scholarly journals Balloon expandable Stent utility for early Secondary Prevention of new Cerebral Ischemic events Caused by Intracranial Atherosclerotic Stenosis. Technical Nuances

2022 ◽  
Vol 11 (1) ◽  
pp. 01-10
Author(s):  
Orlando Villarreal-Barrera ◽  
Gustavo Melo-Guzman ◽  
Juan Isidro Ramirez-Rodriguez ◽  
Jonathan Ortiz-Rafael ◽  
Emma Del Carmen Macias-Cortes ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Secondary Prevention ◽  
Cerebral Artery ◽  
Statistical Significance ◽  
Categorical Variables ◽  
Intracranial Atherosclerotic Disease ◽  
Atherosclerotic Stenosis ◽  
Cerebral Ischemic ◽  
Ischemic Events

Objective: Recurrent cerebral ischemic events are estimated to appear in between 12-15% of symptomatic intracranial atherosclerotic disease (ICAD), regardless of the use of leading pharmacological therapies. Balloon expandable stent (balloon mounted coronary stent) could represent a feasible alternative in this disease’s treatment. This study pretends to report the balloon-expandable placement experience in our center. Materials and Methods: A unicentric retrospective study dated between September 2009 and March 2018 was conducted. Patients previously diagnosed with ICAD and symptomatic stenosis treated with balloon-expandable stent were included. Clinical features, morbidity, mortality, short and long-term evolution, and pre-and post-treatment angiographic features were analyzed, as well as a mean 8 years-period follow-up. Data are presented as means, frequencies, and percentages for categorical variables, and ranks for continuous variables. Statistical analysis was carried by IBM SPSS Statistics Base V22.0 (IBM Corporation, Mexico). A Wilcoxon Signed-rank test statistical analysis was performed. Statistical significance was considered when a p-value lesser than 0.05 was measured for every result. Results: A total of 6 patients with 7 affected vessels were treated, with an average age of 62.7 years. Affected and treated vessels were located in the Internal Carotid Artery (ICA) segment in 42.9%, Vertebral Artery (VA) V4 segment in 14.3%, Middle Cerebral Artery (MCA) M1 segment in 28.5%, and Posterior Cerebral Artery (PCA) P1 segment in 14.3%. The incidence of peri-operatory thrombotic events was 0%. Intracranial hemorrhage presented in 0% of cases. Recurrent ischemic or thrombotic events were not reported in a 97-months mean follow-up. 71.4% of patients scored ≤2 in the modified Rankin Score (mRS) pre-treatment, in a 90 day and 12-month follow-up. 100% presented a favorable evolution with mRS ≤2. Restenosis cases were not reported in radiologic control and retreatment was not needed in a 97-month mean follow-up. Conclusions: This study suggests that balloon-expandable stent therapy with some technical endovascular variants for its navigation and placement could be a safe and effective alternative in the treatment of ICAD as a means of cerebral ischemic event early secondary prevention. We propose to consider not to limit endovascular treatment exclusively to those symptomatic ICAD patients refractory to medical-exclusive treatment, as a means to reduce the risk of presenting a new neurological deficit. Further expanded clinical trials are needed to confirm these findings and the advantage of this kind of stents against other kinds reported in the literature.

scholarly journals Balloon-expandable stents for treatment of symptomatic middle cerebral artery stenosis: Clinical outcomes during long-term follow-up

2018 ◽  
Vol 24 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Sung Hyun Baik ◽  
Hyo Sung Kwak ◽  
Gyung Ho Chung ◽  
Seung Bae Hwang
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Reperfusion Therapy ◽  
Stent Insertion ◽  
Recurrence Rates ◽  
Long Term Follow Up ◽  
Ischemic Events

Background Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. Results Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0–2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. Conclusions In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up.

Abstract TMP92: Higher Risk of Ischemic Events in Secondary Prevention for Patients With Persistent Versus Paroxysmal Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Masatoshi Koga ◽  
Sohei Yoshimura ◽  
Yasuhiro Hasegawa ◽  
Satoshi Shibuya ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Chads2 Score ◽  
Multicenter Observational Study ◽  
Hemorrhagic Events ◽  
Anticoagulated Patients ◽  
Prospective Multicenter Observational Study ◽  
Ischemic Events

Background and purpose: The discrimination between paroxysmal and persistent atrial fibrillations (AF) has not been considered to guide secondary stroke prevention, because it remains unclear whether patients with persistent AF are at higher risk compared with paroxysmal AF, particularly in secondary prevention. We aimed to assess the differences in clinical outcomes between mostly anticoagulated patients with persistent vs. paroxysmal AF who had ischemic stroke or TIA. Methods: Using interim data of 1192 nonvalvular AF (NVAF) patients with acute ischemic stroke or TIA who were registered in the SAMURAI-NVAF study (an ongoing prospective, multicenter, observational study) to determine choice of anticoagulantion therapy and clinical outcomes, we divided patients into those with paroxysmal AF and those with persistent AF. We compared clinical outcomes between the 2 groups. Results: The median follow-up period was 1.0 year (IQR 0.3-2.0). Of the 1192 patients, 434 (191 women, 77.3±10.0 y.o.) and 758 (336, 77.9±9.9) were assigned to the paroxysmal AF group and persistent AF group, respectively. Of each group, 220 (50.7%) and 442 (58.3%) were anticoagulated with warfarin and 199 (45.9%) and 276 (36.4%) were so with non-vitamin K antagonist oral anticoagulant (NOAC) (p=0.004). As for primary outcomes, 30 (6.2%/person-year) and 78 (9.9) ischemic events, respectively [hazard ratio adjusted for sex, age, initial NIHSS, CHADS2 score, creatinine clearance, anticoagulation with warfarin (vs. NOAC) (HR) 0.65; 95% CI 0.42-0.98], and 18 (4.9%/person-year) and 31 (3.8) hemorrhagic events, respectively (HR 0.97, 0.52-1.75), occurred during follow-up. As for secondary outcomes, the person-year rate of ischemic stroke or TIA was 3.9% and 8.4%, respectively (HR 0.46, 0.27-0.76), that of intracranial hemorrhage was 1.6% and 1.7%, respectively (HR 0.97, 0.36-2.37), and that of death was 11.1% and 15.7%, respectively (HR 0.90, 0.64-1.26). Conclusions: Among patients with prior ischemic stroke or TIA, those with persistent AF had a higher risk of ischemic events, and ischemic stroke or TIA compared with those with paroxysmal AF. The prevention of progress to persistent AF from paroxysmal AF may be beneficial for secondary prevention in patients with NVAF.

scholarly journals Predictors of Successful Smoking Cessation in a Family Practice-Based Cardiovascular Risk Factor Intervention Program: ‘Real-World’ Experience From the Heartwatch Program

2010 ◽  
Vol 5 (2) ◽  
pp. 151-157
Author(s):  
Catherine McGorrian ◽  
Moira Lonergan ◽  
Cecily Kelleher ◽  
Leslie Daly ◽  
Patricia Fitzpatrick
Keyword(s):  
Smoking Cessation ◽  
Secondary Prevention ◽  
Intervention Program ◽  
Statistical Significance ◽  
Logistic Regression Models ◽  
Established Coronary Artery Disease ◽  
Stop Smoking ◽  
Baseline Factors ◽  
Artery Disease

AbstractHeartwatch is an Irish primary care-delivered secondary prevention program for patients with established coronary artery disease (CAD). We aimed to describe the patterns of smoking cessation in Heartwatch and examine the associates of successful smoking cessation. Participants with established CAD were invited to baseline and three-monthly clinic visits. Data on all persons reporting tobacco use at baseline were examined. Associations between smoking cessation and baseline factors were examined using logistic regression models. Data were available on 1,679 Heartwatch patients who were smoking at first visit. One third of smokers (581 participants: 34.6%) achieved smoking cessation during the study period (2003 to 2007), 80.4% of whom remained nonsmokers at end of follow-up. Positive associates of successful smoking cessation included increasing age, male sex, a body mass index > 25 and increasing number of study visits. Negative associates included having a means-tested general medical services allocation, being unemployed, and documentation of stop-smoking advice. All factors except employment status retained statistical significance when examined in a multivariable model. In conclusion, high levels of smoking cessation were achieved in this secondary prevention population of persistent smokers. Associates of successful smoking cessation were identified. Specific stop-smoking strategies should be considered for those subpopulations less likely to quit.

