Images in clinical medicine. Septic (Aspergillus) embolus.
Explore the source record for details and available documents.
Aortic Aneurysm↗
Biomedical subjects
W H Pearce
Publications and source records attributed to W H Pearce.
Peripheral bypass surgery and amputation: northern Illinois demographics, 1993 to 1997.
HYPOTHESIS: This study tests whether age, sex, income, and racial differences predict rates of aortoiliac and femorodistal bypass surgery and above- and below-knee amputation for residents of northern Illinois from 1993 to 1997. DESIGN: A hospital discharge survey study describing standardized procedure rates and the odds of undergoing amputation vs bypass procedures for specified sociodemographic populations. Multiple logistic regression was used to compare the odds of undergoing major amputation vs bypass surgery controlling for the prevalence of diabetes, gangrene, high-risk comorbid conditions, and treatment at major area teaching hospitals. RESULTS: Between 1993 and 1997, 19,250 study procedures were performed during 18,603 admissions at 105 Illinois hospitals. The mean annual major amputation rate per 100,000 was 20.77; femorodistal and aortoiliac bypass rates were 24.26 and 4.70, respectively. Significantly higher odds (between 1.14 and 1.36) of undergoing amputation were found for low-income areas and ZIP codes with large and medium African American populations. Severe comorbidity, diabetes, and especially gangrene (odds ratio, 12.9) predicted amputation, while treatment at a major teaching hospital and male sex predicted a higher odds of undergoing bypass procedures. CONCLUSIONS: Results are consistent with unmeasured racial and income differences in the severity of atherosclerosis (or related risk factors such as smoking, diet, and exercise), barriers to timely primary care, or selective referral of lower-income and African American patients to hospitals with less vascular surgery capacity. These findings imply a particular need to identify and review the quality of care for patients undergoing primary lower-extremity amputations.
Adult↗
Transrectal ultrasound assessment of murine aorta and iliac arteries.
Recent research in arterial aneurysm formation has focused on animal model development. Mice are an ideal experimental organism due to their short life cycle, prolific progeny, and extensively studied genome. Most experiments require the sacrifice of the mice to observe and assess any morphological changes. Noninvasive or minimally invasive imaging is limited due to the relatively small size of the structures. The development of such a technique, therefore, is especially useful for allowing repeated measurement without sacrificing the mice. We introduce a novel technique of imaging and measuring the aorta, the aorta/inferior vena cava complex, and the right and the left common iliac artery/vein complex by the use of an intravascular ultrasound catheter. The catheter is inserted through the anus and rectum and into the sigmoid and left colon, where the aorta can be observed to fluctuate at approximately 500 beats/min. The aortic bifurcation can also be observed. The diameters of the aorta and the inferior vena cava were measured first with the transrectal ultrasound technique and then with direct visualization upon laparotomy for 10 mice. This revealed a percentage error between 13.7 and 14.2% for this novel technique. Fifteen more sets of vessel measurements were also made with 8 male and 7 female mice. The results demonstrated a correlation between vessel size and body weight in male but not female mice and suggested an intersex difference in vessel growth rate. We conclude that transrectal ultrasound is a useful tool in imaging and measuring the murine aorta and its bifurcation.
Animals↗
Carotid endarterectomy: characterization of recent increases in procedure rates.
