1. The document discusses Chronic Cerebrospinal Venous Insufficiency (CCSVI), a condition linked to multiple sclerosis (MS) where veins draining the brain and spinal cord are narrowed or blocked.
2. It provides details on diagnosing and treating CCSVI using procedures like Doppler ultrasound, MRI, venography, and venous angioplasty to widen blocked veins.
3. While the relationship between CCSVI and MS is still being studied, the document reports that over 600 MS patients treated for CCSVI experienced reduced fatigue, improved quality of life, psychological state, and physical condition based on evaluation scales.
This document describes a bilaterally symmetric form of Hirayama disease observed in some patients. Out of 106 patients studied between 1992-2008, 11 showed nearly symmetric involvement of both upper limbs. The key characteristics of these symmetric cases included onset in teenage years, symmetric or near-symmetric muscle wasting in certain spinal segments, and MRI findings during neck flexion of cord flattening and enhancement of the posterior epidural space in both sides of the cervical spine. This suggests a rarer symmetric form of Hirayama disease can occur in some patients.
The study investigated the relationship between dilated Virchow-Robin spaces (VRS) seen on MRI and cerebral microvascular disease in elderly patients with dementia. 75 patients with Alzheimer's disease, ischemic vascular dementia, or frontotemporal dementia underwent MRI and were compared to 35 healthy volunteers. VRS scores were significantly higher in patients with vascular dementia compared to those with Alzheimer's disease, frontotemporal dementia, or healthy volunteers. VRS scores accounted for 29% of the variance in a regression model, more than periventricular hyperintensities, suggesting dilated VRS are a sensitive indicator of cerebral microvascular disease.
1 enfermedad cv ateroesclerótica figura 1 (1)sagita28
This document summarizes recent advances in imaging technologies for detecting and assessing atherosclerotic cardiovascular disease. It discusses how MRI, CT, and molecular imaging techniques can now detect atherosclerosis earlier in its development by imaging plaque composition in arterial walls, in addition to imaging advanced stenosis and its effects. These new imaging approaches may help stratify disease risk, monitor treatment effects, and improve understanding of atherosclerosis biology.
This study compared cardiac magnetic resonance imaging (CMR) to echocardiography for assessing left ventricular non-compaction (LVNC) in 16 patients. CMR was able to analyze all heart segments, while echocardiography could only analyze 87.5% at end-diastole and 87.1% at end-systole. CMR detected a two-layered heart structure in 54% of segments compared to 42.9% for echocardiography at end-diastole and 41.4% at end-systole. Echocardiography at end-systole underestimated the ratio of non-compacted to compacted layer thickness compared to CMR and echocardi
Coronary artery ectasia (CAE) is an inappropriate dilatation of the coronary arteries. It has an unknown etiology but may be due to genetic or inflammatory factors. CAE is detected in 3-8% of angiograms and can be diffuse or localized. It can cause angina due to turbulent blood flow. Diagnosis is typically made using angiography, CT, or MRI imaging. Treatment involves aspirin due to risk of thrombosis, with surgical revascularization for significant coronary artery disease.
CARDIOPULMONARY BYPASS AND PRETERM NEONATES Adhi Arya
This document discusses the surgical options and risks for a 3 day old premature infant born with transposition of the great arteries, coarctation of the aorta, and hypoplastic right ventricle. It notes the risks of surgery in preterm infants include complications from immature organ systems, effects of cardiopulmonary bypass like coagulation abnormalities, and the underlying heart defects. The document advocates for strategies like limiting bypass and cross-clamp times, minimizing hemodilution, steroid administration, and close postoperative management to optimize outcomes for these high-risk patients.
An approach to myocardial biopsy interpretationSaurav Singh
The endomyocardial biopsy is the gold standard for diagnosing various primary and secondary cardiac conditions. It involves using a biopsy catheter inserted via the femoral vein to obtain small tissue samples from the right ventricle. The procedure allows differentiation between cardiomyopathies, myocarditis, amyloidosis, and assessment of transplant rejection and drug cardiotoxicity. Proper handling and processing of biopsy specimens is important for accurate histological and molecular diagnosis. Complications are rare but include perforation and hemorrhage. The endomyocardial biopsy remains a valuable diagnostic tool for evaluating cardiomyopathies and monitoring transplant patients.
This document summarizes the findings of a study analyzing 19,482 left main stem percutaneous coronary intervention (LMS-PCI) procedures from the British Cardiovascular Intervention Society National Database between 2007-2014:
1) Use of radial artery access for LMS-PCI increased significantly over time and radial access was associated with reduced vascular complications, major bleeding, and shorter hospital stays.
2) Radial access was independently associated with lower in-hospital mortality and major adverse cardiac and cerebrovascular events (MACE) compared to femoral access.
3) Independent predictors of 12-month mortality following LMS-PCI included acute kidney injury, older age, chronic renal failure, acute coronary syndrome presentation, and
This document describes a bilaterally symmetric form of Hirayama disease observed in some patients. Out of 106 patients studied between 1992-2008, 11 showed nearly symmetric involvement of both upper limbs. The key characteristics of these symmetric cases included onset in teenage years, symmetric or near-symmetric muscle wasting in certain spinal segments, and MRI findings during neck flexion of cord flattening and enhancement of the posterior epidural space in both sides of the cervical spine. This suggests a rarer symmetric form of Hirayama disease can occur in some patients.
The study investigated the relationship between dilated Virchow-Robin spaces (VRS) seen on MRI and cerebral microvascular disease in elderly patients with dementia. 75 patients with Alzheimer's disease, ischemic vascular dementia, or frontotemporal dementia underwent MRI and were compared to 35 healthy volunteers. VRS scores were significantly higher in patients with vascular dementia compared to those with Alzheimer's disease, frontotemporal dementia, or healthy volunteers. VRS scores accounted for 29% of the variance in a regression model, more than periventricular hyperintensities, suggesting dilated VRS are a sensitive indicator of cerebral microvascular disease.
1 enfermedad cv ateroesclerótica figura 1 (1)sagita28
This document summarizes recent advances in imaging technologies for detecting and assessing atherosclerotic cardiovascular disease. It discusses how MRI, CT, and molecular imaging techniques can now detect atherosclerosis earlier in its development by imaging plaque composition in arterial walls, in addition to imaging advanced stenosis and its effects. These new imaging approaches may help stratify disease risk, monitor treatment effects, and improve understanding of atherosclerosis biology.
This study compared cardiac magnetic resonance imaging (CMR) to echocardiography for assessing left ventricular non-compaction (LVNC) in 16 patients. CMR was able to analyze all heart segments, while echocardiography could only analyze 87.5% at end-diastole and 87.1% at end-systole. CMR detected a two-layered heart structure in 54% of segments compared to 42.9% for echocardiography at end-diastole and 41.4% at end-systole. Echocardiography at end-systole underestimated the ratio of non-compacted to compacted layer thickness compared to CMR and echocardi
Coronary artery ectasia (CAE) is an inappropriate dilatation of the coronary arteries. It has an unknown etiology but may be due to genetic or inflammatory factors. CAE is detected in 3-8% of angiograms and can be diffuse or localized. It can cause angina due to turbulent blood flow. Diagnosis is typically made using angiography, CT, or MRI imaging. Treatment involves aspirin due to risk of thrombosis, with surgical revascularization for significant coronary artery disease.
CARDIOPULMONARY BYPASS AND PRETERM NEONATES Adhi Arya
This document discusses the surgical options and risks for a 3 day old premature infant born with transposition of the great arteries, coarctation of the aorta, and hypoplastic right ventricle. It notes the risks of surgery in preterm infants include complications from immature organ systems, effects of cardiopulmonary bypass like coagulation abnormalities, and the underlying heart defects. The document advocates for strategies like limiting bypass and cross-clamp times, minimizing hemodilution, steroid administration, and close postoperative management to optimize outcomes for these high-risk patients.
