Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center

OBJECTIVES: Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment. METHOD: A retrospective analysis of patients who underwent carotid artery stenting by our interventional neuroradiology team was conducted. Patients were divided into two groups: symptomatic and asymptomatic patients. The primary endpoints were ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage and major adverse cardiac and cerebrovascular events at 30 days. The secondary endpoints included ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage, ipsilateral transient ischemic attack and major adverse cardiac and cerebrovascular events between the 1- and 12-month follow-ups. RESULTS: A total of 200 consecutive patients were evaluated. The primary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral stroke (2.4% vs. 2.7%, p = 1.00), ipsilateral parenchymal hemorrhage (0.8% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (4.7% vs. 2.7%, p = 0.71). The secondary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral ischemic stroke (0.0% vs. 0.0%), ipsilateral parenchymal hemorrhage (0.0% vs. 0.0%), ipsilateral TIA (0.0% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (11.2% vs. 4.1%, p = 0.11). CONCLUSIONS: In this retrospective study, carotid artery stenting was similarly safe and effective when performed as a first-intention treatment in both symptomatic and asymptomatic patients. The study results comply with the safety requirements from current recommendations to perform carotid artery stenting as an alternative treatment to carotid endarterectomy

Incidence and prognosis of transient ischemic attack in Brazil: a population-based study

INTRODUÇÃO: as doenças cerebrovasculares (DCVs) estão entre as principais causas de mortalidade e morbidade no Brasil e no mundo. O ataque isquêmico transitório (AIT) - DCV evanescente que prediz um evento isquêmico definitivo em até 40% dos casos - é uma entidade de extrema importância, porém de difícil caracterização epidemiológica, especialmente nas populações brasileiras. Objetivamos entender o perfil epidemiológico dos pacientes com AIT e os possíveis fatores relacionados a prognóstico e risco de recorrência de eventos vasculares graves em um estudo de base populacional realizado no município de Matão-SP. MÉTODOS: partindo de estudo epidemiológico de base populacional prospectivo de DCVs, em vigor no município de Matão-SP, levantamos retrospectivamente todos os casos de AIT registrados no único hospital desta cidade, com a perspectiva de relacionar estatisticamente os fatores epidemiológicos e clínicos pregressos com os desfechos de recorrência de novo evento cerebrovascular, mortalidade e eventos cardiovasculares graves (MACE, do Inglês Major Adverse Cardiovascular Events), através de estatística descritiva e inferencial. Além disso, realizamos análise comparativa de incidência de AIT com padronização estratificada por faixa-etária, confrontando-a com população nacional e internacional. RESULTADOS: identificamos 55 casos de AIT de um total de 783 eventos de DCVs, entre 2015 e 2020, com uma incidência total de 0,16 caso/mil habitantes/ano e mortalidade de 0,0018 caso/mil habitantes/ano. Destes, 6 sofreram novo evento cerebrovasculares e 15(27,27%) sofreram algum desfecho MACE, com hipertensão arterial sistêmica previa, uso prévio de antitrombóticos, histórico de coronariopatia e história familiar de AVC sendo relacionados ao desfecho combinado. A incidência de nova DCV foi de 87/100.000 habitantes adultos, e 2,18%/ano para a casuística de AIT. A incidência anual de MACE foi de 21 eventos/100.000 habitantes e 5,42% ao ano para a casuística de AIT. Nesta casuística de pacientes com AIT, a presença de doença arterial coronariana prévia foi o principal preditor de ocorrência de MACE (OR: 20,571; intervalo de confiança 95%: 1,98-212,7; p:0,004) CONCLUSÕES: a incidência estimada do AIT na cidade de Matão-SP está próxima a esperada para o Brasil, porém aquém da incidência esperada no comparativo com população internacional, o que sugere uma possível subnotificação e identificação de casos de AIT no município e em nosso país, e alerta para a necessidade de medidas de educação populacional e de serviços de saúde na região. Resultados também sugerem uma alta taxa de recorrência de eventos vasculares graves nos pacientes com AIT no Brasil, especialmente nos indivíduos com doença arterial coronariana prévia.INTRODUCTION: cerebrovascular diseases are among the main causes of mortality and morbidity in Brazil and worldwide. Transient ischemic attack (TIA) - an evanescent cerebrovascular event that predicts a definitive ischemic event in up to 40% of cases - is an extremely important entity, but with difficult epidemiological characterization, especially in Brazilian populations. We aimed to understand the epidemiological profile of TIA patients and possible factors related to the recurrence of major cardiovascular events (MACE) in a populational based study in the city of Matão-SP. METHODS: based on a prospective CVD database of the city of Matão-SP, we retrospectively surveyed all TIA registered cases, aiming to relate epidemiological and clinical factors with recurrence of new cerebrovascular events, mortality, and Major Adverse Cardiovascular Events (MACE), through descriptive and inferential statistics. Also, we compared the incidence of TIA with other populations (both national and international), through age standardization. RESULTS: we identified 55 cases of TIA out of 783 CVDs cases between 2015 and 2020, with a total incidence of 0.16 cases/thousand inhabitants/year and mortality of 0.0018 cases/thousand inhabitants/year. Of these, 6(10.9%) suffered a new cerebrovascular event and 15 (27.27%) had a MACE, and previous systemic arterial hypertension, previous use of antithrombotics, history of coronary disease and family history of stroke were related to combined outcome. The incidence of new CVD was 87 per 100,000 adult inhabitants, and 2.18%/year for TIA series. The annual incidence of MACE was 21 events per 100,000 inhabitants and 5.42%/year for the TIA series. In this populational sample of TIA patients, previous symptomatic coronary artery disease was the strongest predictor of MACE (OR: 20.571; 95% confidence interval: 1.98-212.7; p:0.004). CONCLUSIONS: the estimated incidence of TIA in the city of Matão-SP is close to that expected for Brazil, but below the expected incidence in comparison with international population, which highlights the relevance of a structured prospective database, demonstrates the possible underreporting and identification of TIA cases in the municipality and in the country and alerts to the need for population education measures and health services in the region. Our results also suggest a high rate of recurrence of MACE in TIA patients in Brazil, especially in those with previous coronary artery disease

