occlusion percutaneous coronary intervention during the COVID-19 pandemic: Insights from the PROGRESS-CTO registry. Hellenic J Cardiol 2021; 62:372-373. [PMID: 34098128 PMCID: PMC8178534 DOI: 10.1016/j.hjc.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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Shah FA, Maiolo A. Progressive Collateral Stenosis Leading to Symptomatic Chronic Total Occlusion. Cureus 2021; 13:e12524. [PMID: 33564528 PMCID: PMC7863054 DOI: 10.7759/cureus.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a case of chronic total occlusion (CTO) in a functional 79-year-old female with no past history of coronary artery disease, who was previously asymptomatic due to robust collateral circulation. A 79-year-old Caucasian female presented to the emergency department complaining of chest pain radiating to the neck, jaw, left arm with associated numbness in the left fingers, that had started earlier in the day. She has no previous cardiac history and never had similar symptoms before. Troponin levels were negative. Nuclear stress test showed findings worrisome for ischemia and was a high-risk exam. The patient underwent diagnostic angiography. There was complete total occlusion of the mid right coronary artery, with collateral circulation supplying the distal right coronary artery territory. Ultimately, it found that progressive stenosis of the left anterior descending (LAD) artery led to inadequate collateral circulation and completely occluded the right coronary artery's territory, causing the patient's new-onset angina. Afterwards, the patient underwent percutaneous coronary intervention (PCI). Successful implantation of two drug-eluting stents occurred. The final angiographic result was 0% residual stenosis and Thrombolysis in Myocardial Infarction (TIMI)-3 flow. CTO affecting one or more coronary arteries is not uncommon in patients taken to the catheterization laboratory. However, despite recent advancements in PCI outcomes, treatment of CTO by PCI remains relatively low, due to fear of adverse outcomes such as cardiac perforations. Recent research has supported the safety of performing PCIs on patients with CTO. This case report further reinforces the need to approach treating CTO via angioplasty.
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Affiliation(s)
- Farhan A Shah
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Holm M, Tornvall P, Henareh L, Jensen U, Golster N, Alström P, Santos-Pardo I, Witt N, Fedchenko N, Venetsanos D, Beck O, van der Linden J. The MOVEMENT Trial. J Am Heart Assoc 2020; 8:e010152. [PMID: 30636504 PMCID: PMC6497337 DOI: 10.1161/jaha.118.010152] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Morphine administration is a strong predictor of delayed onset of action of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction, likely because of impaired gastrointestinal motility. The aim of this study was to evaluate whether the peripheral opioid antagonist methylnaltrexone could improve pharmacodynamics and pharmacokinetics of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction receiving morphine. Methods and Results The MOVEMENT (Methylnaltrexone to Improve Platelet Inhibition of Ticagrelor in Morphine‐Treated Patients With ST‐Segment Elevation Myocardial Infarction) trial was a multicenter, prospective, randomized, controlled trial in patients with ST‐segment–elevation myocardial infarction treated with morphine and ticagrelor. Upon arrival to the catheterization laboratory, patients were randomized to a blinded intravenous injection of either methylnaltrexone (8 or 12 mg according to weight) or 0.9% sodium chloride. The proportion of patients with high on‐treatment platelet reactivity and plasma concentrations of ticagrelor and AR‐C124910XX were assessed at baseline (arrival in the catheterization laboratory) and 1 and 2 hours later. A total of 82 patients received either methylnaltrexone (n=43) or placebo (n=39). Median (interquartile range) time from ticagrelor administration to randomization was 41 (31–50) versus 45.5 (37–60) minutes (P=0.16). Intravenous methylnaltrexone administration did not significantly affect prevalence of high on‐treatment platelet reactivity at 2 hours after inclusion, the primary end point, when compared with placebo (54% versus 51%, P=0.84). Plasma concentrations of ticagrelor and its active metabolite, the prespecified secondary end points, did not differ significantly between the groups over time. There was no significant difference in patient self‐estimated pain between the groups. Conclusions Methylnaltrexone did not significantly improve platelet reactivity or plasma concentrations of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction receiving morphine. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02942550.
