[Position paper on the indication for and implementation of interventional treatment of extracranial carotid stenosis].
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Angioplasty, Balloon↗
Biomedical subjects
K Mathias
Publications and source records attributed to K Mathias.
[Interventional treatment of extracranial carotid stenoses: current status, requirements and indications].
Interventional treatment of extracranial carotid stenoses: current status, requirements and indications Around 30000 strokes per year in Germany are caused by extracranial obstructions of the carotid arteries. Besides the well established surgical endatherectomy, which has been proven to be superior to medical treatment alone in randomized multicenter trials, percutaneous treatment by balloon angioplasty and stent placement is increasingly performed. This consensus paper summarizes the present status of scientific studies and controlled treatment registries of carotid angioplasty and stenting and yields to recommendations regarding its performance and indication. A Medline search was done until August 2005 including all randomized comparative studies with clinical endpoints and all controlled registries with more than 500 patients included. Both completed randomized trials comparing angioplasty and stenting with surgery (CAVATAS and SAPPHIRE) did not show a significant difference with respect to stroke and death within 30 days. The incidence of this combined endpoint was between 3.3 and 6.9% in large multicenter registries. Thus, the current endovascular treatment results in a perlinterventional complication rate comparable to that which is commonly accepted for vascular surgery. A systematic preferably external quality monitoring as well as interdisciplinary cooperation most importantly with neurologists is recomendedfor all interventionalists. Based on available clinical data, this consensus paper defines recommendation classes I or II with a level of evidence B or C depending on symptoms, operative risk status of the patient and severity of the underlying stenosis.
Angioplasty, Balloon↗
[Angiographic follow-up after carotid artery stenting of bifurcation stenosis].
PURPOSE: The purpose of this prospective study was to determine the restenosis grade, the intima hyperplasia and the stent expansion via angiographic follow-up six months after carotid artery stenting. MATERIALS AND METHODS: In 100 patients, angiographic follow-up was performed 5.9 months (range: 2.9-11.4 months) after carotid artery stenting. The restenosis grade, the intima hyperplasia and the stent expansion were measured by selective angiography of the treated carotid artery. RESULTS: The mean restenosis grade was 16 % (range: 0-78 %). In 6 of 100 patients (6 %), a restenosis grade of > 50 % was measured. In 4 patients the restenosis grade was 50-70 %. In 2 patients the restenosis grade was > 70 %. In 91 of 100 patients (91 %), the restenosis was localized in the former area of stenosis of the carotid artery, and in 9 of 100 patients (9 %), the restenosis was localized in the cranial stent end. The mean grade of intima hyperplasia was 31 % (range: 2-70 %). The mean increase in stent expansion at the time of follow-up was 10 % (range: 0-59 %). No correlation was able to be determined between the grade of stenosis and the grade of restenosis (rho = 0.017, range: - 0.180-0.213), between the grade of residual stenosis and the grade of restenosis (rho = 0.257, range: 0.064-0.431) and between intima hyperplasia and the grade of restenosis (rho = 0.476, range: 0.309-0.615). CONCLUSIONS: Carotid artery stenting is associated with a low incidence of high-grade restenosis 6 months after an intervention. The intima hyperplasia, which can be observed in each Wallstent, is partly compensated by the expansion of the self-expandable stent. Without a correlation between the grade of residual stenosis and the grade of restenosis, low-grade residual stenosis can be accepted. Therefore, we recommend undersized postdilation of the Wallstent.
Aged↗
Presumed Pseudomonas folliculitis outbreak in children following an outdoor games event.
In early summer 2001, an outbreak of atypical rash occurred among children from 24 junior schools who attended an outdoor games event. The event comprised a series of five water games including a water slide, and within 24 hours of attending the event 151/593 (26%) children developed a papulopustular rash. The rash had a characteristic distribution, predominantly over the lower trunk and buttocks, with some involvement of the arms and legs. Pseudomonas aeruginosa was isolated from a water butt used to draw water for the games, and from the tank of a fire engine that supplied the water. Similar outbreaks, due to Pseudomonas folliculitis, have been previously described and in immunocompromised people this can be associated with serious illness. We recommend that superchlorinated water be used for water play events and that care be taken to avoid abrasive surfaces.
