Differences and Similarities Between Spontaneous Dissections of the Internal Carotid Artery and the Vertebral Artery

Abstract

in target lesion revascularization and target vessel occlusion in patients with diabetes and critical limb ischemia (CLI).Summary: It is well known percutaneous treatment of calcific tibial artery disease is now possible. Efficacy of PTA using conventional balloons for treatment of tibial artery lesions has, however, been limited by 12-month restenosis rates reported as high as 70% (Schmidt A et al, Catheter Cardiovasc Interv 2010;76:1047-54). For treatment of below-the-knee arteries, however, there is increasing evidence that local delivery of paclitaxel using drug-eluting balloons may result in a decrease in tibial artery restenosis after angioplasty. Reductions in 3-month binary restenosis rates have been observed with drug-eluting balloons for below-the-knee angioplasty compared with PTA alone (Schmidt A et al, J Am Coll Cardiol 2011; 58:1105-9). In this article, the authors report a prospective randomized trial comparing the performance of a specific drug-eluting balloon (IN.PACT Amphirion; Medtronic, Santa Rosa, Calif) with conventional PTA in treatment of de novo, long atherosclerotic lesions of tibial arteries in patients with diabetes. The primary end point was 1-year binary restenosis. This was a randomized, but open-label, single-center study. Inclusion criteria were presence of diabetes mellitus, CLI, as defined as Rutherford class $4, significant stenosis or occlusion >40 mm of at least one below-theknee vessel with distal runoff, and life expectancy >1 year. Angiography or ultrasound follow-up was used to determine binary in-segment restenosis at 1 year. Secondary end points included clinically driven target lesion revascularization, major amputation, and target vessel occlusion. This was not an intention-to-treat study. Patients were enrolled in the study only after successful passage of the wire through the lesion. The authors enrolled 132 patients with 158 infrapopliteal atherosclerotic lesions. Mean length of the treated segments was 129 6 83 mm in the drug-eluting balloon group compared with 131 6 79 mm in the PTA group (P ¼ .7). As assessed by angiography, in >90% of patients, binary restenosis occurred in 20 of 74 lesions (27%) in the drug-eluting balloon group and in 55 of 74 lesions (74%) in the PTA-alone group (P < .001). Target lesion revascularization occurred in 18% in the drug-eluting balloon group vs 43% in the PTA-alone group (P ¼ .002). Target vessel occlusion occurred in 17% of the drugeluting balloon group vs 55% of the PTA-alone group (P < .001). There was only one major amputation, which occurred in the PTA-alone group (P ¼ .9).Comment: This was a nonblinded device trial performed by a single high-volume center, and no external angiography or duplex ultrasound core laboratories adjudicated end points. Only one major amputation was necessary in this group of 132 patients with diabetes and CLI, suggesting that the "critical" portion of the limb ischemia may not have been as critical as that of patients in other centers. Nevertheless, there is enough here to encourage industry to ...

Диссекция Внутренней Сонной И Позвоночной Артерий: Морфология, Патофизиология, Провоцирующие Факторы

“…Наиболее распространенными провоцирующими факторами у наших больных были движения в шее и физическая нагрузка (42%), которые при диссекции ПА встречались чаще (61%), чем при диссекции ВСА (27%). В зарубежной литературе обсуждают провоцирующую роль мануальной терапии [5], которая имела место и у отдельных наших больных, а также травмы шеи [6,7]. Наибольшая уязвимость ПА при поворотах головы объясняется ее анатомическими особенностями, а именно фиксацией в позвоночном канале.…”

“…Обнаруженное нами повышение уровня ММТ-9 и орозомукоида у больных с диссекцией подтверждает этот механизм провоцирующего действия инфекции. Прием контрацептивов как фактор, провоцирующий диссекцию, был выявлен у 12% обследованных нами женщин, что несколько реже, чем в европейских исследованиях [6,7]. Гормональные препараты, повидимому, усиливают диспластические изменения артериальной стенки, предрасполагая ее к расслоению.…”

“…Последний при диссекции ВСА/ПА происходит очень редко, что и приводило к ошибочному представлению о раритетности диссекции. После широкого внедрения в клинику методов нейровизуализации, а именно магнитно-резонансной ангиографии (МРА) и компьютернотомографической ангиографии (КТА), а также режимов магнитно-резонансной томографии (МРТ), позволяющих визуализировать ИМГ, стало очевидным, что диссекция ВСА/ПА служит основной причиной ишемического инсульта в молодом возрасте, а также причиной шейной и головной болей, которые часто не распознают или диагностируют с большим опозданием [1,[3][4][5][6][7].…”

Prognostic significance of pulsatile tinnitus in cervical artery dissection

“…Local signs include headache, neck pain, Horner syndrome, cranial nerve palsy, cervical-root injury and pulsatile tinnitus (PT) [1][2][3]. PT has been observed in about 5%-15% of CeAD patients, perhaps favouring female sex [4][5][6]. Dissections in the carotid system are about three times more often associated with PT than dissections in the vertebral artery system [4].…”

“…PT has been observed in about 5%-15% of CeAD patients, perhaps favouring female sex [4][5][6]. Dissections in the carotid system are about three times more often associated with PT than dissections in the vertebral artery system [4]. Different causes can lead to blood flow accelerations and local turbulence that may result in the perception of PT.…”