Atherosclerotic Artery Disease Research Articles

Stroke mechanisms and their correlation with functional outcome in medullary infarction

PurposeTo study the stroke mechanism of medullary infarction (MI) and their correlation with prognosis. MethodsWe collected 81 consecutive patients with acute isolated MI including 50 patients with lateral MI (LMI), 30 with medial MI (MMI) and one with combined MI. The stroke mechanisms were defined as follows: 1. Large artery atherosclerotic occlusive disease (LAOD): with severe stenosis (>50%) or occlusion on the relevant arteries. 2. Penetrating artery disease (PAD): occlusion of penetrating arteries that arise from vertebral artery or basilar artery with no significant stenosis of the vertebro-basilar artery. 3. Dissection: angiographic findings met the criteria. 4. Cardiogenic embolism: abrupt onset with atrial fibrillation. The poor outcome was defined as a condition that includes the mRS ≥2 and/or dysphagia at one year after onset. ResultsThere were 20 patients with PAD (40%), 18 with dissection (36.0%) and 11 with LAOD (22.0%) in LMI and 17 with PAD (56.6%), 10 with LAOD (33.3%) in MMI. LAOD and dissection compared with PAD were independently correlated with poor outcome in LMI (OR: 12.8, p = 0.029 and OR: 14.9, p = 0.035). LAOD was significantly correlated with poor outcome in MMI (OR: 13.4, p = 0.014). ConclusionsPAD was the most predominant stroke mechanism in MI and generally showed favorable outcome. Patients with LAOD and dissection showed worse outcome than those with PAD.

Abstract TP155: Comparison Between Medical Therapy and Endovascular Treatment of the Extracranial Atherosclerotic Vertebral Artery Disease: A Systematic Review

Objective: To assess the potential benefit of endovascular treatment compared to medical treatment in patients with symptomatic extracranial vertebral artery (ECVA) atherosclerotic disease in terms of clinical outcomes through a systematic literature review of published reports. Methods: We identified ECVA studies published between January 1966 and December 2017 using a search on PubMed and Cochrane libraries supplemented by review of bibliographies of selected publications based on pre-specified criteria. The rates of stroke and stroke and/or death were estimated for best medical treatment and endovascular treatment, at 1 month and at last follow-up. A random effects model was used to calculate pooled proportions (PP) across all studies and 95% confidence intervals. Results: Of a total of 57 reports reviewed, 8 studies reported outcomes in patients receiving medical treatment only (362 patients) and 49 studies reported upon patients treated with endovascular approach (2142 patients). The mean age of patients in the medical group was 65.6 years (range 61.3 - 69.0 years) and 64.1 years (range 53.5 - 72 years ) in the endovascular group. The 30 day incidence of stroke was 26 (7.2%) in the medical treatment group compared to 18 (0.84%) in the endovascular group, resulting in a higher risk for patients in the best medical treatment when compared to endovascular treatment [PP 0.0559 vs. 0.0025; p-value = 0.0001)]. Similarly at follow-up, 33 (12.3 %) stroke were observed in the medical group compared to 51(2.4 %) in the endovascular group [PP 0.1027 vs. 0.0109 ; p-value = 0.0001)].There was also statistically difference in stroke related death in the medical group vs endovascular group 12 (4.5 % ) vs 1 (0.04% ) [PP 0.03309 vs. 0.0000 ;p-value =0.001] . There was no statistically significant difference in the rates of recurrent TIA or death to other causes between the two groups. Conclusion: Our analysis demonstrated that endovascular treatment significantly reduced the risk of stroke and death when compared to best medical treatment alone at 30 days and at follow-up. Randomized clinical trial is warranted for further understanding of the safety and efficacy of the endovascular treatment.

Abstract TP38: Re-Occlusion During Endovascular Therapy for Acute Stroke Patients With Large Vessel Occlusion