Child↗
Immunisation coverage in Tairawhiti.
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Child, Preschool↗
Endoluminal treatment of internal carotid artery stenosis.
Percutaneous transluminal stent-angioplasty of the carotid artery has indications that are similar but not identical to those for carotid surgery. Certain clinical conditions and morphologic findings, such as myocardial infarction, occlusion of the contralateral carotid artery, or tandem stenoses, favor use of the endoluminal technique. On the other hand, large clots at the site of stenosis, heavily calcified plaques, or elongated, kinked carotid arteries are better suited for carotid endarterectomy. Our experiences with angioplasty of more than 800 carotid stenoses and reports of other groups dealing with carotid angioplasty permit a preliminary evaluation of the method. The technical success rates, complication rates, and the few known long-term results are more or less equal to those of vascular surgery. Therefore further prospectively randomized studies are necessary to determine from which procedure the patient with his or her individual condition can gain the highest benefit.
Angioplasty, Balloon↗
Digital chest radiography with a large-area flat-panel silicon X-ray detector: clinical comparison with conventional radiography.
This was a radiologists' preference study to compare a digital chest radiography system that utilizes a large-area silicon flat-panel detector with conventional radiography for visualizing anatomic regions of the chest. Conventional and digital posteroanterior (PA) and lateral chest radiographs were obtained in 115 patients. The PA and lateral image pairs were compared independently by three radiologists rating the overall appearance, 11 anatomic regions in the PA, and 9 in the lateral views. Statistical analysis was performed with the Wilcoxon signed-rank test with Bonferroni-Holm adjustment (p=0.05). For the PA view, the digital system performed significantly better for the overall appearance and for all anatomic regions except for the peripheral pulmonary vasculature and hilum, where no significant difference was found. For the lateral digital images, the regions trachea, costodiaphragmatic recess, and hilum were rated significantly worse. The regions retrosternal and retrocardiac lung were rated significantly better. The other regions and the overall appearance showed no significant differences. The described digital chest radiography system showed statistically superior visualization of anatomic regions for PA and an ambiguous performance for lateral images as compared with conventional radiography. After changing some image processing parameters for the lateral view, this system may be suitable for digitalization of chest radiography.
Adult↗
Global experience in cervical carotid artery stent placement.
The purpose of this article is to review and update the current status of carotid artery stent placement in the world. Surveys to major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent information from these 24 centers in addition to 12 new centers has been obtained to update the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 5,210 procedures involving 4,757 patients. There was a technical success of 98.4% with 5,129 carotid arteries treated. Complications that occurred during the carotid stent placement or within a 30-day period following placement were recorded. Overall, there were 134 transient ischemic attacks (TIAs) for a rate of 2.82%. Based on the total patient population, there were 129 minor strokes with a rate of occurrence of 2.72%. The total number of major strokes was 71 for a rate of 1.49%. There were 41 deaths within a 30-day postprocedure period resulting in a mortality rate of 0.86%. The combined minor and major strokes and procedure-related death rate was 5.07%. Restenosis rates of carotid stenting have been 1.99% and 3.46% at 6 and 12 months, respectively. The rate of neurologic events after stent placement has been 1.42% at 6-12-month follow-up. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients that are high risk for standard carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have not changed significantly since the first survey results. Cathet. Cardiovasc. Intervent. 50:160-167, 2000.
Carotid Stenosis↗
[Small intestinal transit with radio-opaque markers to localize intermittent small bowel obstruction] .