An approach to myocardial biopsy interpretationSaurav Singh
The endomyocardial biopsy is the gold standard for diagnosing various primary and secondary cardiac conditions. It involves using a biopsy catheter inserted via the femoral vein to obtain small tissue samples from the right ventricle. The procedure allows differentiation between cardiomyopathies, myocarditis, amyloidosis, and assessment of transplant rejection and drug cardiotoxicity. Proper handling and processing of biopsy specimens is important for accurate histological and molecular diagnosis. Complications are rare but include perforation and hemorrhage. The endomyocardial biopsy remains a valuable diagnostic tool for evaluating cardiomyopathies and monitoring transplant patients.
This document summarizes the findings of a study analyzing 19,482 left main stem percutaneous coronary intervention (LMS-PCI) procedures from the British Cardiovascular Intervention Society National Database between 2007-2014:
1) Use of radial artery access for LMS-PCI increased significantly over time and radial access was associated with reduced vascular complications, major bleeding, and shorter hospital stays.
2) Radial access was independently associated with lower in-hospital mortality and major adverse cardiac and cerebrovascular events (MACE) compared to femoral access.
3) Independent predictors of 12-month mortality following LMS-PCI included acute kidney injury, older age, chronic renal failure, acute coronary syndrome presentation, and
This document summarizes the EXCEL trial, which compared everolimus-eluting stents to bypass surgery for treating left main coronary artery disease. The trial included over 2900 patients across 17 countries. At 3 years, the primary endpoint of death, stroke, or heart attack was similar between the stent and surgery groups, but the stent group had fewer adverse events in the first 30 days. However, at 5 years stent patients had higher rates of non-procedural heart attacks and required more repeat procedures, though mortality remained similar. The conclusion is that stents may be preferable to surgery for selected left main disease patients after discussion, though surgery provided better long-term outcomes.
Cryopreserved saphenous vein allografts were evaluated for infragenual bypass surgery in 92 patients with critical limb ischemia over 15 years. Primary and primary assisted patency rates at 1 year were 49.9% and 55.7%, and limb salvage rates at 1, 3, and 5 years were 85%, 70%, and 64%. While allografts are an alternative to prosthetic materials when autologous veins are unavailable, better patient selection and use of statins may improve results, though availability remains limited.
This document summarizes a case study of a 40-year-old male patient presenting with right-sided ataxic hemiparesis and oral and genital ulcerations. MRI scans showed hyperintense lesions in the midbrain, thalamus, and pons, suggesting demyelination along the corticospinal tract. The clinical and radiological findings were consistent with neuro-Behcet syndrome, a condition characterized by inflammation of blood vessels in the central nervous system. Pathological studies of lesions from neuro-Behcet syndrome patients support a pathogenesis involving small vessel vasculitis, predominantly of veins. The selective involvement of corticospinal fibers in this case can be explained by the inflammatory process affecting
This document describes a study of 10 patients with intraventricular meningiomas of the lateral ventricles treated over 28 years. Most patients presented with headache and visual disturbances. MRI showed enhancing masses within the ventricles. Surgery was performed in 9 cases, with total resection in 8. Total resection via a posterior parieto-occipital or transtemporal approach is the standard treatment for these rare tumors, though recurrence is possible.
This document discusses hybrid operating rooms and procedures that combine endovascular and open surgical techniques. It begins by explaining the rationale for hybrid approaches, which allow treating more complex cardiac conditions while minimizing invasiveness. A hybrid OR has capabilities for both endovascular interventions and open surgery simultaneously. Key components include cath lab and surgical equipment that can be used together. The document discusses examples like using a stent graft with open surgery for aortic aneurysm or replacing valves percutaneously along with coronary artery bypass. It emphasizes teamwork and convergence of specialties to determine the best individualized approach. Hybrid procedures may reduce recovery time compared to traditional open surgery alone.
Ascending aortic aneurysm and its clinical significance: A case reportApollo Hospitals
Aorta, the major conductance vessel of the body, can be affected by a variety of pathologic processes leading to aneurysm, dissection, or ischemic syndromes. There has been a drastic increase in the incidence of aortic aneurysm making it the 18th most common cause for death.
When ignored, the patients’ condition might worsen leading to death due to rupture and hemorrhage. Here we report a case of ascending aortic aneurysm affecting the aortic root and proximal part of ascending aorta. Conscious awareness of this pathological process augments a great deal to radiologists and sonographers during various imaging techniques and rescues the patient from aneurysm-related deaths.
Coronary Artery Aneurysms and Ectasia Michael Katz
This document summarizes the morning report of a 59-year-old man with a history of kidney transplant, SLE, and prior STEMI managed with thrombus extraction. He presented with recurrent chest pain. Key findings include inferolateral wall perfusion defect on nuclear stress test. The report reviews coronary aneurysms/ectasia classification, etiologies including atherosclerosis, Kawasaki disease, inflammatory disorders. The patient's systemic lupus erythematosus and transplant status suggest an inflammatory cause is possible. Evaluation and management of antiplatelet therapy is discussed.
LVNC is a rare genetic cardiomyopathy characterized by a spongy appearance of the myocardium due to incomplete compaction of the embryonic myocardium. It can present with heart failure, arrhythmias, or thromboembolism. Echocardiography and cardiac MRI are used to diagnose LVNC based on identifying a two-layered myocardium. Management involves treating heart failure and preventing thromboembolism with anticoagulation in high-risk patients. While the cause of LVNC is thought to be due to an arrest in normal myocardial compaction during embryonic development, the pathophysiology is not fully understood.
Journal club drug eluting balloon for cadKunal Mahajan
This document discusses treatment options for in-stent restenosis (ISR) in a patient with a past history of percutaneous coronary intervention. It summarizes the findings of several studies comparing drug-eluting balloons (DEBs) and drug-eluting stents (DES) for treating ISR. The studies found that DES were superior to DEBs for reducing repeat revascularization, while safety outcomes like death and heart attack were similar. However, DEBs may be preferred over DES in certain high risk cases, like those with multiple stent layers or who are at high risk of bleeding complications from long-term dual antiplatelet therapy. Additional research with longer follow-ups is still needed to further compare DEBs
Enormous thoracic solitary fibrous tumour with inferior vena compression case...Abdulsalam Taha
This case report describes an extremely large solitary fibrous tumor (SFT) that arose in the thoracic cavity of a middle-aged male patient. The tumor filled the entire left hemithorax, displacing the heart and lungs to the right side and compressing the inferior vena cava. Though initially deemed inoperable, the tumor was successfully resected via median sternotomy. Histopathological examination confirmed the diagnosis of SFT. The report highlights the surgical management of this rare but potentially life-threatening intrathoracic tumor.
This document discusses hybrid coronary revascularization (HCR), which combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). HCR was introduced in 1996 as a treatment for multivessel coronary artery disease. It aims to reduce surgical trauma while preserving long-term survival and minimizing adverse events. The hybrid approach involves using a left internal mammary artery graft for the left anterior descending artery and PCI for other lesions. This takes advantage of the excellent outcomes of the arterial graft and improvements in stents. HCR may provide benefits for higher surgical risk patients and allow shorter recovery times compared to traditional CABG. However, some debate remains around its additional complexity and costs compared to established treatments.
1. Arterial aneurysms most commonly occur in the abdominal aorta and can be caused by degenerative processes, infections, trauma, or genetic conditions.
2. Abdominal aortic aneurysms are the most prevalent type of aneurysm in the United States and rupture of aneurysms is a serious complication.