Introduction: Endovascular Therapy (EVT) has demonstrated significant benefits for selected acute ischemic stroke (AIS) with emergent large vessels occlusion (ELVO). Early recanalization is one of the most significant predictors of favorable outcome. However, re-occlusion during the procedure remains a challenge and may prolong the time needed for recanalization in a subset of patients. We planned to explore the clinical, radiographic and laboratory features that are associated with intra-procedural re-occlusion. Method: We retrospectively reviewed consecutive patients who received EVT for ELVO in a single academic health system. Re-occlusion was defined if the occluded target vessel recanalized with TICI ≥2, but became TICI<2 on repeated diagnostic angiography. T test/Wilcoxon test and Chi-square were used to compare risks factors, atherosclerotic plaque burden, and coagulation profile (obtained prior to procedure) between patients with and without re-occlusion. Results: Among 265 patients (male 46.4%, mean age 69 ±14.4 year old), 25 patients had re-occlusion intra-operatively. The history of cardiovascular risks factors (HTN, HLD, DM, smoking, atrial fibrillation), prior use of antiplatelets or antithrombotics, the number of cerebral arteries with atherosclerotic lesions, and the level of platelets, PT, PTT, INR, LDL and HbA1c were similar between patients with and without re-occlusion. Compared to patients without re-occlusion, those with re-occlusion had a higher proportion of stroke with the etiology of large artery atherosclerosis (34.8% vs 3.2%, p<0.001), and tended to have a longer time from last know well to groin puncture (498 ± 411 vs 408±328 minutes, p=0.15). Conclusion: Large artery atherosclerotic disease was a more common stroke etiology in patients with re-occlusion during thrombectomy for ELVO. Underlying vasculopathy and plaque rupture may have precipitated the thrombotic process.

Management of Patients with Asymptomatic and Symptomatic Carotid Artery Disease: Update on Anti-Thrombotic Therapy.

The most common causes of ischaemic stroke are represented by carotid artery atherosclerotic disease (CAAD) and atrial fibrillation. While oral anticoagulants substantially reduce the incidence of thromboembolic stroke (< 1%/year), the rate of ischaemic stroke and other cardiovascular disease events in patients with CAAD remains high, ranging from 8.4 to 18.1 events per 100 patient-years. Similar to any other atherosclerotic disease, anti-thrombotic therapies are proposed for CAAD to reduce stroke and other cardiovascular events. The 2017 European Society of Cardiology (ESC)/European Society for Vascular Surgery (ESVS) guidelines recommend for patients with asymptomatic CAAD ≥60% the use of aspirin 75 to 100 mg once daily or clopidogrel 75 mg once daily at the exception of patient at very high bleeding risk. For patients with symptomatic CAAD ≥50%, the use of aspirin 75 to 100 mg once daily or clopidogrel 75 mg once daily is recommended. New perspectives for anti-thrombotic therapy for the treatment of patients with CAAD come from the novel dual pathway strategy combining a low-dose anticoagulant (i.e. rivaroxaban) and aspirin that may help reduce long-term ischaemic complications in patients with CAAD. This review summarizes current evidence and recommendations for the anti-thrombotic management of patients with symptomatic or asymptomatic CAAD or those undergoing carotid revascularization.

The use of drug-eluting stents in infrapopliteal arteries: an updated systematic review and meta-analysis of randomized trials.

Endovascular treatment below-the-knee is safe and effective but limited by poor patency. Coronary drug-eluting stents (DES) may play a role in providing mechanical scaffolding and deliver anti-proliferative drug to the site of vascular barotrauma to reduce the incidence of restenosis. Our aim was to evaluate and compare the use of contemporary DES with standard endovascular-therapies for atherosclerotic disease of infrapopliteal arteries. We performed a meta-analysis of randomized controlled trials comparing DES with conventional treatment for symptomatic peripheral artery disease (search date 30 August 2017). The primary endpoint was primary patency. Secondary endpoints were freedom from target lesion revascularization (TLR), major amputation, sustained Rutherford class improvement and mortality. We identified 7 trials enrolling 801 randomly assigned patients (392 DES, 409 control). At the median follow-up of 12-months DES improved rates of primary patency (OR 3.49, 95%CI 2.38-5.12, I2=0%, P<0.00001), freedom from TLR (OR 2.19, 95%CI 1.30-3.69, I2=38%, P=0.003), major amputation (OR 0.56, 95%CI 0.31-0.99, I2=0%, P=0.049), and Rutherford class improvement (OR 1.62, 95%CI 1.01-2.59, I2=65%, P=0.046), but not mortality (OR 1.05, 95%CI 0.68-1.62; I2 =0%, P=0.91) compared to control. Subgroup analysis of primary patency favoured DES coated in sirolimus analogues compared to paclitaxel (Test for subgroup differences, Chi2=6.51, df=1, P=0.01, I2=84.6%). At midterm follow-up DES significantly improved rates of primary patency, re-intervention, Rutherford class improvement and major amputation for the treatment of atherosclerotic disease of infrapopliteal arteries compared to control therapy, with no effect on patient survival. Stents coated in sirolimus analogues were more effective than paclitaxel.

