Severe Vascular Stenosis Research Articles

Evaluating the role of pericoronary adipose tissue on coronary artery disease: insights from CCTA on risk assessment, vascular stenosis, and plaque characteristics.

Pericoronary adipose tissue (PCAT) plays a significant role in the occurrence and progression of coronary artery disease (CAD). This study investigates the relationship between PCAT and CAD, focusing on the occurrence of the disease, the severity of vascular narrowing, and the characteristics of arterial plaques. We analyzed a cohort of 152 individuals with CAD and 55 individuals with non-coronary artery disease (N-CAD). Participants underwent both coronary computed tomography angiography (CCTA) and digital subtraction angiography (DSA). Utilizing United Imaging software for artificial intelligence delineation, we measured the fat attenuation index (FAI) and volume of PCAT in the left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Our findings demonstrate that while CCTA is effective in diagnosing CAD compared to DSA, its diagnostic power for individual coronary arteries remains limited. Further analysis revealed that the FAI of the RCA and the overall PCAT volume independently influenced CAD (OR: 1.057, 95% CI: 1.002 to 1.116; OR: 0.967, 95% CI: 0.936 to 0.999). FAI showed a significant independent effect on RCA stenosis (OR: 1.041, 95% CI: 1.003 to 1.081), while the fat volume of the LAD had a significant independent effect on LAD stenosis (OR: 0.884, 95% CI: 0.809 to 0.965). A higher FAI and a lower fat volume were significantly correlated with more severe vascular stenosis percentages in all three arteries (p < 0.05), except for the fat volume and stenosis of the LCX. Moreover, we found the significant differences in the fat volume of the LCX between different plaque types (H = 8.869, p = 0.012), with calcified plaques consistently exhibiting the lowest fat volume across all three arteries. Finally, the likelihood ratio test confirmed that incorporating the PCAT fat volume parameter of LAD significantly improved the diagnostic ability of CCTA for both CAD (p = 0.01543) and LAD stenosis (p = 0.001585). The quantification of PCAT has potential application value in the comprehensive assessment of CAD. It is recommended that cardiology and radiology departments consider incorporating PCAT into the assessment criteria for patients suspected of having CAD.

Sub-satisfactory stenting recanalization of severe vascular stenosis of the posterior circulation can significantly improve cerebral hemodynamic perfusion

PurposeTo investigate the effect of sub-satisfactory stenting recanalization of severe vascular stenosis of the posterior circulation on cerebral hemodynamic perfusion. Materials and methodsPatients with severe vascular stenosis of the posterior circulation who had undergone three-dimensional cerebral angiography before and after stenting were retrospectively enrolled. Computational fluid dynamic (CFD) analysis of hemodynamic parameters at the stenosis, perforating branch, and normal arterial segments proximal and distal to the stenosis were performed. ResultsSixty-two patients with basilar artery stenosis aged 60.9 ± 9.6 years were enrolled, and stent angioplasty resulted in the reduction of stenosis degree from 85.3 ± 7.2% before to 18.6 ± 6.4% after stenting. After stenting, at the proximal normal artery, the total pressures had significantly (P < 0.05) decreased, whereas all the other parameters (WSS, cell Reynolds number, velocity, vorticity, turbulence intensity, turbulence kinetic energy and dissipation rate) had significantly (P < 0.05) increased. At the stenosis, all hemodynamic parameters had significantly decreased. At the stenosis perforating branch, the WSS, cell Reynolds number, velocity, and vorticity were all significantly decreased, and the total pressure, turbulence intensity, kinetic energy, and dissipation rate were all significantly increased. At the distal normal artery, the total flow pressure (perfusion pressure) and velocity were both significantly (P < 0.05) increased, and the total pressure, WSS, cell Reynolds number, vorticity, turbulence intensity, kinetic energy, and dissipation rate were all significantly (P < 0.05) decreased. The hemodynamic parameters after stenting were closer to those after virtual stenosis repair at all measurements. ConclusionSub-satisfactory recanalization has significantly restored the stenosis and improved the hemodynamic parameters near the stenosis and at the root of the perforating branch, thus significantly improving the cerebral perfusion, similar to the changes of hemodynamic status and cerebral perfusion after virtual removal of the vascular stenosis. This may indicate the good effect of sub-satisfactory stenting recanalization of the vascular stenosis at the posterior circulation.

Pseudoshock: A Challenging Presentation of Bilateral Subclavian Artery Stenosis.

