Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial

Saddle Aortic Embolus With Paraplegia in a 60-Year-Old Diabetic and Hypertensive Patient: A Rare Case of Acute Lower Limb Ischemia

Acute lower limb ischemia (ALI) is a vascular emergency that necessitates prompt intervention to avert irreversible damage. The relationship between ALI and paraplegia is a rare occurrence, particularly in patients with vascular risk factors such as diabetes mellitus (DM) and hypertension (HTN). We present the case of a 60-year-old male with a medical history of DM, HTN, and ischemic heart disease (IHD) who developed acute paraplegia 12 days after undergoing coronary artery bypass grafting (CABG). Initially suspected to have Guillain-Barré syndrome (GBS), further evaluation revealed occlusion of the abdominal aorta and iliac arteries. The patient underwent emergency bilateral fasciotomy and thrombectomy, resulting in partial recovery of lower limb function, with motor and sensory evaluations showing improvement in the right limb but limited recovery in the left. Postoperative complications included acute kidney injury, which was effectively managed. This case highlights the necessity of a broad differential diagnosis for rapidly progressing lower limb paralysis in patients with significant vascular risk factors. Timely diagnosis, prompt intervention, and careful monitoring of outcomes are essential for optimizing results in complex cases of ALI.

High-density lipoprotein dysfunction in carotid artery stenosis

Background: High density lipoprotein (HDL) is well established to have an athero-protective role under normal conditions; however, pro-inflammatory alteration of HDL proteins may transform the HDL particle into a dysfunctional molecule. Our aim was to investigate HDL dysfunction by measuring enzyme-based markers in carotid artery stenosis (CAS). Patients and methods: All participants underwent duplex ultrasound and 52 subjects diagnosed with CAS and 51 subjects who had no significant stenosis (as controls) were enrolled in this study. Serum lipid profiles and serum parameters associated with dysfunctional HDL including myeloperoxidase (MPO), paraoxonase 1 (PON1), arylesterase (ARE) activity, and lipid hydroperoxide (LOOH) levels were measured. Results: It was found that the patients with CAS had increased levels of MPO and LOOH while PON1 activity was decreased. There was no significant difference between the CAS and non-CAS groups in terms of HDL levels. MPO/PON1, MPO/ARE, and LOOH/PON1 ratios were significantly increased in the CAS group. MPO/PON1 and MPO/ARE ratios both demonstrated significant correlations with degree of stenosis (%). Conclusions: The MPO/PON1 and MPO/ARE ratios may be potential serum markers that can enable the monitoring of HDL functionality and the assessment of atherosclerotic disease risks. Additionally, monitoring the oxidative balance of lipids on HDL molecules by LOOH/PON1 ratio may have value in the early detection of pro-atherosclerotic transformation of the HDL particle.