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https://www.readbyqxmd.com/read/28329291/coronary-artery-bypass-graft-surgery-versus-drug-eluting-stent-implantation-for-high-surgical-risk-patients-with-left-main-or-multivessel-coronary-artery-disease
#1
Mineok Chang, Cheol Whan Lee, Jung-Min Ahn, Rafael Cavalcante, Yohei Sotomi, Yoshinobu Onuma, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, Patrick W Serruys, Seung-Jung Park
OBJECTIVES: There are limited data comparing long-term outcomes of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with high surgical risk. We evaluated 5-year outcomes following CABG versus PCI with DES in 598 patients with left main or multivessel coronary artery disease (CAD) and a high surgical risk [EuroSCORE (European system for cardiac operative risk evaluation) ≥ 6]. METHODS: Databases were merged from the BEST, PRECOMBAT and SYNTAX trials...
December 20, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28327889/hemodynamic-changes-after-unilateral-revascularization-for-moyamoya-disease-serial-assessment-by-quantitative-magnetic-resonance-angiography
#2
Tackeun Kim, Jae Seung Bang, O-Ki Kwon, Gyojun Hwang, Jeong Eun Kim, Hyun-Seung Kang, Won-Sang Cho, Cheolkyu Jung, Chang Wan Oh
BACKGROUND: Ultrasonic flow meters and quantitative magnetic resonance angiography quantitatively assess flow during hemodynamic evaluation of cerebral ischemia. Although their reliability and reproducibility have been verified, their clinical impact in moyamoya disease has rarely been reported. OBJECTIVE: To investigate flow measurement outcomes in moyamoya disease patients pre- and postoperatively through a retrospective observational study. METHODS: We evaluated 41 patients undergoing their first revascularization surgery who were followed ≥6 mo...
January 2, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28323182/treatment-of-large-and-giant-middle-cerebral-artery-aneurysms-risk-factors-for-unfavorable-outcomes
#3
Wonhyoung Park, Jaewoo Chung, Jae Sung Ahn, Jung Cheol Park, Byung Duk Kwun
OBJECTIVE: This study aimed to assess the clinical and radiological outcomes after neurosurgical treatment of large and giant aneurysms of the middle cerebral artery (MCA). In addition, we aimed to identify risk factors for unfavorable outcomes. METHODS: This retrospective study included 105 patients with 106 large or giant MCA aneurysms treated with neurosurgical methods, including microsurgery and endovascular treatment, over a 15-year period. RESULTS: The mean aneurysm size was 15...
March 16, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28300680/evaluation-by-mri-of-silent-brain-infarcts-in-pre-and-post-operative-asymptomatic-carotid-surgery
#4
Remy Pascot, Anne Daoudal, Alain Cardon, Gilles Godet, Antoine Lucas, Elodie Clochard, Jean-Yves Gauvrit, Yann Le Teurnier, Adrien Kaladji
OBJECTIVE: To report the prevalence of Silent Brain Infarcts (SBI) at MRI before and after surgery for asymptomatic high grade carotid stenosis. DESIGN: Single-center retrospective observational study METHODS: Asymptomatic patients who underwent carotid endarterectomy between October 2012 and October 2014 were included. The preoperative assessment included a Doppler and a CT scan dating less than 3 months. A neurological examination was performed during the anesthesia consultation and in the 15 days before surgery...
March 11, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28288887/transapical-endovascular-repair-of-thoracic-aortic-pathology
#5
Takashi Murakami, Shinsuke Nishimura, Mitsuharu Hosono, Yoshitsugu Nakamura, Etsuji Sohgawa, Yukimasa Sakai, Toshihiko Shibata
BACKGROUND: Alternative access for thoracic endovascular aortic repair (TEVAR) has been explored for patients with unsuitable femoral and iliac access, but few cases of transapical access have been described. We report our experience with transapical access for various aortic pathologies. METHODS: We reviewed six cases undergoing transapical access for endovascular repair of thoracic aortic pathology between December 2013 and August 2015. Five patients had an aortic arch aneurysm and 1 patient presented with Stanford type A subacute aortic dissection...
