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Artery Stenosis (artery + stenosis)
Kinds of Artery Stenosis Selected AbstractsTransthoracic Doppler Echocardiographic Coronary Flow Imaging in Identification of Left Anterior Descending Coronary Artery Stenosis in Patients with Left Bundle Branch BlockECHOCARDIOGRAPHY, Issue 10 2008Ozer Soylu M.D. Background: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56,0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB. [source] Noninvasive Assessment of Significant Right Coronary Artery Stenosis Based on Coronary Flow Velocity Reserve in the Right Coronary Artery by Transthoracic Doppler EchocardiographyECHOCARDIOGRAPHY, Issue 6 2003M.D., Yoshiki Ueno Background: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE) has been reported to be useful for the noninvasive assessment of coronary stenosis in the left anterior descending artery. However, the measurement of CFVR in the right coronary artery by TTDE has not yet been validated in a clinical study. Objective: The aim of this study was to evaluate whether CFVR by TTDE can detect significant stenosis in the right coronary artery. Methods: We studied 50 patients who underwent coronary angiography. Coronary flow velocity in the posterior descending branch of the right coronary artery (PD) was measured by TTDE both at baseline and during hyperemia induced by the intravenous infusion of adenosine triphosphate. CFVR was calculated as the hyperemia/baseline (average diastolic peak velocity). Results: Adequate spectral Doppler recordings in the PD were obtained in 36 patients including 26 patients who were given an echocardiographic contrast agent to improve Doppler spectral signals. The study population was divided into 2 groups with (Group A;n = 11) and without (Group B;n = 25) significant stenosis in the right coronary artery. CFVR in Group A was significantly smaller than that in Group B (1.6±0.3versus2.5±0.4; P < 0.0001). The sensitivity of a CFVR of <2.0 for predicting the presence of significant stenosis in the right coronary artery was 91%, and the specificity was 88%. Conclusions: The measurement of CFVR in the PD by TTDE is useful for the noninvasive assessment of significant stenosis in the right coronary artery. (ECHOCARDIOGRAPHY, Volume 20, August 2003) [source] Subclavian Artery Stenosis Detected with Transit-Time Flowmeter during OPCABJOURNAL OF CARDIAC SURGERY, Issue 2 2010Vassilios Economopoulos M.D. (J Card Surg 2010;25:176-177) [source] Renal Artery Stenosis in Hypertension: What about the "Other" Alternative?JOURNAL OF CLINICAL HYPERTENSION, Issue 1 2001Raymond R. Townsend MD No abstract is available for this article. [source] European Carotid PROCAR Trial: Prospective Multicenter Trial to Evaluate the Safety and Performance of the ev3 ProtégéÔ Stent in the Treatment of Carotid Artery Stenosis,1- and 6-Month Follow-UpJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006JENNIFER SUGITA Background: The purpose of the European PROCAR Trial was to evaluate the safety and performance of the Protégé stent in the treatment of common and/or internal carotid artery stenoses with adjunctive use of a filter embolic protection device. Method: The Protégé® GPS stent is a self-expanding Nitinol stent system mounted on a 6 Fr 0.018, (6,9 mm stent) or 7 Fr 0.035, (10 mm stent) over-the-wire delivery system. Study patient assessments were conducted at baseline, periprocedure, discharge, and 1 and 6 months postprocedure. A total of 77 patients have been enrolled in the trial. Results: In the 77 lesions treated (31 symptomatic, 46 asymptomatic), the procedure was technically successful in 76 (99%), with an average residual stenosis of less than 30%. One procedure failed because the embolic protection device could not be retrieved and the patient was sent to surgery. Within 30 days, there were four (5.2%) major adverse neurological events (MANEs). Three of the MANEs were major strokes (3.9%), one a minor stroke. The fifth MANE occurred prior to the 6-month follow-up visit; this patient had a major stroke 75 days after the procedure and died 36 days later. One additional death occurred because of urosepsis. Conclusions: The PROCAR trial shows that the Protégé stent with adjuvant use of a filter embolic protection device satisfies safety and performance criteria for the treatment of carotid artery stenosis. The incidence of MANEs for the Protégé stent is comparable to the incidence of these events in other recent carotid stent studies and standard carotid endarterectomy (CEA). [source] Contemporary Management of Carotid Artery Stenosis: No Resting Places, No PlateausJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2006F.A.C.C., KISHORE J. HARJAI M.D. First page of article [source] Descending Thoracic Aorta to Left Pulmonary Artery Fistula After Stent Implantation for Acquired Left Pulmonary Artery StenosisJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2002NICOLA