PubMed · 14310708
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
A VARDAR. 1965. [ARTERIAL PATCH (PATCH-GRAFT ANGIOPLASTY)].. https://pubmed.ncbi.nlm.nih.gov/14310708/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
BACKGROUND AND PURPOSE: Whether cerebral protection during carotid angioplasty and stenting (CAS) is associated with a lower risk of periprocedural stroke or death remains to be established. We report on 80 patients randomized in the CAS arm of the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis trial comparing CAS (with or without cerebral protection) with carotid surgery in patients with recently symptomatic, severe carotid stenosis. SUMMARY OF REPORT: The Safety Committee recommended stopping unprotected CAS, because the 30-day rate of stroke was 3.9 (0.9 to 16.7) times higher than that of CAS with cerebral protection (4/15 versus 5/58). CONCLUSIONS: Although this result was not based on a randomized comparison of unprotected versus protected CAS, it suggests that the use of cerebral protection devices during CAS reduces periprocedural strokes.
BACKGROUND: Recent evidence indicates that stromal cell-derived factor-1alpha (SDF-1alpha) is expressed in human atherosclerotic plaques, whereas high plasma levels are clinically associated with stable coronary artery disease. Herein, we investigate the involvement of SDF-1alpha in neointimal formation after vascular injury. METHODS AND RESULTS: SDF-1alpha was detected by immunohistochemistry in carotid arteries of apolipoprotein E-deficient (apoE-/-) mice at various stages of neointima formation after wire-induced injury. Double immunofluorescence revealed that SDF-1alpha staining was mostly confined to smooth muscle cells (SMCs). Furthermore, SDF-1alpha plasma levels peaked 1 day after vascular injury. Treatment of apoE-/- mice after carotid injury with a neutralizing SDF-1alpha monoclonal antibody for 3 weeks reduced neointimal lesion area by 44% (n=5, P<0.05) compared with isotype control. In SDF-1alpha antibody-treated apoE-/- mice, neointimal SMC content was decreased (21.7+/-2% versus 39.4+/-4%, n=5, P=0.005), whereas the relative content of neointimal macrophages remained unchanged. As shown by flow cytometry, carotid injury resulted in a marked expansion of circulating Sca-1+lineage- progenitor cells (PBPCs) in the peripheral blood of apoE-/- mice after 1 day, which was mediated by SDF-1alpha. Systemic injection of isolated PBPCs after vascular injury demonstrated their recruitment to neointimal lesions, where they can adopt an SMC-like phenotype. CONCLUSIONS: SDF-1alpha plays an instrumental role in neointimal formation after vascular injury in apoE-/- mice by regulating neointimal SMC content. This contribution appears to be attributable to SDF-1alpha-dependent recruitment of circulating SMC progenitor cells.
BACKGROUND: Carotid endarterectomy is the most common surgical procedure used to treat stenosis of the extracranial precerebral carotid artery. Data from several randomized controlled trials are available to help guide its use in specific patient subgroups. Carotid angioplasty with stenting is also being performed, and clinical trials comparing this procedure with carotid endarterectomy are in progress. SUMMARY OF REPORT: For patients with symptomatic high-grade (ie, 70% to 99%) stenosis, carotid endarterectomy is associated with an overall benefit (risk ratio estimate for the combined end point of nonfatal stroke, nonfatal myocardial infarction, or death, 0.67; 95% CI, 0.54 to 0.83). The benefit is more modest for patients with less severe stenosis (ie, 50% to 69%) and may vary with specific patient characteristics. Selected patients with asymptomatic carotid stenosis may also benefit from the operation, but it needs to be performed with very low complication rates, which can be difficult to achieve in clinical practice. Several studies of angioplasty, angioplasty with stenting, and more recently angioplasty with stenting and a so-called distal protection device have also been performed. The technology involved continues to evolve rapidly, presenting a challenge for the design and conduct of clinical trials. CONCLUSIONS: Surgical intervention for extracranial carotid stenosis remains a major potential therapeutic modality for the prevention of stroke in selected patients. Endovascular approaches continue to be evaluated in ongoing trials.