Cardiac function response to stenting in atherosclerotic renal artery disease with and without heart failure: results from the Carmel study.

AimsConsensus‐derived guidelines recommend renal stenting for patients with atherosclerotic renal artery disease (ARAD) and heart failure (HF). The aim of this prospective multi‐centre observational study was to verify our hypothesis that changes in E/e′, an echocardiographic correlate of left ventricular (LV) filling pressure, following renal stenting may differ between ARAD patients with and without HF.Methods and resultsThis study enrolled de novo ARAD patients undergoing renal stenting at 14 institutions. The primary endpoint was the difference in E/e′ change between ARAD patients with and without HF. Clinical and echocardiographic data were prospectively collected at baseline, the day following renal stenting, and 1 month and 6 months afterwards. ARAD patients with HF were defined as patients with New York Heart Association (NYHA) Class 2 and more, or a history of HF hospitalization. A total of 76 patients were included, and 39% were ARAD patients with HF. ARAD patients with HF had significantly lower estimated glomerular filtration rate (P = 0.028) and higher NYHA functional class (P < 0.001) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (P = 0.001) than ARAD patients without HF. Also, ARAD patients with HF had significantly lower LV ejection fraction (P = 0.003) and e′‐velocity (P = 0.003) and higher E/e′ ratio (P = 0.001), left atrial volume index (LAVI) (P = 0.046), LV end‐diastolic volume (LVEDV) (P = 0.001), LV end‐systolic volume (LVESV) (P = 0.001), and LV mass index (P = 0.009) than ARAD patients without HF. All procedures were successful. In contrast to blood pressure and renal function, there was a significant interaction in E/e′ (P interaction < 0.001) between time and HF, and ARAD patients with HF showed a significant (P < 0.001) decrease in E/e′ albeit those without HF. By the same token, there was a significant interaction in NYHA class (P interaction < 0.001), MLHFQ score (P interaction = 0.018), E‐velocity (P interaction = 0.002), LAVI (P interaction = 0.001), LVEDV (P interaction = 0.003), and LVESV (P interaction = 0.001) between time and HF with a significant improvement in all these variables in ARAD patients with HF (NYHA class, P = 0.001; MLHFQ score, P = 0.002; E‐velocity, P = 0.005; LAVI, P = 0.001; LVEDV, P = 0.017; and LVESV, P = 0.011).ConclusionsChange in LV filling pressure after renal stenting differed between ARAD patients with and without HF, with a significant improvement in LV filling pressure in patients with HF‐ARAD. These unique findings might support clinical cardiac benefits of renal stenting in ARAD patients with HF.

Misery perfusion and amyloid deposition in atherosclerotic major cerebral artery disease.

Although experimental studies have shown that global cerebral hypoperfusion leads to amyloid deposition in the hemisphere with carotid artery occlusion in rodents, the results of such occurrence are controversial in humans. Hence, we aim to determine whether global cerebral hypoperfusion leading to decreased blood flow relative to metabolic demand [increased oxygen extraction fraction (OEF), misery perfusion] is associated with increases in amyloid deposition in the hemisphere with atherosclerotic major cerebral artery disease in patients. We evaluated the distribution of β-amyloid plaques using positron emission tomography and a [18F]-pyridylbenzofuran derivative (18F-FPYBF-2) in 13 patients with unilateral atherosclerotic disease of the internal carotid artery (ICA) or middle cerebral artery (MCA) disease and no cortical infarction. The distribution volume ratio (DVR) of 18F- FPYBF-2 was calculated using dynamic data and Logan graphical analysis with reference tissue and was correlated with the cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and OEF, obtained from 15O-gas PET. The mean cortical value was calculated as the mean value within the frontal, posterior cingulate, precuneus, parietal, and lateral temporal cortical regions. Significant reductions in CBF and CMRO2 and increases in OEF were found in the hemisphere ipsilateral to the arterial lesion compared with the contralateral hemisphere. There was no significant difference for 18F-FPYBF-2 DVR between hemispheres. The ipsilateral to contralateral ratio of the 18F- FPYBF-2 DVR was increased in 3 patients, while the ipsilateral to contralateral OEF ratio was increased in 4 patients. The incidence of an increased hemispheric DVR ratio was significantly higher in patients with an increased hemispheric OEF ratio (3/4) than in patients without (0/9) (p < 0.02). Although the 18F- FPYBF-2 DVR in the ipsilateral hemisphere was positively correlated with OEF after adjustment for the 18F- FPYBF-2 DVR in the contralateral hemisphere using multiple regression analysis (p < 0.05), the contribution rate of OEF was small (R2 = 5.5%). Only one of the 4 patients with an increased hemispheric OEF ratio showed amyloid positivity based on the DVR value. In atherosclerotic major cerebral artery disease, misery perfusion accompanied only small increases of amyloid deposition at best. Misery perfusion was not associated with amyloid positivity.

Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease.

Endovascular intervention has emerged as a potential alternative to open surgery in treating common femoral artery (CFA) atherosclerotic disease. The aim of this systematic review was to assess the safety and efficacy of both techniques. Thirteen electronic databases from 1980 to 3 January 2018 were searched. Study quality was assessed using the National Institute for Health and Care Excellence Interventional Procedure Programme quality assessment tool. Safety and efficacy outcome measures were analysed. Thirty-one studies reporting 813 endovascular procedures and 3835 endarterectomies were included. Only two small RCTs have been reported. The methodological quality of available studies was generally low and follow-up short. Safety endpoint assessment revealed a similar risk of wound haematoma for endovascular intervention and endarterectomy (5·5 (95 per cent c.i. 0·2 to 17·2) versus 3·9 (1·7 to 6·9) per cent respectively), a lower risk of wound infection with endovascular procedures (0 versus 5·9 (3·4 to 9·0) per cent) and a lower risk of wound lymph leakage (0 versus 5·7 (3·3 to 8·6) per cent). Efficacy endpoint assessment at 1 year identified that endovascular intervention had a lower primary patency rate than endarterectomy (78·8 (73·3 to 83·8) versus 96·0 (92·2 to 98·6) per cent respectively), a higher revascularization rate (16·0 (6·1 to 29·4) versus 5·8 (1·0 to 14·2) per cent) and a similar amputation rate (2·7 (1·2 to 4·8) versus 1·9 (0·7 to 3·8) per cent). Endovascular intervention of CFA disease appears to reduce the risk of wound complications but is associated with a lower patency rate and increased rates of subsequent revascularization procedures. Standardization of the endovascular technique and quantification of the proportions of patients suitable for either technique are required.

Endovascular treatment of erectile dysfunction due to internal iliac artery atherosclerotic disease

Endovascular treatment of erectile dysfunction due to internal iliac artery atherosclerotic disease

Impact of symptomatic atherosclerosis in patients with pulmonary embolism

BackgroundAtherosclerosis is associated with increased cardiovascular mortality. Associations between venous thromboembolism and atherosclerosis were recently reported. We aimed to investigate the impact of symptomatic atherosclerosis on adverse outcomes in patients with pulmonary embolism (PE) and to identify significant differences among patients with PE stratified by symptomatic atherosclerosis. MethodsPatients were selected by screening the nationwide inpatients sample for PE (ICD-code I26) stratified by symptomatic atherosclerosis (composite of coronary artery disease [ICD-code I25], myocardial infarction [ICD-code I21], ischemic stroke [ICD-code I63], and/or atherosclerotic arterial diseases [ICD-code I70]). We compared PE patients with (PE + Athero) and without (PE − Athero) symptomatic atherosclerosis and analysed the impact of symptomatic atherosclerosis on adverse outcomes. ResultsOverall, 213,995 patients with PE (54.2% females) were included in this analysis. Of these, 30,157 (14.1%) had symptomatic atherosclerosis with age-dependent incline. Deep vein thrombosis or thrombophlebitis (45.1% vs. 36.9%, P < 0.001) was more commonly observed in the PE − Athero group (Odds Ratio (OR) 0.713 [95% CI 0.695–0.731], P < 0.001). In-hospital mortality (12.1% vs. 9.6%, P < 0.001) and adverse in-hospital events (16.8% vs. 12.6%, P < 0.001) were affected by symptomatic atherosclerosis; both in-hospital mortality (OR 1.107 [95% CI 1.061–1.155], P < 0.001) and adverse in-hospital outcomes (OR 1.143 [95%CI 1.102–1.186], P < 0.001) were affected independently of age, gender, comorbidities, and reperfusion treatments. ConclusionsSymptomatic atherosclerosis in patients with PE increased with age and was associated with a poorer outcome. Cardiovascular-atherosclerotic diseases might play a major role in thrombus formation in isolated PE.

