1/4. Bilateral carotid stenting prior to coronary artery bypass graft: a case report.BACKGROUND: carotid stenosis is an independent possible complication of the central nervous system of patients after receiving a coronary artery bypass graft (CABG). The risk increases when the patient has bilateral carotid stenosis even if asymptomatic. CASE REPORT: A 76 year-old female was admitted because of unstable angina. The coronary angiography showed triple vessel disease and required CABG for revascularization. Her physical examination revealed bilateral carotid bruits. She did not have any history of neurological deficit. Carotid Doppler showed critical stenosis of bilateral carotid arteries. The carotid angiography demonstrated 70 per cent diameter stenosis of both internal carotid arteries just above the bifurcation of the external carotid artery. A 7 x 20 mm self-expandable Smart stent was implanted first in the right carotid artery with good angiographic result. Five days later, another 7 x 20 mm self-expandable Smart stent was implanted in the left carotid artery without residual stenosis. The patient did not have any cardiovascular complications. CABG was performed 2 weeks later with a good result. The patient was discharged 10 days after CABG. CONCLUSION: Bilateral carotid stenting is feasible and produces an acceptable outcome. This procedure is an alternative treatment for preventing stroke during CABG surgery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Carotid endarterectomy complicated by vein patch rupture.saphenous vein patch angioplasty has been used to improve the results of carotid endarterectomy by decreasing the incidence of postoperative occlusion and recurrent stenosis. A rare but potentially lethal complication of this technique is aseptic necrosis and rupture of the vein patch during the postoperative period. We report three cases of this phenomenon and review an additional 13 cases from the literature. This event generally occurs without warning 2 to 7 days postoperatively and may result in death or stroke. At reoperation, the central portion of the vein patch is necrotic, without evidence of infection. Technical considerations in the harvesting and preparation of these grafts are reviewed, as are the physical parameters predisposing certain vein patches to rupture. saphenous vein harvested from the ankle has been linked to every reported case. Small diameter veins in particular appear to carry a higher risk of rupture.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Regressing intracranial carotid occlusions in childhood.Though detected with increasing frequency, intracranial carotid artery dissection remains less common in infancy. We report on 3 otherwise healthy children aged 8, 12 and 15 years who presented with focal headache and stroke secondary to intracranial carotid occlusive disease consistent with arterial dissection. In 2 cases this was precipitated by strenuous physical exertion. The protean angiographic configuration included long tapered narrowing with focal stenosis, beaded narrowing with Moya Moya vascular network and 'string sign'; occlusion of the anterior cerebral artery was always present. Control angiograms revealed complete or partial recanalization in all cases suggesting self-healing dissection. The clinical course was smooth in all patients, and at long-term follow-up (5, 3, and 2 years) they remain in good neurological condition. Although intracranial carotid dissection has a poor reputation, regression to normal and fair outcome may sometimes occur as in the extracranial counterpart, suggesting the existence of benign forms of the disease. Surgical procedures should be weighed against the spontaneous resolution of the lesion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Is the use of ankle saphenous vein for carotid artery patch closure justified?saphenous vein patch angioplasty has been introduced to prevent early and late restenosis after carotid artery endarterectomy. We describe a case of vein patch rupture on the first postoperative day, resulting in death of a hypertensive female patient. Although the incidence of this complication is low (0.5 to 1%), the morbidity and mortality rate is dramatically high when it occurs. In similar cases published, saphenous vein harvested from the ankle is involved almost exclusively, suggesting that small-diameter veins have a higher risk of rupture when used as a carotid patch. Old age, female gender, diabetes and arterial hypertension seem to be further factors negatively influencing the physical properties of the vein. Therefore, if a venous patch is needed in selected patients most probably in female patients with small internal carotid arteries, it seems appropriate to use the proximal part of the saphenous vein from the groin or the thigh.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |