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Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Cantisano AL, Porto CLL, Amaral SID, Veloso OCG, Morais Filho DD, Teodoro JAR, Petisco ACGP, Saleh MH, Barros MVLD, Barros FS, Engelhorn ALDV, Engelhorn CA, Nardino ÉP, Silva MADM, Biagioni LC, Souza AJD, Sarpe AKP, Oliveira ACD, Moraes MRDS, Francisco Neto MJ, Françolin PC, Rochitte CE, Iquizli R, Santos AASMDD, Muglia VF, Naves BDL. Recommendation Update for Vascular Ultrasound Evaluation of Carotid and Vertebral Artery Disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol 2023; 120:e20230695. [PMID: 37991060 DOI: 10.36660/abc.20230695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Ana Cristina Lopes Albricker
- Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, MG - Brasil
- IMEDE - Instituto Mineiro de Ultrassonografia, Belo Horizonte, MG - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Empresa Brasileira de Serviços Hospitalares (UBSERH), Brasília, DF - Brasil
| | | | | | | | | | | | - Orlando Carlos Glória Veloso
- Rede UnitedHealth Group (UHG), Rio de Janeiro, RJ - Brasil
- Hospital Pasteur, Rio de Janeiro, RJ - Brasil
- Hospital Américas, Rio de Janeiro, RJ - Brasil
- Hospital de Clínicas Mário Lioni, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Érica Patrício Nardino
- Faculdade de Medicina do ABC Paulista, SP - Brasil
- Faculdade de Medicina Unoeste, Guarujá, SP - Brasil
| | | | | | | | | | | | | | | | - Peter Célio Françolin
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (Hcor), São Paulo, SP - Brasil
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Wang C, Zhao P, Sun T, Han M, Wang Y, Wu W, Li X, Wang D. Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center. Front Neurol 2020; 11:604672. [PMID: 33329364 PMCID: PMC7732432 DOI: 10.3389/fneur.2020.604672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatment of in-stent restenosis and occlusion. Methods : A cohort of 12 refractory patients with in-stent restenosis or occlusion who underwent hybrid recanalization, a combination of endarterectomy and endovascular intervention, were retrospectively analyzed. Medical records, including presenting symptoms, comorbidities, contralateral ICA/VA findings, use of antiplatelet drugs, postoperative complications, and angiographic outcomes, were collected. Results : Among 415 consecutive patients with ICA, common carotid artery, and V1 segment lesions, 12 refractory patients (2.89%) with 13 cases were enrolled in our study (1 female and 11 male). All patients underwent successful hybrid recanalization. There were no cases of postoperative stroke or death. Only two patients sustained hoarseness, but it resolved within 2 weeks after surgery. Three patients were treated with dual antiplatelet (aspirin and clopidogrel), seven with single antiplatelet (aspirin), one with single antiplatelet (clopidogrel), and one with single antiplatelet (ticagrelor). All patients were followed up in the outpatient department according to the protocol, with a mean follow-up period of 13 months (range, 6-24 months). No death or recurrent symptoms occurred during the regular follow-up period. Conclusion : The hybrid technique maybe a safe and feasible treatment option to recanalize in-stent restenosis or occlusion with acceptable complications.
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Affiliation(s)
- Chao Wang
- School of Clinical Medicine, Shandong University, Jinan, China.,Dezhou City People's Hospital, Dezhou, China.,Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China.,Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Peng Zhao
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Tao Sun
- School of Clinical Medicine, Shandong University, Jinan, China.,Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Mengtao Han
- School of Clinical Medicine, Shandong University, Jinan, China.,Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Yunyan Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Xingang Li
- School of Clinical Medicine, Shandong University, Jinan, China.,Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
| | - Donghai Wang
- School of Clinical Medicine, Shandong University, Jinan, China.,Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
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Zimoski R, Ugurov P, Veljanoska-Kiridjievska L, Hristov N, Idoski E, Gjorgon M, Milevska-Kostova N, Rosalia RA, Mitrev Z. Minimally Invasive Surgical Repair of Vertebral Artery Ostium Stenosis in Patients with Ischemic Stroke: A Single-Center Case Series. World Neurosurg 2020; 146:367-375.e2. [PMID: 33212278 DOI: 10.1016/j.wneu.2020.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ischemic stroke is the second leading cause of death in North Macedonia. Posterior circulation disease, caused by vertebral artery (VA) ostium (VAo) stenosis, is a common cause of ischemic stroke. We established a treatment approach using surgical revascularization of posterior circulation disease. In the present observational study, we assessed the outcome after surgical revascularization of the posterior circulation ischemia caused by VAo stenosis. METHODS A retrospective analysis of 20 consecutive patients who had undergone surgery from January 2017 to December 2019. The VA was accessed through a 3-cm incision in the upper medial clavicle. The corrective procedures consisted of resection and anastomosis (15 of 20), VA to subclavian artery transposition (16 of 20), endarterectomy (10 of 20), vein graft interposition techniques (4 of 20), and vein graft bypass (1 of 20). RESULTS The cohort included 9 acute cases. The mean patient age was 66.5 years (range 46-77). Of the 20 patients, 8 were women and 12 were men. Left-sided VA pathology was present in 75% of the cases. We observed rapid clinical improvement in 19 patients (95%). The total study period was 321 patient-months, with a median follow-up of 18 months (interquartile range, 5-24 months). One patient had died of an unknown cause after 12 months. During the follow-up period, 15 patients (75%) had reported permanent clinical improvement with no significant relapse of symptoms. CONCLUSIONS Minimally invasive surgical revascularization of the posterior brain circulation is a clinically effective therapeutic approach to manage ischemia caused by VAo stenosis. It can be performed safely, promote long-lasting symptom relief, and prevent recurrent strokes.
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Affiliation(s)
- Riste Zimoski
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia
| | - Petar Ugurov
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia
| | | | - Nikola Hristov
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia
| | - Enver Idoski
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia
| | - Marko Gjorgon
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia
| | | | - Rodney Alexander Rosalia
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia; Maastricht School of Management, Maastricht, The Netherlands
| | - Zan Mitrev
- Department of Cardiovascular Surgery, Zan Mitrev Clinic, Skopje, Republic of North Macedonia.
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