CARANO M.D. This is a case report of a Fontan patient with previous Potts anastomosis who underwent stent implantation for left pulmonary artery stenosis. At follow-up the patient developed a fistula between the descending thoracic aorta and the left pulmonary artery at the site of the stent. This represents a late complication of stent placement. [source] Is Transcranial Doppler Ultrasound Undervalued for Detection of Intracranial Internal Carotid Artery Stenosis?JOURNAL OF NEUROIMAGING, Issue 3 2010Gustavo J. Rodriguez MD No abstract is available for this article. [source] Is Carotid Artery Stent Placement a Viable Option for Carotid Artery Stenosis in Patients Aged 80 years or Greater?JOURNAL OF NEUROIMAGING, Issue 2 2010Ramachandra P. Tummala MD No abstract is available for this article. [source] A Broad Diagnostic Battery for Bedside Transcranial Doppler to Detect Flow Changes With Internal Carotid Artery Stenosis or OcclusionJOURNAL OF NEUROIMAGING, Issue 3 2001Ioannis Christou MD ABSTRACT Background and Purpose. The authors establish accuracy parameters of a broad diagnostic battery for bedside transcranial Doppler (TCD) to detect flow changes due to internal carotid artery (ICA) stenosis or occlusion. Methods. The authors prospectively studied consecutive patients with stroke or transient ischemic attack referred for TCD. TCD was performed and interpreted at bedside using a standard insonation protocol. A broad diagnostic battery included major criteria: collateral flow signals, abnormal siphon or terminal carotid signals, and delayed systolic flow acceleration in the middle cerebral artery. Minor criteria included a unilateral decrease in pulsatility index (, 0.6 or , 70% of contralateral side), flow diversion signs, and compensatory velocity increase. Angiography or carotid duplex ultrasound (CDU) was used to grade the degree of carotid stenosis using North American criteria. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TCD findings were determined. Results. Seven hundred and twenty patients underwent TCD, of whom 517 (256 men and 261 women) had angiography and/or CDU within 8.8 ± 0.9 days. Age was 63.1 ± 15.7 years. For a 70% to 99% carotid stenosis or occlusion, TCD had sensitivity of 79.4%, specificity of 86.2%, PPV of 57.0%, NPV of 94.8%, and accuracy of 84.7%. For a 50% to 99% carotid stenosis or occlusion, TCD had sensitivity of 67.5%, specificity of 83.9%, PPV of 54.5%, NPV of 90.0%, and accuracy of 81.6%. TCD detected intracranial carotid lesions with 84.9% accuracy and extracranial carotid lesions with 84.4% accuracy (sensitivity of 88% and 79%, specificity of 85% and 86%, PPV of 24% and 54%, and NPV of 99% and 95%, respectively). The prevalence of the ophthalmic artery flow reversal was 36.4% in patients with , 70% stenosis or occlusion. If present, this finding indicated a proximal ICA lesion location in 97% of these patients. Conclusions. In symptomatic patients, bedside TCD can accurately detect flow changes consistent with hemodynamically significant ICA obstruction; however, TCD should not be a substitute for direct carotid evaluation. Because TCD is sensitive and specific for , 70% carotid stenosis or occlusion in both extracranial and intracranial carotid segments, it can be used as a complementary test to refine other imaging findings and detect tandem lesions. [source] Who Should Be Screened for Asymptomatic Carotid Artery Stenosis?JOURNAL OF NEUROIMAGING, Issue 2 2001Experience From the Western New York Stroke Screening Program ABSTRACT Objective. Identification of significant asymptomatic carotid artery stenosis (ACAS) is important because of the stroke-risk reduction observed with carotid endarterectomy. The authors developed and validated a simple scoring system based on routinely available information to identify persons at high risk for ACAS using data collected during a community health screening program at various sites in western New York. A total of 1331 unselected volunteers without previous stroke, transient ischemic attack, or carotid artery surgery were evaluated by personal interview and duplex ultrasound. The main outcome measure was carotid artery stenosis >60% by duplex ultrasound. In the derivation set (n= 887), 4 variables were significantly associated with ACAS >60%: age >65 years (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 2.6,6.7), current smoking (OR = 2.0, 95% CI = 1.2,3.5), coronary artery disease (OR = 2.4, 95% CI = 1.5,3.9), and hypercholesterolemia (OR = 1.9, 95% CI = 1.2,2.9). Three risk groups (low, intermediate, and high) were defined on the basis of total risk score assigned on the basis of the strength of association. The scheme effectively stratified the validation set (n= 444); the likelihood ratio and posttest probability for ACAS in the high-risk group were 3.0 and 35%, respectively, and in the intermediate and low-risk groups were 1.4 and 