Early results of endovascular treatment of patients with bilateral stenoses of the internal carotid arteries using proximal protection systems at 30-day follow-up

Background: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an very important role as alternative treatment modality, especially in patients with critical, symptomatic lesions. This study was single-centre study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic and asymptomatic carotid stenosis in patients with bilateral, advanced lesions of carotid arteries (bilateral stenoses or stenosis and occlusion). Methods: This was a post hoc analysis, with 30-day follow up. We analyzed results of treatment of 38 patients who underwent 38 CAS with PPS, 17 such procedures in asymptomatic (group A), and 21 in symptomatic individuals (group B). The GORE® Flow Reversal System (W.L. Gore, Flagstaff, AZ, USA) was used in 2 patients, and the Mo.Ma Ultra device (Medtronic, Minneapolis, MN, USA) in 36 patients. Mean age was 68 7 years, 65% percent of patient were male. Results: There were no procedural and during 30-day follow-up neurologic events. Intolerance of occlusion system occurred in 4 patients (11%) in both groups with any later symptoms. Risk factors of this adverse event comprised: lesions of the left internal carotid lesion and coexisiting diabetes mellitus. Conclusions: CAS in high risk patients with bilateral lesions of carotid arteries with the use of PPS seems to be a relatively very safe procedure

Early results of endovascular treatment of patients with bilateral stenoses of the internal carotid arteries using proximal protection systems at 30-day follow-up

Background Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an very important role as alternative treatment modality, especially in patients with critical, symptomatic lesions. This study was single-centre study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic and asymptomatic carotid stenosis in patients with bilateral, advanced lesions of carotid arteries (bilateral stenoses or stenosis and occlusion). Methods This was a post hoc analysis, with 30-day follow up. We analyzed results of treatment of 38 patients who underwent 38 CAS with PPS, 17 such procedures in asymptomatic (group A), and 21 in symptomatic individuals (group B). The GORE® Flow Reversal System (W.L. Gore, Flagstaff, AZ, USA) was used in 2 patients, and the Mo.Ma Ultra device (Medtronic, Minneapolis, MN, USA) in 36 patients. Mean age was 68±7 years, 65% percent of patient were male. Results There were no procedural and during 30-day follow-up neurologic events. Intolerance of occlusion system occurred in 4 patients (11%) in both groups with any later symptoms. Risk factors of this adverse event comprised: lesions of the left internal carotid lesion and coexisiting diabetes mellitus. Conclusions CAS in high risk patients with bilateral lesions of carotid arteries with the use of PPS seems to be a relatively very safe procedure

Safety and efficacy of endovascular treatment for carotid artery stenoses using proximal protection systems: 30-day follow-up

Introduction. Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an important role as alternative treatment modality, especially in high risk patients. This study was aimed at the assessment of safety of CAS with use of the PPS and also at identification of risk factors associated with this procedure. Material and methods. This was a post hoc analysis, with 30-day follow-up. We analysed results of treatment of 94 patients who underwent 97 CAS with PPS, 47 such procedures in asymptomatic, and 50 in symptomatic individuals. Results. There were 0 strokes during 30-day follow-up. Transient ischaemic attacks occurred in 2 patients (2%) in symptomatic group. Risk factors of these adverse events comprised: tortuosity of the managed artery, chronic obstructive pulmonary disease, long lesion of the internal carotid artery and history of myocardial infarction. Conclusions. CAS with the use of PPS seems to be a relatively very safe procedure in high risk patients.Introduction. Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an important role as alternative treatment modality, especially in high risk patients. This study was aimed at the assessment of safety of CAS with use of the PPS and also at identification of risk factors associated with this procedure. Material and methods. This was a post hoc analysis, with 30-day follow-up. We analysed results of treatment of 94 patients who underwent 97 CAS with PPS, 47 such procedures in asymptomatic, and 50 in symptomatic individuals. Results. There were 0 strokes during 30-day follow-up. Transient ischaemic attacks occurred in 2 patients (2%) in symptomatic group. Risk factors of these adverse events comprised: tortuosity of the managed artery, chronic obstructive pulmonary disease, long lesion of the internal carotid artery and history of myocardial infarction. Conclusions. CAS with the use of PPS seems to be a relatively very safe procedure in high risk patients

