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Biomedical subjects

C Baracchini

Publications and source records attributed to C Baracchini.

8 recordsLinked to original sources
PubMed2005

Age-adjusted reference limits for carotid intima-media thickness as better indicator of vascular risk: population-based estimates from the VITA project.

BACKGROUND: An increase of carotid intima-media thickness (CIMT) has been demonstrated to be associated in many studies with the subsequent risk of cardio- and cerebrovascular events, but the threshold level of CIMT for an increased risk at different ages remains uncertain. OBJECTIVES: We aimed at establishing optimal reference limits associated with a definite increased vascular risk in the general population. METHODS: A cohort of 2580 subjects was enrolled in a population-based cross-sectional survey. CIMT was measured on both left and right common carotid arteries, and age-specific, percentile-based reference ranges for CIMT were computed together with the Framingham risk score. RESULTS: A significant, steady increase of CIMT reference ranges was observed within different age strata. CIMT levels were linearly related with an increase of the Framingham risk score, but after age-adjustment only the upper CIMT quintile was associated with a higher Framingham risk score. CONCLUSIONS: Age-specific reference limits provide better estimate of vascular risk in the population and correlation with established risk factors.

Age Distribution↗
PubMed2002

Subclavian carotid transposition for symptomatic subclavian artery stenosis or occlusion. A comparison with the endovascular procedure.

BACKGROUND: Although subclavian-carotid transposition (SCT), among all extrathoracic revascularization procedures, has emerged as the treatment of choice for symptomatic subclavian artery (SA) stenosis or occlusion, some authors advocate percutaneous transluminal angioplasty with stenting as the optimum primary therapy. AIM: to assess safety, efficacy and durability of SCT in the treatment of symptomatic SA stenosis or occlusion. METHODS DESIGN: review of a prospectively maintained vascular surgical registry. SETTING: University vascular surgical service. PATIENTS: 39 patients requiring surgery for symptomatic stenosis or occlusion of the proximal SA from September 1985 to August 1999. INTERVENTION: SCT. MEASURES: data were collected prospectively from hospital charts and office medical records to determine demographics, risk factors, presenting clinical manifestation, blood pressure differentials, location of the SA lesion and early postoperative outcome. Long-term follow-up was available in all patients. Patency of the revascularization was determined by physical examination and non-invasive laboratory studies. RESULTS: The perioperative mortality and morbidity rates were 2.5% (1 of 39) and 2.5% (1 of 39), respectively. Immediate relief of symptoms was achieved in 100% of cases. Mean follow-up was 6.8 years. Revascularization neither failed during the follow-up period, nor did patients have recurrent symptoms. The overall survival rates at 1, 3, 5 and 10 years were 100%, 100%, 86% and 68%. Overall late mortality rate was 18.4%: no death was stroke related. CONCLUSIONS: SCT is a very safe and effective surgical procedure for the treatment of symptomatic SA atherosclerotic disease, ensuring an excellent long-term patency.

Arterial Occlusive Diseases↗
PubMed2000

Carotid endarterectomy in women: early and long-term results.

BACKGROUND: Although many randomized trials and other multicenter studies have demonstrated the benefits of carotid endarterectomy (CEA) in selected symptomatic and asymptomatic patients, including women, there is a remarkable lack of reports regarding the outcome of CEA with respect to sex. To analyze and compare the outcome of CEA in men and women in a single-group experience, we reviewed a consecutive series of 619 CEAs performed in 539 patients, 371 men (423 CEAs) and 168 women (196 CEAs). METHODS: Data collection was retrospective up to August 1, 1992 and prospective for all 405 patients treated thereafter. RESULTS: Women were significantly less likely than men to have overt evidence of coronary artery disease (P < .001) and had a significantly higher incidence of diabetes (P < .001). No perioperative death occurred in the female group (P = NS), and no statistical difference was found in perioperative stroke risk incidence. Women had a significantly higher incidence of late occlusive events (P = .01), which were all asymptomatic. No late stroke occurred in the female group (P = NS). Life-table cumulative survival rates at 1, 3, 5, and 7 years were 99.3%, 90.5%, 85.9%, and 82.3%, respectively, in women, and 98.9%, 91.9%, 85.2%, and 79.6% in men (log-rang P = .8). CONCLUSIONS: These findings show that perioperative stroke risk and mortality rates, as well as late stroke-free, mortality, and recurrence rates, in patients undergoing CEA, are comparable in men and women. Further, larger comparative studies are necessary to provide more information on the benefit and durability of CEA in asymptomatic patients, but the results of this study suggest that the early and late outcomes are excellent and comparable in symptomatic and asymptomatic men and women.

Adult↗
PubMed2000

A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion.