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Affiliation(s)
- Manne Holm
- 1 Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.,2 Perioperative Medicine and Intensive Care, B31 Karolinska University Hospital Huddinge, Stockholm Sweden
| | - Per Tornvall
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Loghman Henareh
- 4 Coronary Artery and Vascular Disease Heart and Vascular Theme Department of Medicine Karolinska Institute and Karolinska University Hospital Stockholm Sweden
| | - Ulf Jensen
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Nanna Golster
- 1 Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Patrik Alström
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Irene Santos-Pardo
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Nils Witt
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Nikolai Fedchenko
- 3 Unit of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Dimitrios Venetsanos
- 4 Coronary Artery and Vascular Disease Heart and Vascular Theme Department of Medicine Karolinska Institute and Karolinska University Hospital Stockholm Sweden
| | - Olof Beck
- 5 Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
| | - Jan van der Linden
- 1 Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
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Abstract
Background Racial disparities in invasive cardiac procedures such as percutaneous coronary intervention (PCI) in the general population are well documented; however, national-level data on such disparities in the end-stage renal disease (ESRD) population are lacking. We assessed racial differences in PCI between black and white patients with ESRD on maintenance dialysis. Methods and Results Using the US Renal Data System database, we abstracted Medicare inpatient procedure claims for PCI in a cohort of 268 575 Medicare-primary patients who initiated treatment on maintenance dialysis from January 1, 2009, through June 1, 2013. We conducted Cox regression analyses with PCI being the event, adjusted for demographic characteristics, Hispanic ethnicity, cause of ESRD, comorbidities, and socioeconomic factors. We also assessed the probability of PCI, accounting for death or transplant in competing risk regression models. The crude incidence rate of PCI among white patients was 25.8 per 1000 patient-years versus 15.5 per 1000 patient-years among black patients. Cox regression analyses demonstrated that black patients were significantly less likely to undergo PCI compared with white patients (adjusted hazard ratio: 0.64; 95% CI, 0.62-0.67; P<0.001). In the competing risk models, the racial gap for PCI among black and white patients remained significant with death (subdistribution hazard ratio: 0.81; 95% CI, 0.76-0.85; P<0.001) or transplant as a competing event (subdistribution hazard ratio: 0.67; 95% CI, 0.64-0.70; P<0.001). Conclusions A racial gap exists in PCI use among dialysis patients despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical, socioeconomic factors, and death or transplant as competing events.
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Affiliation(s)
- Robert Nee
- Nephrology Service Walter Reed National Military Medical Center Bethesda MD.,Uniformed Services University Bethesda MD
| | - Guofen Yan
- Department of Public Health Sciences University of Virginia School of Medicine Charlottesville VA
| | - Christina M Yuan
- Nephrology Service Walter Reed National Military Medical Center Bethesda MD.,Uniformed Services University Bethesda MD
| | | | - Keith C Norris
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
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Zanaty M, Howard S, Roa JA, Alvarez CM, Kung DK, McCarthy DJ, Samaniego EA, Nakagawa D, Starke RM, Limaye K, Al Kasab S, Chalouhi N, Jabbour P, Torner J, Tranel D, Hasan D. Cognitive and cerebral hemodynamic effects of endovascular recanalization of chronically occluded cervical internal carotid artery: single-center study and review of the literature. J Neurosurg 2019; 132:1158-1166. [PMID: 30925474 DOI: 10.3171/2019.1.jns183337] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Revascularization of a symptomatic, medically refractory, cervical chronically occluded internal carotid artery (COICA) using endovascular techniques (ETs) has surfaced as a viable alternative to extracranial-intracranial bypass. The authors aimed to assess the safety, success, and neurocognitive outcomes of recanalization of COICA using ETs or hybrid treatment (ET plus carotid endarterectomy) and to identify candidate radiological markers that could predict success. METHODS The authors performed a retrospective analysis of their prospectively collected institutional database and used their previously published COICA classification to assess the potential benefits of ETs or hybrid surgery to revascularize symptomatic patients with COICA. Subjects who had undergone CT perfusion (CTP) imaging and Montreal Cognitive Assessment (MoCA) testing, both pre- and postprocedure, were included. The authors then performed a review of the literature on patients with COICA to further evaluate the success and safety of these treatment alternatives. RESULTS The single-center study revealed 28 subjects who had undergone revascularization of symptomatic COICA. Five subjects had CTP imaging and MoCA testing pre- and postrevascularization and thus were included in the study. All 5 patients had very large penumbra involving the entire hemisphere supplied by the ipsilateral COICA, which resolved postoperatively. Significant improvement in neurocognitive outcome was demonstrated by MoCA testing after treatment (preprocedure: 19.8 ± 2.4, postprocedure: 27 ± 1.6; p = 0.0038). Moreover, successful revascularization of COICA led to full restoration of cerebral hemodynamics in all cases. Review of the literature identified a total of 333 patients with COICA. Of these, 232 (70%) showed successful recanalization after ETs or hybrid surgery, with low major and minor complication rates (3.9% and 2.7%, respectively). CONCLUSIONS ETs and hybrid surgery are safe and effective alternatives to revascularize patients with symptomatic COICA. CTP imaging could be used as a radiological marker to assess cerebral hemodynamics and predict the success of revascularization. Improvement in CTP parameters is associated with significant improvement in neurocognitive functions.