March 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28281006/signal-reduction-of-donor-artery-on-mri-after-superficial-temporal-artery-to-middle-cerebral-artery-anastomosis-a-retrospective-analysis
#6
Satoshi Koizumi, Toshikazu Kimura, Tomohiro Inoue
OBJECT: Microsurgical anastomosis from the superficial temporal artery (STA) to the middle cerebral artery (MCA) is a treatment option for appropriately selected patients with cranial atherosclerotic steno-occlusive disease (CASD). However, the long-term efficacy and patency of the donor artery remain unclear. We reviewed the signal intensity of the donor artery on magnetic resonance angiography (MRA) after STA-MCA anastomosis in patients with CASD and clarified the incidence of and risk factors for reduction in postoperative signal of STA...
March 9, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28276534/non-invasive-assessment-of-cerebral-blood-flow-and-oxygen-metabolism-in-neonates-during-hypothermic-cardiopulmonary-bypass-feasibility-and-clinical-implications
#7
Silvina L Ferradal, Koichi Yuki, Rutvi Vyas, Christopher G Ha, Francesca Yi, Christian Stopp, David Wypij, Henry H Cheng, Jane W Newburger, Aditya K Kaza, Maria A Franceschini, Barry D Kussman, P Ellen Grant
The neonatal brain is extremely vulnerable to injury during periods of hypoxia and/or ischemia. Risk of brain injury is increased during neonatal cardiac surgery, where pre-existing hemodynamic instability and metabolic abnormalities are combined with long periods of low cerebral blood flow and/or circulatory arrest. Our understanding of events associated with cerebral hypoxia-ischemia during cardiopulmonary bypass (CPB) remains limited, largely due to inadequate tools to quantify cerebral oxygen delivery and consumption non-invasively and in real-time...
March 9, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28259574/a-comparison-of-results-of-carotid-endarterectomy-in-octogenarians-and-nonagenarians-to-younger-patients-from-the-mid-america-vascular-study-group-and-the-society-for-vascular-surgery-vascular-quality-initiative
#8
Joseph R Schneider, Cheryl R Jackson, Irene B Helenowski, Michael J Verta, Julia B Wilkinson, Stanley Kim, Andrew W Hoel
OBJECTIVE: Carotid endarterectomy (CEA) reduces stroke risk in selected patients. However, CEA risk profile may be different in older patients. We compared characteristics and outcomes of octogenarians and nonagenarians with those of younger patients. METHODS: Deidentified data from CEA patients were obtained from the Society for Vascular Surgery Vascular Quality Initiative (VQI) database. Prior CEA, carotid artery stent, or combined CEA and coronary artery bypass were excluded, yielding 7390 CEAs in octogenarians and nonagenarians (≥80 years of age) and 35,303 CEAs in younger patients (<80 years of age)...
March 1, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28258019/open-and-endovascular-management-of-severe-cerebral-ischemia-in-takayasu-s-arteritis
#9
Xiao Yun Luo, Qing Hua Wu, Fu Xian Zhang
BACKGROUND: Severe cerebral ischemia in patients with Takayasu's arteries was caused by occlusion of most supra-aortic arteries. Arterial revascularization is necessary to decrease the incidence of stroke and improve the quality of life, but may be complicated with multiple occlusive lesions and inflammation condition of this disease. This study was to assess options and long-term outcomes of surgical and endovascular treatment. METHODS: Twenty nine patients with severe cerebral ischemic symptoms underwent surgical or endovascular treatment from January 1991 to July 2015...