IntroductionSubclavian artery stenosis (SAS) is a manifestation of peripheral artery disease (PAD). Presentation varies, ranging from arm claudication and muscle fatigue to symptoms which reflect vertebrobasilar hypoperfusion, among which are syncope, ataxia and dysphagia. Although rare, severe bilateral SAS can exist and present as refractory hypotension. We describe a case of bilateral SAS masquerading as circulatory shock, or rather ‘pseudoshock’.Case DescriptionA 59-year-old female patient presented to the emergency department with complaints of dark stools. She was anaemic and hypotensive and therefore suspected to have an acute gastrointestinal bleed (GIB) with resultant haemorrhagic shock. Her hypotension was unresponsive to fluid resuscitation and blood transfusions. Bilateral upper extremity radial artery catheters confirmed low blood pressures. After her blood pressure failed to improve despite the addition of several vasopressors, a femoral artery catheter (FAC) was placed, which revealed significant hypertension discordant with the hypotension measured by the radial artery catheters. Review of CT angiography of the upper extremities revealed the presence of bilateral SAS which was deemed to be the aetiology of the falsely low blood pressure.DiscussionSAS should be suspected in patients with lower extremity PAD or a blood pressure (BP) differential of 15 mmHg or more between arms. When bilateral subclavian arteries are stenosed, this difference in BP may be concealed, making lower extremity BP measurements, as seen in non-invasive tests such as ankle brachial index (ABI) tests or through more invasive procedures such as FAC placement, critically important.ConclusionBilateral SAS may present as pseudo-hypotension. In cases of refractory shock of unclear aetiology, especially in patients with known PAD, a high index of suspicion is warranted for ‘pseudoshock’ secondary to severe vascular stenosis. Comparison of upper and lower extremity BP via invasive arterial catheters or non-invasive ABI tests can aid in the diagnosis of bilateral SAS.LEARNING POINTSBilateral subclavian artery stenosis (SAS) may present as pseudo-hypotension and shock of unclear aetiology.In patients with underlying peripheral arterial disease, pseudoshock should be considered in the differential diagnosis.Comparison of upper and lower extremity blood pressure via invasive arterial catheters or the non-invasive ankle brachial index (ABI) test has diagnostic value for bilateral SAS.Pseudoshock is managed via secondary prevention with antiplatelets and statins for asymptomatic patients, and revascularization for symptomatic patients.

Value of acute neurovascular imaging in patients with suspected transient ischemic attack

PurposeAcute neurovascular imaging including MRA and/or CTA are routinely performed in the emergency departments (ED) for patients who present with suspected transient ischemic attacks (TIA). Given the current emphasis on mitigating the rising cost of health care nationally, and promoting high value practice, we sought to determine 1) the value of acute neurovascular imaging in patients presenting to the ED with TIA-like symptoms, and 2) whether these neurovascular studies led to a difference in management strategies. MethodWe retrospectively reviewed 398 ED patients who presented with transient neurological deficits and underwent neurovascular imaging from 2015 to 2018. We reviewed diffusion weighted imaging (DWI) and neurovascular results by patient demographics, baseline risk factors, final diagnosis, treatment/management dispositions and three-month follow-up. Results28.1% (112/398) of patients were diagnosed with true TIA, whereas 71.9% patients were deemed to have a non-vascular etiology. Total rates of positive MRA/CTA for severe intracranial (>50%) and cervical vessel (>70%) stenosis were 10.5% and 1.7%. Patients with positive DWI scans had significantly higher rates of severe vascular stenosis (24.4% versus 7.8% intracranially and 2.4% versus 0.9% in the neck) compared to those with negative DWI scans. All patients were treated with multi-pronged medical therapies with no immediate surgical intervention. A follow-up stroke was equally likely in TIA patients with or without severe vascular stenosis. ConclusionsIn patients presenting with TIA-like symptoms and DWI negative scans, the overall rate of positive neurovascular studies is very low. Triaging with DWI can reduce the frequency of unnecessary neurovascular imaging.

Predictors for the prognosis and recurrence of ischaemic stroke among young Chinese patients: a cohort study

ObjectiveTo identify predictors of young Chinese patients with ischaemic stroke outcome and recurrence of stroke.DesignThrough considered the risk factors, neuroimaging findings, distribution, vascular stenosis, and the post-stroke treatment of young...