20% and 0.4 and 7%, respectively. Routinely available information can be used to identify persons in the community at high risk for ACAS. Doppler ultrasound screening in this subgroup may prove to be cost-effective and have an effect on stroke-free survival. [source] Risk Factors and Long-Term Outcome of Transplant Renal Artery Stenosis in Adult Recipients After Treatment by Percutaneous Transluminal AngioplastyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2006V. Audard Transplant renal artery stenosis (TRAS) is a common complication of kidney transplantation but attempts to identify predisposing risk factors for TRAS have yielded conflicting results. In order to determine the predisposing factors for transplant (TRAS), we retrospectively reviewed the records of 29 renal allograft recipients with TRAS treated with percutaneous transluminal angioplasty (PTA). The TRAS group was compared with a case-control group of 58 patients. Predisposing factors for TRAS included CMV infection (41.4% vs. 12.1% p = 0.0018) and initial delayed graft function (DGF) (48.3% vs. 15.5% p = 0.0018), respectively in the TRAS and the control group. Acute rejection occurred more frequently in patients from the TRAS group (48.3%) compared with the control group (27.6%), although the difference was not significant (p = 0.06). In a multivariate analysis, only CMV infection (p = 0.005) and DGF (p = 0.009) appear to be significantly and independently associated with TRAS. The long-term graft survival was significantly higher in the control group, compared with the TRAS group (p = 0.03). Our study suggests that CMV infection and DGF are two reliable risk factors for TRAS. Despite treatment by PTA with primary successful results, TRAS significantly affects long-term graft outcome. [source] Percutaneous Intervention of Superior Mesenteric Artery Stenosis in Elderly PatientsCLINICAL CARDIOLOGY, Issue 5 2009Neelima Penugonda MD This review article focuses on stent placement in mesenteric arteries in older patients with an increasingly common diagnosis of chronic mesenteric ischemia (CMI). We reviewed the articles that focused on the treatment of this gastrointestinal disorder by stenting/open surgical revascularization to avoid further ischemic episodes and bowel infarction and necrosis. The advantages of stent placement in mesenteric arteries are discussed in comparison to open surgical revascularization. In summary, the low morbidity and high technical success rate of catheter-based techniques have made this approach the first line of therapy for CMI due to superior mesenteric artery stenosis for many elderly patients especially high-risk operative candidates. Copyright © 2009 Wiley Periodicals, Inc. [source] Prevalence of and risk factors for extracranial internal carotid artery stenosis in Korean Type 2 diabetic patientsDIABETIC MEDICINE, Issue 12 2006J. H. Park Abstract Aims The objectives of this study were to evaluate the prevalence of and risk factors for extracranial internal carotid artery stenosis in Type 2 diabetic patients. Methods This study included 406 patients aged 40,79 years with Type 2 diabetes (male 55.4%, female 44.6%). Both carotid arteries of each patient were examined by carotid duplex scanning. The duplex ultrasound criteria based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) measurement method were used for the identification of carotid stenosis. Results Extracranial internal carotid artery stenosis , 40% by velocity criteria was detected in 5.2% of the patients. The prevalence of carotid stenosis increased with advancing age: 1.0% at 40,49 years of age, 5.0% at 50,59 years, 7.3% at 60,69 years and 9.5% at 70,79 years. The degree of stenosis was > 70% in 42.9% of patients with stenosis, Bilateral stenosis was detected in 14% of patients. Of the patients with , 40% carotid stenosis, 33% had a decreased ankle-brachial index, 38% had a previous history of stroke, and only one patient (5%) had a documented history of coronary artery disease. Multivariate analysis, including variables determined to be significantly different by univariate analysis between patients with or without , 40% stenosis, indicated that age, systolic blood pressure and high-density lipoprotein (HDL)-cholesterol (inverse correlation) were independent risk factors associated with carotid stenosis. Conclusions Carotid duplex scanning is a useful strategy in identifying carotid stenosis in older Type 2 diabetic patients with high systolic blood pressure, or low levels of HDL cholesterol. The early identification and subsequent appropriate management of carotid stenosis, particularly in this group of patients, may facilitate efforts to reduce the incidence of macrovascular complications. [source] The Relation Between Mitral Annular Calcification and Mortality in Patients Undergoing Diagnostic Coronary AngiographyECHOCARDIOGRAPHY, Issue 9 2006Howard J. Willens M.D. To determine