IntroductionAlthough surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials.AimTo assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure.Material and methodsThis was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions.ResultsThere were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation.ConclusionsStenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.
Objectives: In this pilot study we examined the potent vasoconstrictor, endothelin-1, in the blood of multiple sclerosis patients in the context of chronic cerebrospinal venous insufficiency hypothesis. For this purpose we measured endothelin-1 concentrations in blood samples that were obtained during selective catheterisation of the main veins draining the central nervous system: the internal jugular veins and the azygous vein.
Material and methods:We measured endothelin-1 concentrations in peripheral blood in nine multiple sclerosis patients and five healthy controls. In multiple sclerosis patients this peptide was also evaluated in blood samples obtained from the internal jugular veins and azygous vein. Also, in five patients peripheral endothelin-1 levels were measured one and seven days after angioplasty for stenosed internal jugular veins. Results: We found similar concentrations of endothelin-1 in peripheral blood in multiple sclerosis patients and healthy controls, a higher endothelin-1 level in the upper part of right internal jugular veins, and unchanged concentrations of this peptide in peripheral blood following angioplasty. Conclusions: Considering the pilot nature of our trial and the small number of the patients and controls assessed, our findings should be interpreted with caution, but they may represent a useful framework for further research in this field. However, our study shows that it is unlikely that endothelin-1 circulating in the blood is responsible for the symptoms of multiple sclerosis.
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