|
|
|
Ultrasound
|
During atrial fibrillation, the heart's two small upper chambers (the atria) quiver instead of beating effectively. Atrial Fibrillation is a leading contributor to the heart disease epidemic and EP Lab Digest has covered this condition in great detail. Feel free to browse through our collection of articles.
Gamma Bracytherapy for the Treatment of In-Stent Restenosis of Renal Arteries
Purpose. The incidence of in-stent restenosis (ISR) after renal artery stenting is 12 to 21%, yet there is no standard treatment method for this problem. Our aim was to assess the safety and efficacy of gamma brachytherapy (g-BT) for the treatment of ISR in renal arteries. Materials and Methods. Eleven patients who presented with renal ISR from January 2003 to March 2004, documented by selective renal angiography, were assigned to treatment with g-BT using Ir-192, followed by balloon angioplasty, laser or re-stenting. Patients were followed clinically at 1, 3, 6, and 9 months, and duplex ultrasound was conducted at 9 months. Results. All patients were hypertensive and on a mean of 2.3 antihypertensive medications. Mean age was 64 ± 8.68 years, 45.5% were males, 36.4% had diabetes mellitus, and 64% were smokers. The mean RVD was 5.4 ± 0.58 mm. The prescribed dose of radiation was 22.8 ± 0.6 Gy, with a dwell time 30.25 ± 1.92 minutes, and was well-tolerated by all patients. Procedural success was 100% and free of complications. Clinical follow-up was available in all patients, and duplex ultrasound in 10 patients. No significant changes in blood urea nitrogen, serum creatinine, creatinine clearance, or the number of antihypertensive medications were observed at follow-up. One patient (9.1%) required target lesion revascularization at 9 months. Conclusion. Gamma brachytherapy as adjunct therapy for the treatment of renal artery ISR appears safe and feasible. However, the clinical benefit of this therapy has to be proven in a large, randomized clinical trial.
|
Duplex Ultrasound Surveillance after Carotid Stent Angioplasty: When to Follow-up and What to Look for
medical therapy for stroke prevention in patients with severe atherosclerotic ICA stenosis in both the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS),3,4 and is currently being compared to carotid stent-assisted angioplasty (CAS) in the Carotid Revascularization Endovascular Stent Trial (CREST). Angiography confirmed > 75% DR CAS stenosis in all 6 patients, resulting in balloon angioplasty (n = 3), stent angioplasty (...
|
New Approaches for the Treatment of Superficial Venous Reflux and Symptomatic Varicose Veins
In many cases, the varicose veins causing symptoms in the distribution of either the greater or lesser saphenous vein (GSV/LSV) do not need to be excised if the incompetent saphenous vein has been successfully ablated. Contraindications include a post-phlebitic vein that cannot be accessed, a mega-saphenous vein (>12 mm) and significant dilation of the proximal saphenous vein with an ? Conclusion New, minimally invasive techniques for the treatment of superficial venous reflux and ...
|
Inaccurate Ultrasound Assessment of Internal Carotid Disease in Patients with Carotid Artery Disease and Aortic Valve Stenosis Candidates to Endovascular Carotid Stenting and Cardiac Surgery
Purpose. The association of internal carotid artery disease (ICAD) with aortic valve stenosis (AVS) constitutes a very high-risk clinical occurrence in which combined surgery may increase the operative risks. Therefore, carotid stenting before or after cardiac surgery may be a valuable option. Unfortunately, in patients with aortic valve stenosis (AVS), the evaluation of carotid arteries by Doppler ultrasound (DUS) may be inaccurate. The present retrospective study is aimed to evaluate the pitfalls of DUS and the role of carotid angiography in evaluating ICAD in patients with AVS. Methods. We analyzed the clinical, hemodynamic and angiographic findings of 200 patients with moderate to severe AVS (5.5% of 3600 patients undewent cardiac catheterization, mean age 68.5 ± 10.6 years) investigated in our institution over the past 2 years. Patients with moderate to severe AVS, candidates for open cardiac surgery, underwent carotid ultrasonography to assess ICAD and complete left and right catheterization with coronary artery angiography. In case of doubtful carotid artery sonography, the patients also underwent carotid artery angiography at the time of complete cardiac catheterization before confirming the indication to carotid stenting or combined surgery. Results. Seventy patients with moderate to severe AVS and doubtful carotid ultrasonography underwent coincident carotid angiography. The use of suboptimal Doppler ultrasonographic examinations are related to the anatomical or difficult evaluation of Doppler flow due to hemodynamic influences of aortic valve stenosis. On carotid angiography, 20 patients (28.5%, male/female: 8/12, mean age 72.1 + 5.1 years) were diagnosed with critical stenosis of one (16 patients) or both (4 patients) internal carotid arteries. In 5 patients, a significant ICAD was not diagnosed by DUS, whereas in 7 patients the stenosis was underestimated by DUS (mean luminal narrowing 58 + 12.7% versus 76.7 + 19.3%, p<0.03), and in the other 8, DUS overestimated ICA
|
Cartoid Artery Stenting: An Update
Cartoid Artery Stenting: An Update Feature: Cartoid Artery Stenting: An Update - An interview with Jay Yadav, MD What are some of the implications of the SAPPHIRE* trial thus far? Dr. Yadav can be contacted at yadavj@ccf.org *SAPPHIRE: Stenting and Angioplasty with Protection in Patients at HIgh Risk for Endarterectomy **CREST: Carotid Revascularization Endarterectomy versus Stent Trial ***CAVATAS: Carotid and Vertebral Artery Transluminal Angioplasty Study For Further Reading 1. Abou-Chebl ...