whether the observed association between mitral annular calcification (MAC) and mortality is independent of the severity of coronary artery disease (CAD), we analyzed data from 134 male veterans (age 63 ± 10 years) followed for 5 years who had undergone diagnostic coronary angiography and transthoracic echocardiography within 6 months of each other. Echocardiograms were retrospectively reviewed for the presence of MAC. The relation of MAC to all-cause mortality was analyzed using logistic regression, and odds ratios (OR) were calculated. MAC was present in 49 (37%) subjects. Over the 5-year follow-up period, 38 (28%) patients expired. Five-year survival was 80% for subjects without MAC and 56% for subjects with MAC (P = 0.003). MAC (OR = 3.16, 95% confidence interval [CI]= 1.43,6.96, P = 0.003), ejection fraction (OR = 0.76, 95% CI = 0.59,0.97, P = 0.02), and left main CAD (OR = 2.70, 95% CI = 1.11,6.57, P = 0.02) were significantly associated with mortality in univariate analysis. After adjusting for left ventricular ejection fraction, number of obstructed coronary arteries and the presence of left main coronary artery stenosis, MAC significantly predicted death (OR = 2.48, 95% CI = 1.09,5.68, P = 0.03). Similarly, after adjusting for predictors of MAC, including ejection fraction, age, diabetes, peripheral vascular disease, and heart failure, MAC remained a significant predictor of death (OR = 2.38, 95% CI = 1.02,5.58, P = 0.04). MAC also predicted death independent of smoking status, hypertension, serum creatinine, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and C-reactive protein levels (OR = 3.98, 95% CI = 1.68,9.40, P = 0.001). MAC detected by two-dimensional echocardiography independently predicts mortality and may provide an easy-to-perform and inexpensive way to improve risk stratification. [source] Regional Response of Myocardial Acceleration During Isovolumic Contraction During Dobutamine Stress Echocardiography: A Color Tissue Doppler Study and Comparison with Angiocardiographic FindingsECHOCARDIOGRAPHY, Issue 10 2005Linda B. Pauliks M.D. Background: Color tissue Doppler imaging permits noninvasive quantitation of regional wall motion. In experimental studies, a new marker, the slope of the isovolumic contraction wave, isovolumic acceleration (IVA) was more insensitive to ventricular loading conditions than myocardial velocities. This study compared the regional response IVA to dobutamine stress echocardiography to angiographic findings. Methods: The Myocardial Doppler in Stress Echocardiography (MYDISE) study prospectively recruited 149 consecutive patients with chest pain for dobutamine stress tissue Doppler echocardiography prior to coronary angiography. This color tissue Doppler database was analyzed for IVA in 1192 basal and mid segments at rest and again at peak stress. Angiographic findings were compared to IVA and peak systolic velocities (PSV) in corresponding cardiac segments. The diagnostic accuracy of IVA to predict coronary artery stenosis was determined using cut-off values for three representative segments and with the MYDISE diagnostic model including eight segments. Results: Regional IVA increased in a dose-dependent manner during dobutamine infusion. The response was blunted in the supply territory of stenosed coronary artery branches. IVA performed slightly better than PSV as single marker for coronary artery stenosis. A diagnostic model incorporating IVA and PSV was 85,95% accurate (area under receiver operating characterstic curves). Conclusions: Regional changes of isovolumic acceleration during dobutamine stress echocardiography reflect regional wall motion and can be used to predict coronary artery stenosis with similar accuracy as a model based on systolic myocardial velocities. As a single marker, IVA performed better than myocardial velocities. (ECHOCARDIOGRAPHY, Volume 22, November 2005) [source] Vasodilator Stress Induces Infrequent Wall Thickening Abnormalities Compared to Perfusion Defects in Mild-to-Moderate Coronary Artery Disease: Implications for the Choice of Imaging Modality with Vasodilator StressECHOCARDIOGRAPHY, Issue 4 2004M.R.C.P., Ph.D., Prem Soman M.D. Background: Experimental evidence suggests that although vasodilator stress agents consistently induce regional flow disparity between stenosed and normal coronary vascular beds, the occurrence of functional myocardial ischemia is infrequent, especially in mild-to-moderate coronary artery stenosis. Thus, it is hypothesized that dipyridamole infusion, even at high doses, will result in a disproportionately higher frequency of perfusion defects compared to regional wall thickening abnormalities. Methods: We performed simultaneous high-dose (0.84 mg/kg) dipyridamole stress echocardiography (Echo) and Tc-99m sestamibi SPECT (MIBI, methoxyisobutyl isonitrile) in 46 patients with coronary artery diameter stenosis >50% and ,90% in one or two