INTRODUCTION: Recent increases in the rate of carotid endarterectomies (CEAs) have been attributed to results of clinical trials demonstrating efficacy when CEA is performed in centers of excellence. Subsequent population-based data suggest that trial results may not be matched in the community. This study was undertaken to characterize trends in CEA procedure rates after the dissemination of trial data and to describe any change in patient outcomes with population-based data from a single state. METHODS: Hospital administrative data on CEAs from 1992 to 1996 (n = 45,744) were obtained for the state of Florida. Annualized CEA rates per 100, 000 Florida residents were analyzed to determine trends in patient age, sex, admission type, size of hospital beds, ownership type and teaching status, and annual hospital and surgeon CEA volume. Outcomes were examined to track trends in complication rates. RESULTS: The annual number of CEA procedures increased 74% from 63.7 per 100,000 residents per year to 110.8 per 100,000 residents per year between 1992 and 1996. A single large increase occurred during the second half of 1994 when CEAs increased 73.5% from 16.6 per 100, 000 residents per quarter to 28.8 per 100,000 residents per quarter after a clinical alert on benefits to CEAs in asymptomatic patients. Over 5 years, there were significant trends toward more nonemergent admissions, and more procedures were performed in high-volume hospitals and by high-volume surgeons. Procedure rates in both women and very elderly patients increased more than 70%, which was in step with younger patients and men. The incidence of inpatient stroke and death declined over the 5-year period, whereas the rate of perioperative myocardial infarction remained constant. CONCLUSIONS: Experience from Florida indicates that CEA rates increased as results of the Asymptomatic Carotid Artery Study disseminated. Trial results have been broadly interpreted to include women and very elderly patients. More patients are being referred to busier hospitals and to high-volume surgeons, which should continue to result in better patient outcomes.
Aged↗
Natural history of composite sequential bypass: ten years' experience.
BACKGROUND: We previously reported 48-month patency rates of composite sequential bypass (CSB) approaching 60%. Yet, extended patency and limb salvage rates are unknown. HYPOTHESIS: Long-term patency and limb salvage rates of CSB are affected by sex, bypass configuration, and warfarin therapy. DESIGN: Medical records of all patients who underwent CSB during a 10-year period were retrospectively reviewed. SETTING: A referral center for the Chicago, Ill, region. PATIENTS: One hundred consecutive patients (mean age, 68.8 years; 57% were men and 49% had diabetes) undergoing 102 CSBs for limb salvage (ulcer, 43%; rest pain, 39%; and gangrene, 18%) from January 1986 to January 1996 were identified. INTERVENTIONS: Warfarin was used after surgery by 72% of patients and aspirin was used by the remainder of them. MAIN OUTCOME MEASURES: Life table primary patency and limb salvage rates were compared for sex, diabetes mellitus status, location of distal prosthetic anastomosis (above knee vs. below knee), and anticoagulation drug therapy (warfarin sodium vs aspirin) with log-rank statistics. RESULTS: Primary patency of CSB was 56% at 24 months, 29% at 48 months, and 20% at 84 months (SE <10%; mean follow-up, 19.6 months [range, 1.0-110.0 months]). Limb salvage rates were 64% at 24 months, 30% at 48 months, and 23% at 84 months (SE <10%); 66% and 90% of patients had failed grafts requiring amputation by 3 months and 1 year, respectively. CONCLUSIONS: Composite sequential bypass for limb salvage provides reasonable 2-year patency. However, patency rates steadily declined from year 2 to year 5. After CSB failure, limb salvage rates are poor, with 90% of patients progressing to amputation within 1 year.
Adult↗
Preexisting thrombus and aortic aneurysm size change after endovascular repair.
BACKGROUND: Recent studies have demonstrated the effectiveness of endovascular grafting with aneurysm shrinkage following total exclusion of the abdominal aortic aneurysm (AAA). However, little is known about the effect of the preexisting thrombus (PT) on changes in aneurysm size following endovascular grafting. Therefore, this study is designed to determine the effect of PT on aneurysm size following endovascular grafting. METHODS: Blinded measurements of preoperative, postoperative, and 1-year computed tomographic scans of 44 patients undergoing endovascular grafting for AAA were performed. PT fraction was determined by the formula This was normalized for preoperative AAA growth. Pearson correlations were performed with AAA minor diameter change over the first year. RESULTS: There was no statistically significant relationship between PT fraction and rate of aneurysm size change (all patients, r = 0. 196 and P = 0.207). When patients with persistent leaks were excluded, the r = 0.234 and P = 0.170 also were not statistically significant. CONCLUSIONS: The amount of PT bears no important relationship to the response of the aneurysm following endovascular repair. Failure of aneurysms to shrink after endovascular treatment should not be attributed to large PT, but should prompt a thorough investigation for incomplete exclusion of the AAA. Long-term studies are needed to validate the efficacy of this new form of treatment.