AIM: In difficult diagnostic cases of partial small bowel obstruction, radiopaque, non-digestible markers were used to challenge and localize the site of obstruction. MATERIAL AND METHOD: 32 patients (19 female, 13 male, 3-80 years) were examined. Each patient received 20 4-mm radiopaque markers orally. Abdominal radiographs were obtained at 4-8 h intervals. Mechanical obstruction was defined as the clustering of at least 3 markers for 4 hours or longer. The transit of radiopaque markers was compared to plain radiography, ultrasound, barium meal, computed tomography, enteroclysis and operative findings. RESULTS: 18 of 32 patients showed small bowel clustering suggestive of obstruction. Diagnostic agreement was found in 12 of 14 cases with ultrasound, in 7 of 13 cases with plain radiography and in 3 of 6 cases with enteroclysis. 13 of the 18 patients with clustering had surgery. All of them (13/13) had adhesions with the need of resection. CONCLUSION: This investigation is an alternative diagnostic method for the decision between conservative and surgical treatment in cases of intermittent partial small bowel obstruction.
Adolescent↗
Digital radiography versus conventional radiography in chest imaging: diagnostic performance of a large-area silicon flat-panel detector in a clinical CT-controlled study.
OBJECTIVE: The objective of this study was to compare the diagnostic performance of a digital large-area silicon flat-panel detector with that of a conventional screen-film system in clinical chest imaging using abnormal findings documented by CT as the reference standard. SUBJECTS AND METHODS: Eighty patients (46 men and 34 women; age range,18-91 years; mean age, 63 years) who underwent CT of the chest were examined with the new digital radiography system, which is based on a 43 x 43 cm silicon flat-panel detector, and with a conventional screen-film system, which is used routinely in clinical practice. Posteroanterior and lateral radiographs were obtained. Four radiologists analyzed the digital and conventional images separately for chest abnormalities and rated the images using a five-level scale of confidence; CT was used as the reference standard. Diagnostic value was assessed using receiver operating characteristic curves for each abnormality. RESULTS: No significant differences were found between the area under the receiver operating characteristic curve of the digital and that of the conventional radiography method for almost all investigated criteria. The only exception was mediastinal abnormalities, for which the digital method provided better results than the conventional method (p < 0.05). CONCLUSION: The diagnostic performance of the new large-area silicon flat-panel detector is equivalent or superior to that of the conventional screen-film system for clinical chest imaging and can replace conventional radiography systems. This new technology offers transmission and storage possibilities inherent to digital radiology that would facilitate daily practice and reduce the initial high costs in the long-term.
Adolescent↗
[Endoluminal therapy in carotid stenosis].
Stent angioplasty of atherosclerotic carotid artery stenosis has proven its benefit in 912 treated vessels with a success rate of 99% and a rate of permanent neurological deficit of 2.7%. The procedure is indicated in symptomatic patients with a stenosis of > 70% and in asymptomatic patients > 80%. The early and late results are not significantly different from those of carotid surgery. But the endoluminal treatment is more gentle to the patient, requires a shorter hospital stay and reduces the costs of the treatment. Moreover, patients who are no longer surgical candidates for general medical or local reasons or can only be dealt with surgically with a comparably high risk can be treated.
Aged↗
[Interventional treatment of arteriosclerotic carotid stenosis].
PURPOSE: Angioplasty and stent placement of atherosclerotic internal carotid artery stenosis (ICA) are evaluated based on own experiences with the method and reports of other groups and are compared with vascular surgery. METHODS: ICA-stenoses of more than 70% were treated by angioplasty and stent placement mainly using the Wallstent. The patients had follow-up examinations with an angiogram after 6 months and colour-coded duplex ultrasound at regular intervals. RESULTS: In 633 patients 799 ICA stenoses were treated, 70% of them were symptomatic and 30% asymptomatic. In 99% of the patients the stenoses could be removed with a reduction of the degree of stenosis from 82% to 12%. Transient neurological deficits occurred in 5% and permanent deficits in 2.7% of the patients with decreasing incidence over the years. Five-year patency was 91.6%. CONCLUSION: Endoluminal treatment of atherosclerotic ICA stenosis is an efficient procedure which can be applied in patients, in whom carotid surgery is indicated, but also in cases with an increased operative risk or inoperability from technical or medical reasons.
Angioplasty, Balloon↗
Current global status of carotid artery stent placement.