epicardial coronary arteries, and no previous myocardial infarction. Results: Of a total of 828 segments, MIBI showed 97 reversible defects while Echo showed only 23 reversible wall thickening abnormalities. Of the 97 segments with reversible MIBI defects, only 13 (13%) showed simultaneous reversible wall thickening abnormalities during dipyridamole infusion. There were 24 patients with MIBI defects, of whom 10 (41%) showed a corresponding wall thickening abnormality. The sensitivity of MIBI and Echo for the detection of coronary artery disease was 52% and 21%, respectively (P = 0.001). Conclusion: This suggests that vasodilator stress is not optimally suited for use with techniques that use regional wall thickening abnormality as a marker of ischemia for the diagnosis of coronary artery disease. (ECHOCARDIOGRAPHY, Volume 21, May 2004) [source] Osteopontin as a novel prognostic marker in stable ischaemic heart disease: a 3-year follow-up studyEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 4 2010Panagiota Georgiadou Eur J Clin Invest 2010; 40 (4): 288,293 Abstract Objectives, Osteopontin (OPN) is a glycoprotein, which may play a major role in the regulation of biological phenomena. Increased levels of OPN have been linked to the presence and to the severity of atherosclerosis. This study was undertaken to assess the prognostic significance of plasma OPN levels in patients with stable ischaemic heart disease (IHD). Methods, In 101 patients with stable IHD and angiographically documented significant coronary artery stenosis, plasma OPN levels were measured at baseline (time of coronary arteriography). Patients were prospectively followed for a median time of 3 years (minimum 2·25, maximum 3·9 years). The primary study endpoint was the composite of cardiovascular death, non-fatal myocardial infarction, need for revascularization and hospitalization for cardiovascular reasons. Results, Baseline lnOPN levels were directly related to age (r = 0·27, P < 0·001) and inversely to left ventricular ejection fraction (r = ,0·32, P < 0·01). Left ventricular ejection fraction was an independent predictor of plasma OPN levels after adjustment for age and gender (, = ,0·013, P = 0·02). Median OPN value was 55 ng mL,1. In the univariate Cox-regression analysis, OPN levels > 55 ng mL,1 (n = 50) were significantly related to adverse cardiac outcome (HR = 2·40, 95% CI: 1·11,5·23, P = 0·027). In multivariate model, OPN levels > 55 ng mL,1 remained statistically significant independent predictor of adverse outcome after adjustment for age, gender, left ventricular ejection fraction and the number of diseased coronary arteries (HR = 2·88, 95% CI: 1·09,7·58, P = 0·032). Conclusion, OPN may provide significant prognostic information independent of other traditional prognostic markers in patients with stable IHD. [source] Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treatEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2010V. Parkhutik Background and purpose:, Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. Methods:, Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply. Results:, Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 ± 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 ± 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography. Conclusions:, Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis. [source] Symptomatic stenosis of the vertebrobasilar arteries: results of extra- and intracranial stent-PTAEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2009T. Seifert Background and purpose:, About half of all transient ischaemic attacks (TIAs) or strokes in the posterior circulation are caused by the arterial stenosis. The purposes of this study were to determine the safety of stent-assisted percutaneous transluminal angioplasty (stent-PTA) and its efficacy for the prevention of recurrent stroke in patients with symptomatic artery stenosis in the extra- and intracranial posterior circulation. Methods:, Forty-six patients with a previous stroke or TIA who received balloon-mounted coronary stents for vertebral artery origin stenosis (VAOS; 29 patients) or self-expanding nitinol stents for vertebrobasilar intracranial stenosis (VBIS; 17 patients) were followed-up for a mean of 24.1 (VAOS) and 12.7 (VBIS) months. Results:, When all cause morbidity/mortality within 30 days from stent-PTA and stroke or death from stroke in the treated vascular territory during the first 12 months of follow-up are combined, the incidence of periprocedural complications and disease progression for the first year is 10.3% in VAOS patients and 17.6% in the VBIS group. Vessel restenosis ,50% was found in 52.0% of VAOS and in 32.1% of VBIS patients who completed 6 months follow-up. Conclusions:, We observed a higher periprocedural complication rate for patients with VBIS and a higher rate of restenosis in VAOS patients after stent-PTA for symptomatic artery