Aortic Aneurysm, Abdominal↗
Characterization of vascular gene transfer using a novel cationic lipid.
INTRODUCTION: Cationic liposomes are an alternative non-viral vector for gene therapy, but several factors affect transfection efficiency. A novel cationic lipid, o-ethyldioleoylphosphatidylcholinium (EDOPC), was studied for characterization of the time course and effects of lipid composition, concentration, charge ratio, mixing techniques, passage number, and stimulated state on transfection of human vascular cells, represented by human umbilical vein endothelial cells (HUVEC). METHODS: HUVEC cultures were seeded at a density of 45,000 cells/well in 24-well plates and incubated overnight. Triplicate wells were transfected with samples of EDOPC/reporter plasmid for 2 h, followed by a 24-h expression time, which was the peak expression time point in an initial time-course experiment. Measuring luciferase in cell lysates quantitated gene expression. RESULTS: Transfection of HUVEC with EDOPC was optimal with a concentration of 100 microgram lipid/well, ratio of 3:1 EDOPC:plasmid, fractional mixing of lipid and plasmid, centrifugation, and incubation in serum-free media. Transfections in sequential passages showed striking decreases in gene expression and regression analysis revealed the relationship: RLU = 120,000 - (10, 400 x passage number), r(2) = 0.947. HUVEC activated by cytokine stimulation remain susceptible to gene transfer specifically with EDOPC. SUMMARY: During transfection of HUVEC with cationic lipid species, an increase in passage number is associated with linear reduction in luciferase expression, and hence passage number must be controlled in comparative experiments. Characteristics of EDOPC may permit site-specific efficient transfection of activated human vascular cells that can be isolated from serum by mechanical methods.
Blood Proteins↗
Up-regulation of vascular endothelial growth factor mRNA and angiogenesis after transmyocardial laser revascularization.
BACKGROUND: Angiogenesis has been proposed as a potential mechanism whereby transmyocardial laser revascularization (TMLR) has provided clinical relief of angina. Experimental work has found histologic evidence supporting this, as well as an improved response when angiogenic growth factors have been added to TMLR. The purpose of this study was to demonstrate that the molecular response to TMLR was an increase in the production of endogenous vascular endothelial growth factor to promote angiogenesis. METHODS: Ameroid constrictors were placed on the proximal circumflex artery in 12 domestic pigs. After a chronic ischemic zone was established the animals were randomly divided into two groups. In the TMLR group the ischemic zone was treated with carbon dioxide laser. In the control group the ischemic zone was untreated. Six weeks later the animals were sacrificed, and sections from the ischemic zone and the nonischemic zone were submitted for immunohistochemical, histologic, and molecular analysis. Messenger RNA was obtained from northern blot analysis after being probed with vascular endothelial growth factor. RESULTS: There was a twofold increase in the vascular endothelial growth factor messenger RNA in the ischemic zone of the TMLR group compared with the control group. Additionally, there was a threefold increase in the number of new blood vessels in the ischemic zone of the TMLR group compared with the control group. CONCLUSIONS: Transmyocardial laser revascularization promotes angiogenesis by upregulation of vascular endothelial growth factor. The resulting angiogenesis could be the principle mechanism for the clinical efficacy of TMLR.
Animals↗
Early clinical results and studies of aortic aneurysm morphology after endovascular repair.
Endovascular repair is a feasible treatment alternative with favorable short-term results compared with standard operations. Nonrandomized, multicenter trials already in progress should help to define the role of endovascular grafting in the treatment of patients who are otherwise candidates for conventional repair. Long-term follow-up studies will test the durability of the procedure, including clinical repercussions of late endoleaks and migration related to slow alterations in aortic morphology, such as neck dilation and aortic shortening. More research is needed into long-term aortic morphologic changes; further insights into these changes may allow subclinical prediction of clinical events and permit intervention before a catastrophic failure. How great an advantage this procedure has over observation in high-risk patients for whom no open surgical alternative is available is also unknown because the overall mortality of this patient cohort may mitigate any treatment benefits. In today's cost-conscious world, the viability of this new technology may be dependent on balancing the short-term benefits of this procedure against its associated requirements for monitoring and subsequent reinterventions.