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Affiliation(s)
| | - Susanna Howard
- 2Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | | | | | - David K Kung
- 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J McCarthy
- 5Departments of Neurosurgery and Radiology, University of Miami, Florida
| | - Edgar A Samaniego
- Departments of1Neurosurgery.,3Neurology, and.,6Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daichi Nakagawa
- 7Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Robert M Starke
- 5Departments of Neurosurgery and Radiology, University of Miami, Florida
| | | | | | - Nohra Chalouhi
- 8Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - Pascal Jabbour
- 8Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | | | - Daniel Tranel
- 10Neurology, and.,11Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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Ma N, Zhang Y, Shuai J, Jiang C, Zhu Q, Chen K, Liu L, Li B, Shi X, Gao L, Liu Y, Wang F, Li Y, Liu T, Zheng H, Mo D, Gao F, Wang Y, Wang Y, Feng L, Miao Z. Stenting for symptomatic intracranial arterial stenosis in China: 1-year outcome of a multicentre registry study. Stroke Vasc Neurol 2018; 3:176-184. [PMID: 30294474 PMCID: PMC6169608 DOI: 10.1136/svn-2017-000137] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 02/25/2018] [Accepted: 03/04/2018] [Indexed: 02/05/2023] Open
Abstract
Background and purpose A multicentre prospective registry study of individually tailored stenting for a patient with symptomatic intracranial atherosclerotic stenosis (ICAS) combined with poor collaterals in China showed that the short-term safety and efficacy of stenting was acceptable. However, it remained uncertain whether the low event rate could be of a long term. We reported the 1-year outcome of this registry study to evaluate the long-term efficacy of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals. Methods Patients with symptomatic ICAS caused by 70%-99% stenosis located at the intracranial internal carotid, middle cerebral, intracranial vertebral or basilar arteries combined with poor collaterals were enrolled. Balloon-mounted stent or balloon plus self-expanding stent were selected based on the ease of vascular access and lesion morphology determined by the operators. The primary outcome was the rate of 30-day stroke, transient ischaemic attack and death, and 12-month ischaemic stroke within the same vascular territory, haemorrhagic stroke and vascular death after stenting. Results From September 2013 to January 2015, 300 patients (ages 58.3±9.78 years) were recruited. Among them, 159 patients were treated with balloon-mounted stent and 141 with balloon plus self-expanding stent. During the 1-year follow-up, 25 patients had a primary end point event. The probability of primary outcome at 1 year was 8.1% (95% CI 5.3% to 11.7%). In 76 patients with digital subtraction angiography follow-up, 27.6% (21/76) had re-stenosis ≥50% and 18.4% (14/76) had re-stenosis ≥70%. No baseline characteristic was associated with the primary outcome. Conclusion The event rate remains low over 1 year of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals. Further randomised trial of comparing individually tailored stenting with best medical therapy is needed. Trial registration number NCT01968122; Results.