February 28, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28255031/progressive-cortical-neuronal-damage-and-extracranial-intracranial-bypass-surgery-in-patients-with-misery-perfusion
#10
H Yamauchi, S Kagawa, Y Kishibe, M Takahashi, T Higashi
BACKGROUND AND PURPOSE: Misery perfusion may cause selective neuronal damage in atherosclerotic ICA or MCA disease. Bypass surgery can improve misery perfusion and may prevent neuronal damage. On the other hand, surgery conveys a risk for neuronal damage. The purpose of this retrospective study was to determine whether progression of cortical neuronal damage in surgically treated patients with misery perfusion is larger than that in surgically treated patients without misery perfusion or medically treated patients with misery perfusion...
March 2, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28254602/evaluation-of-a-traumatic-vertebral-artery-occlusion
#11
Jaclyn J Renfrow, Mark B Frenkel, Matthew S Edwards, John A Wilson
BACKGROUND: Penetrating neck injury occurs in 5-10% of all trauma cases and carries a significant burden of morbidity and mortality (15%). We describe the evaluation and management of a 25 year-old man shot in the neck with occlusion of the left vertebral artery from its origin to C6. This is a case report where medical data was retrospectively analyzed with institutional IRB approval. CASE DESCRIPTION: Neurologic examination revealed paresthesias and dysesthesias in a left C8 dermatomal distribution...
February 27, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28223258/the-neurologic-protection-of-unilateral-versus-bilateral-antegrade-cerebral-perfusion-in-aortic-arch-surgery-with-deep-hypothermic-circulatory-arrest-a-study-of-77-cases
#12
Bowen Li, Xiaoping Hu, Zhiwei Wang
BACKGROUD: Unilateral and bilateral antegrade cerebral perfusions (ACP) are recognized methods of cerebral protection in aortic arch surgery. However, the adequacy of cerebral protection in aortic arch surgery with deep hypothermic circulatory arrest is controversial. In this study, we compared unilateral and bilateral ACP of cerebral protection in aortic arch surgery by assessing the patient's intraoperative and postoperative brain function. METHODS: A total of 77 patients undergoing aortic arch surgery were included in this study...
February 20, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28223049/outcomes-of-coronary-artery-bypass-and-stents-for-unprotected-left-main-coronary-stenosis
#13
Yin-Shu Chang, Jia-Xiang Wang, Da-Wei Chang
BACKGROUND: This study assessed the short-, medium-, and long-term outcomes of coronary artery bypass grafting vs stenting for patients with unprotected left main coronary artery disease through a meta-analysis of randomized controlled trials. METHODS: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were systematically searched for randomized controlled trials of coronary artery bypass grafting compared with stents in unprotected left main coronary artery disease...
February 18, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28215461/the-use-of-ultrasound-for-postoperative-monitoring-of-cerebral-bypass-grafts-a-technical-report
#14
Ryan P Morton, Isaac Joshua Abecassis, Anne E Moore, Cory M Kelly, Michael R Levitt, Louis J Kim, Laligam N Sekhar
Duplex ultrasound and transcranial Doppler are valuable tools for post-operative monitoring of extracranial-intracranial cerebral bypass grafts. Here we describe our technique for the evaluation of both high-flow and low-flow cerebral bypass grafts over a nine year period. 186 bypass grafts were studied daily during the inpatient period between Jan 2005 and Dec 2014 after surgery for various cerebrovascular pathologies. There was a technical success rate of 97%. Duplex ultrasonographic flow measurements had excellent interobserver reliability with an intraclass correlation coefficient (ICC) of 0...
February 16, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28209313/the-arborization-bypass-sequential-intracranial-intracranial-bypasses-for-an-unruptured-fusiform-mca-aneurysm
#15
Jonathan J Russin
Revascularization techniques are being featured more prominently as endovascular treatments continue to select out complex cerebrovascular pathologies for open surgical management. The current healthcare environment requires decreased hospital stays and improved clinical outcomes despite the growing complexity of open surgical cases. Recent efforts to reduce operative room time and decrease risk for bypass surgery have focused on avoiding graft harvest and maintaining the entire bypass intracranial. The presented technique features an arborization bypass to serially anastomose the middle cerebral artery vessels allowing for proximal trapping of a complex aneurysm without graft harvest...