Aortic Aneurysm↗
The importance of surgeon volume and training in outcomes for vascular surgical procedures.
PURPOSE: Mortality and morbidity rates after vascular surgical procedures have been related to hospital volume. Hospitals in which greater volumes of vascular surgical procedures are performed tend to have statistically lower mortality rates than those hospitals in which fewer procedures are performed. Only a few studies have directly assessed the impact of the surgeon's volume on outcome. Therefore, the purpose of this study was to review a large state data set to determine the impact of surgeon volume on outcome after carotid endarterectomy (CEA), lower extremity bypass grafting (LEAB), and abdominal aortic aneurysm repair (AAA). METHODS: The Florida Agency for Health Care Administration state admission data from 1992 to 1996 were obtained. The data included all nonfederal hospital admissions. Frequencies were calculated from first-listed International Classification of Diseases-9 codes. Multiple logistic regression was used to test the significance on outcome of surgeon volume, American Board of Surgery certification for added qualifications in general vascular surgery, hospital size, hospital volume, patient age, and gender. RESULTS: During this interval, there were 31,172 LEABs, 45,744 CEAs, and 13,415 AAAs performed. The in-hospital mortality rate increased with age. A doubling of surgeon volume was associated with a 4% reduction in risk for adverse outcome for CEA (P =.006), an 8% reduction for LEAB, and an 11% reduction for AAA ( P =.0002). However, although hospital volume was significant in predicting better outcomes for CEA and AAA procedures, it was not associated with better outcomes for LEAB. Certification for added qualifications in general vascular surgery was a significant predictor of better outcomes for CEA and AAA. Certified vascular surgeons had a 15% lower risk rate of death or complications after CEA (P =.002) and a 24% lower risk rate of a similar outcome after AAA (P =.009). However, for LEAB, certification was not significant. CONCLUSION: Surgeon volume and certification are significantly related to better patient outcomes for patients who undergo CEA and AAA. In addition, surgeons with high volumes demonstrated consistently lower mortality and morbidity rates than did surgeons with low volumes. Hospital volume for a given procedure also is correlated with better outcomes.
Aortic Aneurysm, Abdominal↗
Combined arterial reconstruction and free tissue transfer for limb salvage.
PURPOSE: Lower-extremity arterial anatomy that is insufficient for successful vein bypass grafting and major proximal foot wounds often lead to leg amputation in patients with severe ischemia. Free tissue transfer, which can provide limb salvage in these patients after arterial reconstruction, was studied. METHODS: During a 45-month period, 21 patients who otherwise would have undergone leg amputation were treated with arterial bypass by means of vein grafting and free tissue transfer. Ages of the patients ranged from 40 to 73 years (average, 59 years); 18 of the 21 patients had diabetes mellitus; and all patients except one were men. Arterial reconstruction was performed from the femoral (nine of 21 patients) or popliteal artery (12 of 21 patients) to the posterior tibial (eight patients), dorsalis pedis (five patients), peroneal (three patients), popliteal (one patient), or anterior tibial artery (one patient), or directly to the free flap (three patients). The tissue transferred included latissimus dorsi (five patients), rectus abdominus (five patients), omentum (five patients), gracilis (two patients), radial forearm flaps (three patients), and a scapular flap (one patient). Foot defects were debrided, including the appropriate toe or transmetatarsal amputation, covered with the transferred flap, and then split-thickness skin grafted. Arterial flow for all flaps was through the vein grafts, with direct arterial anastomosis and with venous outflow through adjacent tibial veins. RESULTS: All 21 procedures were successful initially, without operative mortality, but three failed within 4 weeks because of uncontrolled infection (two) or embolization from a remote site (one) and required below-knee amputation. Grafts remained patent in 18 procedures, and follow-up of this cohort ranged from 1 to 45 months (mean, 13.3 months). Two patients died, one after 4 months and one after 6 months, of unrelated illness; at the time of death, they had functioning grafts. The remaining 19 patients are alive. Of these, 15 have patent arterial grafts, all viable free flaps. Thus, limb salvage was accomplished in 18 of 21 (86%) patients who otherwise would have required below-knee amputation. CONCLUSION: Patients destined for leg amputation despite aggressive traditional arterial bypass grafting methods can achieve limb salvage with the additional technique of free tissue transfer.
