Impact of Carotid Artery Stenosis on Quality of Life: A Systematic Review

© 2018, Springer Nature Switzerland AG. Objectives: The aim of this study was to identify themes that determine health-related quality of life (HRQoL) in patients with carotid artery stenosis and identify the patient-reported outcome measures (PROMs) that best cover the identified themes. Methods: A systematic review of the main six databases from inception to September 2018 was undertaken to identify primary qualitative studies reporting on the HRQoL of patients with carotid artery stenosis. The quality of studies was assessed using the Critical Appraisal Skills Programme (CASP) criteria. Findings from the included studies were analysed using framework analysis methodology. The identified themes were mapped against the items/domains from the PROMs used previously in patients with carotid artery stenosis. Results: The systematic review identified four papers that fulfilled the inclusion criteria. The included papers reported the views of 62 patients with symptomatic carotid artery stenosis; 24 of the patients were awaiting assessment for intervention, 26 had carotid endarterectomy, and 12 were turned down for intervention and received best medical therapy. The overall quality of the included studies was good based on CASP criteria. Framework analysis identified 16 themes that were divided into five main domains: anxiety, impact on personal roles and activities, effect on independence, psychological impact, and symptoms. The best-fit generic and disease-specific PROMs were the Medical Outcomes Study 36-Item Short Form (SF-36®) and the Carotid Stenosis Specific Outcome Measure (CSSOM), respectively. None of the PROMs covered all the themes identified in the qualitative systematic review. Conclusion: The findings from the review identified the important themes that affect patients with carotid stenosis disease. The current generic and disease-specific PROMs do not cover all themes that impact the HRQoL of patients suffering with this disease. The proposed themes can be used to develop a new disease-specific PROM to measure HRQoL

Bepaling van histamine en 1-methylhistamine in humaan plasma met behulp van hoge-druk vloeistofchromatografie en fluorescentie detectie

Voor de bepaling van histamine en 1-methylhistamine (=Nt-methylhistamine=histamine metaboliet) in humaanplasma is de vloeistofchromatografische methode gebruikt. De uit het plasma geextraheerde histaminen werden met behulp van fluorescamine gederivatiseerd tot fluorescerende verbindingen. De derivaten werden met behulp van HPLC gescheiden op een octadecylsilica-kolom met als eluens een mengsel van 25 mM fosfaatbuffer (pH=9.1)/ acetronitril. De derivaten werden met behulp van een fluorescentiedetector gedetecteerd. De binnen laboratorium reproduceerbaarheid varieerde voor histamine tussen 52-7% (n=2) binnen het concentratiegebied van 1.7-24.7 mug/l en dat voor het 1-methylhistamine varieerde van 86-41% (n=2) binnen het concentratiegebied van 1.4-20.4 mug/l. Deze waarden waren voor histamine acceptabel maar te hoog voor het kwantitatief bepalen van 1-methylhistamine.This report describes a method for the determination of histamine and 1-methylhistamine (=Nt-methylhistamine) in samples of human plasma. The analytes were extracted from the sample using a cation-exchange solid-phase extraction cartridge and derivatized to fluorescense compounds with fluorescamine. The derivatives were detected using a fluorescence detection. The standard curve for histamine was linear within the range of 1.7-24.7 mug/l and for 1-methylhistamine within the range of 1.4-20.4 mug/l. The within-laboratory reproducibility for histamine varied from 52-7% (n=2) for the concentration range of 1.7-24.7 mug/l. The within-laboratory reproducibility for 1-methylhistamine varied from 86-41% (n=2) for the concentration range of 1.4-20.4 mug/l. These values were acceptable for histamine but too high for accurate quantification of 1-methylhistamine.IG

Evaluation of proximal protection devices during carotid artery stenting as the first choice for embolic protection

Aims: To assess the use of proximal protection devices in consecutive patients as the preferred means of cerebral embolic protection for primary carotid stenting. Methods and results: This was a prospective single-centre study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic (≥50%) and asymptomatic (≥70%) carotid stenosis. Proximal protection devices were used for embolic protection in 124 consecutive patients. No patients were excluded for anatomical reasons. The GORE® Flow Reversal System (W.L. Gore, Flagstaff, AZ, USA) was used in 92 patients, and the Mo.Ma Ultra device (Medtronic, Minneapolis, MN, USA) in 32 patients. Follow-up duration was 30 days. Mean age was 71±8 years. Seventy-five percent of patients were male (n=93). Twenty-six of 124 (21%) treated stenoses were symptomatic. Technical success was achieved in 122 of 124 cases (98%). Due to anatomical conditions, in two patients flow reversal could not be established. In both cases additional distal filter devices were used. Carotid stenting was successful in 124 lesions (100%). Ten patients (8.1%) had contraindications to flow reversal (three high-grade ostial stenoses of the external carotid artery, seven contralateral occlusions of the internal carotid artery) in none of whom complications occurred. There were no procedural neurologic events. Within 30 days of follow-up, one patient had an ischaemic stroke (on day 11). Conclusions: Proximal protection is a safe method as the first choice for embolic protection. It can be used with a high rate of technical success