stenosis. [source] Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stentingEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2008K. Gröschel A recently symptomatic carotid artery stenosis carries a high risk of subsequent ischaemic events and thus requires rapid treatment. We investigated the influence of the time delay between the last symptomatic event of a carotid stenosis and subsequent carotid artery stenting (CAS) with respect to the combined 30-day outcome of stroke and death. In a group of 320 patients undergoing CAS the median delay before the intervention was 19 days (interquartile range 10,36) and the combined 30-day complication rate was 8.4%. Time delay was not significantly associated with peri-procedural complications, regardless of whether this variable was dichotomized (<14 days and ,14 days), separated into interquartile ranges or analysed as a continuous variable. Our results indicate that early CAS is not associated with an increased complication rate in patients with a recently symptomatic carotid stenosis. Thus, if CAS has been selected as the treatment modality for a patient, it should be performed as soon as possible to maximize the benefit of the intervention in reducing the risk of stroke. [source] Cerebral vasomotor reactivity of bilateral severe carotid stenosis: is stroke unavoidable?EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2006A. Y. Gur We evaluated the cerebral hemodynamic features of severe bilateral carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. VMR was evaluated by recording the percentage differences in peak systolic blood flow velocity in each MCA and VA at baseline and by the Diamox test. Twenty-eight symptomatic (SCAS) and 31 asymptomatic (ACAS) patients with bilateral severe (>70%) internal carotid artery stenosis were studied. The mean MCA VMR% was 29 ± 26.9% in SCAS and 43.2 ± 26.8% in ACAS patients (P < 0.01). Their respective mean VA VMR% was 30.2 ± 36.5% and 39.6 ± 24.4% (P = NS). VMR% of the symptomatic MCA side in SCAS patients was significantly lower than the opposite side (20.5 ± 31.1% and 39.2 ± 37.9% respectively; P < 0.03). In contrast, the VA VMR% of both sides in SCAS patients remained similar (28.1 ± 39.3% and 34.6 ± 47.9% respectively; P = NS). VMR% of the MCA and VA in ACAS patients was also similar for both sides of bilateral carotid stenosis. The cerebral hemodynamic features differ between SCAS and ACAS patients with bilateral carotid occlusive disease in the anterior part of the circle of Willis. An independent cerebral vascular reserve capacity of the posterior circulation is proposed. [source] Cognitive performance following endarterectomy in asymptomatic severe carotid stenosisEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2003J. Aharon-Peretz Cognition and the effects of carotid endarterectomy (CEA) were evaluated in 22 non-demented subjects with vascular risk factors (VRF) and asymptomatic severe carotid artery stenosis (ASCAS), 14 volunteers with VRF but without stenosis, and 24 healthy controls (HC) without VRF. Non-demented subjects with VRF, with or without carotid stenosis scored inferior to HC. It is concluded that carotid stenosis is not a primary cause of cognitive deterioration and CEA does not improve cognition in patients with ASCAS. [source] Ischemic nephropathy in an elderly patientGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2008Satoshi Hoshide Congestive heart failure often occurs in patients with bilateral renal artery stenosis. Recently, Jacobson and Breyer, and Jacobson introduced the term "ischemic nephropathy", which implies critical bilateral involvement or global ischemia. Ischemic nephropathy is not only a cause of hypertension but also an important cause of end-stage renal disease. However, the aging kidney often show that the renal artery does not demonstrate stenosis of the main trunks, but stenosis of an atherosclerotic branch. We present a case of multiple atherosclerotic peripheral renal arteries, which might have caused ischemic nephropathy in an elderly hypertensive patient with advanced atherosclerosis. [source] Diagnosis and Management of Renovascular Disease and Renovascular HypertensionJOURNAL OF CLINICAL HYPERTENSION, Issue 5 2007Michael J. Bloch MD Renovascular disease is a common but complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerosis. Clinically, it can present as asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. Assessing the clinical index of suspicion remains essential in determining an appropriate diagnostic strategy. For diagnosis in patients with suspected fibromuscular disease, it may be reasonable to proceed directly to renal angiography; however, for most patients with suspected atherosclerotic disease, there are a number of noninvasive tests available that can aid in decision making. The choice of the most appropriate initial test should be based on patient characteristics, clinical presentation, and local expertise. Treatment options include medical, surgical, or percutaneous approaches. Generally, in patients with fibromuscular disease, percutaneous intervention provides durable improvement or cure of hypertension. In patients with atherosclerotic disease, the data are less consistent, and there does appear to be a group of patients who will respond well to medical management alone. As technology advances, the diagnostic and treatment paradigms will continue to evolve. [source] Novel parameter for the diagnosis of distal middle cerebral artery stenosis with transcranial Doppler sonographyJOURNAL OF CLINICAL ULTRASOUND, Issue 8 2010Suk-Won Ahn MD Abstract Purpose Transcranial Doppler sonography (TCD) is commonly used for the diagnosis of middle cerebral artery (MCA) stenosis. However, TCD indices to predict distal MCA (M2) stenosis have not yet been established. We compared TCD and magnetic resonance angiography (MRA) to validate a new index for the diagnosis of M2 stenosis. Methods Consecutive patients who underwent TCD and MRA were included. Based on MRA, M2 stenosis was defined as >50% narrowing beyond the bifurcation area. TCD index of the M2/M1 ratio was defined as the ratio between the mean flow velocity (MFV) obtained at a depth of 30,44 mm (M2) and a depth of 45,65 mm (M1). Sensitivity and specificity of the M2/M1 ratio were calculated from the receiver operating characteristic curve. The diagnostic yield of elevated MFV (>80 cm/s) and asymmetry index of >30% for M2 stenosis were also investigated. Results Among the consecutive patients, 105 with M2 stenosis were compared with 123 without MCA stenosis. The M2/M1 ratio was significantly higher in the M2 stenosis group (1.10 versus 0.86, p < 0.001). Sensitivity and specificity for M2 stenosis were most satisfying when the M2/M1 ratio of 0.97 was adopted as the cutoff value. Diagnostic yield of the M2/M1 ratio was better than MFV or asymmetry index. Conclusions The M2/M1 ratio may be a highly specific parameter for assessing M2 stenosis with TCD. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:420,425, 2010 [source] Routine intraoperative Doppler sonography in the evaluation of complications after living-related donor liver transplantationJOURNAL OF CLINICAL ULTRASOUND, Issue 9 2007Jin-Young Choi MD Abstract Purpose To determine whether quantitative and qualitative analysis of intraoperative Doppler sonography data are predictive of vascular complications after living-related donor liver transplantation. Methods Intraoperative sonograms of 81 transplanted livers (right lobe in 61 patients, left lobe in 20 patients) were analyzed for the presence of blood flow, resistance index, systolic acceleration time (SAT), peak systolic velocity, and morphologic characteristics of spectral waveform of the hepatic artery. Peak velocity and spectral waveforms of portal and hepatic veins were also analyzed. Intraoperative sonography results were compared with information obtained with multidetector-row CT (MDCT) angiography or conventional angiography. The time interval between operation and angiography ranged from 1 to 23 days (mean, 8.5 days). Results Hepatic artery stenosis (HAS) was identified in 20 patients via MDCT angiography, conventional angiography, or both. The Doppler parameters found helpful for predicting HAS were tardus-parvus pattern and delayed SAT. The sensitivity, specificity, and negative predictive value (NPV) were 60.0%, 73.7%, and 84.9%, respectively, for tardus-parvus pattern and 40.0%, 83.6%, and 80.9%, respectively, for delayed SAT. Peak velocities of the portal and hepatic veins were not reliable indicators of vascular complication. Loss of triphasity of the hepatic vein had a 98.4% NPV for venous obstruction. Conclusions Delayed SAT of the hepatic artery and loss of triphasity of the hepatic vein had a >80% for specificity for predicting vascular complications. Tardus-parvus pattern, delayed SAT of the hepatic artery, and loss of triphasity of the hepatic vein showed an acceptable NPV for identifying vascular complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007 [source] Role of hyperlipidemia in atherosclerotic plaque formation in the internal carotid arteryJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2006Levente Kerenyi MD Abstract Purpose. The role of hyperlipidemia in atherosclerotic changes of the carotid artery is controversial. The aims of this retrospective study were to assess (1) the relationship between total serum cholesterol and triglyceride and the grade of internal carotid artery stenosis and (2) whether total serum cholesterol and triglyceride levels are independent risk factors for internal carotid artery atherosclerosis. Methods. The files of 1,934 acute ischemic stroke patients were investigated retrospectively. The atherosclerotic involvement of the internal carotid artery was assessed via duplex sonography