Background— Carotid artery stenting (CAS) has become an alternative treatment for patients presenting symptomatic carotid artery stenosis. The improvement in clinical outcomes with CAS has been associated with the development of embolic protection devices. The trial aim is to compare flow reversal versus filter protection during CAS through femoral access. Methods and Results— Patients were randomly enrolled in CAS using flow reversal or filter protection. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS. The secondary end points included major adverse cardiac and cerebrovascular events, transient ischemic attack, and definitive ischemic brain lesions on fluid-attenuated inversion recovery magnetic resonance image at a 3-month follow-up. Ischemic brain lesions were assessed by a 3T magnetic resonance image. Neurological outcomes were evaluated by means of the National Institutes of Health Stroke Scale and the modified Rankin Scale (mRS). Forty consecutive patients were randomly assigned. Compared with flow reversal (n=21), filter protection (n=19) resulted in a significant reduction in the incidence (15.8% versus 47.6%, P =0.03), number (0.73 versus 2.6, P =0.05), and size (0.81 versus 2.23 mm, P =0.05) of new ischemic brain lesions. Two patients, 1 from each group, presented transient ischemic attack at 3-month follow-up. There were no major adverse cardiac and cerebrovascular events in the hospital or at 3-month follow-up. Conclusions— In this small sample size trial, filter protection was more effective than flow reversal in reducing ischemic brain lesions during CAS through femoral approach. Clinical Trial Registration— URL: http://portal2.saude.gov.br/sisnep/ . Unique identifier: 0538.0.004.000-10.

OBJECTIVE:Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke.METHODS:Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score.RESULTS:Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17±6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilar artery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5±107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4±58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9±7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%.CONCLUSIONS:Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.

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Dogs have been studied for several reasons, such as the genetic improvement, their use as experimental models, in zoonotic research, cell therapy and as a model for human diseases. However, many features relating to the embryonic development of dogs remain unknown because of the absence of embryological studies. Considering the importance of the cardiorespiratory system in the development of embryos, the aim of this study was to investigate the development of the main cardiorespiratory organs of dog embryos and foetuses with estimated gestational ages from 16 to 46 days using macro- and microscopic descriptions. On day 16 of development, the neural tube and crest were formed, the anterior and posterior neuropore closure had begun and the somites had developed. Between days 22 and 27 of gestation, the lung buds and the initial formation of the primary bronchi and heart chambers were observed. The heart chambers exhibited the endo-, myo- and epicardial layers but did not have obvious differences in thickness among each other. Between days 41 and 46 of gestation, the nasal conchae and septa and trachea were formed, which exhibited characteristic epithelia. The lung formation and lobation were complete. The heart and major vessels exhibited mature histological architecture when their anatomical development was complete. The results of this study contribute to a more accurate definition of the embryonic and foetal developmental stages in dogs.

O mote café com prosa foi proposto pelo tão lembrado colega Herbe Xavier. A hora do café com prosa é a toda hora. O mais badalado é o café da tarde, acompanhado de quitandas e quitutes e muita prosa. A presença da quitandeira e da quituteira é uma personagem simbólica e tradicional. A hospitalidade brasileira se revela na hora de partilhar um café quentinho, com acompanhamentos doces ou salgados e uma prosa calorosa e sem fim. Esta é uma homenagem que fazemos ao geógrafo e professor Herbe Xavier, oferecendo um cafezinho e um papinho.

We appreciated the editorial by Stabile and Esposito, 1 where the authors made an extensive discussion on conflicting results between our trial and others previously published. [2][3][4] The authors' conjectures on these studies suggest that operator experience with carotid artery stenting procedures seems to be the best brain embolic protective factor. We agree with the authors in most of their comments and here address additional points with the aim of expanding available knowledge of the subject in focus.Stabile and Esposito considered that a lower experience of operator with flow-reversal device (12 cases versus >400 cases with filters) was the major factor associated with the poorer results obtained by the flow-reversal group of our trial.2 In fact, operator experience imbalances are usually an inherent limitation of interventional trials assessing new devices. Nevertheless, we are not completely convinced that it could definitively explain disparities among results. Indeed, the authors reported that both the European studies come from centers with large experience in carotid artery stenting.1 However, in a recent Brazilian study, that compared filter protection against the same proximal blockage device used in previous trials, 3,4 Cano et al 5 showed best results with the proximal blockage device, even with a lower operator's experience of the technique (13 cases).Furthermore, Stabile and Esposito 1 conclude that the operator's experience imbalance of our study largely explain our final outcomes. The authors argued that our reported differences between flow-reversal and filter procedure times (22.41 versus 16.78 minutes; P<0.001) were in accordance with the lower operator's experience with the flow-reversal device.1 However, in previous trials, the mean procedure times were also significantly longer with proximal than with distal protection devices 30 versus 22 minutes (P=0.003) and 29.5 versus 24.2 minutes (P=0.051) reported by Bijuklic et al 4 and Cano et al, 5 respectively, whereas Montorsi et al 3 did not report procedure times with the proximal protection group. Moreover, it is noteworthy that our mean procedure time with flow-reversal (22.41 minutes) was the shortest, which clearly contradicts Stabile's opinion.Another interesting finding that could influence discrepancies among studies was the premedication protocols of antiplatelet and heparin regimens. Although other studies used aspirin (100 mg/d), clopidogrel (75 mg/d), and unfractionated heparin (5000 UI bolus), [3][4][5] we indicated aspirin (300 mg/d), clopidogrel (75 mg/d), and unfractionated heparin (7500 UI bolus).2 Although we cannot prove that these differences among premedication protocols explain conflicting results, different premedication protocols have been suggested as a significant factor influencing outcomes. 6 Finally, small sample trials using a highly sensitive surrogate outcome measure tool may be associated with a high number of confounder factors and we think that the operator's experience is one of the most efficient embol...