3. Aneurysms can be classified by their morphology (fusiform vs. saccular), etiology (degenerative, inflammatory, infectious), and location (aortic, iliac, femoral, etc.). Management depends on the type and severity of the individual aneurysm.
Stent assisted reconstruction of difficult aneurysms in acute subarachnoid he...Dr Vipul Gupta
This document summarizes the experience of a single center in using stent-assisted reconstruction to treat difficult aneurysms in patients presenting with acute subarachnoid hemorrhage. It describes treating 35 aneurysms in 33 patients that were not amenable to standard coiling, balloon-assisted coiling, or surgery. Stent placement was used to support the neck of wide-neck or dissecting/blister aneurysms to avoid coil protrusion. Most patients (28 of 33) had good outcomes, while 2 had management morbidity and 3 died. The results demonstrate stent-assisted coiling is a viable option for challenging aneurysms in acute subarachnoid hemorrhage cases.
This document discusses cerebral haemorrhage (ICH), which accounts for 10-15% of strokes. ICH can result from several mechanisms, including hypertension (47-66% of cases), cerebral amyloid angiopathy (CAA), and vascular malformations. CAA typically affects the elderly and causes lobar ICH that is often recurrent or involves multiple simultaneous haemorrhages. Vascular malformations like arteriovenous malformations (AVMs) and cavernous angiomas are a common cause of ICH in young, non-hypertensive patients. Imaging techniques like CT and MRI can identify vascular malformations and help determine the underlying cause of ICH.
Carotid blowout syndrome (CBS) is an uncommon but dreaded complication that occurs in patients treated for head and neck cancer. CBS is the result of necrosis of the arterial wall, which can occur following resection, after reirradiation for a recurrent or second primary tumor, by direct tumor invasion of the carotid artery wall or by a combination of these factors.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
Limitations of carotid stenting - dr Antoni Ferenspiodof
This document summarizes the limitations of carotid stenting from a neurologist's point of view. It discusses guidelines from ESO and AHA/ASA on when carotid stenting is recommended versus endarterectomy. The indications and medical, anatomical, and center-based limitations of revascularization of the carotid artery are outlined. It concludes by emphasizing the need to carefully consider all factors for each individual patient when determining whether to stent or not.
1) The document defines terms related to strokes including stroke, transient ischemic attack, progressive stroke, and completed stroke.
2) It discusses the epidemiology of strokes, noting they are a leading cause of death and disability worldwide. Prevalence and risk factors like age, gender, and medical conditions are outlined.
3) Strokes are classified as either ischemic (caused by clot or blockage) or hemorrhagic (caused by bleeding). The major types and causes of ischemic and hemorrhagic strokes are summarized.
A stroke occurs when blood flow to the brain is interrupted, depriving brain tissue of oxygen and nutrients. The main causes are blood clots (ischemic stroke) or bleeding (hemorrhagic stroke). Symptoms depend on the affected brain region but may include weakness, numbness, vision issues, and speech problems. Risk factors include age, family history, diabetes, high blood pressure, smoking and obesity. Diagnosis involves physical exams, CT scans and MRI. Treatment focuses on rehabilitation to regain functions through therapies like occupational and physical therapy. Prevention emphasizes controlling risk factors through healthy lifestyle choices and medical management of conditions.
This document summarizes the EXCEL trial, which compared everolimus-eluting stents to bypass surgery for treating left main coronary artery disease. The trial included over 2900 patients across 17 countries. At 3 years, the primary endpoint of death, stroke, or heart attack was similar between the stent and surgery groups, but the stent group had fewer adverse events in the first 30 days. However, at 5 years stent patients had higher rates of non-procedural heart attacks and required more repeat procedures, though mortality remained similar. The conclusion is that stents may be preferable to surgery for selected left main disease patients after discussion, though surgery provided better long-term outcomes.
Cryopreserved saphenous vein allografts were evaluated for infragenual bypass surgery in 92 patients with critical limb ischemia over 15 years. Primary and primary assisted patency rates at 1 year were 49.9% and 55.7%, and limb salvage rates at 1, 3, and 5 years were 85%, 70%, and 64%. While allografts are an alternative to prosthetic materials when autologous veins are unavailable, better patient selection and use of statins may improve results, though availability remains limited.
This document summarizes a case study of a 40-year-old male patient presenting with right-sided ataxic hemiparesis and oral and genital ulcerations. MRI scans showed hyperintense lesions in the midbrain, thalamus, and pons, suggesting demyelination along the corticospinal tract. The clinical and radiological findings were consistent with neuro-Behcet syndrome, a condition characterized by inflammation of blood vessels in the central nervous system. Pathological studies of lesions from neuro-Behcet syndrome patients support a pathogenesis involving small vessel vasculitis, predominantly of veins. The selective involvement of corticospinal fibers in this case can be explained by the inflammatory process affecting
This document describes a study of 10 patients with intraventricular meningiomas of the lateral ventricles treated over 28 years. Most patients presented with headache and visual disturbances. MRI showed enhancing masses within the ventricles. Surgery was performed in 9 cases, with total resection in 8. Total resection via a posterior parieto-occipital or transtemporal approach is the standard treatment for these rare tumors, though recurrence is possible.
This document discusses hybrid operating rooms and procedures that combine endovascular and open surgical techniques. It begins by explaining the rationale for hybrid approaches, which allow treating more complex cardiac conditions while minimizing invasiveness. A hybrid OR has capabilities for both endovascular interventions and open surgery simultaneously. Key components include cath lab and surgical equipment that can be used together. The document discusses examples like using a stent graft with open surgery for aortic aneurysm or replacing valves percutaneously along with coronary artery bypass. It emphasizes teamwork and convergence of specialties to determine the best individualized approach. Hybrid procedures may reduce recovery time compared to traditional open surgery alone.
Ascending aortic aneurysm and its clinical significance: A case reportApollo Hospitals
Aorta, the major conductance vessel of the body, can be affected by a variety of pathologic processes leading to aneurysm, dissection, or ischemic syndromes. There has been a drastic increase in the incidence of aortic aneurysm making it the 18th most common cause for death.
When ignored, the patients’ condition might worsen leading to death due to rupture and hemorrhage. Here we report a case of ascending aortic aneurysm affecting the aortic root and proximal part of ascending aorta. Conscious awareness of this pathological process augments a great deal to radiologists and sonographers during various imaging techniques and rescues the patient from aneurysm-related deaths.
Coronary Artery Aneurysms and Ectasia Michael Katz
This document summarizes the morning report of a 59-year-old man with a history of kidney transplant, SLE, and prior STEMI managed with thrombus extraction. He presented with recurrent chest pain. Key findings include inferolateral wall perfusion defect on nuclear stress test. The report reviews coronary aneurysms/ectasia classification, etiologies including atherosclerosis, Kawasaki disease, inflammatory disorders. The patient's systemic lupus erythematosus and transplant status suggest an inflammatory cause is possible. Evaluation and management of antiplatelet therapy is discussed.
LVNC is a rare genetic cardiomyopathy characterized by a spongy appearance of the myocardium due to incomplete compaction of the embryonic myocardium. It can present with heart failure, arrhythmias, or thromboembolism. Echocardiography and cardiac MRI are used to diagnose LVNC based on identifying a two-layered myocardium. Management involves treating heart failure and preventing thromboembolism with anticoagulation in high-risk patients. While the cause of LVNC is thought to be due to an arrest in normal myocardial compaction during embryonic development, the pathophysiology is not fully understood.