|
Strategies to Optimize Percutaneous Coronary Intervention Outcomes in Diabetics
Strategies to Optimize Percutaneous Coronary Intervention Outcomes in Diabetics Feature: Strategies to Optimize Percutaneous Coronary Intervention Outcomes in Diabetics - Umesh K. Arora, MD and Meeney Dhir, MD Diabetes is a major public health problem. In patients with diabetes treated with oral agents and receiving a Cypher stent the in-stent re-stenosis was 4.8%, and 9.3% in insulin-requiring diabetics as compared to 2.4% in the non-diabetic patients. In patients with diabetes treated ...
|
A Single Center Clinical Evaluation of Carotid Stenting for the Treatment of Obstructive Carotid Artery Disease: Experience in a Community Hospital
Objectives. Carotid angioplasty and stenting (CAS) is a less invasive alternative to conventional carotid endarterectomy (CEA). We sought to demonstrate that carotid angioplasty and stenting can be accomplished safely and successfully in a community hospital with results comparable to those attained in clinical trials at academic centers. Background. Trials performed in academic centers have concluded that CAS with an embolic protection device is not inferior to carotid endarterectomy in high-risk patients and has been shown to have fewer complications in the short term. Methods. We report prospective data on fifty consecutive cases utilizing a standardized carotid protocol at our institution performed by a single operator. CAS was completed in 48 high-risk patients. The majority (96%) of procedures included embolic protection devices. Neurological examination and duplex scans were performed at baseline and in follow-up (1 month, 6 months, and 1 year). Long-term results were assessed retrospectively by telephone interview and chart review. Results. Angiographic success was obtained in all 50 cases. Neurological complications included one (2%) major stroke and one minor stroke (2%). One mortality occurred (2%) as a result of a major stroke. There was one non-neurologic complication. During 1 year of follow-up, there was one stroke. The reintervention rate at one year was 0%. There were no further strokes and one reintervention with long-term follow-up (average 2.6 years). Conclusions. In comparison to outcomes from academic centers and multi-center trials, our data suggest that carotid angioplasty and stenting with the use of an embolic protection device is safe and effective in high-risk patients when performed in a community hospital.
|
Infectious Contributions to Atherosclerosis and Vascular Disease: Do we really know the answer?
Learning objectives. At the conclusion of this activity, the participant should be able to: 1) Discuss rationale for previous use of antibacterial agents in cardiovascular disease trials and the current basis of evidence supporting or refuting further effort in this area; 2) Describe the importance of endpoint selection in clinical trials in this area as it relates to powering clinical studies; 3) Identify influences in patient populations that might affect the apparent impact of antibiotic therapy; 4) Describe the basis of evidence for various pathogens for their impact on cardiovascular disease; 5) Review the potential implications of chlamydia lifecycle and characteristics of vascular infection for selection of appropriate antibacterial therapies; 6) Describe the evidence and rationale for understanding why different vascular beds (coronary, peripheral, carotid) might demonstrate different results with antibiotic therapy. Activity instructions. Successful completion entails participants obtaining a score of at least 70% on the post-test. A certificate of completion will be mailed to the address listed on your post-test/evaluation form within 6 weeks of receipt of the documents. Estimated time to complete this activity: 1.5 hours Initial release date: July 31, 2006 Expiration date: July 31, 2007 Target audience: Physicians. Accreditation statements. Physicians (MD/DO):This activity is sponsored by the North American Center for Continuing Medical Education (NACCME) NACCME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. NACCME designates this continuing medical education activity for a maximum of 1.5 category 1 credits toward the AMA Physician?s Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with the ACCME Essential Areas and Policies. <
|
Aggressive Management of Cath-Related Femoral Artery Pseudoaneurysms and Arterio-Venous Fistulae: Can it be Justified?
Aggressive Management of Cath-Related Femoral Artery Pseudoaneurysms and Arterio-Venous Fistulae: Can it be Justified? Editor's Corner: Aggressive Management of Cath-Related Femoral Artery Pseudoaneurysms and Arterio-Venous Fistulae: Can it be Justified? Vascular Disease Management - ISSN: 1553-8036 - Volume 3 - Issue 6 - November 2006 - Pages: A2 - A4 Aggressive Management of Cath-Related Femoral Artery Pseudoaneurysms and Arterio-Venous Fistulae: Can it be Justified?
|
Endovascular Stent-Graft Repair of Dissection with Expanding Intramural Hematoma Following Renal Artery Stenting
Endovascular Stent-Graft Repair of Dissection with Expanding Intramural Hematoma Following Renal Artery Stenting Feature: Endovascular Stent-Graft Repair of Dissection with Expanding Intramural Hematoma Following Renal Artery Stenting - Nicolas W. Shammas, MS, MD, Eric J. Dippel, MD, Karen E. Butler, RTR Case Report: A 75-year-old male presented with recurrent episodes of flash pulmonary edema, angina, renal insufficiency (creatinine 2.1 mg/dl) and recurrent transient ischemic attacks. ...
|
|
|
|
|