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Affiliation(s)
- Ning Ma
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yong Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China
| | - Jie Shuai
- Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Changchun Jiang
- Department of Neurology, Baotou Central Hospital, Baotou, China
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, China
| | - Kangning Chen
- Department of Neurology, Xi Nan Hospital, Third Military Medical University, Chongqing, China
| | - Li Liu
- Department of Neurology, The Hospital of Chifeng City, Chifeng, China
| | - Baomin Li
- Department of Neurosurgery, The PLA General Hospital, Beijing, China
| | - Xiangqun Shi
- Department of Neurology, The Lanzhou General Hospital of PLA, Lanzhou, China
| | - Lianbo Gao
- Department of Neurology, The Affiliated Fourth Hospital of China Medical University, Shenyang, China
| | - Yajie Liu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Feng Wang
- Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yongli Li
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tieyan Liu
- Department of Interventional Radiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongbo Zheng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dapeng Mo
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Feng Gao
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Lei Feng
- Departments of Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA
| | - Zhongrong Miao
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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11
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Santiago-Dieppa DR, Hirshman BR, Wali A, Scott Pannell J, Alam Y, Olson S, Cheung VJ, Steinberg JA, Gupta M, Khalessi AA. The circle of Willis predicts the antihypertensive effects of carotid artery stenting. Neurosurg Focus 2017; 42:E18. [PMID: 28366069 DOI: 10.3171/2017.1.focus16487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Carotid artery stenting (CAS) has antihypertensive effects, but the durability and degree of this response remain variable. The authors propose that this clinical variability is a function of the presence or absence of a complete circle of Willis (COW). Incomplete COWs perfuse through a higher-resistance pial collateral pathway, and therefore patients may require a higher mean arterial pressure (MAP). Carotid artery revascularization in these patients would reduce the end-organ collateral demand that has been hypothesized to drive the MAP response. METHODS Using a retrospective, nonrandomized within-subject case-control design, the authors compared the postoperative effects of CAS in patients with and without a complete COW by using changes in MAP and antihypertensive medication as end points. They recorded MAP and antihypertensive medications 3 months prior to surgery, preoperatively, immediately postoperatively, and at the 3-month follow-up. RESULTS Data were collected from 64 consecutive patients undergoing CAS. Patients without a complete COW (25%) were more likely to demonstrate a decrease in BP response to stenting (i.e., a drop in MAP of 10 mm Hg and/or a reduction or cessation of BP medications at 3 months postoperatively). Of the patients in the incomplete COW cohort, 75% had this outcome, whereas of those in the complete COW cohort, only 41% had it (p < 0.041). These findings remained statistically significant in a logistic regression analysis for possible confounders (p < 0.024). A receiver operating curve analysis of preoperative data indicated that a MAP > 96.3 mm Hg was 55.5% sensitive and 57.4% specific for predicting a complete COW and that patients with a MAP > 96.3 mm Hg were more likely to demonstrate a good MAP decrease following CAS (p < 0.0092). CONCLUSIONS CAS is associated with a significant decrease in MAP and/or a reduction/cessation in BP medications in patients in whom a complete COW is absent.
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Affiliation(s)
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, California
| | - Arvin Wali
- Department of Neurosurgery, University of California, San Diego, California
| | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego, California
| | - Yasaman Alam
- Department of Neurosurgery, University of California, San Diego, California
| | - Scott Olson
- Department of Neurosurgery, University of California, San Diego, California
| | - Vincent J Cheung
- Department of Neurosurgery, University of California, San Diego, California
| | | | - Mihir Gupta
- Department of Neurosurgery, University of California, San Diego, California
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12
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Heer T, Hochadel M, Schmidt K, Mehilli J, Zahn R, Kuck KH, Hamm C, Böhm M, Ertl G, Hoffmeister HM, Sack S, Senges J, Massberg S, Gitt AK, Zeymer U. Sex Differences in Percutaneous Coronary Intervention-Insights From the Coronary Angiography and PCI Registry of the German Society of Cardiology. J Am Heart Assoc 2017; 6:JAHA.116.004972. [PMID: 28320749 PMCID: PMC5524024 DOI: 10.1161/jaha.116.004972] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Several studies have suggested sex‐related differences in diagnostic and invasive therapeutic coronary procedures. Methods and Results Data from consecutive patients who were enrolled in the Coronary Angiography and PCI Registry of the German Society of Cardiology were analyzed. We aimed to compare sex‐related differences in in‐hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease, non‐ST elevation acute coronary syndromes, ST elevation myocardial infarction, and cardiogenic shock. From 2007 until the end of 2009 data from 185 312 PCIs were prospectively registered: 27.9% of the PCIs were performed in women. Primary PCI success rate was identical between the sexes (94%). There were no sex‐related differences in hospital mortality among patients undergoing PCI for stable coronary artery disease, non‐ST elevation acute coronary syndromes, or cardiogenic shock except among ST elevation myocardial infarction patients. Compared to men, women undergoing primary PCI for ST elevation myocardial infarction have a higher risk of in‐hospital death, age‐adjusted odds ratio (1.19, 95% CI 1.06‐1.33), and risk of ischemic cardiac and cerebrovascular events (death, myocardial infarction, transient ischemic attack/stroke), (age‐adjusted odds ratio 1.19, 95% CI 1.16‐1.29). Furthermore, access‐related complications were twice as high in women, irrespective of the indication. Conclusions Despite identical technical success rates of PCI between the 2 sexes, women with PCI for ST elevation myocardial infarction have a 20% higher age‐adjusted risk of death and of ischemic cardiac and cerebrovascular events. Further research is needed to determine the reasons for these differences.
