Biomedical subjects

M C Acconcia

Publications and source records attributed to M C Acconcia.

13 recordsLinked to original sources

PubMed2006

Early carotid endarterectomy after ischemic stroke: the results of a prospective multicenter Italian study.

OBJECTIVES: To evaluate safety of early carotid endarterectomy (CEA) in patients with acute brain ischemia presenting to the emergency department stroke units (EDSU). METHODS: The neurologists, neuroradiologists and vascular surgeons on duty in emergency departments enrolled 96 patients who underwent very early CEA according to a predefined protocol within two years. The protocol included evaluation of neurological status by National Institute of Health Stroke Scale (NIHSS), neuroimaging assessment, ultrasound of the carotid arteries and Transcranial Doppler. Patients with NIHSS>22 or whose neuroimaging showed brain infarct >2/3 of the middle cerebral artery territory were excluded. All eligible patients underwent CEA as soon as possible. Primary end points of the study were mortality, neurological morbidity by NIHSS and postoperative hemorrhagic conversion on neuroimaging. Statistical analysis was performed by univariate analysis. RESULTS: The mean time elapsing between the onset of stroke and endarterectomy was 1.5 days (+/-2 days). The overall 30-day morbidity mortality rate was 7.3% (7/96). No neurological mortality occurred. On hospital discharge, three patients (3%) experienced worsening of the neurological deficit (NIHSS score 1 to 2, 1 to 3 and 9 to 10 respectively). Postoperative CT demonstrated there were no new cerebral infarcts nor hemorrhagic transformation. At hospital discharge 9/96 patients (9%) had no improvement in NHISS scores, 37 were asymptomatic and 45 showed a median decrease of 4.5 NIHSS points (range 1-18). By univariate analysis none of the considered variables influenced the clinical outcome. CONCLUSION: Our protocol selected patients who can safely undergo very early (<1.5 days) surgery after acute brain ischemia. Large randomized multicenter prospective trials are warranted to compare very early CEA versus best medical therapy.

Aged↗

PubMed1997

Collateral flow prevents unintentional myocardial ischemia during antegrade cardioplegia in patients undergoing coronary artery bypass grafting.

OBJECTIVE: We evaluated, in the prevention of perioperative unintentional myocardial ischemia, the role of coronary collateral flow in patients with left anterior descending coronary artery stenosis or occlusion who underwent elective coronary artery bypass grafting. METHODS: Coronary lesions and collaterals were assessed by coronary angiography in 21 patients. Anteroseptal myocardial viability was evaluated by dobutamine echocardiography. Antegrade perfusion of cardioplegic solution was assessed by myocardial contrast echocardiography. Time-intensity curves were generated from the anteroseptal region. Twelve parameters were measured and averaged in the following four groups of patients: those with stenosis of the left anterior descending artery and poor collaterals; those with stenosis of the left anterior descending artery and good collaterals; those with occlusion of the left anterior descending artery and good collaterals; and those with occlusion of the left anterior descending artery and poor collaterals. RESULTS: Time-intensity curves were significantly different in patients with stenosis versus occlusion of the left anterior descending artery (p < 0.005); multiple comparisons with Bonferroni's correction showed that this difference was mainly a result of the impact of collateral circulation (p < 0.01). However, the role of collaterals was nonsignificant within the groups with stenosis and occlusion of the left anterior descending artery. Patients with occlusion of the left anterior descending artery and good collaterals had perfusion parameters similar to those of patients with stenosis of the left anterior descending artery (p = not significant), except for the ascending slope and time to peak values (p < 0.05 and p < 0.01, respectively), which reflected a higher flow resistance in the collateral circulation. Regional systolic function after coronary artery bypass grafting was depressed in patients with poor collaterals and poor perfusion of cardioplegic solution, as compared with findings in other subgroups. CONCLUSIONS: Incomplete myocardial protection may impair the early recovery of function after coronary artery bypass grafting.

Cell Survival↗

PubMed1995

Risk factors of incomplete distribution of cardioplegic solution during coronary artery grafting.

Myocardial distribution of cardioplegic solution infused by combined antegrade/retrograde routes was assessed with myocardial contrast echocardiography in 18 patients with chronic stable angina and three-vessel disease undergoing elective coronary artery bypass grafting. Overall myocardial opacification was significantly greater in retrograde than in antegrade cardioplegia (77.7% +/- 13.4% versus 59.1% +/- 15.7%; p = 0.0009). The difference was affected by collateral circulation, as pointed out by the significant interaction between coronary collateral circulation and percent of myocardial opacification after antegrade and retrograde cardioplegia (p = 0.002). When we performed multiple comparisons, in patients with good collaterals the opacification difference between antegrade and retrograde cardioplegia was not statistically significant (66.4% +/- 10.2% versus 76.0% +/- 15.2%; p = not significant), whereas in patients with poor collaterals myocardial opacification during retrograde cardioplegia was significantly greater (44.3% +/- 15.0% versus 81.2% +/- 9.0%; p < 0.02). During antegrade cardioplegia, patients with poor collaterals showed a lower degree of myocardial opacification than patients with good collaterals (44.3% +/- 15.0% versus 66.4% +/- 10.2%; p < 0.01). Our results show that retrograde cardioplegia in patients undergoing elective coronary artery bypass grafting offers no advantage over antegrade cardioplegia when collateral circulation is well developed. On the other hand, conventional aortic root infusion may not provide adequate myocardial protection in the subset of patients with significantly narrowed or occluded coronary arteries and poor collaterals.

Angina Pectoris↗

PubMed1993

[Anterograde and retrograde cardioplegia in myocardial revascularization. An intraoperative contrast echographic study].

The aim of this study was to assess the distribution of antegrade and retrograde cardioplegia with intraoperative contrast echocardiography in patients undergoing coronary artery bypass grafting. Fifteen patients with chronic stable angina pectoris and severe coronary artery disease were studied. The severity of coronary artery disease was assessed at coronary angiography, using the Jeopardy Score System. The presence and the extent of collateral circulation was evaluated on the basis of preoperative coronary angiography and graded as: absent or poor; good or excellent. Coronary revascularization was carried out during extracorporeal circulation and myocardial protection was performed with antegrade (aortic root) and retrograde (right atrial) cardioplegia. The echo contrast agent was sterilely prepared 1 hour prior to surgery and consisted of a solution of sonicated 5% human albumin microbubbles. Two ml of sonicated albumin were injected along with antegrade cardioplegia and 4 ml with retrograde cardioplegia. The echocardiographic images were obtained with transesophageal echocardiography in the transgastric left ventricular short-axis view. Images were recorded on videotape for off-line planimetric measurement of percent myocardial opacification. Data were analyzed with the analysis of variance. Multiple comparisons were made with Student's paired t test and using Bonferroni's correction. Myocardial opacification was 58.9 +/- 12.9% during antegrade cardioplegia and 77.5 +/- 16.4% during retrograde cardioplegia (p = 0.003). This overall difference was mainly due to the impact of collateral circulation in the distribution of antegrade cardioplegia. Patients with absent or poor collateral circulation showed a lower degree of myocardial opacification than patients with good or excellent myocardial opacification (44.3 +/- 12.0% versus 64.2 +/- 8.6%; p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed1988