scholarly journals Spinal biopsies: a clinicopathologic review of 53 cases diagnosed between 2011 and 2018 at a tertiary hospital in Kampala, Uganda

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
James J. Yahaya
Keyword(s):  
Spinal Cord ◽  
Statistical Analysis ◽  
Early Diagnosis ◽  
Statistical Difference ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Categorical Variables ◽  
Ethical Approval ◽  
The Mean ◽  
Malignant Neoplasia

Abstract Background Early diagnosis of spinal cord neoplasia serves patients from developing a number of complications and even death. Methods After obtaining ethical approval, retrospectively, a total of 53 tissue blocks of patients attended at the spinal ward were reviewed. Statistical analysis was done using SPSS version 20.0, and p value of less than 0.05 was applied to establish the existence of statistical significance between the compared categorical variables. Results The mean age of the patients was 30.7 ± 15.96 years. Most of the patients 32.1% (n = 17) were aged ≤ 19 years, and majority of the neoplasia 77.3% (n = 41) were extramedullary. Also, majority of the neoplasia 60.4% (n = 32) were benign and the malignant ones were 35.8% (n = 19). The mean duration of onset of symptoms for benign and malignant neoplasia in this study was 13.1 ± 16.4 and 3.4 ± 2.8 years, respectively, with statistical difference (95% CI 2.09–17.35, p = 0.014). Conclusion The patients with spinal cord neoplasia in the present study were of young age, and majority of them had benign neoplasia that were extramedullary located. The mean duration of onset of symptoms for patients with malignant neoplasia was significantly shorter than that of benign neoplasia.

scholarly journals Evaluation of axillary response to neoadjuvant chemotherapy in luminal breast carcinoma treated in caism-unicamp between 2013 and 2018

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Pedro Lavigne de Castello Branco Moreira ◽  
César Cabello dos Santos ◽  
Renato Zocchio Torresan ◽  
Fabrício Palermo Brenelli ◽  
Susana Oliveira Botelho Ramalho
Keyword(s):  
Breast Cancer ◽  
Statistical Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Axillary Dissection ◽  
Statistical Significance ◽  
Malignant Neoplasm ◽  
Nonparametric Tests ◽  
Categorical Variables ◽  
Convenience Sample ◽  
Response To Neoadjuvant Chemotherapy

Introduction: Breast cancer is the most common malignant neoplasm affecting the female gender (besides non-melanoma skin cancer). It is a heterogenous disease with different phenotypic subtypes; the most common subtype is the luminal-like, which presents poor response to neoadjuvant chemotherapy. If patients with positive axilla at diagnosis are submitted to surgery, axillary dissection must be carried out, which is a surgery with major morbidities; however, if the patients are treated with neoadjuvant chemotherapy and develop negative axillary disease, they can avoid axillary dissection. Objective: to assess axillary response to neoadjuvant therapy in patients with cT1-3 cN1-2 luminal-like breast cancer. The secondary objectives were to assess the association between the axillary response to neoadjuvant chemotherapy according to: tumor replication marker (Ki67), estrogen and progesterone receptors (ER and PR), tumor histological grade, according to the Nottingham classification, tumor size (cT), level of axillary compromise (cN1, cN2 or cN3), chemotherapy scheme, luminal subtype and epidemiological variables (age, BMI, menopause status). Method: reconstituted cohort including female patients diagnosed with invasive breast cancer stage cT1-3 cN1-2 M0 at physical or ultrasound examination, who received neoadjuvant chemotherapy. Axillary compromise can be assumed. The patients were followed-up at the ambulatory of Clinical Oncology and Mastology at CAISM UNICAMP. A convenience sample was used. Statistical analysis: Statistical analysis will be carried out using the Statistical Package for the Social Sciences, version 22.0 (SPSS). Correlations between categorical variables will be analyzed with the chi-square test. Differences between means will be verified using Student’s t-test. Nonparametric tests will be used according to necessity. All tests will be bicaudal, with 5% as the threshold of statistical significance. Results: One hundred and forty three cases were included, respecting the inclusion criteria. Of these, 2.8% evolved with pathological complete response per se (pCR); 5.6%, with pCR in the breast; and 23.1%, with axillary pCR. The lower the axillary compromise at diagnosis, the higher the frequency of axillary pCR (cN1 26.7%, cN2-3 11.1% - p=0.049). The smaller the residual lesion in the breast after chemotherapy (ycT), the higher the chances of axillary pCR (ycT0 28.8%, ycT1 38.5%, ycT2 9.7%, ycT3-4 0 cases – p=0.042). The anthropometric, immunohistochemical and anatomopathological parameters did not present statistical relevance. Conclusion: Patients with luminal-like breast cancer and axillary compromise at diagnosis may benefit from avoiding dissection in about 20% of the time if treated with neoadjuvant chemotherapy, so this therapeutic strategy should be considered in these cases.

scholarly journals Comparative Evaluation of the Radiopacity of Bone Graft Materials used in Dentistry

2017 ◽  
Vol 7 (3) ◽  
pp. 150-155 ◽  
Author(s):  
Emine S Kursun-Çakmak ◽  
Nihat Akbulut ◽  
Dogan D Öztas
Keyword(s):  
Statistical Analysis ◽  
Bone Graft ◽  
Bone Tissue ◽  
Optical Density ◽  
Comparative Evaluation ◽  
Statistical Significance ◽  
Radiographic Images ◽  
X Ray ◽  
Materials Used

ABSTRACT Introduction Ample radiopacity in order to distinguish from the surrounding tissues is a desirable property of dental graft materials. A total of 15 bone graft materials’ (BGMs) opacities were analyzed in this study. Materials and methods Graft materials were placed in the implant cavity (5 × 10 mm) in cadaver's mandible respectively. Cavity was exposed by using periapical film and a dental X-ray machine at 70 kVp and 8 mA. The optical density of the radiographic images was measured with a transmission densitometer. One-way analysis of variance (ANOVA) was conducted for statistical analysis. Results Among the materials tested, the most radiolucent bone grafts were Grafton and Allogenix with a statistical significance of p ≥ 0.05. 4Bone and Bego Oss exhibited the highest radiopacity with a statistical significance of p ≥ 0.05. Inadequate radiopacity of the dental graft materials may lead to confusion among clinicians in the radiographical follow-up. Among 15 BGMs tested, only three had higher density than bone tissue. Conclusion The radiopacity of the BGM was found to be higher than bone at only three of them. How to cite this article Kursun-Çakmak ES, Akbulut N, Öztas DD. Comparative Evaluation of the Radiopacity of Bone Graft Materials used in Dentistry. J Contemp Dent 2017;7(3):150-155.

Abstract MP48: Intracranial Dolichoectasia in Patients With Symptomatic Intracranial Atherosclerotic Disease: The Myriad Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Victor J Del Brutto ◽  
Azhar Nizam ◽  
george cotsonis ◽  
Iszet Campo-Bustillo ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Brain Mri ◽  
Early Recurrence ◽  
Atherosclerotic Disease ◽  
Common Finding ◽  
Stroke Recurrence ◽  
Entire Cohort ◽  
Intracranial Atherosclerotic Disease ◽  
Study Population ◽  
Ischemic Events

Background: It is unknown whether intracranial atherosclerotic disease (IAD), in addition to vessel narrowing, also contributes to the abnormal dilation and increased tortuosity of intracranial vessels, a condition known as intracranial dolichoectasia (IDE). We aim to determine the degree to which these two arteriopathies coexist and whether IDE correlates with subsequent ischemic events in patients with recently symptomatic moderate-to-severe IAD. Methods: The study included 99 patients (mean age 6311 years; 57% men) enrolled in the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) study. Intracranial vessels diameter, length, and tortuosity were determined by semiautomatic vessel segmentation and were considered abnormal if ≥2 standard deviations from the study population mean. Either ectasia (increased diameter) or dolichosis (increased tortuosity) defined IDE. We assessed the correlation of IDE in the symptomatic vessel with the composite outcome of either new infarcts in the territory of the affected vessel on brain MRI performed at 6-8 weeks from the index event or stroke recurrence during 12-month follow up. Results: IDE prevalence was 34% (isolated ectasia 8%, isolated dolichosis 18%, and both ectasia and dolichosis 8%) and 14% of symptomatic vessels. Patients with and without IDE had similar demographics and vascular risk factors prevalence (Table). I Twenty-two out of 85 (26%) patients with brain MRI at 6-8 weeks had new infarct(s) in the territory and 9% of the entire cohort had stroke recurrence during follow-up. Coexistence of IAD and IDE in the target vessel was not associated to subsequent ischemic events (21.4% versus 29.4%; P=0.54). Conclusion: IDE is a common finding in patients with moderate-to-severe IAD. Superimposed IDE did not increase the already heightened risk of subsequent ischemic events in patients with symptomatic IAD. ClinicalTrials.gov Identifier: NCT02121028

