scholarly journals Cerebral Angiogenesis: A Realistic Therapy for Ischemic Disease?

2014 ◽  
pp. 21-24 ◽  
Author(s):  
David A. Greenberg
Keyword(s):  
Ischemic Disease

A 1-Donor 2-Recipient Superficial Temporal Artery-Middle Cerebral Artery Bypass for Moyamoya Syndrome: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Jacques J Morcos
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Anatomy ◽  
Large Area ◽  
Ischemic Disease ◽  
Near Occlusion ◽  
Direct Bypass

Abstract We present the case of a 34-yr-old male who suffered repeated ischemic events resulting in right-sided weakness. He was found to have left M1 segment near occlusion on angiography with a large area of uncompensated hypoperfusion. The patient underwent a direct superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Direct bypass in the acute setting of ischemia has been previously described.1-5 Moyamoya ischemic disease can be treated with either direct or indirect surgical revascularization. There have been several techniques developed for direct bypasses in moyamoya ischemic disease. These include the standard 1-donor 1-recipient (1D1R) end-to-side (ES) bypass, the “double-barrel” 2-donor 2-recipient (2D2R) ES bypass, and the more recently developed 1-donor 2-recipient (1D2R)6,7 utilizing both an ES and a side-to-side (SS) bypass with a 1-donor vessel. The case presentation, surgical anatomy, decision-making, operative nuances, and postoperative course and outcome are reviewed. The patient gave verbal consent for participating in the procedure and surgical video.

Left ventricular remodeling: is there a real impact of cardiac rehabilitation?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
NPD Cunha ◽  
I Aguiar-Ricardo ◽  
T Rodrigues ◽  
P Silverio Antonio ◽  
S Couto Pereira ◽  
...  
Keyword(s):  
Exercise Training ◽  
Left Ventricle ◽  
Cardiac Rehabilitation ◽  
Phase Ii ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ischemic Disease ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive.  Purpose Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram.  Methods Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP. Results 205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) <40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%).  After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF < 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device.  Conclusions A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.

Mendelian Randomization Focused Analysis of Vitamin D on the Secondary Prevention of Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Yap-Hang Chan ◽  
C. Mary Schooling ◽  
Jie Zhao ◽  
Shiu-Lun Au Yeung ◽  
Jo Jo Hai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vitamin D ◽  
Ischemic Stroke ◽  
Risk Score ◽  
Genetic Risk ◽  
Odds Ratio ◽  
Mendelian Randomization ◽  
De Novo ◽  
Genetic Risk Score ◽  
Ischemic Disease

Background and Purpose: Experimental studies showed vitamin D (Vit-D) could promote vascular regeneration and repair. Prior randomized studies had focused mainly on primary prevention. Whether Vit-D protects against ischemic stroke and myocardial infarction recurrence among subjects with prior ischemic insults was unknown. Here, we dissected through Mendelian randomization any effect of Vit-D on the secondary prevention of recurrent ischemic stroke and myocardial infarction. Methods: Based on a genetic risk score for Vit-D constructed from a derivation cohort sample (n=5331, 45% Vit-D deficient, 89% genotyped) via high-throughput exome-chip screening of 12 prior genome-wide association study–identified genetic variants of Vit-D mechanistic pathways ( rs2060793 , rs4588 , and rs7041 ; F statistic, 73; P <0.001), we performed a focused analysis on prospective recurrence of myocardial infarction (MI) and ischemic stroke in an independent subsample with established ischemic disease (n=441, all with prior first ischemic event; follow-up duration, 41.6±14.3 years) under a 2-sample, individual-data, prospective Mendelian randomization approach. Results: In the ischemic disease subsample, 11.1% (n=49/441) had developed recurrent ischemic stroke or MI and 13.3% (n=58/441) had developed recurrent or de novo ischemic stroke/MI. Kaplan-Meier analyses showed that genetic risk score predicted improved event-free survival from recurrent ischemic stroke or MI (log-rank, 13.0; P =0.001). Cox regression revealed that genetic risk score independently predicted reduced risk of recurrent ischemic stroke or MI combined (hazards ratio, 0.62 [95% CI, 0.48–0.81]; P <0.001), after adjusted for potential confounders. Mendelian randomization supported that Vit-D is causally protective against the primary end points of recurrent ischemic stroke or MI (Wald estimate: odds ratio, 0.55 [95% CI, 0.35–0.81]) and any recurrent or de novo ischemic stroke/MI (odds ratio, 0.64 [95% CI, 0.42–0.91]) and recurrent MI alone (odds ratio, 0.52 [95% CI, 0.30–0.81]). Conclusions: Genetically predicted lowering in Vit-D level is causal for the recurrence of ischemic vascular events in persons with prior ischemic stroke or MI.

