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Journal ArticleDOI

Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico

01 Aug 2009-Radiologia Brasileira (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem)-Vol. 42, Iss: 4, pp 231-234

AbstractOBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7%). The neointimal hyperplasia volume ranged from 49.02 mm3 to 112.87 mm3 (mean, 80.33 mm3). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors.

Topics: Neointimal hyperplasia (60%), Stent (53%)

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Journal ArticleDOI
TL;DR: The results of this case series and literature review results allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.
Abstract: BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89). Thirty seven were male (62.72%) and 22 female (37.28%). The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84%) and rest pain or trophic lesions (critical ischemia) in 29 cases (49.15%). Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years), with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.

References
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Abstract: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others. The original structure is retained, and the book continues to serve as a combined text/reference.

35,466 citations


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Abstract: Applied Linear Statistical Models 5e is the long established leading authoritative text and reference on statistical modeling. The text includes brief introductory and review material, and then proceeds through regression and modeling for the first half, and through ANOVA and Experimental Design in the second half. All topics are presented in a precise and clear style supported with solved examples, numbered formulae, graphic illustrations, and "Notes" to provide depth and statistical accuracy and precision. The Fifth edition provides an increased use of computing and graphical analysis throughout, without sacrificing concepts or rigor. In general, the 5e uses larger data sets in examples and exercises, and where methods can be automated within software without loss of understanding, it is so done.

10,745 citations


Journal ArticleDOI
TL;DR: The goals of this new consensus are to provide an abbreviated document to focus on key aspects of diagnosis and management, and to update the information based on new publications and the newer guidelines, but not to add an extensive list of references.
Abstract: The Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) was published in January 2000 as a result of cooperation between fourteen medical and surgical vascular, cardiovascular, vascular radiology and cardiology societies in Europe and North America. This comprehensive document had a major impact on vascular care amongst specialists. In subsequent years, the field has progressed with the publication of the CoCaLis document and the American College of Cardiology/American Heart Association Guidelines for the Management of Peripheral Arterial Disease. Aiming to continue to reach a readership of vascular specialists, but also physicians in primary health care who see patients with peripheral arterial disease (PAD), another consensus process was initiated during 2004. This new consensus document has been developed with a broader international representation, including Europe, North America, Asia, Africa and Australia, and with a much larger distribution and dissemination of the information. The goals of this new consensus are to provide an abbreviated document (compared with the publication in 2000), to focus on key aspects of diagnosis and management, and to update the information based on new publications and the newer guidelines, but not to add an extensive list of references. Unreferenced statements are, therefore, to be found, provided they are recognized as common practice by the authors, with existing evidence. The recommendations are graded according to levels of evidence. It should also be emphasized that good practice is based on a combination of the scientific evidence described below, patients’ preferences, and local availability of facilities and trained professionals. Good practice also includes appropriate specialist referral.

6,461 citations


Journal ArticleDOI
TL;DR: This study compared the efficacy and safety of three antithrombotic-drug regimens — aspirin alone, aspirin and warfarin, and aspirin and ticlopidine — after coronary stenting to prevent stent thrombosis.
Abstract: Background Antithrombotic drugs are used after coronary-artery stenting to prevent stent thrombosis. We compared the efficacy and safety of three antithrombotic-drug regimens — aspirin alone, aspirin and warfarin, and aspirin and ticlopidine — after coronary stenting. Methods Of 1965 patients who underwent coronary stenting at 50 centers, 1653 (84.1 percent) met angiographic criteria for successful placement of the stent and were randomly assigned to one of three regimens: aspirin alone (557 patients), aspirin and warfarin (550 patients), or aspirin and ticlopidine (546 patients). All clinical events reflecting stent thrombosis were included in the prespecified primary end point: death, revascularization of the target lesion, angiographically evident thrombosis, or myocardial infarction within 30 days. Results The primary end point was observed in 38 patients: 20 (3.6 percent) assigned to receive aspirin alone, 15 (2.7 percent) assigned to receive aspirin and warfarin, and 3 (0.5 percent) assigned to rece...

1,621 citations


Journal ArticleDOI
Abstract: BACKGROUND: Restenosis remains an important limitation of interventional cardiology. Therefore, we aimed to determine the safety and efficacy of sirolimus (a cell-cycle inhibitor)-coated BX Velocity stents. METHODS AND RESULTS: Thirty patients with angina pectoris were electively treated with 2 different formulations of sirolimus-coated stents (slow release [SR], n=15, and fast release [FR], n=15). All stents were successfully delivered, and patients were discharged without clinical complications. Independent core laboratories analyzed angiographic and 3D volumetric intravascular ultrasound data (immediately after procedure and at 4-month follow-up). Eight-month clinical follow-up was obtained for all patients. There was minimal neointimal hyperplasia in both groups (11.0+/-3.0% in the SR group and 10.4+/-3.0% in the FR group, P:=NS) by ultrasound and quantitative coronary angiography (in-stent late loss, 0.09+/-0.3 mm [SR] and -0.02+/-0.3 mm [FR]; in-lesion late loss, 0.16+/-0.3 mm [SR] and -0.1+/-0.3 mm [FR]). No in-stent or edge restenosis (diameter stenosis >or=50%) was observed. No major clinical events (stent thrombosis, repeat revascularization, myocardial infarction, or death) had occurred by 8 months. CONCLUSIONS: The implantation of sirolimus-coated BX Velocity stents is feasible and safe and elicits minimal neointimal proliferation. Additional placebo-controlled trials are required to confirm these promising results.

817 citations