scholarly journals Comparison of Uncomfortable Loudness Level in Stapedotomy with or without Stapedial Tendon Preservation

2021 ◽  
Vol 27 (2) ◽  
pp. 117-123
Author(s):  
Tamanna Nawshin ◽  
Kanu Lal Saha ◽  
Shah Sohel ◽  
Sabyasachi Talukdar ◽  
Sheikh Mohammad Tanjil Ul Alam
Keyword(s):  
Statistical Significance ◽  
Pure Tone Audiometry ◽  
Neck Surgery ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Group I ◽  
Loudness Level ◽  
Group Ii

Background: Otosclerosis is one of the commonest diseases of the ear mostly involves the otic capsule. Most often otosclerotic foci appear in stapes region leading to stapes fixation, predominantly affect the adolescence female. The most common presenting symptom of clinical otosclerosis is conductive deafness. The mainstay of treatment for otosclerosis is surgery. Surgical options include stapedectomy, stapedotomy with or without stapedial tendon preservation. The latter being is the procedure of choice. Aim: The aim of this study is to compare the outcome of uncomfortable loudness level in stapedotomy with or without stapedial tendon preservation. Methods: A prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months in patients with otosclerosis. Total 30 subjects were selected based on the inclusion and exclusion criteria. All patients were assessed pre-operatively by clinical examination, otoscopy and microscopic examination. Hearing was assessed by pure tone audiometry. Uncomfortable level and stapedial reflex threshold were tested in all cases. The selected cases were placed into two groups. Stapedial tendon resection in Group-I and stapedial tendon preservation in Group-II. Post-operative follow up was done at 3 months and 6 months. Hearing and uncomfortable loudness level were evaluated with PTA during follow up by calculating the average of 500Hz, 1000Hz, 2000Hz and 4000HZ. The data were calculated manually. The statistical significance was set to P< 0.05. Results of the study were expressed as mean, standard deviation (± SD), frequency and percentages. Means and standard deviations were reported for continuous variables. Frequencies and percentages were reported for categorical variables. Unpaired Student’s t test was done to compare the continuous variables and Chi Square test was done to compare the categorical variables. Results: In this study preoperative average ABG for group I and group II were 35 ± 4.57 dB and 34 ± 4.17 dB respectively. In group I, post operative average ABG after 3 months and 6 months were 14 ± 3.7 dB and 13±3.3 dB respectively. Post operative average ABG after 3 months was 13 ± 5.7 dB and was 12 ± 4.4 dB for group II. But the hearing improvement between two groups was not statistically significant. In case of preoperative mean UCL was 95 ± 1.8 dB and 96 ± 2.5 dB for group I and group II respectively. Postoperative mean UCL after 3 months was 96 ± 3.57 dB and after 6 months was 99 ± 6.28 dB in group I. For group II, postoperative mean UCL after 3 months and 6 months was 107±4.2 dB and 113 ± 3.2 dB respectively. Here mean UCL was on average 11 dB higher for group II in 3 months and additional 6 dB improvement noted after 6 months, but show minimal change in group I. This finding was statistically significant. Conclusion: Preservation of the stapedial tendon is the choice in the surgical treatment of otosclerosis which helps to improve functional outcomes as well as to provide the more physiologic protection of middle ear. Postoperative discomfort threshold levels were increased in patients who had their stapedial tendon restored. Bangladesh J Otorhinolaryngol 2021; 27(2): 117-123

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