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Affiliation(s)
- Tobias Heer
- Klinikum München Schwabing, Academic Teaching Hospital, University of Munich, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Karin Schmidt
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Julinda Mehilli
- Medizinische Klinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | | | | | - Michael Böhm
- Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Georg Ertl
- Medizinische Klinik und Poliklinik I/Comprehensive Heart Failure Center, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Stefan Sack
- Klinikum München Schwabing, Academic Teaching Hospital, University of Munich, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Steffen Massberg
- Medizinische Klinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.,Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Uwe Zeymer
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.,Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
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13
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Affiliation(s)
- Martijn A van Lavieren
- From the AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- From the AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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14
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Khot UN, Johnson-Wood ML, VanLeeuwen R, Ramsey C, Khot MB. A hospital-wide system to ensure rapid treatment time across the entire spectrum of emergency percutaneous intervention. Catheter Cardiovasc Interv 2015; 88:678-689. [PMID: 26700212 PMCID: PMC5132092 DOI: 10.1002/ccd.26372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/27/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study's aim was to describe a hospital-wide system to deliver rapid door-to-balloon time across the entire spectrum of emergency percutaneous intervention. BACKGROUND Many patients needing emergency PCI are excluded from door-to-balloon public reporting metric; these groups do not achieve door-to-balloon times ≤90 min and have increased mortality rates. METHODS We prospectively implemented a protocol for patients with STEMI or other emergency indication for catheterization mandating (1) emergency department physician or cardiologist activation of the catheterization lab and (2) immediate patient transfer to an immediately available catheterization lab by an in-house nursing transfer team. RESULTS From September 1, 2005 to December 31, 2008, 526 consecutive patients underwent emergency PCI. Median door-to-balloon time was 68 min with 85.7% ≤90 min overall. Important subgroups included primary emergency department (62.5 min), cardiorespiratory arrest (71 min), cardiogenic shock (68 min), need for temporary pacemaker or balloon pump (67 min), initial ECG without ST-elevation (66.5 min), transfer from another ED (84 min), in-hospital (70 min), and activation indications other than STEMI (68 min). Patients presenting to primary ED and in transfer were compared to historical controls. Treatment ≤90 min increased (28%-85%, P < 0.0001). Mean infarct size decreased, as did hospital length-of-stay and admission total hospital costs. Acute myocardial infarction all-cause 30-day unadjusted mortality and risk-standardized mortality ratios were substantially lower than national averages. CONCLUSION A hospital-wide systems approach applied across the entire spectrum of emergency PCI leads to rapid door-to-balloon time, reduced infarct size and hospitals costs, and low myocardial infarction 30-day all-cause mortality. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Umesh N Khot
- Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, Ohio
| | | | | | | | - Monica B Khot
- Cleveland Clinic Department of Cardiovascular Medicine, Cleveland, Ohio
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15
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Gao P, Zhao Z, Wang D, Wu J, Cai Y, Li T, Wu W, Shi H, He W, Zhu F, Jiao L, Ling F. China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS): A new, prospective, multicenter, randomized controlled trial in China. Interv Neuroradiol 2015; 21:196-204. [PMID: 25934656 DOI: 10.1177/1591019915581778] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with symptomatic stenosis of intradural arteries are at high risk for subsequent stroke. Since the SAMMPRIS trial, stenting is no longer recommended as primary treatment; however, the results of this trial, its inclusion criteria and its center selection received significant criticism and did not appear to reflect our experience regarding natural history nor treatment complications rate. As intracranial atherosclerosis (ICAS) is the most common cause for stroke in Asian countries, we are hereby proposing a refined prospective, randomized, multicenter study in an Asian population with strictly defined patient and participating center inclusion criteria. METHODS The China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS) trial is an ongoing, government-funded, prospective, multicenter, randomized