Health-related quality of life in ischaemic stroke survivors after carotid endarterectomy (CEA) and carotid artery stenting (CAS) : confounder-controlled analysis

Introduction: Atherosclerotic carotid artery stenosis (CS)-related strokes are a significant overall stroke burden contributor. Aim: To evaluate the effect of surgical (carotid endarterectomy – CEA) vs. percutaneous (neuroprotected carotid artery stenting – CAS) carotid revascularization on health-related quality of life (HRQoL) in stroke survivors: analysis controlled for major HRQoL determinants beyond strokes. Material and methods: Our database of 856 carotid revascularization procedures (48.7% symptomatic CS) performed over 3 years showed 42 pairs (CEA-CAS) of right hemispheric stroke patients matched for age, sex, marital and educational status, hypertension, heart failure and diabetes, who underwent uneventful carotid revascularization, experienced no major adverse clinical events, and completed the Short Form Outcome Study (SF-36) questionnaire within 7 days before, 14 days after, 6 months after, and 12 months after carotid revascularization. Results: Baseline HRQoL was low and similar in both groups (30.8 ±4.6% vs. 29.1 ±3.9%, p = 0.68; data given for CEA vs. CAS). National Institute of Health Stroke Scale chronic severity was 5.4 ±2.8 vs. 5.9 ±3.1 (p = 0.44). Revascularization was associated with a major HRQoL improvement, that was significantly greater in CAS (60.4 ±9.2% vs. 71.5 ±6.2%, p < 0.001). At 6 months the CEA-CAS difference was narrower (70.7 ±9.7% vs. 74.6 ±5.9%, p = 0.026), becoming statistically insignificant at 12 months (72.6 ±6.7% vs. 75.1 ±5.1%, p = 0.062). The early CEA-CAS difference was driven by less bodily pain and better physical functioning/role-physical plus better role-emotional and higher general well-being scores in CAS (p < 0.05). Conclusions: Carotid revascularization has a major positive impact on stroke survivor patient-reported HRQoL. The improvement is initially greater in CAS, with the remaining difference small at 12 months and statistically insignificant

Małoinwazyjne leczenie tętniaków tętnicy podobojczykowej jako skuteczny i bezpieczny sposób leczenia pacjentów z licznymi obciążeniami, na przykładzie doświadczeń zespołu Oddziału Chirurgii Naczyń z Pododdziałem Zabiegów Endowaskularnych Szpitala im. Jana

The authors present a review of literature concerning symptoms, diagnosis, prognosis and treatment of subclavian artery aneurysms, which constitute 0.13–0.5% of all peripheral arterial aneurysms. Usually, they are asymptomatic and remain undiagnosed for a long time or may cause troublesome symptoms, diagnostic errors and serious threats. A large part of even asymptomatic subclavian artery aneurysms require surgical treatment. Once detected, the presence of subclavian artery aneurysm should incline to look for aneurysms in other locations, as they coexist in 33–47%. Based on our observations, we have presented the possibilities of an effective and safe therapeutic approach, including endovascular methods, particularly in patients with significant burdens.Autorzy przedstawiają przegląd doniesień dotyczących objawów, rozpoznawania, rokowania i leczenia tętniaków tętnicy podobojczykowej, które stanowią 0,13–0,5% wszystkich tętniaków tętnic obwodowych. Tętniaki tętnicy podobojczykowej najczęściej przebiegają bezobjawowo, pozostając długo nierozpoznane, lub mogą być przyczyną uciążliwych dolegliwości, pomyłek diagnostycznych i poważnych zagrożeń. Znaczna część tętniaków nawet bezobjawowych tętnicy podobojczykowej wymaga leczenia zabiegowego. Po wykryciu tętniaka tętnicy podobojczykowej należy również poszukiwać tętniaków w innych lokalizacjach, które współistnieją w 33–47%. Na podstawie własnych obserwacji przedstawiono możliwości skutecznego i bezpiecznego postępowania terapeutycznego, w tym metod wewnątrznaczyniowych, w szczególności w grupie chorych z istotnymi obciążeniami

Coexistence and management of abdominal aortic aneurysm and coronary artery disease

Background: Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented.Methods: 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD.Results: Significant coronary stenosis (&gt; 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6–18.2, p &lt; 0.001) and patients’ age (OR = 1.1, 95% CI 1.0–1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p &lt; 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2–70] vs. 7 [3–181] days, p = 0.007) and intensive care unit stay (1 [0–9] vs. 1 [0–70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms.Conclusions: Patients with AAA might benefit from an early coronary artery evaluation strategy

Transradial approach for carotid artery stenting in a patient with severe peripheral arterial disease

We present a case of a 73-year-old man with critical bilateral internal carotid artery stenosis, recent right hemisphere stroke and severe peripheral artery disease in whom right internal carotid artery stenting (RICA-CAS) was performed successfully via a right transradial approach