Our purpose was to review the current status of carotid artery stent placement throughout the world. Surveys were sent to major interventional centers in Europe, North and South America, and Asia. Information from peer-reviewed journals was also included and supplemented the survey. The survey asked various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. Of the centers which were sent surveys, 24 responded. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 2,048 cases, with a technical success of 98.6%. Complications that occurred during carotid stent placement or within a 30-day period following placement were recorded. Overall, there were 63 minor strokes, with a rate of occurrence of 3.08%. The total number of major strokes was 27, for a rate of 1.32%. There were 28 deaths within a 30-day postprocedure period, resulting in a mortality rate of 1.37%. Restenosis rates of carotid stenting have been 4.80% at 6 mo. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative to vascular surgery, especially for patients that are at high risk for standard carotid endarterectomy. The periprocedural risks for major and minor strokes and death are generally acceptable at this early stage of development.
Angioplasty, Balloon↗
[Interventional radiology in central venous obstructions. Dilatation--stent implantation--thrombolysis].
PURPOSE: Venous congestion of the superior or inferior caval system has to be considered as a medical emergency. The results of various recanalization procedures and their utility are analyzed. PATIENTS AND METHODS: 176 patients with superior and 28 with inferior caval obstruction were treated with Gianturco-Z (n = 39) and Wall Stents (n = 207) respectively. Balloon venoplasty was performed prior to stent implanation. In 27 cases, local thrombolysis with urokinase was employed. RESULTS: Interventional procedures were successful in 198 and without success in 6 patients. In most patients, symptoms were relieved during or early after recanalization. No major complications were found. DISCUSSION: Balloon angioplasty with stent placement and local thrombolysis are successful in the treatment of superior and inferior caval obstruction. Self-expanding Wallstents are superior to Gianturco-Z-stents. Oncologists should be made familiar with this type of treatment.
Adolescent↗
[High-flow priapism following blunt perineal trauma. Interventional therapy].
A 10-year old boy developed an arteriocavernosal fistula with a permanent penile erection (high-flow priapism) after a blunt perineal trauma. The diagnosis was established by Doppler ultrasound, blood gas analysis and angiography. A conservative treatment attempt with penile cooling and puncture of the cavernosal corpera with blood aspiration and etilefrine instillation failed to resolve the priapism. An embolization of both bulbocavernosal arteries was followed by an immediate detumescence. Normal functional erection was preserved. No recurrence was observed during a follow-up of 6 months.
Accidents, Traffic↗
Discovery of MC-02,331, a new cephalosporin exhibiting potent activity against methicillin-resistant Staphylococcus aureus.
A systematic approach toward building activity against methicillin-resistant staphylococci into the cephalosporin class of beta-lactam antibiotics is described. Initial work focused on finding the optimal linkage between the cephem nucleus and a biphenyl pharmacophore, which established that a thio linkage afforded potent activity in vitro. Efforts to optimize this activity by altering substitution on the pharmacophore afforded iodophenylthio analog MC-02,002, which although highly potent against MRSA, was also highly bound to serum proteins. Further work to decrease serum protein binding showed that replacement of the iodo substituent by the positively-charged isothiouronium group afforded potent activity and reduced serum binding, but insufficient aqueous solubility. Solubility was enhanced by incorporation of a second positively-charged group into the 7-acyl substituent. Such derivatives (MC-02,171 and MC-02,306) lacked sufficient stability to staphylococcal beta-lactamase enzymes. The second positive charge was incorporated into the cephem 3-substituent in order to utilize the beta-lactamase-stable aminothiazolyl(oximino)acetyl class of 7-substituents. These efforts culminated with the discovery of bis(isothiouroniummethyl)phenylthio analog MC-02,331, whose profile is acceptable with respect to potency against MRSA, serum binding, aqueous solubility, and beta-lactamase stability.
Animals↗
[Stent treatment of a false postoperative carotid aneurysm].
A 64-year old man developed an aneurysm at the distal anastomosis of a carotido-carotid PTFE-interposition which was treated by placement of a stent. Angiographic and computertomographic follow-up examinations after 9 months demonstrated the complete disappearance of the aneurysm after implantation of a self-expanding uncovered stent (Wallstent).
Aneurysm, False↗
[Comment on the contributions regarding quality assurance in mammography].
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Female↗