trial. It recruits patients with recent TIA or stroke caused by 70%-99% stenosis of a major intracranial artery. Patients with previous stroke related to perforator ischemia will not be included. Only high-volume centers with a proven track record will enroll patients as determined by a lead-in phase. Patients will be randomized (1:1) to best medical therapy alone or medical therapy plus stenting. Primary endpoints are any stroke or death within 30 days after enrollment or after any revascularization procedure of the qualifying lesion during follow-up, or stroke in the territory of the symptomatic intracranial artery beyond 30 days. The CASSISS trial will be conducted in eight sites in China with core imaging lab review at a North American site and aims to have a sample size of 380 participants (stenting, 190; medical therapy, 190). Recruitment is expected to be finished by December 2016. Patients will be followed for at least three years. The trial is scheduled to complete in 2019. CONCLUSION In the proposed trial, certain shortcomings of SAMMPRIS including patient and participating center selection will be addressed. The present manuscript outlines the rationale and design of the study. We estimate that this trial will allow for a critical reappraisal of the role of intracranial stenting for selected patients in high-volume centers.
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Affiliation(s)
- Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital of the Ministry of Health, China
| | - Jian Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Yiling Cai
- Department of Neurology, the 306 Hospital of PLA, China
| | - Tianxiao Li
- Department of Intervention, Henan Provincial People's Hospital, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University, China
| | - Huaizhang Shi
- Department of Neurosurgery, The 1st Affiliated Hospital of Harbin Medical University, China
| | - Weiwen He
- Department of Neurology, The 2nd Affiliated Hospital of Guangzhou Medical College, China
| | - Fengshui Zhu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
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16
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Liu B, Li Z, Xie P. Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging. Neural Regen Res 2015; 9:2095-101. [PMID: 25657727 PMCID: PMC4316475 DOI: 10.4103/1673-5374.147937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 01/13/2023] Open
Abstract
Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.
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Affiliation(s)
- Bo Liu
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China
| | - Zhiwei Li
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China ; Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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17
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Rubin MN, Barrett KM, Brott TG, Meschia JF. Asymptomatic carotid stenosis: What we can learn from the next generation of randomized clinical trials. JRSM Cardiovasc Dis 2014; 3:2048004014529419. [PMID: 25247072 PMCID: PMC4157468 DOI: 10.1177/2048004014529419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stroke remains an exceedingly incident and prevalent public health burden across the globe, with an estimated 16 million new strokes per annum and prevalence over 60 million, and extracranial internal carotid artery atherosclerotic disease is an important risk factor for stroke. Randomized trials of surgical treatment were conducted (North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial) and demonstrated efficacy of carotid endarterectomy for secondary prevention of stroke in patients with cerebrovascular events (e.g. ipsilateral stroke, transient ischemic attack, and/or amaurosis fugax) attributable to a diseased artery with 50–99% stenosis. Therapeutic clarity, however, proved elusive with asymptomatic carotid artery disease. Asymptomatic Carotid Atherosclerosis Study (ACAS), Asymptomatic Carotid Surgery Trial, and Veterans Affairs Cooperative Study (VACS) suggested only modest benefit from surgical intervention for primary stroke prevention and the best medical therapy at the time of these trials is not comparable to modern medical therapy. ACT-1, Asymptomatic Carotid Surgery Trial-2, Stent-Protected Angioplasty in asymptomatic Carotid artery stenosis versus Endarterectomy Trial-2, European Carotid Surgery Trial-2, Carotid Revascularization Endarterectomy Versus Stenting Trial-2 are trials that are recent, ongoing, or in development that include diverse populations across Europe and North America, complementary trial designs, and a collaborative spirit that should provide clinicians with evidence that informs best clinical practice for asymptomatic carotid artery disease.
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Affiliation(s)
- Mark N Rubin
- Mayo Clinic, Department of Neurology, Jacksonville, FL, USA
| | | | - Thomas G Brott
- Mayo Clinic, Department of Neurology, Jacksonville, FL, USA
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