Far-infrared radiation alleviates cisplatin-induced vascular damage and impaired circulation via activation of HIF-1α.

Severe vascular damage and complications are often observed in cancer patients during treatment with chemotherapeutic drugs such as cisplatin. Thus, development of potential options to ameliorate the vascular side effects is urgently needed. In this study, the effects and the underlying mechanisms of far‐infrared radiation (FIR) on cisplatin‐induced vascular injury and endothelial cytotoxicity/dysfunction in mice and human umbilical vein endothelial cells (HUVECs) were investigated. An important finding is that the severe vascular stenosis and poor blood flow seen in cisplatin‐treated mice were greatly mitigated by FIR irradiation (30 minutes/day) for 1‐3 days. Moreover, FIR markedly increased the levels of phosphorylation of PI3K and Akt, and VEGF secretion, as well as the expression and the activity of hypoxia‐inducible factor 1α (HIF‐1α) in cisplatin‐treated HUVECs in a promyelocytic leukemia zinc finger protein (PLZF)‐dependent manner. However, FIR‐stimulated endothelial angiogenesis and VEGF release were significantly diminished by transfection with HIF‐1α siRNA. We also confirmed that HIF‐1α, PI3K, and PLZF contribute to the inhibitory effect of FIR on cisplatin‐induced apoptosis in HUVECs. Notably, FIR did not affect the anticancer activity and the HIF‐1α/VEGF cascade in cisplatin‐treated cancer cells under normoxic or hypoxic condition, indicating that the actions of FIR may specifically target endothelial cells. It is the first study to demonstrate that FIR effectively attenuates cisplatin‐induced vascular damage and impaired angiogenesis through activation of HIF‐1α–dependent processes via regulation of PLZF and PI3K/Akt. Taken together, cotreatment with the noninvasive and easily performed FIR has a therapeutic potential to prevent the pathogenesis of vascular complications in cancer patients during cisplatin treatment.

Cinnamon and Aspirin for Mild Ischemic Stroke or Transient Ischemic Attack: A Pilot Trial

Cinnamon can reduce levels of blood lipids, blood glucose, and inflammation, which are risk factors for ischemic stroke and transient ischemic attack (TIA).The goal of this study was to observe the safety and efficacy of aspirin combined with cinnamon in the treatment of patients with mild stroke or TIA. This pilot study included patients with mild stroke or TIA treated at Guangdong Provincial People's Hospital-Nanhai Hospital between January 2014 and December 2016. The primary end point was recurrent stroke (within 90 days after the first attack; intention-to-treat analysis). The secondary end points included biochemical indices, carotid color Doppler ultrasound, safety indices, and adverse reactions. A total of 122 patients were included, including 62 in the aspirin-cinnamon group (41 men and 21 women; mean age, 62.0 [3.5] years) and 60 in the aspirin-placebo group (40 men and 20 women; mean age, 63.0 [3.2] years). The number of participants with recurrent stroke was two (3.2%) and nine (15.0%) in the aspirin-cinnamon group and the aspirin-placebo group, respectively (P=0.002). Compared with aspirin-cinnamon, aspirin-placebo rates of unstable plaque and severe vascular stenosis were higher, whereas the rate of mild vascular stenosis with aspirin-cinnamon was higher than with aspirin-placebo (P < 0.05). One case of mild to moderate upper gastrointestinal bleeding in each group was observed. Among patients with TIA or mild ischemic stroke, the combination of cinnamon and aspirin could be superior to aspirin alone for reducing the risk of 90-day recurrent stroke.

Magnetic resonance imaging reconstruction algorithm under complex convolutional neural network in diagnosis and prognosis of cerebral infarction.