February 10, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28193536/blood-brain-barrier-disruption-after-cardiopulmonary-bypass-diagnosis-and-correlation-to-cognition
#16
Dan Abrahamov, Oren Levran, Sharon Naparstek, Yael Refaeli, Shani Kaptson, Mahmud Abu Salah, Yaron Ishai, Gideon Sahar
BACKGROUND: Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response that may impair blood-brain barrier (BBB) integrity. BBB disruption can currently be detected by dynamic contrast enhancement magnetic resonance imaging (MRI), reflected by an increase in the permeability constant (K(trans)). We aimed to determine (1) whether CPB induces BBB disruption, (2) duration until BBB disruption resolution, and (3) the obtainable correlation between BBB injury (location and intensity) and neurocognitive dysfunction...
February 10, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28191623/the-ivy-sign-on-fluid-attenuated-inversion-recovery-images-related-to-single-photon-emission-computed-tomography-cerebral-blood-flow-in-moyamoya-disease-a-case-report
#17
Fumihiro Matano, Yasuo Murai, Asami Kubota, Takayuki Mizunari, Shiro Kobayashi, Akio Morita
BACKGROUND: Moyamoya disease is an idiopathic progressive cerebrovascular steno-occlusive disorder characterized by the formation of numerous collaterals called moyamoya vessels. Accurate evaluation of vascular status and CBF is needed for prompt treatment to prevent ischemic and/or hemorrhagic events. The pathogenesis of the ivy sign on fluid attenuated inversion recovery (FLAIR) images of moyamoya disease patients is unclear. We report a moyamoya disease case wherein the ivy sign changed in relation to SPECT-measured CBF during progression and following treatment...
January 17, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28191601/the-maxillary-artery-and-its-variants-an-anatomical-study-with-neurosurgical-applications
#18
Jorge E Alvernia, Joaquin Hidalgo, Marc P Sindou, Chad Washington, Gustavo Luzardo, Eddie Perkins, Remi Nader, Patrick Mertens
BACKGROUND: The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES: To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS: Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques...
February 13, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28190436/neurologic-complications-of-cardiac-and-vascular-surgery
#19
REVIEW
K N Sheth, E Nourollahzadeh
This chapter will provide an overview of the major neurologic complications of common cardiac and vascular surgeries, such as coronary artery bypass grafting and carotid endarterectomy. Neurologic complications after cardiac and vascular surgeries can cause significant morbidity and mortality, which can negate the beneficial effects of the intervention. Some of the complications to be discussed include ischemic and hemorrhagic stroke, seizures, delirium, cognitive dysfunction, cerebral hyperperfusion syndrome, cranial nerve injuries, and peripheral neuropathies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28186451/techniques-and-outcomes-of-microsurgical-management-of-ruptured-and-unruptured-fusiform-cerebral-aneurysms
#20
Sam Safavi-Abbasi, M Yashar S Kalani, Ben Frock, Hai Sun, Kaan Yagmurlu, Felix Moron, Laura A Snyder, Randy J Hlubek, Joseph M Zabramski, Peter Nakaji, Robert F Spetzler
OBJECTIVE Fusiform cerebral aneurysms represent a small portion of intracranial aneurysms; differ in natural history, anatomy, and pathology; and can be difficult to treat compared with saccular aneurysms. The purpose of this study was to examine the techniques of treatment of ruptured and unruptured fusiform intracranial aneurysms and patient outcomes. METHODS In 45 patients with fusiform aneurysms, the authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; the outcome at discharge and last follow-up; and the change in the aneurysm at last angiographic follow-up...
February 10, 2017: Journal of Neurosurgery
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