as percent of stenosis and was graded as follows: group 1, no plaque; group 2, <30% stenosis; group 3, 30,99% stenosis; and group 4, occlusion. Results. The mean age of the patients was 66.9 ± 12.8 years. Patients without any plaque had significantly lower cholesterol levels compared with those with any degree of internal carotid artery stenosis. Univariate analysis revealed that age (p < 0.001), sex (p < 0.001), hypertension (p < 0.05), cholesterol (p < 0.01), triglycerides(p < 0.05), and smoking (p < 0.001) were significant contributors to atherosclerosis. In the ordinal logistic regression model, age (p < 0.001), sex (p < 0.001), smoking(p < 0.001), and cholesterol (p < 0.05) remained independent predictors of internal carotid artery atherosclerosis. Conclusions. Total serum cholesterol level seems to be an independent risk factor of atherosclerosis in the carotid artery. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:283,288, 2006 [source] Reliability of intrarenal Doppler sonographic parameters of renal artery stenosisJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2003Gülgün Demirpolat MD Abstract Purpose The goal of this study was to retrospectively evaluate false-negative results of Doppler sonography in the diagnosis of renal artery stenosis (RAS) using intrarenal criteria. Methods We reviewed the clinical data and Doppler sonographic data for all patients in whom a diagnosis of RAS had been confirmed angiographically between November 1992 and January 2001. Mean intrarenal acceleration and acceleration time values,data obtained directly from color Doppler sonography,and findings of angiographic examination of the kidneys and stenotic renal arteries were evaluated. Results During the study period, 55 cases of RAS had been angiographically confirmed in 46 patients (25 male and 21 female; mean age, 50 ± 19 years [± standard deviation]). Intrarenal arterial acceleration, acceleration time values, or both were abnormal in 42 kidneys (76%) (group A) and normal in 13 kidneys (24%) (group B). The mean age ± standard deviation was significantly higher for patients in group B (60 ± 12 years) than for those in group A (47 ± 20 years) (p > 0.05). In group B, most of the stenotic lesions were atherosclerotic, and in all kidneys but 1, the lesions were located at the renal ostium or the proximal half of the artery. Conclusions Isolated use of intrarenal Doppler sonographic criteria for RAS may lead to an unacceptably high incidence of false-negative results in the diagnosis of this condition, especially in elderly patients. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:346,351, 2003 [source] Duplex Doppler sonography of transplant renal artery stenosisJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2003Ruth Helena de Morais MD Abstract Purpose The aim of this study was to evaluate the accuracy of duplex Doppler sonography in diagnosing transplant renal artery stenosis (TRAS) and to determine which parameter is the most reliable for making that diagnosis. Methods Over a 3-year period, we sonographically evaluated patients who were referred for investigation of possible TRAS. We investigated the following parameters: peak systolic velocity (PSV) in the external iliac and renal arteries, acceleration time and acceleration in the intrarenal arteries, acceleration time in the renal artery, resistance index, and the ratio of the PSVs in the renal and external iliac arteries. We also used MR angiography and digital subtraction arteriography to verify the degree of stenosis. After the evaluations, the patients were classified into 2 groups, 1 with and the other without significant stenosis (> 50% narrowing of the lumen) on digital subtraction arteriography. We also included a control group of patients who had undergone renal transplantation at least 6 months before, had had a good course after transplantation, had a diastolic blood pressure of 90 mm Hg or less, and were taking a maximum of 1 antihypertensive drug. Results Our study population consisted of 22 patients suspected to have TRAS (10 without and 12 with confirmed significant stenosis) and 19 control patients. We found statistically significant differences between the mean values of these 3 groups except for the PSV in the iliac artery and the resistance index in the intrarenal arteries. The most accurate parameters to use in diagnosing TRAS were an acceleration time of 0.1 second or higher in the renal and intrarenal arteries, a PSV of greater than 200 cm/second in the renal artery, and a ratio of PSVs in the renal and external iliac arteries of greater than 1.8. Conclusions Duplex Doppler sonography is an excellent method for screening patients suspected to have TRAS and can help select which of those patients should undergo digital subtraction arteriography. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:135,141, 2003 [source] | ||||||||||||||||||||||||||||||||||||||||