This study was to explore the application value of magnetic resonance imaging (MRI) image reconstruction model based on complex convolutional neural network (CCNN) in the diagnosis and prognosis of cerebral infarction. Two image reconstruction methods, frequency domain reconstruction network (FDRN) and image domain reconstruction network (IDRN), were introduced based on the CCNN algorithm. In addition, they were integrated to form two new MRI image reconstruction models, namely D-FDRN and D-IDRN. The peak signal to noise ratio (PSNR) value and structural similarity index measure (SSIM) value of the image were compared and analyzed before and after the integration. The MRI images of patients with cerebral infarction in the dataset were undertaken as the data source, the average diffusion coefficient (DCavg) and apparent diffusion coefficient (ADC) values of different parts of the MRI image were measured, respectively. The correlation of the vein abnormality grading (VABG) to the infarct size and the degree of stenosis of the responsible vessel was analyzed in this study. The results showed that the PSNR and SSIM values of the MRI reconstructed image of the D-IDRN algorithm based on the CCNN algorithm in this study were higher than those of other algorithms. There was a positive correlation between the VABG and the infarct size (r = 0.48 and P = 0.002), and there was a positive correlation between the VABG the degree of stenosis of the responsible vessel (r = 0.58 and P < 0.0001). The ADC value of the central area of the infarct on the affected side was significantly greatly lower than that of the normal side (P < 0.01), and the DCavg value of the central area of the infarct was much lower in contrast to the normal side (P < 0.05). It indicated that an image reconstruction algorithm constructed in this study could improve the quality of MRI images. The ADC value and DCavg value changed in the infarct central area could be used as the basis for the diagnosis of cerebral infarction. If the vein was abnormal, the patient suffered from severe vascular stenosis, large infarction area, and poorer prognosis.

327 The Incidence of Clinically Significant Magnetic Resonance Angiography Findings for Transient Ischemic Attack Patients in the Observation Unit

Background: A transient ischemic attack (TIA) is no longer considered to be a benign event, rather it is a serious warning for an impending stroke. Studies show that this “transient event” is associated with a 90-day risk of a stroke in approximately 10% of people, with half of these strokes occurring within 48 hours of the inciting event. This critical statistic favors the need for close monitoring and expeditious neurologic workup. With advancements in technology one of the major diagnostic studies for cerebrovascular accident (CVA) is magnetic resonance angiography (MRA). MRA is advantageous as it can detect hyperacute and minute ischemic lesions as well as lesions in the posterior fossa, in addition to aneurysms and arteriovenous malformations. This study serves to evaluate the incidence of clinically significant MRA findings following a TIA, in our emergency department observation unit (EDOU). To determine if there is a significant amount of patients with clinically relevant findings on MRA that may have otherwise gone undiagnosed. Clinical significance is defined as any finding that warrants further workup or intervention. This descriptive study was a retrospective chart analysis of 684 asymptomatic TIA patients admitted to the EDOU, over a 20-month period. Patients were divided by significant or no significant findings for either brain or neck MRA or both. There were no significant findings for either the brain or neck MRA in 70.8% (n=484) of patients. 9.8% (n=67) had significant findings for only the neck MRA. 12.0% (n=82) of patients had significant findings for only the brain MRA. 7.5% (n=51) had significant findings for both brain and neck MRA. Significant findings included moderate to severe vascular stenosis and/or occlusion of the vertebral arteries, carotid, aneurysms (saccular and fusiform), subclavian steal syndrome, and thyroid nodules. Clinically significant findings were noted in 29.4% of the 684 patients. With the use of MRA of the brain and neck, we are discovering more clinically significant findings that may have gone years undiagnosed. Based on this data, it seems fitting that the use of MRI of the brain with MRA of the brain and neck should be utilized for evaluation of TIA patients when able, thus replacing prior workups such as, carotid ultrasound.

Acute treatment of critical vascular stenoses with a bioabsorbable magnesium scaffold in infants with CHDs

Post-operative severe vascular stenosis and proliferating endothelial tissue lead to severe circulatory disorders and impair organ perfusion. Bioabsorbable magnesium scaffolds may help to overcome these obstructions without leaving obstructing stent material. We analyse their role in the treatment of vascular stenosis in infants. Since 2016, 15 magnesium scaffolds with a diameter of 3.5 mm were implanted in 9 patients aged 15 days to 7.6 years. Eight scaffolds were implanted in pulmonary venous restenoses, five in pulmonary arterial stenosis including one in-stent stenosis, one into a stenotic brachiocephalic artery, and one in a recurrent innominate vein thrombosis. All patients clinically improved after the implantation of a scaffold. The magnesium scaffolds lost integrity after 30-48 days (mean 42 days). The innominate vein thrombosed early, while all other vessels remained open. Two patients died after 1.3 and 14 weeks not related to the scaffolds. Five patients needed further balloon dilations or stent implantations after the scaffold had fractured. At first recatheterisation after in mean 2.5 months, the mean minimum/maximum diameter in relation to the scaffold's original diameter was 89%/99% in the arterial implantations (n = 6) and 66%/77% in the pulmonary venous implantations. The magnesium scaffolds can be used as a bridging solution to treat severe vascular stenosis in different locations. Restenosis can occur after degradation and make further interventions necessary, but neither vessel growth nor further interventions are hindered by stent material. Larger diameters may improve therapeutic options.

Clinical usefulness of endoscopic ultrasound for optimized patient management with visceral artery dissection

Background and Objectives:We evaluated the clinical usefulness of endoscopic ultrasound (EUS) in diagnosing visceral vascular dissection and in assessing morphological and hemodynamic characteristics required for optimized patient management.Methods:EUS was performed in 62 patients with clinically suspected visceral artery dissection as determined by computed tomography scan between February 2012 and December 2016. Conventional B-mode, color Doppler, and contrast-enhanced harmonic-EUS (CEH-EUS) were done to evaluate vascular status of celiac artery and superior mesenteric artery.Results:EUS and CEH-EUS identified all the visceral vascular dissections. Five patients (8%) underwent surgical or radiological intervention, whereas the others were managed conservatively with or without anticoagulation therapy. Vascular stenosis was more severe in patients who underwent surgical or radiological intervention (92% ± 8% vs. 67% ± 20%, P = 0.007). The severe vascular stenosis was associated with surgical or radiological intervention rather than conservative management (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.07–1.68, P = 0.01). The presence of false lumen thrombi (HR 0.24, 95% CI 0.025–2.301, P = 0.22) and collateral circulation (HR 0.30, 95% CI 0.04–2.06, P = 0.22) tended to predict conservative management of visceral vascular dissection without statistical significance. In multivariate analysis, degree of vascular stenosis was the only significant factor predicting surgical or radiological intervention in visceral vascular dissection.Conclusions:EUS may be a promising diagnostic modality to assess the visceral artery dissection without exposure to radiation. Moreover, EUS is a useful tool to determine the appropriate treatment options for patients with visceral artery dissection based on the degree of vascular stenosis.

OP160: The effect of peripheral vascular disease on the blood supply of the anterolateral thigh free flap: A radiographic study

Purpose The anterolateral thigh (ALT) flap has gained popularity over the last few decades for the reconstruction of various surgical defects given its distinct advantages including great versatility and low donor site morbidity. The anatomy of the main perforating vessel of the ALT flap, the descending branch of the lateral circumflex femoral artery (dbLCFA), has been well described in the literature, however only one study has investigated its patency in patients with significant co-morbidities. The aim of this study is to assess the degree of vascular stenosis of the dbLCFA in patients with multiple co-morbidities as compared to medically-fit controls. Material and methods 128 sets of angiographic data were collected from 93 patients retrospectively over a 12 month period. The percentage stenosis of superficial femoral artery (SFA), LCFA and dbLCFA was measured and converted into an established scoring system. Statistical analyses were performed using Chi-square tests. Results Mean stenosis of dbLCFA was 12.5%. Interestingly, 24.0% of patients without peripheral vascular disease (PVD) showed some degree of stenotic changes in dbLCFA, whereas only 10.7% of those with PVD had some degree of stenosis. There was no correlation between dbLCFA stenosis and patient co-morbidity. The SFA was significantly affected by smoking, hypercholesterolaemia (p Conclusions This study shows that the dbLCFA is not affected by patient co-morbidity including peripheral vascular disease when compared to medically-fit controls. Even in individuals with severe vascular stenosis of the superficial system (including complete obstruction); there is often complete sparing of the deep vascular system. Surgical reconstruction using the ALT flap is a relatively safe procedure for patients even with multiple co-morbidities including significant peripheral vascular disease and no additional pre-operative investigations are required.

Vertebral artery injury and third-party liability: the wrongful attack to whiplash injury, L.27/12 (G.U.n.71 del 24.03.12)

