Concerns on carotid stenting in octogenarians.

Zahn et al.¹ should be complimented for creating an inter-hospitalcarotid artery stenting (CAS) registry and for presenting their10 year experience, including many procedures performed on octogenarian.Although their analysis is retrospective in nature and unbalanced(321 patients > 80 years vs. 2557 patients < 80 years),it shows that     

Concerns on carotid stenting in octogenarians: reply

Barracchini and Ballotta¹ point out some important issues concerningour registry data on carotid artery stenting (CAS) as well ason CAS in general. They mention that a distinction neither between ischemic andhaemorrhagic stroke nor between different types of     

Concerns regarding the Centers for Disease Control's published guidelines for pelvic inflammatory disease.

The International-Infectious Disease Society for Obstetrics and Gynecology-USA (I-IDSOG-USA) has concerns about the most recently published Centers for Disease Control and Prevention (CDC) guidelines for pelvic inflammatory disease (PID). I-IDSOG-USA advocates the following changes when the guidelines are revised. We recommend the use of the term "upper genital tract infection" (UGTI), followed by the designation of the etiologic agent, instead of the currently employed term, "pelvic inflammatory disease," or PID. In diagnoses, there should be greater emphasis on signs and symptoms related to subclinical or occult UGTI. Therapeutic recommendation for the treatment of UGTI should be documented for various stages of this diverse disease entity. There should be greater emphasis on hospitalization for infected nulligravida teenagers. This permits monitoring of antibiotic treatment and provides a site for medical educational efforts to teach this medically underserved segment of our society how to protect their future fertility, their health, and their lives.     

Digital subtraction angiography of the carotid bifurcation

This report described the results of digital subtraction angiography (DSA) in the diagnosis of arteriosclerotic disease of the extracranial arteries, especially the distal part of the common- and proximal part of the internal carotid arteries compared to the catheter angiography. 50 patients underwent DSA and conventional angiography. In 85% of the patients, the quality of the DSA examination was good. For the internal carotid arteries the standard sensitivity was 91% and the standard specificity 93%. In all patients both vertebral arteries were visualized on DSA. All patients underwent the non-invasive tests (OPG, Doppler, Duplex). These tests and the DSA together cannot always replace the catheter-angiography in case of carotid pathology. We started an investigation to assess in which cases the catheter-angiography can be replaced by DSA to arrive at the same diagnosis. The preliminary results indicate that replacement of the conventional angiography by DSA is possible in 80% of this patients group.     

Combined right transradial coronary angiography and selective carotid angiography: safety and feasibility in unselected patients.

We evaluated the safety and feasibility of ad hoc carotid angiography following the right transradial coronary angiography. Selective carotid angiography was performed subsequent to coronary angiography in 213 consecutive patients. A 5 Fr Simmons catheter was reformed in descending or ascending aorta, then, withdrawn and rotated to cannulate the left and right carotid artery. Both carotid angiography was performed selectively in 211 (99%) patients. In two patients with severely tortuous subclavian artery, selective cannulation of the left carotid artery failed. There was no thromboembolism or arterial dissection. After the learning phase of 50 patients, the time to reform the catheter in aorta and to cannulate the left and right carotid artery was 50 +/- 77, 66 +/- 68, and 58 +/- 57 sec, respectively. Total procedural time was 195 +/- 145 sec. In conclusion, ad hoc carotid angiography can be performed reliably and safely following the right transradial coronary angiography. It might be useful for evaluation of an isolated or associated carotid artery stenosis. Cathet Cardiovasc Intervent 2001;53:380-385.     

CT angiography of stented carotid arteries: comparison with Doppler ultrasonography.

PURPOSE: To determine whether computed tomographic angiography (CTA) is a feasible modality for assessing stented carotid arteries and whether in-stent restenosis based on CTA concurs with ultrasonography (US). METHODS: A retrospective review was conducted of 37 follow-up CTA and US images from 27 patients (23 men; median age 70 years, range 56-77) who received 34 nitinol carotid stents. CTA and US images were compared with respect to assessability and percent stenosis. Both visual estimation (>or=50% or not) and the NASCET method were used to determine percent stenosis in CTA images. For US, a determination of >or=50% stenosis was based on peak systolic velocity (>or=200 cm/s) and an internal carotid artery to common carotid artery ratio >or=2.5. Percent stenosis values by CTA were also compared to values (n=7, 21%) determined by catheter angiography. RESULTS: CTA and US images were "totally assessable" in 27 (73%) and 15 (41%), "totally non-assessable" in 0 (0%) and 3 (8%), and "partially assessable" in 10 (27%) and 19 (51%), respectively. Assessability of CTA images was equal to or better than that of US images in 33 (89%). The percent stenoses by CTA and US were comparable in 20 cases. CTA found >or=50% stenosis using the NASCET method in 4 of 20 stents; none of these showed >or=50% stenosis by visual estimation of CTA or by spectral Doppler US. Compared with catheter angiography, CTA overestimated percent stenosis from 34% to 66% (mean 53%). US confirmed 2 angiographically proven restenoses, but CTA identified only 1. CONCLUSION: CTA provides better image quality for stented carotid arteries than US, but it might be inferior to US in determining restenosis in assessable cases. Therefore, CTA is likely to be an alternative to US in cases of non-assessability. A large-scale study including more restenosis cases is warranted to reveal which modality is more reliable for diagnosis of restenosis.     

3.0 T颈动脉全景磁共振血管造影比较

目的比较时间飞跃磁共振血管造影(TOF-MRA)和增强高分辨MRA(CE-MRA)、动态MRA(Dynamic,Dyn-MRA)对全景头颈部动脉粥样硬化狭窄的诊断价值。方法对31例患者行3.0 T MRA检查,均接受TOF-MRA扫描后随机接受CE-MRA和Dyn-MRA。分别对血管段显示、血管信号强度和静脉污染进行评分;以数字减影血管造影术为标准,对颈动脉分叉、颈总动脉起始部狭窄进行评价。结果与CE-MRA和Dyn-MRA比较,TOF-MRA评分4分血管段显示比例低(Z=-3.13,Z=-3.16,P<0.05);与Dyn-MRA比较,TOF-MRA评分4分血管信号强度增强比例高(Z=-2.05,P<0.05)。TOF-MRA静脉无污染,与Dyn-MRA比较,CE-MRA出现静脉污染比例高(Z=-8.62,P<0.05)。TOF-MRA诊断颈总动脉分叉处狭窄准确率高于颈总动脉起始部。结论TOF-MRA、CE-MRA和Dyn-MRA均能实现头颈部动脉全景成像;TOF-MRA可作为一线颈动脉粥样硬化筛查方法,补充CE-MRA和Dyn-MRA有助于提高颈动脉狭窄的准确性。     

Our experience with carotid restenoses. Value of digital angiography using the arterial approach

Between January 1980 and December 1985, 721 operations on the internal carotid artery were performed in the Department of Vascular Surgery, H?pital de la Timone, Marseilles. During this 6-year period, carotid artery restenosis was detected in eleven patients. All had been operated upon initially in the department: carotid thromboendarterectomy (10 cases), internal saphenous vein graft (1 case). All but one patient were asymptomatic at time of diagnosis of restenosis, the mean a period of which was 20.5 months. Identification was by cervical murmur (5 cases), routine review Doppler examination (2 cases), digital subtraction angiography by arterial approach (2 cases); this examination being conducted on contralateral carotid artery during preoperative investigations, and conventional arteriography of supra-aortic trunks to determine permeability of a contralateral temporo-sylvian anastomosis in one patient. Digital subtraction angiography by the arterial approach was carried out in 8 of the 11 patients. Apart from the simplicity of repeated examinations (16 times in these 8 patients) this procedure permitted medical treatment to be instituted for 2 cases of restenosis and was sufficient to indicate the need for 5 repeat operations. A total of 6 recovery operations were performed, one in a symptomatic patient and five in asymptomatic patients: rapid surgery was necessary in 4 of these because of an immediate critical restenosis. Surgery was carried out in the last case due to progressive worsening of repeated stenotic lesions on serial angiographic examinations. Operations included venous grafts (crural internal saphenous vein) in 4 cases and angioplasty with venous patch grafts in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

CT血管造影对颈动脉粥样硬化性病变的诊断价值

目的 探讨CT血管造影(CTA)诊断颈动脉粥样硬化性病变的价值.方法 对92例前循环缺血发作患者行16层螺旋CTA检查,其中55例于CTA检查前后1周内进行了数字减影血管造影(DSA)检查,64例进行了彩色多普勒超声(CFDS)检查.CTA扫描横断面轴位图像应用三维重建技术作图像后处理,测量颅外段颈内动脉狭窄程度,统计颈动脉粥样硬化斑块,并分别与DSA和CFDS结果比较.结果 CTA与DSA对颅外段颈内动脉狭窄程度分级判断的一致性为90.9％(Kappa=0.87,P＜0.01),CTA对颅外段颈内动脉各级狭窄诊断的灵敏度、特异度、阳性预测值、阴性预测值均较高.CTA与CFDS在颈动脉的斑块检出率差异无统计学意义,两种检查方法共同判断的113处斑块的性质判定的一致性为77.9％(Kappa=0.67,P＜0.01).结论 CTA对颈动脉狭窄程度、粥样硬化斑块诊断有较高的准确性,可作为颈动脉粥样硬化性病变筛选的常规方法.