Adult↗
Increased plasma levels of metalloproteinase-9 are associated with abdominal aortic aneurysms.
PURPOSE: Previous investigators have identified disease-specific elevations of metalloelastase-9 (MMP-9) in aneurysm tissue biopsies. We hypothesized that circulating MMP-9 might also be elevated in patients with aneurysms. The purpose of this study was to compare plasma and aortic tissue MMP-9 levels in patients with infrarenal aneurysms (AAAs), patients with symptomatic aortoiliac occlusive disease (AOD), and healthy patients. METHODS: A sandwich enzyme-linked immunosorbent assay was used to measure plasma MMP-9 in patients with AAA (n = 22; mean age, 72.7 years), with AOD (n = 9; mean age, 60.5 years), and without disease (n = 8; mean age, 35.3 years). The MMP-9 levels also were measured in 48-hour supernatants of organ culture tissue explants from patients with AAA (n = 10; mean age, 66.2 years) and AOD (n = 5; mean age, 50.4 years) and organ donors (n = 7; mean age, 48.1 years). The results were reported as the mean +/- the standard error of the mean and analyzed with analysis of variance with multivariate regression. RESULTS: The plasma MMP-9 levels were significantly higher in the patients with AAA (85.66 ng/mL +/- 11.64) than in the patients with AOD (25.75 ng/mL +/- 4.159; P <.001) or the healthy patients (13.16 ng/mL +/- 1. 94; P <.001). No significant difference in plasma MMP-9 levels between patients with AOD and healthy patients was identified. The patients with multiple aneurysms had significantly higher levels of plasma MMP-9 than did the patients with an isolated AAA (134.68 ng/mL +/- 17.5 vs 71.03 ng/mL +/- 10.7; P <.04). In organ culture, AAA and AOD tissue explants produced significantly higher levels of MMP-9 (3218.5 ng/gm +/- 1115.2 and 1283.1 ng/gm +/- 310.6 aortic tissue) than did disease-free explants (6.14 ng/gm +/- 2.3 aortic tissue; P <.0001). No significant difference in MMP-9 production between AAA and AOD explants was identified. CONCLUSION: Plasma MMP-9 levels are significantly higher in patients with AAA than in patients with AOD or in healthy volunteers. The patients with multiple aneurysms have higher levels than those patients with an isolated AAA. Organ culture studies suggest that diseased aortic tissue is the source of MMP-9.
Adult↗
Reoperative aortic surgery.
The presentation of long-term complications after conventional aortic surgery and the treatment of patients that have had reoperative aortic operations are reviewed. Ninety-seven consecutive patients that had 102 subsequent aortic operations at a tertiary referral center were studied. Presenting symptoms, demographics, risk factors, indications for initial and second procedures, operative techniques and outcomes were recorded in a computerized database. There were 70 men and 27 women studied, with an average age of 64 years. First operations were performed primarily for aneurysm (56%) and occlusive disease (44%). The interval between procedures ranged up to 23 years, with a mean of 6 years. Indications for reoperation were subsequent aneurysm (65), graft occlusions (25) and/or infections (24). Seventy-three percent of the subsequent aneurysms were true metachronous aneurysms; the others were associated with the graft or an anastomosis. Para-anastomotic aneurysms may be more common with a primary end-to-side graft configuration. One-third of subsequent aneurysms were not palpable and asymptomatic. Graft occlusion can be treated safely with elective repeat bypass (mortality 0%). Graft infections that require total graft removal remain a challenging problem (mortality 17%). Although surgical approach for reoperations utilized more extensive exposure and proximal clamping, 59 elective aneurysm cases had a 5.1% mortality rate; eight emergent procedures for ruptured aneurysms resulted in 88% mortality. Reoperation for graft occlusion or infection showed a similar high mortality rate with emergent cases. In this referral practice, graft occlusion and infection are relatively less frequent, whereas metachronous aneurysm formation is now the most common indication for reoperation. These aneurysms often remain undetected until symptoms occur; frank rupture is usually lethal. As elective repair with modern reoperative techniques can be safely performed, routine computed tomographic examination is advisable at least every 5 years after aortic operations.