Journal club drug eluting balloon for cadKunal Mahajan
This document discusses treatment options for in-stent restenosis (ISR) in a patient with a past history of percutaneous coronary intervention. It summarizes the findings of several studies comparing drug-eluting balloons (DEBs) and drug-eluting stents (DES) for treating ISR. The studies found that DES were superior to DEBs for reducing repeat revascularization, while safety outcomes like death and heart attack were similar. However, DEBs may be preferred over DES in certain high risk cases, like those with multiple stent layers or who are at high risk of bleeding complications from long-term dual antiplatelet therapy. Additional research with longer follow-ups is still needed to further compare DEBs
Enormous thoracic solitary fibrous tumour with inferior vena compression case...Abdulsalam Taha
This case report describes an extremely large solitary fibrous tumor (SFT) that arose in the thoracic cavity of a middle-aged male patient. The tumor filled the entire left hemithorax, displacing the heart and lungs to the right side and compressing the inferior vena cava. Though initially deemed inoperable, the tumor was successfully resected via median sternotomy. Histopathological examination confirmed the diagnosis of SFT. The report highlights the surgical management of this rare but potentially life-threatening intrathoracic tumor.
This document discusses hybrid coronary revascularization (HCR), which combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). HCR was introduced in 1996 as a treatment for multivessel coronary artery disease. It aims to reduce surgical trauma while preserving long-term survival and minimizing adverse events. The hybrid approach involves using a left internal mammary artery graft for the left anterior descending artery and PCI for other lesions. This takes advantage of the excellent outcomes of the arterial graft and improvements in stents. HCR may provide benefits for higher surgical risk patients and allow shorter recovery times compared to traditional CABG. However, some debate remains around its additional complexity and costs compared to established treatments.
1. Arterial aneurysms most commonly occur in the abdominal aorta and can be caused by degenerative processes, infections, trauma, or genetic conditions.
2. Abdominal aortic aneurysms are the most prevalent type of aneurysm in the United States and rupture of aneurysms is a serious complication.
3. Aneurysms can be classified by their morphology (fusiform vs. saccular), etiology (degenerative, inflammatory, infectious), and location (aortic, iliac, femoral, etc.). Management depends on the type and severity of the individual aneurysm.
Stent assisted reconstruction of difficult aneurysms in acute subarachnoid he...Dr Vipul Gupta
This document summarizes the experience of a single center in using stent-assisted reconstruction to treat difficult aneurysms in patients presenting with acute subarachnoid hemorrhage. It describes treating 35 aneurysms in 33 patients that were not amenable to standard coiling, balloon-assisted coiling, or surgery. Stent placement was used to support the neck of wide-neck or dissecting/blister aneurysms to avoid coil protrusion. Most patients (28 of 33) had good outcomes, while 2 had management morbidity and 3 died. The results demonstrate stent-assisted coiling is a viable option for challenging aneurysms in acute subarachnoid hemorrhage cases.
This document discusses cerebral haemorrhage (ICH), which accounts for 10-15% of strokes. ICH can result from several mechanisms, including hypertension (47-66% of cases), cerebral amyloid angiopathy (CAA), and vascular malformations. CAA typically affects the elderly and causes lobar ICH that is often recurrent or involves multiple simultaneous haemorrhages. Vascular malformations like arteriovenous malformations (AVMs) and cavernous angiomas are a common cause of ICH in young, non-hypertensive patients. Imaging techniques like CT and MRI can identify vascular malformations and help determine the underlying cause of ICH.
Carotid blowout syndrome (CBS) is an uncommon but dreaded complication that occurs in patients treated for head and neck cancer. CBS is the result of necrosis of the arterial wall, which can occur following resection, after reirradiation for a recurrent or second primary tumor, by direct tumor invasion of the carotid artery wall or by a combination of these factors.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
Limitations of carotid stenting - dr Antoni Ferenspiodof
This document summarizes the limitations of carotid stenting from a neurologist's point of view. It discusses guidelines from ESO and AHA/ASA on when carotid stenting is recommended versus endarterectomy. The indications and medical, anatomical, and center-based limitations of revascularization of the carotid artery are outlined. It concludes by emphasizing the need to carefully consider all factors for each individual patient when determining whether to stent or not.
1) The document defines terms related to strokes including stroke, transient ischemic attack, progressive stroke, and completed stroke.
2) It discusses the epidemiology of strokes, noting they are a leading cause of death and disability worldwide. Prevalence and risk factors like age, gender, and medical conditions are outlined.
3) Strokes are classified as either ischemic (caused by clot or blockage) or hemorrhagic (caused by bleeding). The major types and causes of ischemic and hemorrhagic strokes are summarized.
A stroke occurs when blood flow to the brain is interrupted, depriving brain tissue of oxygen and nutrients. The main causes are blood clots (ischemic stroke) or bleeding (hemorrhagic stroke). Symptoms depend on the affected brain region but may include weakness, numbness, vision issues, and speech problems. Risk factors include age, family history, diabetes, high blood pressure, smoking and obesity. Diagnosis involves physical exams, CT scans and MRI. Treatment focuses on rehabilitation to regain functions through therapies like occupational and physical therapy. Prevention emphasizes controlling risk factors through healthy lifestyle choices and medical management of conditions.
Cerebrovascular Accident CVA (Stroke), Angin Ahmar (malay)edge ryan
A cerebrovascular accident (CVA), also known as a stroke, occurs when blood flow to the brain is interrupted by a blockage or rupture of a blood vessel, depriving brain cells of oxygen and nutrients. It is the leading cause of disability. Risk factors include age, heredity, high blood pressure, diabetes, smoking, obesity, and physical inactivity. Treatment focuses on prevention through lifestyle changes and medication to prevent clots, as well as rehabilitation after a stroke to regain functions that may be lost.
1. LETM refers to transverse myelitis (TM) that extends over 3 or more vertebral segments. It has many potential causes including inflammatory, infectious, metabolic, vascular and neoplastic etiologies.
2. Neuromyelitis optica (NMO), an autoimmune condition where antibodies attack astrocytes, is an important consideration as a cause of LETM. Diagnostic criteria for NMO include involvement of the optic nerve and spinal cord.
3. Other conditions like Sjogren's syndrome, systemic lupus erythematosus, Behcet's disease and sarcoidosis can also present with LETM and involve both autoimmune and inflammatory mechanisms. Accur
cerebrovascular accident, commonly known as stroke is one of the most common health problems of the world. in the developing world, its increasing incidence is a matter of concern among the health workers across the globe. thus adequate knowledge about this medical condition is a must to deal with it effectively.
The major arteries supplying the brain and spinal cord are the internal carotid arteries, vertebral arteries, and their branches. The internal carotid arteries enter the cranium and give rise to the anterior and middle cerebral arteries. The vertebral arteries join to form the basilar artery, which branches into the posterior cerebral arteries. These arteries anastomose to form the Circle of Willis, supplying different regions of the brain. The vertebral and basilar arteries also give rise to branches that supply the brainstem and cerebellum. The spinal cord receives blood from the anterior and posterior spinal arteries as well as segmental arteries originating from nearby vessels. Occlusion of cerebral arteries can cause strokes with deficits corresponding to the territory of the occluded vessel
The document discusses the blood supply of the brain. It begins by describing the two pairs of arteries that supply the brain - the vertebral and internal carotid arteries. These arteries are interconnected to form the circle of Willis at the base of the brain. The vertebrobasilar system arises from the vertebral arteries and forms the basilar artery, which divides into the posterior cerebral arteries. The internal carotid system gives rise to the anterior and middle cerebral arteries. These arteries and their branches supply different regions of the brain. The circle of Willis provides an important anastomosis between the two systems to ensure adequate blood flow to the brain.
Efek varicocelectomy tentang aliran arteri antara laaproskopik dengan mikroandilania
This study investigated the effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal varicocelectomy (MV) on testicular blood flow and semen quality. Color Doppler Flow Imaging was used to measure blood flow parameters in the testicular arteries before and after surgery. Both LV and MV significantly improved testicular blood flow and semen parameters. However, MV resulted in greater improvements in testicular blood flow earlier after surgery compared to LV. The study concludes that varicocelectomy improves testicular function by enhancing blood supply and microperfusion to the testes.
The study investigated the incidence and risk factors of venous obstruction before and after implantation of transvenous pacing leads in 131 patients using digital subtraction angiography (DSA). DSA was performed before implantation and at 44 months follow-up in 79 patients. Prior to implantation, venous obstruction was found in 18 patients (13.7%), mainly in the left innominate vein. After implantation, venous obstruction occurred in 26 of 79 patients (32.9%) at follow-up DSA. There were no significant differences in risk factors between patients with or without obstruction. The incidence of obstruction after implantation was lower than previous reports, possibly due to pre-existing obstruction being identified prior to implantation.
Vasculitis refers to inflammation of blood vessels. It is classified based on vessel size and pathology. The most common pediatric vasculitides are Henoch-Schonlein purpura and Kawasaki disease. Diagnosis involves evaluating symptoms, radiology like angiograms, histopathology of biopsied tissues, and serology tests like ANCA. Treatment depends on type and severity of vasculitis. Prognosis varies, with most children recovering fully from HSP or KD, while other types like AAV carry higher risks of organ damage and mortality if not properly treated.
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Présentation du Dr Dake lors du plus grand congrès de cardiologie interventionnelle.
Présentation faite en salle plénière devant plus de 800 personnes.
The document discusses strategies for improving cardiovascular disease diagnosis and treatment in Ukraine. It argues that current approaches are insufficient as they focus on static examination of individual vascular segments rather than a dynamic, integrated analysis of the entire cardiovascular system. The article recommends predictive, preventive, and personalized medicine approaches using new technologies developed in Ukraine, such as ultrasound dopplerography, that allow comprehensive examination of vascular function and blood flow dynamics. Clinical trials of these innovative strategies showed improved treatment outcomes compared to conventional methods.
Trans-Cranial Doppler (TCD) is a non-invasive ultrasound technique used to evaluate cerebral blood flow velocities. There are two main types of TCD devices - non-duplex devices which identify arteries "blindly" based on Doppler shift and duplex devices which combine Doppler with B-mode imaging to directly visualize arteries. TCD allows evaluation of intracranial steno-occlusive disease, vasospasm, aneurysms, and other conditions. It can detect elevated velocities indicative of stenosis but has limitations including operator dependence and inability to image distal arteries. TCD is useful for monitoring conditions like sickle cell disease where elevated velocities increase stroke risk.
Thermal Imaging for the Diagnosis of Early Vascular Dysfunctions: A Case Reportasclepiuspdfs
Diseases of blood vessels (referred in this article as vascular dysfunction) cause more morbidity and mortality, than combined impact of any other major non-communicable disease including cancer. We strongly feel that the development of a therapy system based on the management of disease of the vessel than management of the risk factors will yield better results and provide greater opportunity for individualized therapy. Detection of early vascular changes before clinical manifestations of endothelial dysfunction, hardening of the arteries, increased intima-media thickness, is of great importance for early identification of individuals with increased risk of accelerated atherosclerosis.
Acute Myelopathy- Vascular and Infectious Diseases.pdfssuser98b21a
1. Acute myelopathy can be caused by vascular or infectious diseases of the spinal cord. Vascular causes include spinal cord infarction from occlusion of the anterior or posterior spinal arteries, as well as vascular malformations like arteriovenous malformations.
2. Infectious causes include cord compression, intrinsic cord injury, or cord ischemia from conditions like epidural abscess. Rapid imaging can identify the pathological process and guide antimicrobial treatment and other medical or surgical management.
3. Management of acute spinal cord infarction focuses on intravascular volume resuscitation, blood pressure support, and prevention of medical complications. Outcomes are limited due to lack of effective treatments for established infarction.
A 58-year-old man presented with a seizure and loss of consciousness. Neuroimaging revealed a highly vascularized 5.7 x 5 cm solid mass in his right temporo-parietal region. Biopsy determined the mass was a solid supratentorial hemangioblastoma, a rare tumor. Further tests ruled out Von Hippel-Lindau disease. The patient underwent partial resection of the mass, improving his symptoms. Solid supratentorial hemangioblastomas occurring as single lesions unrelated to Von Hippel-Lindau disease are infrequent and atypical clinical presentations like this case are rarely reported.
Chronic cerebrospinal venous insufficiency in india at delhi & mumbai at affo...Pankaj Nagpal
This document discusses chronic cerebrospinal venous insufficiency (CCSVI), a condition linked to multiple sclerosis (MS) where blood has trouble draining from the brain and spine. It describes a liberation treatment developed by Dr. Zamboni to open blocks in the veins through angioplasty. The procedure may help reduce iron buildup in the brain and attacks on myelin by immune cells by improving venous outflow. Potential risks include infection, damage to blood vessels, and relapse of MS symptoms. The cost of screening and treatment in India is outlined.
This study assessed outcomes of arteriovenous fistulas (AVFs) created for hemodialysis access in 67 patients in Baghdad, Iraq over 6 months. Most fistulas were brachiocephalic (91.4%) and functioned initially. Complications included thrombosis (22.2%), aneurysms (4.5%), and steal syndrome (13.6%). Thrombosis was higher than reported rates, while aneurysms and steal syndrome were within typical ranges. The study concluded that initial AVF success was good, but late complications like thrombosis were a concern.
The Vertebral Artery Test
Luc Peeters, MSc.Ost. & Grégoire Lason, MSc.Ost.
The International Academy of Osteopathy
http://www.osteopathie.eu/en
http://www.osteopathie.eu/en/publications
info@osteopathy.eu
This document discusses sonographic evaluation for diagnosing upper extremity deep venous thrombosis (UEDVT). It provides an overview of the risk factors and complications of UEDVT. Color Doppler sonography is outlined as the preferred noninvasive screening technique, with sensitivity of 78-100% and specificity of 82-100% for diagnosing UEDVT. The normal venous anatomy of the upper extremity is described and techniques for performing the sonographic examination are explained. Examples of sonographic appearances of acute and chronic UEDVT are illustrated and described.
1) Echocardiography allows me to apply my knowledge of anatomy and physiology to help diagnose heart conditions in a non-invasive manner. 2) I am drawn to its technology aspects and how ultrasound imaging has advanced our understanding of cardiovascular diseases. 3) It is a growing field with job opportunities, and I want to provide valuable diagnostic information to cardiologists and improve patient care.
Primary central nervous system vasculitis (PACNS) is a rare disorder characterized by inflammation of blood vessels in the brain and spinal cord. It presents with non-specific symptoms like headache, cognitive impairment, and focal neurological deficits. Diagnosis involves neuroimaging showing multifocal lesions, angiography revealing vessel narrowing and dilation, and brain biopsy detecting immune cell infiltration of vessel walls. While the cause is unknown, infectious agents may trigger PACNS. Treatment involves immunosuppression but prognosis depends on disease severity and response to treatment.
This document summarizes a study of 89 cases of peripheral vascular disease examined using CT angiography. The study found that hypertension was the most common risk factor, affecting 46.1% of patients. The predominant lesion observed was stenosis (5.61%), followed by hematoma and arteriovenous malformation. The abdominal aorta was the most commonly affected artery (58.43%), followed by the lower limbs. CT angiography provided a noninvasive means to image peripheral vascular disease and obtain data on morphological patterns and risk factors in Bangladeshi patients, which previously lacked disease-specific research.
Study of 89 Cases of Peripheral Vascular Disease by CT AngiographyM A Hasnat
The purpose of this study was to observe the morphological pattern by CT angiography
and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering
from peripheral vascular disease using a multidetector scanner in the evaluation of patients with
peripheral vascular disease.