Optic nerve sheath ultrasonography to assess predictors of neurological deterioration in patients with traumatic brain injury

INTRODUÇÃO: O Traumatismo Cranioencefálico (TCE) é uma das maiores causas de mortalidade e incapacidade em adultos em todo o mundo. Uma complicação frequente e precoce do TCE é o desenvolvimento de hipertensão intracraniana, cujo diagnóstico e tratamento intensivo geralmente requer monitorização invasiva da pressão intracraniana (PIC); o interesse científico neste campo é crescente. Neste contexto, estudos recentes têm demonstrado que é possível detectar hipertensão intracraniana de forma não-invasiva através da aferição ultrassonográfica do diâmetro da bainha do nervo óptico (BNO), utilizando-se ultrassonografia do nervo óptico (USNO) com insonação pela janela transorbitária. Não se sabe ainda, entretanto, se essa aferição do diâmetro da BNO por USNO tem um real significado prognóstico quando aplicada em pacientes na fase aguda de um TCE. Neste estudo, objetiva-se avaliar o valor prognóstico da aferição do diâmetro da BNO por USNO, avaliada na admissão, em pacientes vítimas de TCE moderado e grave. MÉTODOS: Avaliaramse prospectivamente pacientes vítimas de TCE moderado ou grave (pontuação =4 à alta, mesmo após ajuste para idade e GCS na admissão. CONCLUSÕES: Uma maior distensão da bainha do nervo óptico nas primeiras 24 após TCE moderado a grave está independentemente associada a pior déficit neurológico e capacidade funcional à alta. Esses resultados sugerem que a USNO deve ser mais explorada como método com potencial para orientar medidas terapêuticas intensivas de neuroproteção e controle de hipertensão intracraniana na fase aguda do TCE.BACKGROUND: Traumatic brain injury (TBI) is a major cause of mortality and disability among adults worldwide. Intracranial hypertension is a frequent and early complication in such patients and its diagnosis and intensive management often require invasive monitoring of intracranial pressure (ICP). In this context, recent studies have shown that it is possible to non-invasively detect intracranial hypertension by ultrasound measurement of optic nerve sheath diameter (ONSD), using optic nerve ultrasound (ONUS) with trans-orbital window insonation. It is still unclear, however, whether the ONSD measurement through ONUS has real prognostic significance when applied to patients in the acute phase of a TBI. In this study, we aimed to evaluate the prognostic value of ONSD measurement by ONUS at admission in patients with moderate and severe TBI. METHODS: We prospectively evaluated patients with moderate or severe TBI (score =4 at discharge. CONCLUSIONS: Increased distension of the optic nerve sheath in the first 24 after a moderate to severe TBI is independently associated with a worse neurological and functional outcome at discharge. Our results indicate that additional studies should be performed to test ONUS as a method with potential to guide intensive therapeutic measures of neuroprotection and intracranial hypertension control in the acute phase after TBI

Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center

OBJECTIVES: Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment. METHOD: A retrospective analysis of patients who underwent carotid artery stenting by our interventional neuroradiology team was conducted. Patients were divided into two groups: symptomatic and asymptomatic patients. The primary endpoints were ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage and major adverse cardiac and cerebrovascular events at 30 days. The secondary endpoints included ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage, ipsilateral transient ischemic attack and major adverse cardiac and cerebrovascular events between the 1- and 12-month follow-ups. RESULTS: A total of 200 consecutive patients were evaluated. The primary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral stroke (2.4% vs. 2.7%, p = 1.00), ipsilateral parenchymal hemorrhage (0.8% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (4.7% vs. 2.7%, p = 0.71). The secondary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral ischemic stroke (0.0% vs. 0.0%), ipsilateral parenchymal hemorrhage (0.0% vs. 0.0%), ipsilateral TIA (0.0% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (11.2% vs. 4.1%, p = 0.11). CONCLUSIONS: In this retrospective study, carotid artery stenting was similarly safe and effective when performed as a first-intention treatment in both symptomatic and asymptomatic patients. The study results comply with the safety requirements from current recommendations to perform carotid artery stenting as an alternative treatment to carotid endarterectomy

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved