stenosis

Rationale Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis. Methods and design CREST-2 is two multicenter randomized trials of revascularization plus intensive medical therapy versus intensive medical therapy alone. One trial randomizes patients to carotid endarterectomy plus intensive medical therapy versus intensive medical therapy alone; the other, to carotid stenting plus int...

The atrocious food habit and modern life style stimulate the prevalence of stenosis. Stenosis of pulmonary artery branches is an anomaly characterized by narrowed segments of one or more of the main or peripheral branches of the pulmonary artery. This narrowing may force the heart to pump harder, leading to enlarged heart and high blood pressure in the right ventricle and it results in heart failure and lung related disease like chronic obstructive pulmonary disease. To analyze deviations in pressure and velocity in blood flow, the artificial 3D model of different stages of stenotic condition in pulmonary artery is to be created using ANSYS 15 (Autodesk Inventor Software). Through this analysis certain range of pressure and velocity is obtained. This value helps in understanding the treatments suitable for desired stenosis condition.

Compare outcomes of early (<15 days) versus delayed carotid endarterectomy in symptomatic patients. All CEA procedures performed for symptomatic carotid stenosis between January 2006 and May 2010 were retrospectively reviewed. Postoperative mortality (within 30 days), stroke, and Myocardial Infarction (MI) rates were analysed in the early and delayed CEA groups. During the study period, 149 patients were included. Carotid revascularization was performed within 15 days after symptom onset in 62 (41.6%) patients and longer than 15 days after symptom onset in 87 (58.4%). The mean time lapse between onset of neurological symptoms and surgery was 9.3 days (range, 1-15) in the early surgery group and 47.9 days (range, 16-157) in the delayed surgery group. 30-day combined stroke & death rates were respectively 1.7% and 3.5% in the early and the delayed surgery groups. 30-day combined stroke, death, & MI rates were respectively 1.7% and 5.9% in the early and the delayed surgery groups. D...

Selection of patients with atherosclerotic carotid stenosis for revascularization is mainly based on the degree of luminal narrowing of the carotid artery. However, identification of other features of plaque apart from the degree of stenosis could enable better selection for intervention if they are also associated with the occurrence of stroke. Before these risk factors can possibly play a role in treatment decisions, their prognostic value needs to be proven. The purpose of this narrative review is to summarize current knowledge regarding the risk factors for stroke in patients with carotid stenosis, how they can be determined, and to what extent they predict stroke, based on recent literature. References for this review were identified by searches of PubMed between 1995 and October, 2016 and references from relevant articles. For each topic in this review different relevant search terms were used. The main search terms were 'carotid stenosis', 'atherosclerosis', &...

The prognostic impact of microvascular status in patients with high fractional flow reserve (FFR) is not clear. The goal of this study was to investigate the implications of coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients who underwent FFR measurement. Patients with high FFR (>0.80) were grouped according to CFR (≤2) and IMR (≥23 U) levels: group A, high CFR with low IMR; group B, high CFR with high IMR; group C, low CFR with low IMR; and group D, low CFR with high IMR. Patient-oriented composite outcome (POCO) of any death, myocardial infarction, and revascularization was assessed. The median follow-up was 658 days (interquartile range: 503.8 to 1,139.3 days). A total of 313 patients (663 vessels) were assessed with FFR, CFR, and IMR. Correlation (r = 0.201; p < 0.001) and categorical agreement (kappa value = 0.178; p < 0.001) between FFR and CFR were modest. Low CFR was associated with higher POCO than high CFR (p = 0.034). There...

Background and Purpose —Percutaneous angioplasty of the intracranial arteries still carries the risk of dissection, with acute closure and embolization. Stenting has been shown to improve the safety and durability of angioplasty in every circulatory bed in which it has been applied. However, stenting of the intracranial arteries has been limited by the availability of stents that can be reliably deployed intracranially. Methods —Twelve patients underwent elective stenting of the basilar artery after episodes of vertebrobasilar ischemia. In all patients, either medical therapy had failed or the patient had a contraindication for long-term anticoagulation. Information from independent neurological examinations, quantitative angiography, and clinical follow-up was collected. Differences between pretreatment and posttreatment degree of stenoses were subjected to 1-way ANOVA for repeated measures. Results —There were 10 men and 2 women, all white, aged 40 to 82 years (mean age, 62.6 year...