27 research outputs found
The role of carotid plaque echogenicity in baroreflex sensitivity
ObjectiveThe baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery.MethodSpontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4).ResultsSixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (χ2 = 8.0; P < .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (χ2 = 8.5; P < .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F [1, 42] = 10.1; P < .003).ConclusionsThese findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques
The effects of endogenous and exogenous androgens on cardiovascular disease risk factors and progression
Cardiovascular disease incidence rates have long been known to significantly differ between the two sexes. Estrogens alone fail to explain this phenomenon, bringing an increasing amount of attention to the role of androgens. Contrary to what was initially hypothesized, androgens seem to have an overall cardioprotective effect, especially in men. Recent studies and published data continue to support this notion displaying a consistent inverse correlation with atherosclerosis progression and cardiovascular disease both in regressive and prospective study models. Clinical studies have also revealed what seems to be a differential androgenic effect on various cardiovascular risk factors between men and women. Further insight indicates that in order to avoid confusion it may be also preferable to separately examine the effects of endogenous androgen levels from exogenous testosterone administration, as well as discern the differential results of low to normal and supraphysiological administration doses. This review summarizes old and recent data according to the above distinctions, in an attempt to further our understanding of the role of androgens in cardiovascular disease
Persistent type 2 endoleaks after endovascular aneurysm repair: why and when to intervene?
Contemporary Strategies in the Management of Civilian Neck Zone II Vascular Trauma
Neck trauma is the leading cause of death mainly in younger persons posing to surgeons the dilemma whether to proceed with reconstruction of vascular injuries either in the presence of coma or in severe neurological deficit. Vascular injuries in zone II predominate over the other injuries located in zones I/III of the neck. Conventional open repair of carotid injuries with primary closure or interposition grafting is always recommended due to the effective long-term results for penetrating injuries or for patients unfit for endovascular intervention. In cases of blunt trauma, anticoagulation or antiplatelet therapy should be administered first in neurologically stable patients. In case of worsening of the neurological status of the patient despite adequate anticoagulation endovascular means should be considered in cases of appropriate anatomy of the arterial trauma. We provide an update on penetrating/blunt trauma in zone II of the neck, giving emphasis on the anticoagulant and endovascular treatment
Concurrent Versus Two-Stage Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms
Doppler is a Safe Criterion for Ensuring the Implementation of Eversion Carotid Endarterectomy
Objective: This is a prospective study concerning patients with
symptomatic or asymptomatic significant carotid stenosis. Preoperative
and intraoperative measurements of the peripheral extension of the
carotid atherosclerotic plaque have been compared with postoperative
measurements to identify a preoperative method that safely allows the
performance of eversion carotid endarterectomy (ECEA).
Materials and Methods: The study included 37 patients with symptomatic
internal carotid stenosis greater than 70% and 43 patients with
asymptomatic stenosis greater than 80%. Four methods were used for
establishing criteria: preoperative Doppler examination, intraoperative
measurement of the carotid atheroma before artery division, measurement
of the removed plaque, and histological measurement of the plaque.
Results: Preoperative Doppler examination is a method of estimating the
actual distal extension of the internal carotid artery (ICA) atheroma,
with correction as dictated by the following formula:
AL = 0.6704+0.7685. Doppler
In all cases, preoperative ultrasound measurements and intraoperative
estimation confirmed the correct decision to proceed with the eversion
technique.
Conclusion: The peripheral extension of the atherosclerotic plaque of
the ICA can be assessed with accuracy by preoperative Doppler study,
which can be used with safety as a predicting criterion of the existence
of healthy peripheral carotid tissue that allows the performance of the
eversion endarterectomy technique
Concurrent Versus Two-Stage Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms
Neutrophil Gelatinase Associated Lipocalin (NGAL) as a Biomarker. Does It Apply in Abdominal Aortic Aneurysms? A Review of Literature
Neutrophil gelatinase associated lipocalin (NGAL) as a protein derived
from neutrophils has recently been the field of investigation in a wide
range of diseases (renal disease, coronary artery disease, etc). The
MEDLINE/PubMed database was searched for publications with the medical
subject heading “NGAL” and keywords “Abdominal aortic aneurysm
(AAA),” “biomarker,” and “growth”. We restricted our search
to date. In this review, we included 38 articles and abstracts that were
accessible and available in English. An effort to further explain the
role of NGAL within AAA has been made. NGAL seems to be a hopeful marker
for the pathogenesis and the progression of abdominal aortic aneurysms
(AAAs), which has significant morbidity and mortality rates