Lesions after blunt cervical trauma could be, infrequently, associated with complications that require a discussion under clinical and legal medical point of view. Vertebral artery dissection as a serious consequence of a cervical trauma is a rare complication of patients with blunt injury mechanisms. Artery lesions could be frequently initially unrecognized or they may present a variety of symptoms ranging from a simple pain involving neck to ischemic lesions and cerebral ictus. Arterial dissection can cause ischemic stroke either by thromboemboli forming at the site of injury or as a result of hemodynamic insufficiency due to severe vascular stenosis or occlusion. Vertebral artery injury and third-party liability: the wrongful attack to whiplash injury, L. 27/12 (G.U. n.71 del 24.03.12) www.preventionandresearch.com 311 Oct-Dec 2012|P&R Scientific|Volume 2|N°4 In medical literature several injury hypotheses which may cause a dissection of the arterial walls of vertebral arteries have been analyzed. Among them, repeated micro-traumatism which, acting on already altered wall, cause the dissection. Some jobs or sports are characterized by this risk because they imply frequent and repeated flexoextension movements or head rotations. Also a single minor trauma, such as a blunt cervical trauma following car accident, could cause the dissection of the vertebral arterial wall. The case reported concerns a 43 year-old man who suffered a bruising trauma following a car accident (a bumper-tobumper crash with an articulated lorry). The reported symptomatology consisted of pain along the rachis and on the back on the neck and a diagnosis of cervical whiplash was made. After the worsening of the symptomatology, neurological tests revealed right hemiataxia and dysarthria. Succeeding MRI scanning with angiographic sequences revealed a dissection of the left vertebral artery with a hyperdense lesion of the right cerebellar hemisphere, as an outcome of an infarct in the area of a postero-inferior cerebellar artery. Vertebral artery stretch during trauma is a possible pathogenic mechanism that could explain some aspects of the whiplash symptom complex and serious consequences. At the present this issue shows many controversial points from a pathogenetic point of view. The described uncertainties and the rareness of this kind of injury may explain the “superficiality” of a doctor giving first-aid to a patient with cervical whiplash and “generic” symptoms and it could be related to possible economical benefits consequent from insurance indemnity. However the persistence of symptoms or the negative evolution of the same suggests that it wasn’t the “usual whiplash invented for compensation purposes” and that late complications of an injury of the walls of encephalic arteries must be taken into serious consideration specially under clinical point of view.

Diagnosis and management of Takayasu arteritis

Summary Takayasu arteritis is a panaortitis, more frequent in Japan, South-East Asia India and Mexico, that presents in the 2nd or 3rd decade of life with a non-specific inflammatory phase, then vascular stenosis with ‘pulselessness’ with collateral development. Clinical features include reduced/absent pulses, bruits, hypertension, aortic regurgitation, neurological symptoms from ischemia. While the gold standard for diagnosis is arteriography, magnetic resonance angiography and ultrasonography are now widely used due to their non-invasive nature. Steroids are the cornerstone of medical therapy; cytotoxics may be used for failures. Surgery or angioplasty may be needed for severe vascular stenosis.

OC203: Carotid artery blood volume flow and elevated blood pressure in high-risk pregnancy

Introduction: Cerebral hypoxic and ischaemic changes have been implicated in the aetiology of the characteristic seizures that signify theend-progression of pre-eclampsia. Untilrecently,neuronal dysfunction secondary to ischaemic causes or functional impairment has been difficult to study in adult humans due to the relative inaccessibility of the cerebral circulation. Doppler ultrasound now provides a means of assessing the normalcy of blood flow velocity, and has demonstrated consistency in the evaluation of severe vascular stenosis 1. Differences in systemic peripheral resistance between normotensive and preeclamptic pregnant women have also been demonstrated using calibrated carotid pulse tracings 2. Objective: To measure peak Carotid blood volume flow in a group of prospective mothers at high-risk of pregnancy hypertension and preeclampsia following uterine artery Doppler screening. Methods:Carotid artery velocimetric and blood volume flow profiles were evaluated using standardised techniques in 31 pregnant women at 24‐28 weeks gestation. Results: Blood volume flow measurement showed a 75% sensitivity for elevated blood pressure in later pregnancy, 60% sensitivity for the development of preeclampsia and 100% sensitivity for preterm preeclampsia. Conclusion: The measurement of blood volume flow in the Carotid circulation in high-risk pregnant women merits further investigation as a second-tier screening test for pregnancy hypertension and preeclampsia.

Safety and efficacy of pentoxifylline in stable angina pectoris

Despite currently available therapy, many patients with stable angina remain symptomatic. Pentoxifylline (Trental) is a substituted methylxanthine derivative that appears to work by improving blood viscosity. In areas of severe vascular stenosis, blood viscosity may have an important influence on blood flow. Furthermore, patients with coronary artery disease, perhaps because of increased fibrinogen levels, may have increased blood viscosity that further contributes to impaired coronary flow. Therefore, we evaluated in a double-blind, placebo-controlled study the efficacy of pentoxifylline when added to the regimen of patients with stable angina on execution.