Role of adipose tissue and skeletal muscle in macrovascular atherosclerotic occlusive disease-peripheral arterial disease and carotid artery disease

Purpose/Background/ObjectiveCarotid artery disease (CAD) and peripheral arterial disease (PAD) are non-cardiac manifestations of atherosclerotic disease, which are less extensively studied. Presently, adipose tissue (AT) and skeletal muscle (SM) are considered endocrine organs, producing cytokines with vascular effects 1,2,3,4,5,6,7. Main objective is to clarify the role of AT and SM in several stages of atherosclerotic occlusive disease (CAD and PAD), and its connection with arteriosclerotic changes in other territories. Secondary objective: to study the evolution of these parameters after revascularization and after carotid endarterectomy.MethodsStudy Groups (Fig 1): control- without macrovascular atherosclerotic disease eligible for elective varicose veins surgery with inguinal approach. Study group 1- with PAD, confirmed by ankle-brachial index, with or without indication to revascularization. Study group 2- with CAD with or without indication to endarterectomy. We will determine the quantity, endocrine functionand histologyof SM and AT (in groups submitted to surgery). The groups will be evaluated at admission, 3 and 6 months (Fig 2).Expected ResultsThe quantity of AT compartments (visceral, subcutaneous and perivascular) and SM will be determined with transvers abdominal CT scan at the level of 3th vertebra. The endocrine function will be evaluated measuring the myokines and adipokines in blood sample. During the surgery we will collect samples of AT (visceral, subcutaneous and perivascular), SM and artery for histology. We will determine the type, number and size of present cell and vascularization. Additional Central Hemodynamicdata will be obtained from carotid Doppler ultrasound, carotid femoral-pulse wave velocity; peripheral central pulse pressure; anthropometric and muscle mass measurements will be performed.ConclusionWe hope to correlate the atherosclerotic and arteriosclerotic phenotypes with SM and AT characteristics, as well as indexes of sarcopenia.

Abstract 16991: Relationship Between Restenosis After Percutaneous Transluminal Renal Angioplasty for Atherosclerotic Renal Artery Disease and the Preprocedural Renal Resistance Index in the Contralateral Kidney

Introduction: Percutaneous transluminal renal angioplasty (PTRA) is an established treatment for atherosclerotic renal artery disease. Renal resistive index (RRI) is known as an indicator of renovascular atherosclerosis, and several studies reported that high preoperative RRI in the target kidney predicts poor response in hemodynamics and renal function after PTRA. However, RRI is elevated not as a sequence of proximal renal artery stenosis, and relationship between the patency after PTRA and RRI still has not been clarified. Methods: The CARMEL study (Cardiac Benefits of Renal Artery Stenting: A Prospective Multicenter Observational study) is a study of patients with de novo symptomatic ARAD who underwent PTRA between September 2012 and December 2015 at 14 institutions in Japan. Of the 76 patients who included in the final analysis of the CARMEL study, 46 patients (71.8±9.9 years) whose bilateral RRI were recorded before PTRA procedure were retrospectively analyzed. We evaluated renal ultrasonographic data collected before PTRA, and at 1-day, 1-month and 6-month follow-up. Results: 55 lesions of the 46 patients were treated, and preprocedural RRI in the target kidney (tRRI) were higher than 0.8 in 16 lesions (High-tRRI group) and preprocedural RRI in the contralateral kidney (cRRI) were higher than 0.8 in 18 lesions (High-cRRI group). Preprocedural peak systolic velocity (PSV) and renal/aorta ratio (RAR) of the lesions were comparable between High-tRRI group and the rest, and also between High-cRRI group and the rest. However, in High-cRRI group, PSV of the target lesion is significantly higher than the rest at every follow up exam (at 6-month follow up: PSV 224.4±126.5 cm/s vs 113.7±53.7 cm/s, p&amp;lt;0.001; RAR 3.91±2.68 vs 1.99±1.07, p=0.009). (Table 1, Table 2) Conclusion: High preprocedural RRI in the contralateral kidney could be a predictor of restenosis after PTRA.