Aortic Aneurysm, Abdominal↗
Rates of lower-extremity amputation and arterial reconstruction in the United States, 1979 to 1996.
OBJECTIVES: This report describes trends in the rates of lower-extremity amputation and revascularization procedures and vascular disease risk factors. METHODS: We analyzed trends in National Hospital Discharge Survey data for 1979 through 1996 and in National Health Interview Study data for 1983 through 1994. RESULTS: Despite a decline between 1983/84 and 1991/92, by 1995/96 the rate of major amputation had increased 10.6% since 1979/80. The earlier 12-year decline was positively correlated with reductions in the prevalence of smoking (r = 0.88, P < .0001), hypertension (r = 0.65, P = .02), and heart disease (r = 0.73, P = .007), but not diabetes (r = -0.33, P = .29). During the 1980s, amputation and angioplasty rates were inversely correlated (r = -0.75, P = .001), but the decline in amputation rates occurred before the increase in angioplasty. The major amputation rate, which has increased since 1993, was 24.95 per 100,000 people in 1996. CONCLUSIONS: Major amputation rates fell in the years following the diffusion of distal bypass surgery but before the widespread use of peripheral angioplasty. Because disease prevalence and primary amputation rates are unknown, it is difficult to estimate the contribution of recent improvements in vascular surgery to limb preservation.
Adult↗
Proteoglycan gene expression is decreased in abdominal aortic aneurysms.
BACKGROUND: Abdominal aortic aneurysms (AAA) are characterized by both increases in proteolysis and changes in the biosynthesis of the extracellular matrix (ECM) proteins. Proteoglycans are important components of the ECM, particularly the small proteoglycans, biglycan and decorin. Biglycan and decorin regulate cell proliferation and collagen assembly. Therefore, the purpose of this study is to quantify the levels of mRNA for biglycan and decorin in normal aorta (Na) and AAA. MATERIALS AND METHODS: Northern blot hybridization and competitive polymerase chain reaction using gene-specific external standards were used to quantify mRNA levels of bigylcan and decorin in RNA derived from AAA and NA. Results are expressed as a percentage of glyceraldehyde-3-phosphate dehydrogenase or normalized to ribosomal RNA content and compared using the unpaired t test. RESULTS: A statistically significant 15-fold decrease in biglycan mRNA expression was observed in AAA compared to NA (176.9% vs 11.8%, P < 0.001). In contrast to biglycan, the decorin mRNA expression is unchanged in AAA compared to NA. CONCLUSIONS: The marked decrease in biglycan mRNA levels is unique to aneurysmal disease of the aorta. In atherosclerosis and restenosis, biglycan expression is increased in comparison with normal artery. This decrease in biglycan expression may reflect important regulatory changes specific for the AAA. Furthermore, a decrease in biglycan gene expression and biosynthesis could have a broad impact on the physiology and matrix architecture of the aorta.
Adult↗
Hospital vascular surgery volume and procedure mortality rates in California, 1982-1994.