OBJECTIVE: To compare the clinical outcome and restenosis incidence of patients who underwent carotid endarterectomy with patch closure (CEAP) on one side and carotid eversion endarterectomy (CEE) on the other. SUMMARY BACKGROUND DATA: Although a few investigators have compared the results of CEAP versus CEE, no reports have compared the outcome of CEAP versus CEE in the same patient. METHODS: Eighty-six patients were randomly selected for sequential surgical treatment involving either CEAP/CEE or CEE/CEAP. All patients underwent postoperative duplex ultrasound study and clinical follow-up at 1, 6, and 12 months and every year thereafter. Various factors were analyzed to ascertain any association with restenosis, and Kaplan-Meier analysis was used to estimate the risk of restenosis. RESULTS: Demographic and clinical data were similar in the CEAP and CEE groups. The selective shunting rate was statistically higher in the CEAP group. There were no perioperative deaths. Although the incidence of perioperative ipsilateral stroke was not significant, CEAP patients had a rate of combined transient ischemic attacks and strokes that approached statistical significance. The mean follow-up was 40 months. CEAP patients had a significantly higher incidence of restenosis and combined occlusive events and restenoses. Kaplan-Meier analysis showed that CEE had a significantly better cumulative patency rate than CEAP and that freedom from restenoses at 24 and 36 months was 87% and 83% for CEAP and 98% and 98% for CEE, respectively. CONCLUSIONS: CEE is less likely to cause perioperative neurologic complications and restenoses than CEAP. The significantly higher rate of unilateral recurrence suggests that local factors play a more important role than systemic factors in the occurrence of restenosis.

Adult↗
PubMed2000

The quest for early predictors of stroke evolution: can TCD be a guiding light?

BACKGROUND AND PURPOSE: The present study aimed at evaluating the prognostic value of transcranial Doppler ultrasonography (TCD) in the acute phase of ischemic stroke, when major therapeutic decisions must be made. METHODS: Seventy-three patients with a first-ever ischemic hemispheric stroke underwent neurological assessment according to the Unified Neurological Stroke Scale, clinical subgrouping according to the criteria of Bamford, CT scan, cervical duplex sonography, and TCD, all within 12 hours from stroke onset. TCD was repeated on days 2 and 7. Patients were followed for 90 days, during which we calculated the fatality rate and then assessed clinical outcome. RESULTS: Emergency TCD revealed middle cerebral artery (MCA) no-flow in 24 cases and MCA asymmetry in 30 subjects. Serial TCD showed early (<24 hours) MCA recanalization in 6 patients. After 90 days, no patient with MCA occlusion at admission was autonomous, while 17 of 19 patients (89.5%) with a normal baseline TCD were independent. The fatality rate at 3 months was 21% but was 46% in patients with MCA occlusion and 61% in patients without signs of early MCA recanalization. Total anterior circulation infarct and abnormal TCD were significantly correlated (P:<0.001) with higher mortality rate and worse outcome (Barthel Index score </=60), whereas early CT ischemic signs and severe carotid disease were not. Furthermore, TCD identified within the total anterior circulation infarct subgroup 2 prognostic clusters according to MCA patency at admission (P:<0.001). Logistic regression selected normal baseline TCD as an independent predictor of good long-term outcome and MCA no-flow as an independent predictor of disability or death. CONCLUSIONS: TCD findings play an important role in the early prognosis of anterior circulation stroke, providing possible guidance for therapeutic interventions.

Aged↗
PubMed1999

Symptomatic and asymptomatic carotid artery lesions in peripheral vascular disease: a prospective study.

PURPOSE: To assess the incidence and severity of internal carotid artery lesions in patients who were referred to a single institution with peripheral obliterative atherosclerotic disease (POAD) as their chief complaint, in order to identify symptomatic and asymptomatic subjects at risk of stroke who would benefit from surgery. MATERIALS AND METHODS: Consecutive patients with clinically and Doppler scan-proven POAD underwent prospective screening for the presence of carotid symptomatic and asymptomatic atherosclerotic lesions with duplex ultrasound scan (DUS). Associated risk factors for atherosclerosis, i.e. age, sex, diabetes, hypertension, hyperlipidemia, history of smoking and history of coronary artery disease were assessed and recorded. Univariate analysis was performed to correlate the risk factors with the presence of POAD and carotid lesions. RESULTS: Three-hundred and twelve consecutive patients were evaluated over an 18-month period. A 30% or greater carotid stenosis was detected by DUS in 189 patients (19 bilateral); 57 (30%) of these had neurologic symptoms, 19 of whom had a 70-99% carotid lesion, whereas 65 of the 132 asymptomatic patients had 60-99% carotid stenosis. Univariate analysis revealed no differences in the symptomatic and asymptomatic groups between patients who were potential candidates for carotid endarterectomy according to the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerotic Study Group guidelines, respectively, and those who were not as regards associated atherosclerotic risk factors and severity of POAD. All but 2 (n = 17) symptomatic and 18 asymptomatic patients underwent carotid endarterectomy based on DUS criteria alone. The perioperative stroke risk and mortality rates were 0%. CONCLUSIONS: Routine carotid DUS screening of 312 consecutive patients with POAD revealed that 19 patients with symptoms and 65 (5 bilateral) without symptoms would benefit from surgery, representing 27% of the series considered.

Aged↗