Renal dysfunction and heart failure – epidemiology and clinical significance

The prevalence of heart failure (HF) and chronic kidney disease (CKD) tends to increase in the general population as a consequence of the increasing age and improvement of the management and the outcome of acute cardiac and renal syndromes. Both conditions co-exist very often in one and the same patient which is probably due to “sharing” common risk factors like arterial hypertension, diabetes mellitus and atherosclerotic disease. It is considered that cardiac dysfunction may lead to renal failure and vice versa. The prevalence of CKD among patients with HF is around 30-40%. In recent years, we speak about cardiorenal syndrome (CRS) which is a pathophysiological condition of the heart and kidneys where the acute or chronic dysfunction of one of these organs leads to acute or chronic dysfunction of the other. For a more precise chronological and pathophysiological definition CRS is classified in 5 types. New biomarkers for renal impairment such as NGAL, KIM-1, NAG, Cystatin С are already in clinical practice. More vigilance and more frequent laboratory monitoring of serum creatinine and electrolytes is required in patients with HF and CKD who are treated with ACE inhibitors/angiotensin-receptor blocking agents and aldosterone antagonists.

Atherosclerotic occlusive arterial disease of the lower limbs: a historical account of surgical evolution and vascular reconstruction over thirty four years

This is a descriptive study of chronic ischaemia of the lower limb caused by atherosclerotic disease in 588 patients. The study was performed over 34 years in a tertiary clinic in the central province of Sri Lanka. It was found that the pattern of occlusions were similar to that of other reports on western patients. However, critical ischaemia was seen in 57% of Sri Lankan patients, suggesting a more florid disease. Pioneering efforts of reconstructive surgery in 278 patients and in-hospital results are presented.

Outcomes of upper extremity interventions for chronic critical ischemia

BackgroundCritical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management. MethodsA database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (tissue loss and rest pain) were identified. Three management groups were identified: no revascularization (None), endovascular revascularization (Endo), and open revascularization by bypass (Bypass). Patients with acute embolism, active vasculitis, end-stage renal disease, ipsilateral dialysis access complications of steal, and ipsilateral trauma were excluded. ResultsOne hundred eight patients (56% male; average age, 59 years) presented with symptomatic below-the-elbow disease: 93% presented with digital ulceration and the remainder with rest pain. Eighty-one percent had diabetes and 41% had chronic renal insufficiency (not on dialysis). All underwent catheter-based angiography. Fifty-three patients (49%) had no intervention and subsequently were committed to wound care; 26 of these required no further intervention, 10 had an interval palmar sympathectomy, and 17 underwent either a phalanx or digital amputation. Thirty-four patients (31%) underwent an endovascular intervention with a median of 1.5 vessels (ulnar, radial, or interosseous arteries) intervened on. Technical success was achieved in 29 patients (85%). Of the five technical failures, two went on to bypass, one had a focal endarterectomy and patch angioplasty, and one was treated conservatively. Ten patients in the Endo group required either a phalanx or digital amputation. Twenty-one patients (19%) underwent a saphenous vein bypass (reversed or nonreserved) to the radial in 12 and the ulnar in 11 limbs. In follow-up, 11 patients underwent open or endovascular intervention to maintain patency of the bypass. There were nine phalanx or digital amputations in the Bypass group. No below-the-elbow or above-the-elbow amputations were performed within 30 days. The wound healing rate without amputation was 78% (85 of 108). The predictors of wound healing were technical success of the revascularization, intact palmar arch and presence of digital run-off. The presence of an incomplete arch and poor digital run-off were associated with a phalanx or digital amputation. ConclusionsUpper extremity interventions for critical ischemia are associated with a high rate of success. Major amputations are rare and the many can be treated nonoperatively. In appropriately selected patients, both endovascular and open interventions have a high rate of success.

Incidence and Endovascular Treatment of Isolated Atherosclerotic Popliteal Artery Disease: Outcomes from the IPAD Multicenter Study.