PURPOSE: Little is known about the long-term growth and outcomes of vascular surgery procedures over time. Trends in the use of three major vascular surgery procedures by a general population-lower extremity arterial bypass (LEAB), carotid endarterectomy (CEA), and abdominal aortic aneurysm repair (AAA)-are described. The extent to which these procedures are being performed in low-, moderate-, and high-volume hospitals is examined. METHODS: California hospital discharge records for LEAB, CEA, AAA, lower extremity angioplasty, coronary angioplasty, and coronary bypass surgery (CABG) were studied in all non-federal hospitals between 1982 and 1994. The data were age- and sex-adjusted to describe procedure growth. In-hospital mortality rates for LEAB, CEA, and AAA are related to overall hospital procedure volume, using logistic regression to control for risk factors and time trends. RESULTS: Growth in the number of vascular procedures performed in California was modest between 1982 and 1994, with no age-adjusted growth. Lower extremity angioplasty grew considerably in the 1980s and has since plateaued. Annual in-hospital death rates declined for all procedures except ruptured AAA. Comparing the two 5-year periods of 1982-1986 and 1990-1994, in-hospital death rates decreased from 4.2% to 3.3% for LEAB, from 9.2% to 6.2% for unruptured AAA, and from 1.6% to 1.0% for CEA (p < 0.0001). The odds of dying for patients treated in high-volume hospitals for LEAB and CEA procedures compared with patients treated in hospitals performing fewer than 20 procedures in a year were 66.7% (p = < 0.0001) and 66.1% (p < 0.0001), respectively. For patients with ruptured and unruptured AAA procedures, the odds of dying in hospitals with at least 50 AAA procedures in a year were 49.1% (p < 0.0001) and 83.8% (p = 0.016), respectively, compared with the odds of dying in low-volume hospitals. CONCLUSIONS: In-hospital mortality rates for CEA, LEAB, and unruptured AAA have been significantly decreasing over time. Mortality is inversely related to hospital volume and directly related to patient age and emergency status. Mortality trends over time for ruptured AAA remains unchanged; however, mortality is less in high-volume hospitals. Coronary angioplasty (PTCA) has not had an impact on rates for LEAB.
Age Factors↗
Carotid plaque morphology correlates with presenting symptomatology.
PURPOSE: In carotid artery disease, correlation of carotid plaque morphology with the patient's presenting symptoms has drawn conflicting conclusions. The purpose of this series was to correlate carotid plaque characteristics with the presenting symptoms from a large cohort of patients who underwent operation for carotid artery disease. METHODS: From a series of 1252 consecutive patients who underwent carotid endarterectomy, presenting symptoms were divided into three groups: transiently symptomatic (transient ischemic attack [TIA] or amaurosis fugax), prior stroke, and asymptomatic. Plaque characteristics, including ulceration, intraplaque hemorrhage, and degree of stenosis, were recorded prospectively for 1008 procedures. All endarterectomy specimens were inspected during the procedure, and plaque characteristics were recorded immediately after operation. RESULTS: There was a higher incidence of plaque ulceration in the transiently symptomatic and prior stroke groups (391 of 508 [77%] and 91 of 115 [79%]) than in the asymptomatic cohort (231 of 385 [60%]; p < 0.0001, chi2 test). There was no significant difference in the incidence of plaque hemorrhage between the transiently symptomatic and prior stroke patients compared with the asymptomatic patients. There was no statistical difference for ulcerated plaque or plaque hemorrhage between the transiently symptomatic and prior stroke group. Intraplaque hemorrhage occurred more frequently in patients with high-grade stenosis (90% to 99%) than in those with less than 90% stenosis (202 of 299 [68%] versus 97 of 299 [32%]; p = 0.01, chi2 test). CONCLUSIONS: On gross examination of the carotid specimen in the operating room, plaque ulceration correlates with an initial presentation of amaurosis fugax, TIA, or prior stroke compared with patients operated on for asymptomatic disease. The presence of intraplaque hemorrhage is associated with more advanced stenosis of the internal carotid artery. These findings suggest that plaque morphology does play an important role in the presentation of carotid artery disease.
Adult↗
Research initiatives in vascular disease.
Explore the source record for details and available documents.
Adaptation, Physiological↗