Ischemic and non-ischemic dilated cardiomyopathy

Open Medicine ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Giovanni Fazio ◽  
Federica Vernuccio ◽  
Emanuele Grassedonio ◽  
Giuseppe Grutta ◽  
Giuseppe Lo Re ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Ischemic Disease ◽  
Coronary Imaging ◽  
Diagnostic Potential ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Cmr Imaging

AbstractDilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p<0.05). Using CMR imaging a post-myocarditis scar was diagnosed in 2 patients and a post-ischemic scar in 95% of patients with the chronic ischemic disease. The interleukin IL-1, IL-6 and TNF-α levels were higher in the post-ischemic group compared with the non-ischemic one. Conclusions. The use of second level techniques with a high sensitivity and specificity would help distinguish among different sub-forms of dilated cardiomyopathy.

scholarly journals Chronic white matter microvascular ischemic disease

2010 ◽  
Author(s):  
Mostafa El-Feky ◽  
The Radswiki
Keyword(s):  
White Matter ◽  
Ischemic Disease

scholarly journals Histopathological Analysis of the Pro-Arrhythmogenic Changes in a Suspected Chagas Disease Sudden Death

2020 ◽  
Vol 7 (1) ◽  
pp. 11-16
Author(s):  
Héctor O. Rodríguez ◽  
Keyword(s):  
Sudden Death ◽  
Chagas Disease ◽  
Vital Signs ◽  
Histopathological Analysis ◽  
Ischemic Disease ◽  
Chronic Myocarditis ◽  
Massive Necrosis ◽  
Structural Disease ◽  
Death Cases ◽  
Malignant Arrhythmias

Background Sudden death is the principal cause of fatality in Chagas disease, afflicting to non-symptomatic patients younger than 50-years. For this, sudden death associated with chagasic malignant arrhythmias is underdiagnosed and their pathophysiological basis is poorly understood. Aims In this sense, this work aimed to analyze the histopathological alterations in cardiac structures specialized in the generation/conduction of action potential in an anatomopathological case of non-diagnosed sudden death living in a Chagasic endemic area. Methods The donor was a woman, 62-year-old, which ingressed without vital signs to the emergency room of “Antonio María Pineda” hospital, without any apparent antecedents of cardiac disease. The gross examination was normal, with no external evidence of structural/ischemic disease. Results Microscopic examination revealed nodal like cell depopulation, microvascular disturbances, chronic myocarditis with mononuclear and mast cell infiltrate plus extracellular matrix reaction, and profuse damage of neural structures placed in nodal region. Amastigote nest of Trypanosoma cruzi (T. cruzi) was detected. Conclusion These findings suggest a complex association among parasite persistence, sinus disease, micro-ischemia foci, and neural inflammation in the genesis of malignant arrhythmias of Chagas disease despite the absence of structural disease or massive necrosis. It is important to perform a protocol of examination for no explained sudden death cases in chagasic endemic countries, to avoid misdiagnosed of sudden death associated with Chagas disease.

Changing the logic of therapeutic angiogenesis for ischemic disease

2005 ◽  
Vol 11 (5) ◽  
pp. 207-216 ◽  
Author(s):  
Costanza Emanueli ◽  
Paolo Madeddu
Keyword(s):  
Therapeutic Angiogenesis ◽  
Ischemic Disease
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