To report the incidence and long-term outcomes following endovascular treatment of symptomatic, atherosclerotic isolated popliteal artery disease (IPAD). This retrospective, multicenter study included all patients who underwent endovascular treatment of IPAD between January 2010 and December 2016 because of intermittent claudication or critical limb ischemia (CLI), in three tertiary University Hospitals. In total, 4717 peripheral arterial disease (PAD) procedures were analyzed. The study's primary outcome measures were: IPAD incidence, binary restenosis rate and freedom from target lesion revascularization (TLR). Secondary outcome measures included technical success, limb salvage rate and the identification of predictors of outcomes. The incidence of IPAD was 0.98% (46/4717 PAD procedures). In total, 46 patients (38 male; mean age 73 ± 12years) underwent plain balloon (69.5%) or bail-out stenting (30.5%) procedures. Most patients suffered from CLI (65.2%). Mean lesion length was 52.5 ± 32.0mm and 45.6% of the cases were occlusions. Severe calcifications were noted in 26.1%. Technical success was 100%. Mean time follow-up was 32.6 ± 25.6months. According to Kaplan-Meier analysis, restenosis was 15.8, 40.9, 45.8% and TLR-free rate was 90.5, 79.0, 74.1%, at 1, 2 and 3years, respectively. Survival and limb salvage rates were 73.6 and 88.1%, at 5years, respectively. The major amputation rate for CLI patients was 10.0% (3/29 limbs), while no major amputations occurred in the claudication subgroup. Cox multivariable analysis detected baseline occlusion as an independent predictor of increased restenosis (HR 5.3; 95% CI 0.21-0.66, p = 0.02). Isolated popliteal lesions requiring treatment appear in nearly 1% of patients with PAD. Balloon angioplasty and bail-out stenting resulted in acceptable long-term clinical outcomes. Treatment of occlusions was correlated with increased restenosis rate.

Impact of Atherosclerotic Carotid Artery Disease in Patients of Stroke and Recent TIA Using Colour Doppler Sonography- A Prospective Study in Eastern India

Impact of Atherosclerotic Carotid Artery Disease in Patients of Stroke and Recent TIA Using Colour Doppler Sonography- A Prospective Study in Eastern India

2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.

The American College of Cardiology (ACC)/American Heart Association (AHA) performance measurement sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of performance measure development1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including …

Autogenous forearm loop arteriovenous fistula creation.

Arteriovenous fistula is a lifeline for end-stage kidney disease patients on dialysis. The quality of the vein and artery to be used plays a crucial role in attaining a functioning, reliable and long-lasting arteriovenous fistula. The aim of the study is to present an alternative for haemodialysis access to preserve the upper arm vasculature for future use - the forearm loop arteriovenous fistula. From October 2015 to September 2016, 202 patients with chronic kidney disease (CKD), stages 4 and 5, underwent arteriovenous fistula creation at the Universiti Sains Malaysia Hospital, Malaysia. Nine patients, with severe atherosclerosis of the distal artery, but with satisfactory veins, underwent forearm loop arteriovenous fistula creation. Maturation of the fistula was based on the classification by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI). All nine patients who underwent forearm loop arteriovenous fistula have had diabetes mellitus for more than 10 years. Only one fistula failed to mature within 6 weeks. Two arteriovenous fistulas thrombosed at 3 and 5 months, respectively, after the commencement of haemodialysis. However, the other six matured fistulas are still functioning well after a year of regular usage. Distal forearm arteries in diabetics may be severely atherosclerotic. Forearm loop arteriovenous fistula can be considered as the primary access for cases decided as inconvenient for fistula creation due to severe occlusive atherosclerotic disease of the forearm arteries; in order to preserve upper arm veins for future access procedures.

Laboratory signs of activation of the hemostasis system in patients with coronary heart disease, who had coronary artery bypass surgery.

The hypercoagulable state is a risk factor for shunt thrombosis in patients who had coronary artery bypass surgery. That is why the study of factors and operative intervention which can lead to hypercoagulable states are extremely valuable and vital issues. 85 patients who had coronary artery bypass surgery were examined. 40 of them have 2 type diabetes mellitus. All patients underwent a study of the content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, von Willebrand factor, induced platelet aggregation in the blood on the 14th day after the surgery. There were no significant differences in content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, induced platelet aggregation in the blood between patients with diabetes mellitus and patient without diabetes mellitus. It was detected the connection between separate indicators of the hemostatic system studied and age, height, weight, waist circumference and how long ago myocardial infarction had occured. It was detected that indicators of induced platelet aggregation correlate with indicators of lipid metabolism and degree of coronary artery stenosis. According to the information received, progression of hypercoagulable state after coronary artery bypass surgery is depends on weight, waist circumference, age, how long ago myocardial infarction had occurred, indicators of lipid metabolism and degree of atherosclerotic cardiovascular disease of coronary arteries.