Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale <2. Twelve presented with acute basilar artery occlusion and were submitted to mechanical thrombectomy before percutaneous transluminal angioplasty and stenting, while the remaining had severe basilar artery stenosis. Successful stent placement was achieved in 22 (88%). Procedure-related complications included new small ischemic lesions (16%), basilar artery dissection (8%), vertebral artery dissection (12%) and death (12%). At 3 months post-percutaneous transluminal angioplasty and stenting, 10 out of 23 patients (43.5%) were independent (mRS ≤ 2) and six died. Fourteen patients underwent transcranial Doppler ultrasound 3 months post-percutaneous transluminal angioplasty and stenting: 12 showed residual stenosis, one significant stent restenosis and one presented stent occlusion. Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.
SUMMARY Sodium polystyrene sulfonate (PSP) or Kayexalate is a cation-exchange resin, widely used in the management of hyperkalaemia due to renal disease. A rare, yet potentially dangerous, adverse event related to sodium polystyrene sulfonate use is intestinal mucosal injury, especially in the colon. The injury to the gastrointestinal mucosa can range from mild and superficial to wall necrosis and bowel perforation. The mechanism that leads to mucosal damage remains unclear. However, it is believed that sorbitol, commonly given to counteract PSP’s tendency to cause constipation, may play an important role in the development of gastrointestinal injury. Other potential risk factors are uraemia or end-stage renal disease, hemodynamic instability, solid organ transplantation, postoperative status and concomitant opioid administration. The authors present a case of diarrhoea and haematochezia after the administration of PSP without sorbitol, in a patient with hyperkalaemia due to acute kidney injury, in the absence of other risk factors. A colonoscopy was performed and revealed a rectal ulcer which histological findings were suggestive of mucosal injury due to Kayexalate deposition. This case supports the concept that this widely used drug can itself, without sorbitol, cause injury to the gastrointestinal wall. Even though this is a rare adverse effect, the widespread use of this medication may put a large population at risk.
Background:It is generally assumed that once Antiphospholipid syndrome (APS) is diagnosed, patients should be treated with anticoagulation (ACO), possibly for a lifetime1.Objectives:Our main objective was the characterization of a group of patients with primary APS, evaluation of clinical profile, presence of APS antibodies (Ab) over time, recurrent thrombotic events and treatment.Methods:Demographic and clinical features of patients with APS were identified through the Unit’s database. APL significant titers were retrospectively collected, 3, 6 and 9 months, every 6 months until year 6, every year until the last follow-up. LAC and aPL Ab (anticardiolipin IgG and Beta-2 Glycoprotein 1 IgG) were considered positive or negative by DRVVT/ELISA. Comparisons were made using the Wilcoxon Rank Sum and Chi square tests, p values < 0.05 were considered statistically significant (SPSS 22).Results:67 patients were analysed; the majority were female (n=49); mean average age of APS diagnosis was at 40[±13] y-old. Evaluation period: 2 - 20 years. 52 patients had at least one thrombotic event: 7 arterial thrombosis, 30 venous thrombosis and 8 both arterial and venous thrombotic events; 7 patients had obstetrical APS and one of these had both thrombotic and obstetrical APS; 9 had severe non-thrombotic APS manifestations. Fifty-four patients are currently under warfarin, 8 of which had a thrombotic event despite ACO. Patients could be grouped into two distinct patterns: those that became persistently antibody negative (aPL-; n=19) and those in whom the antibodies remained positive, persistently or intermittently (aPL+; n=48). The major difference between groups was the occurrence of cumulative double or triple positivity in 69% of aPL+ versus 37% in aPL- (p=0.026). There were no significant differences in age, age at diagnosis, duration of the disease and frequency/type of thrombosis, between each group (Table I). From the group that became persistently aPL-, 3 patients suspended ACO, without any event after 2 years of follow-Up.Conclusion:Our study suggests that more than one aPL/LAC positivity is associated with antibody persistence over time. In our small series, as previously reported, ACO was safely discontinued in selected patients that become aPL-, in the absence of other risk factors for thrombotic events2. Regular antibodies measurements may help identify a subset of patients in whom ACO may be safely discontinued under careful observation.Table I. Demographic, clinical, laboratory and therapeutic characteristics of patients according to presence of aPL/LAC persistenceCharacteristicsaPL/LAC neg (n=19)aPL/LAC pos (n=48)Statistic testpCurrent Age (median ± IQR range, y)52 (±16)53Wilcoxon rank sum (WRS)0,6Age at diagnosis (median ± IQR, y)40 (±15)41WRS0,54Disease duration (median ± IQR, y)11 (±12)9WRS0,2Number of events (median ± IQR, n)1 (±1)1WRS0,59Arterial thrombosis, n (%)6 (32)22 (46)Chi2 0,4Venous thrombosis, n (%)12 (63)27 (56)Chi2 0,7Hydroxychloroquine therapy (n,%)2 (10)11 (23)Chi2 0,3> 1 positivity (n,%)7 (37)33 (6...
A granulomatose com poliangeíte é uma vasculite sistémica rara e idiopática caracterizada pelo atingimento dos pequenos e médios vasos. A doença atinge, preferencialmente, a vias aéreas superior e inferior e os rins, levando à formação de granulomas e necrose destes órgãos. As manifestações clínicas e o envolvimento orgânico são muito variáveis. O diagnóstico e tratamento são fundamentais e o atraso no diagnóstico pode ser fatal. Os autores apresentam o caso de um doente de sexo masculino, com uma apresentação atípica da doença, onde se documentou envolvimento do trato respiratório e cerebral, mas com uma evolução favorável após diagnóstico e tratamento adequado. Neste trabalho pretendemos fazer uma revisão da doença, formas de apresentação, critérios diagnósticos, abordagem terapêutica e prognóstica.
SUMMARY The authors report a case of a 69-year-old man with idiopathic leukocytoclastic cutaneous vasculitis. For three years, the lesions recurred with progressive worsening and were associated with systemic manifestations of low-grade fever, weight loss and raised inflammatory markers. The patient latter presented a 6th cranial nerve involvement, raising the concern of a possible systemic vasculitis, which was latter evidenced by the development of deep vein thrombosis and angina pectoris. The treatment of the patient witch based on the decreasing of inflammatory activity, by using effective immunosuppressive therapy, with lower toxicity is more important than identifying the type of the vasculitis. This case illustrates the importance of awareness for the systemic involvement that can occur in up to 50% of patients with leukocytoclastic cutaneous vasculitis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.