Familiar lymphangioma - a rare form of splenic cyst

Torbiel śledziony jest schorzeniem rzadkim, rozpoznawanym przypadkowo w trakcie badań obrazowych. Ze względu na etiologię torbieli, dzieli się je na pasożytnicze i niepasożytnicze, a te ostatnie - na torbiele prawdziwe i rzekome. W przypadkach torbieli prawdziwych możliwe jest ich rodzinne występowanie. Ze względu na możliwość wystąpienia powikłań torbiele zazwyczaj leczy się operacyjnie, dążąc do zachowania miąższu śledziony. Poniżej przedstawiono przypadek 19-letniego mężczyzny z olbrzymim naczyniakiem chłonnym śledziony. Siostrę chorego operowano kilka lat wcześniej (splenektomia) z powodu identycznej jednostki chorobowej.Splenic cyst is a rare illness of the spleen, accidentally diagnosed via imaging examinations. We divided the cysts into parasitic and non-parasitic (true and false). The true splenic cyst may be hereditary. Cysts usually required surgical treatment due to the possibility of complications developing - minimal invasive techniques are preferred to preserve the spleen. We present a patient with hereditary, familiar lymphangioma, which was diagnosed on the basis of pathological evaluation

Cholecystocutaneous fistula in the course of untreated chronic calculus cholecystitis - a case report

Przetoka pęcherzykowo-skórna jest rzadkim powikłaniem przewlekłego kamiczego zapalenia pęcherzyka żółciowego. W artykule zaprezentowano przypadek 73-letniego pacjenta z przetoką pęcherzykowo-skórną z ropniem okolicy łuku żebrowego prawego. Ropień zawierał złogi żółciowe. Autorzy przedstawiają przeprowadzoną diagnostykę oraz sposób leczenia chirurgicznego.Cholecystocutaneous fistula is a rare complication of chronic calculus cholecystitis. The article presents a 73-year old patient with cholecystocutaneous fistula and abscess in the right costal arch. The abscess contained gallstones. We present a diagnostic and performed surgical treatment

Uraz cyklisty jako przyczyna objawów przewlekłego niedokrwienia kończyny dolnej u młodych chorych

This paper presents four cases of chronic leg ischaemia in young patients which occured as a result of the sustainment a blunt injury of the iliac or femoral artery in the inguinal region. The time from the occurence of the injury to when the diagnosis was made was from 3 weeks to 6 months. In all cases, a sectional arterial occlusion, with a lack of symptoms of sharp ischaemia, was confirmed during an angiographic examination. Three patients were operated on; in two cases, with a vascular reconstruction being performed intraoperatively using their own saphenous vein and in one case, employing a Dacron prosthesis. In one patient surgery was abandoned because of the lack of the patient’s informed consent.W artykule przedstawiono 4 przypadki przewlekłego niedokrwienia kończyny dolnej u pacjentów w młodym wieku w wyniku doznania tępego urazu tętnicy biodrowej lub udowej wspólnej w okolicy pachwinowej. Czas od urazu do rozpoznania wynosił od 3 tygodni do 6 miesięcy. We wszystkich przypadkach podczas badania angiograficznego stwierdzono odcinkową niedrożność tętnicy przy braku objawów ostrego niedokrwienia. Trzech chorych operowano, wykonując rekonstrukcję z użyciem własnej żyły odpiszczelowej (2 chorych) i wstawki dakronowej (1 chory). U 1 pacjenta odstąpiono od leczenia operacyjnego ze względu na brak zgody

Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain : safety of the treatment at 30-day follow-up

Introduction: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim: To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods: This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results: There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions: Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe

Technique of endovascular repair of iatrogenic subclavian artery injury following subclavian vein catheterization

The iatrogenic subclavian artery injury is a rare but potentially serious complication of subclavian vein cannulation.The use of endovascular techniques is an alternative to surgical repair especially in patients with concomitantdiseases in whom immediate, potentially large surgery would be associated with a high risk of perioperativecomplications. This article discusses technical aspects of endovascular repair of iatrogenic injury of subclavianartery with implantation of covered stents based on two cases. Author’s experience and data from literaturesuggests that endovascular management including covered stent implantation is safe and effective treatmentand should be considered as a method of choice especially among patients in poor general condition and/ormajor comorbidities