Intravascular ultrasound (IVUS) allows for a 360-degree tomographic view of the vessel wall from inside and more accurate assessment of venous pathologies than venography. IVUS is used in diagnosing and treating Chronic Cerebrospinal Venous Insufficiency by precisely locating narrowings for angioplasty procedures. The azygos and jugular veins are routinely assessed during IVUS while renal and iliac veins can be examined if the lumen allows; angioplasty of detected lesions may then be done. IVUS can optimize angioplasty results by providing more accurate information on lesions than venography.
1st medical report on ccsvi treatment ameds centrumAmeds Centrum
AMEDS Centrum has treated over 500 MS patients with chronic cerebro-spinal venous insufficiency (CCSVI) using venous angioplasty. Their patients saw improvements in quality of life measures like a 35% reduction in fatigue levels and a 13% improvement in physical health scores. The majority of patients reported an improved ability to perform daily activities and increased mobility and energy levels following the procedure.
3. CCSVI stands for Chronic Cerebrospinal Venous
Insufficiency and has been a vital issue in scientific
discussions over the last few years.
Recently CCSVI was officially classified as belonging
to a group of venous malformations (Congres Union
Internationale de Phlebologie, Monte Carlo 2009),
and has had its symptoms and methods of
treatment described.
CCSVI procedure consists of different pathologies:
constrictions, stenosis, mostly located near internal
cervical veins (vena jugularis interna) and the
azygos vein (vena azygos).
This disease has a positive correlation to multiple
sclerosis patients.
4. Multiple sclerosis is a demyelinating disease of the central nervous system,
characterized by multifocal damage to the nervous tissue and the ever-changing course.
There are periods of remission and exacerbations (relapses) with progressive loss of
neurons and deterioration of the central nervous system tissue.
In MS, damage to the myelin sheath surrounding the nerve cells occurs, making it
impossible to properly transmit nerve impulses along the tracks in the brain and spinal
cord. A characteristic feature of the disease is the dissemination of CNS lesions in time
and space. There are several subtypes of multiple sclerosis. Primarily progressive form is
characterized by a steady neurologic decline, while relapsing-remitting subtype involves
unpredictable attacks (relapses) followed by periods of remissions. Initial relapsing-
remitting form that begins to have neurologic decline without periods of remission is
known as a secondary progressive subtype.
Multiple sclerosis was first described by Jean-Martin Charcot in 1868. The incidence
depends on the geographic region and ranges from 2 to 150 per 100 000 population in
different countries and specific populations. MS affects mostly young adults, with peak
incidence between 20 and 40 years of age. Women tend to get sick more often than
men.
Many theories have been proposed to determine the etiology of multiple sclerosis, but
so far there is no one underlying cause of multiple sclerosis found. Theory of
autoimmune etiology seems to be dominating, although viral, bacterial, and other
unknown environmental factors may also play an important role in the development of
disease.
5. Hypothesis assuming the relationship between vascular
abnormalities and MS are known for many years.
First observations in the 19th century – in 1863, Rindfleisch
noted cumulation of blood vessels in the center of MS
plaques and Charcot observed vascular blockages in MS
patients.
In 1934 T. Putnam suggested a major role of compromised
venous drainage of the brain in forming MS lesions as well as
inflammatory changes of the central nervous system.
In 1981 F. A. Schelling proposed venous refluxes as one of
the causes of MS.
All those studies led to the introduction of endovascular
procedures in MS patients – called Liberation Treatment,
as first proposed by professor Zamboni in 2009.
6. Professor Zamboni launched a study to define whether there
is a link between CCSVI and MS. With the use of a Doppler
ultrasound, he examined the necks of MS patients and
according to data included in his publication, over 80% of
patients with a RR (relapsing - remitting) type, more than 90%
patients with a SP (secondary - progressive) type, and 90%
patients with PP (primary - progressive) type meet the criteria
for CCSVI diagnosis and liberation treatment (term proposed by prof. Zamboni). The
majority of patients with MS evaluated by the team presented with stenosis, valve
malformations and refluxes.
Dr Paolo Zambonii
Drawing on previous experiences with standard coronary angiography procedures, in
which balloons were used to restore patency of blocked coronary arteries and with the
cooperation of experienced vascular surgeon Dr Galeotti, they proposed venous
angioplasty as a method of CCSVI treatment in MS patients.
Prof. Zamboni’s open labeled angioplasty study involved 65 participants and showed
significant improvement in neurologic outcome and patients’ quality of life.
It has opened doors for further research all over the world and the widespread use of
endovascular treatment of CCSVI.
The subject still remains open and even controversial, especially the theory that the
venous pathology could constitute the primary patomechanism of the autoimmune
process.
7. The real link between CCSVI and MS remains not fully understood;
therefore it is crucial that further studies are carried out to
determine the exact mechanism and the underlying association.
Not every MS patient has his veins blocked, but this correlation is
relatively more significant in MS patients group. Maybe
endovascular treatment does not cure MS, however it definitely
affects its course, improving the state of health and helping to
relieve aggravating symptoms.
Even in studies that were not supportive for CCSVI theory, a link
between CCSVI and MS duration and severity has been
demonstrated. Indeed, there is no certainty around CCSVI and MS
but we have proven efficacy and safety of venous angioplasty in
treating MS patients. What is more, there are a number of
ongoing studies and trials and there are positive statements,
recommendations and guidelines from international associations.
Vascular component does not play a major role in every case.
Still, it is worth trying to restore patency. Improving flow even in
insignificant stenosis often turns out to be beneficial in many
respects and can really change a patient’s life.
8. “The existence of CCSVI, its relation to MS and the legitimacy of
performing balloon angioplasty is the source of much controversy
among and is dismissed by many neurologists. This state of affairs
is the result of the unfamiliarity with CCSVI, the attachment to their
theory of immuno-inflammatory disease, as well as the conviction
that procedures using stents (which are rarely used) are dangerous.
Reports presented at two international symposia devoted to CCSVI in
Katowice and Bologna in March 2011 confirm the association of
CCSVI with MS. As a result of venous re-canalization after
angioplasty, it has been objectively confirmed that the levels of
venous oxygen saturation do improve. The reports emphasized the
positive influence balloon angioplasty has on the quality of life of
patients, on their fatigue levels, bladder disorders, balance
disorders, vision problems, sensory problems and, to a lesser
degree, mobility issues. Improvement was also noted in cognitive
abilities (memory, concentration, attention).”
Professor Jerzy Kotowicz, MD, PhD
9. Ultrasound (Doppler and transcranial)
The basic method used in the diagnosis of
patients with chronic cerebro-spinal venous
insufficiency (CCSVI) is a Doppler ultrasound.
It is a safe and completely non-invasive
diagnosis of the vascular system.
3D Doppler technology is used to determine
the hemodynamic severity of venous
insufficiency.
There were five criteria introduced for the diagnosis of
CCSVI in the Doppler examination. Fulfilling two out of
the five criteria confirms the diagnosis.
The following parameters are assessed during diagnosis:
The presence of venous stenosis
Circulatory disorders and reversed blood flow (reflux)
Flow change in extra-cranial veins dependent on body
position
The presence of valvular disease
10. MRI of the brain and neck has two main purposes:
The assessment of brain activity in the context of
determining the presence and location of
demyelinating lesions, as well as the possible presence
of other abnormalities.
Evaluation of venous outflow, in particular the jugular
and azygos veins. The analysis includes: symmetry of
venous outflow, width and patency of the veins, as well
as an assessment of any stenosis or vein modeling
caused by adjacent anatomical structures.
The examination of the venous system is made using modern techniques with the
use of a contrast agent (which allows for optimum picture clarity): Multi-phase MRI
venography as well as a T1-weighted 3D GRE sequence of very high resolution,
which guarantees very high quality images.
11. The final step in the diagnostic process
is a venography, which produces the
most reliable diagnosis of
abnormalities in the venous system. It
consists of the administration of a
contrast agent into the vein via
a catheter (inserted in either the
femoral or subclavian vein). This allows the
most accurate visualization of vascular
lesions. This procedure is invasive and
therefore entails a risk of complications.
Venography precedes any intra-vascular
operations. The venography procedure
allows for an exact examination and imaging of
the venous system, which provides an excellent
method of verifying and confirming the
presence of any abnormalities detected by
Doppler or MRV.
12. Venous angioplasty, also known as balloon angioplasty, is the basic method
of treatment applied to CCSVI patients.
Venous angioplasty is a procedure performed in order to widen the constricted
vein with the use of a special catheter placed in the vein via percutaneous
access (the catheter is introduced in the groin area, into the femoral vein). A
balloon is then inserted into the constricted vein and inflated with gas, which
enlarges the vessel and restores its patency.
Evidence showed that using cutting balloons may improve the effect of
treatment, decrease the risk of restenosis and reduce the intraoperative trauma
of healthy tissue. For best results balloon with cutting blades is used together
with standard balloon catheters during angioplasty. This technique can also be
beneficial in cases of hardened or calcified occlusion when standard balloons
alone may not be as effective in restoring patency.
In exceptional cases when the narrowing does not expand under the balloon
pressure, or a vein dissection occurs, the balloon angioplasty is supplemented
with the insertion of a stent.
13. Stenting procedure may require the insertion of one or two
stents, depending on whether the stenosis is unilateral or
bilateral.
However according to recent publications and recommendations
in CCSVI management, insertion of stents is not recommended
as a method of choice and should be used only when there is a
direct indication present.
Stents are difficult to deliver particularly in small and twisted
vessels. One should be aware that a stent is a metallic foreign
object placed in the human body, carrying the risk of
thrombosis, systemic reactions and restenosis (due to the
intimal hyperplasia), not to mention stent migration or major
hemorrhages. Once it has been inserted it cannot be removed
or repositioned.
What is more, patient after stent insertion requires prolonged
time of receiving anticoagulants and antiplatelet agents, which
are associated with various side effects and increase the risk of
bleeding.
14. Approximately 2% of patients with implanted stents are prone to
formation of clots in the place of their location within the vessels.
Thrombus may be the cause of embolic complications including
pulmonary embolism and brain stroke.
The risk of forming clots is greatest during the first few months
after placing the stent in the vein. For this reason it is
recommended to use antiplatelet drugs such as aspirin or
clopidogrel, or other anticoagulants for a period of one month to
one year after stent implantation.
The period, during which patients are supposed to be on
anticoagulants, depends on the type of surgery performed, as
well as on the type of stent. Taking anticoagulants and
antiplatelet agents is linked to a number of side effects and
increases the risk of bleeding.
It is difficult to identify the direct cause of stent thrombosis, or to
predict its occurrence. It is suspected that in some patients
developing this serious problem is a result of the suboptimal
response to anticoagulants. Complex and unpredictable clinical
course of stent thrombosis can contribute to many difficulties
met in treating this condition.
15. pregnancy
lack of patient's voluntary consent for the surgery
a relapse occurring (active demyelinating changes
in the MRI)
16. Angioplasty is a very safe procedure with low rate of complications (1-2%)
and rather those of small significance. Most common complications (like
small hematomas or swelling at the puncture site or fever) occur in very low
percentage of patients. Nevertheless, this is an invasive procedure and as
one of such kind may bring some more serious risks like thrombosis,
pulmonary embolism or hemorrhage. Those happen extremely rare (and in
most cases do not put patient in danger) but need to be pointed out.
Worldwide, there have been reports on major complications like cerebral
hemorrhage (2 cases) and stent migration (2-3 cases) but it happened over
20 000 procedures done and involved only stent implantation cases.
Any method of medical treatment is an intrusion in the functioning of human
organism and therefore may be producing, apart from the therapeutic result,
also undesirable side effects. Surgical intervention is a unique form of
intrusion. It involves tissue incision, removal of organs or their parts,
anatomical structure alterations, etc. No matter how beneficial it could be for
regaining one’s health, it incurs a certain risk of complications occurring
either during or after the surgery.
17. Complications, which may occur during the surgery, include: bleeding that
leads to a significant loss of blood; pressure drop; disorder of blood supply
to vital organs and blood clotting disturbances; accidental injury to
anatomical organs and structures caused by their abnormal position or by
inflammatory or neoplastic infiltration; heart action disorder (arrhythmia,
cardiac infarction) and central nervous system disorder (apoplexy) in patients
suffering from cardiovascular system diseases.
Complications which may occur after the surgery include: bleeding from the
wound; intramural or internal hematoma; wound infection; intramural
purulence; arteriovenous fistulas; pulmonary complications / atelectasis;
inflammation; pleural exudates; thrombotic inflammation of veins;
pulmonary embolism; dysuria; urinary tract infection; renal insufficiency;
circulatory insufficiency; respiratory insufficiency; consciousness disorders
(mainly in elderly persons); dissection (rupture) of the vein undergoing
angioplasty; cardiac tamponade; perforation of a vessel.
Apart from "surgical" complications, complications related to anesthetization,
administered medications and to transfusion of blood and blood derivatives
(post-transfusion reactions, viral infections) may also occur.
The risk of occurrence any of the complications listed above is usually very
small, and depends on the type of surgical procedure carried out and on
general condition of the patient. Most complications can be effectively cured,
even if by means of another surgical procedure, and cases of fatal
complications. are extremely rare.
18. The positive effects of treatment of MS patients are
noticeable both in the objective assessment of the
patients’ quality of life as per the MSIS-29 system, as
well as in their own assessment.
AMEDS Centrum has treated more than
600 MS patients to 2011,
from Poland and abroad, MS type
38% of which have been men.
Average age of patients was 46 years. 24% Relapsing-
37% remitting
The statistical patient Secondary
progressive
has been diagnosed with MS 11 years ago. Primary
The majority of patients suffered 39% progressive
from secondary progressive MS.
19. In two thirds of patients with multiple
sclerosis, chronic fatigue is a typical
accompanying symptom of the disease and
always a big problem for the patient. The FSS
scale helps in assessing fatigue levels. The scale
is from 1 to 7, with higher scores reflecting
higher fatigue levels (scores above 5.5 signify
severe fatigue). Our patients have been observed
to experience a marked improvement in the
incidence of fatigue (a reduction of 35% on the
FSS scale!) and a dramatic increase in strength
and energy.
20. The patients who underwent treatment report a significant
improvement of their psychological state and physical
condition. A reduction of points within MSIS-29 scale is
noted after treatment.
Multiple Sclerosis Impact Scale 29 (MSIS-29) is a proven
and reliable scale for measuring the quality of life in
patients with MS. The patient answers 29 questions (20
regarding physical state, coordination and mobility and 9
about mental state). After the score is calculated we obtain
a result on a scale of 0-100, where the higher the
score, the worse the state of health of the patient.
Patients who have undergone treatment display a noticeable
improvement in mental and physical health – shown below
– with a corresponding reduction of points on the MSIS-29
scale.
21. A total of 47 patients suffering from Multiple Sclerosis (MS) with confirmed
diagnosis of Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) who underwent
endovascular treatment were included in the second study.
The improvement group was dominated by females (69% vs. 31% – males). Three out
of four patients in the group with improvement were suffering from Relapsing-
Remitting type of MS.
However, it should be noted that CCSVI treatment is associated with positive results
in people suffering from other types of MS as well.
The study also showed that young patients (age below 30) with short disease
duration are probably benefiting the most from the treatment.
PREVALENCE OF
IMPROVEMENT PREVALENCE OF
IN RELATION TO AGE IMPROVEMENT IN RELATION
100 TO DISEASE DURATION
100
75%
80 80
63%
60 60
36% 25%
40 40
8% 22% 13% 21%
20 20
0 0
<30 30-40 40-50 >50 <5 5-10 10-15 >15
YEARS YEARS YEARS YEARS YEARS YEARS YEARS YEARS
22. Characteristics of patients who have had
positive results from CCSVI treatment indicate
that most beneficial groups are:
females
Relapsing-Remitting type of MS
at young age
with short disease duration
with lower baseline EDSS.
23. After an endovascular surgery and following the discharge from
hospital, patients will have to take anticoagulants on the daily
basis, according to doctor's orders. How long the patient must remain
under anticoagulant treatment depends on the type of surgical
procedure and the type of stent used.
A recommended control test should be carried out after 3 and 6 months
after the procedure. A control test should include: Doppler
ultrasound, magnetic resonance, neurological examination and
laboratory tests. Its objective is to test the flow in the previously treated
veins.
All patients should undergo Doppler control every 6 months. In case of
deterioration of neurological symptoms, a Doppler of the jugular veins
should be done ASAP.
Patients should try not to overload physically during the first month
after the procedure, but you can still do light exercises. At about four
weeks after the procedure you can begin with moderate exercise (i.e.
swimming) but it is advised to wait for 3 months with burdensome
exercise like jogging, tennis or weightlifting in the gym.
24. Slight elevation of the bed (head side) is recommended.
It is important for the patients to be well hydrated, they should drink at
least 1.5 liters of fluid daily.
In order to maximize the benefits from the treatment rehabilitation is
recommended strongly. Of course the best rehabilitation programs are
the ones especially conceived for MS patients. In case of lack of access
to this type of programs benefits can be drawn from swimming pool
exercises, if such possibility exists or at least exercises to be performed
at home developed for MS patients.
As it is the case with all types of conditions here also the appropriate
diet is very important. There are several nutrition programs developed
for MS patients, for instance low fat diet rich in vegetables. In light of
recent research the most important seems to be to restrict animal fat
and saturated fat in the diet. It is worth to use products rich in non-
saturated fat (found mainly in fish), fruit and vegetables (rich in vitamins
and antioxidants) and other diet components including vitamins E, D or
beta-carotene. Of course that quitting smoking and giving up on
alcoholic beverages is highly recommended.
25. We would like you to be aware of the fact that CCSVI treatment should not be perceived as a miracle
drug curing multiple sclerosis once and for all. It can solely be treated as
a complimentary therapy to other methods. The therapy is helpful in combating the condition and
wonderfully complements the treatment methods applied so far, while its effectiveness depends in
large degree from the attitude of the patient himself. The treatment brings the greatest benefits among
persons who support it with regular physical activity (rehabilitation, physiotherapy), healthy lifestyle
and adequate diet (balanced, rich in vitamins, non-saturated fats and omega-3 and omega-6
acids, drinking large amounts of water).
In the reality we are all still at the very beginning of the process of research and understanding of
CCSVI and its correlation to MS. We know however – that independent of the temporary lack of results
from the official clinical trials – the results achieved in many CCSVI treatment centers in the world and
thousands of opinions of individual patients, readily available in the modern world of immediate
communication (internet) – speak for themselves.
Up until now far more about 30 000 CCSVI procedures among patients with multiple sclerosis have
been performed worldwide. According to reliable sources there have been only 3 cases of
complications resulting in patient’s death. This means a mortality level of 1/7000, therefore much
lower than with similar procedures performed for different reasons and considered statistically
acceptable. It should be mentioned that the complications in all
3 cases were linked to some other underlying conditions.
Ultimately, it is the patient who takes the decision to undergo the treatment. Patients make that
decision being aware that in a big majority of cases angioplasty procedure helps and brings a lot of
positive changes such as the decrease of disease symptoms.
26. improvement of blood circulation,
greater warmth felt in the upper and lower limbs,
reduced muscle spasticity and improvement of muscle function,
decreased limb tremors,
full recovery from or significant decrease of fatigue,
sight improvement,
improvement of sphincter function (digestive and urinary tract),
increased endurance during physical effort,
greater psychological strength and better mood,
significant change in the overall quality of life.
27. Angiograph – standard equipment of catheterization laboratory (Cat Lab).
Modern radiologic device dedicated to vascular diagnostics and intravascular
treatment.
Balloon Angioplasty – surgical widening of a narrowed blood vessel by means
of a balloon catheter. Balloon Angioplasty is performed by incising the
femoral vein in the groin and inserting a catheter (a narrow tube). Next, a
balloon is passed through the catheter and into the narrowed location, and
then inflated to a required size and kept in place for several minutes.
Balloon Catheter – thin, flexible tube with a balloon at its tips inserted into
the vessel during angioplasty and used to restore patency of stenotic vessels.
CCSVI - Chronic Cerebro-Spinal Venous Insufficiency, a recently isolated
disease which is a venous pathology (Congres Union Internationale de
Phlebologie, Monte Carlo 2009), officially classified among vascular venous
malformations. CCSVI is a malfunction caused by the narrowing of veins
which collect blood from the brain and the spinal cord. The criteria for
diagnosing CCSVI have been put forth by Prof. Paolo Zamboni.
28. Cutting balloon - is an angioplasty balloon catheter equipped with small blades
attached to its surface. It is a new device developed for use in endovascular treatment of
stenotic vessels. It acts by cutting the stenosis or occlusion when balloon is being
inflated. Evidence showed that using cutting balloons may improve the effect of
treatment, decrease the risk of restenosis and reduce intraoperative trauma of healthy
tissue. For best results balloon with cutting blades is used together with standard
balloon catheters during angioplasty. This technique can also be beneficial in cases of
hardened or calcified occlusion when standard balloons alone may not be as effective in
restoring patency.
Guidewire - very thin wire with a flexible tip inserted into the vessel during angioplasty
before insertion of balloon catheter. Guidewire is passed to the blockage and then is
used as a pathway to stenosis.
High-pressure balloon – these balloons are usually used during high pressure
angioplasty since they are resistant to deformation at high pressure, allowing very
effective dilatation of the narrowing.
Mitoxantrone - is an anti-neoplastic agent also used to treat multiple sclerosis (MS). It is
not an absolute contraindication for the liberation procedure, however it may increase
the risk of complications during and after surgery. There is a possibility of
disqualification from the procedure, due to abnormal blood tests results
(leucopenia, thrombocytopenia) as Mitoxantrone may affect the composition of the
blood.
29. Restenosis – the recurrence of abnormal narrowing of a vessel (vein), which sometimes
occurs after corrective surgery such as vascular Angioplasty.
Stent – a synthetic, elastic tube or a spiral, usually made of 316 LVM steel or
a chromium-cobalt alloy, placed inside the vein to restore its patency. Stents
implantation is used in angioplasty. Stents used in this procedure are not of the drug-
eluting type. Once inserted into patient's body stents are irremovable.
Stenting –inserting one or more stents in the patient's venous vessels.
Valves – in cases of impaired blood flow through the valves the treatment might be
performed. This treatment involves placement of the deflated angioplasty balloon in the
exact area of venous valve and precise inflation in order to swing valve to the right
position. In general one can benefit from this procedure but it is not always possible to
proceed with and certainly not equally effective for all patients.
Venography (also called phlebography) – a procedure where a venogram of the veins is
taken after a special dye (the so called contrast) and injected into the veins via a catheter
inserted into the femoral vein in the groin, thus visualizing them as an X-ray image. This
procedure makes it possible to assess the appearance of all venous vessels, exposing
clogs and malformations.