Fu Wg

Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials Comparing Carotid Artery Stenting and Carotid Endarterectomy in the Treatment of Carotid Stenosis

BACKGROUNDnTo compare carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in the treatment of carotid stenosis, including two recently published, large, prospective, randomized trials of these therapies.nnnMETHODSnWe searched electronic databases for prospective, randomized, controlled trials involving carotid stenosis patients who underwent CAS or CEA, focusing on studies published in 1995 to 2010. Primary outcomes were death, stroke, and myocardial infarction.nnnRESULTSnThirteen trials containing 7,501 patients were analyzed, and odds ratios (ORs) were calculated for CAS versus CEA. The risk of stroke or death within 30 days was higher after CAS than CEA (OR = 1.57; 95% confidence interval [CI] = 1.11-2.22), especially in previously symptomatic patients (OR = 1.89; 95% CI = 1.48-2.41). However, the risk of stroke or death within 1 year was comparable (OR = 1.12; 95% CI = 0.55-2.30). In a subgroup analysis, the risk of death and disabling stroke at 30 days did not differ significantly between CEA and CAS (death: OR = 1.43; 95% CI = 0.85-2.40; disabling stroke: OR = 1.28; 95% CI = 0.89-1.83), whereas the rate of nondisabling stroke within 30 days was much higher in the CAS group (OR = 1.87; 95% CI = 1.40-2.50). The risks of myocardial infarction within 30 days and 1 year were significantly less for CAS.nnnCONCLUSIONnCAS is inferior to CEA with regard to the incidence of stroke or death for periprocedural outcomes, especially in symptomatic patients. However, CAS was associated with a lower incidence of myocardial infarction. These procedures may be considered complementary rather than competing modes of therapy, each of which can be optimized with careful patient selection.

Endovascular Stent-Graft Repair of Mycotic Aneurysms of the Aorta: A Case Series with a 22-Month Follow-Up

BackgroundThe purpose of the present study was to present a single-institution series of patients with mycotic aneurysms of the aorta treated with endovascular stent-graft technology, and to report the efficacy and short-term durability of this repair.MethodsA retrospective review of seven consecutive patients with mycotic aneurysms of the aorta treated with stent-graft between May 2006 and July 2007. Patients were diagnosed based on typical appearance of imaging together with a positive bacteriology culture or clinical evidence of infection. A bifurcated, aorto-uni-iliac (AUI) stent-graft and cuff were used in the endovascular repair after infection control. The follow-up protocol included regular clinical examination, hematologic tests, and computed tomography scans at 3, 6, 12, and 24 months.ResultsEndovascular aneurysm repair (EVAR) was performed successfully in the seven patients (all men, median age 56 years), with complete exclusion of the aneurysms. Five of the patients had infrarenal aortic aneurysms, and the other two had descending thoracic aortic aneurysms. The median hospital stay was 22 days, with no hospital deaths. No paraplegia or other major complications occurred. The patients remained well, with no evidence of graft infection at a mean follow-up of 22.7 months (range: 17–26 months). A significant reduction in the diameter of the aneurysm sac was noted on computed tomography scans in all the patients at 1 year (mean: 6.5 mm; range: 3–40 mm).ConclusionsEndovascular stent-graft treatment represents an alternative treatment with acceptable short-term outcomes for patients with mycotic aneurysms of the aorta.

Carotid artery stenting versus carotid endarterectomy: systematic review and meta-analysis.

BackgroundThe aim of this study was to evaluate and investigate the complications of carotid endarterectomy (CEA) and carotid artery stenting (CAS) by performing a meta-analysis based on prospective randomized controlled trials (RCTs).MethodsWe performed a search of multiple electronic databases for RCTs containing patients with carotid stenosis who underwent CAS or CEA, focusing on studies published during 1995–2008.ResultsEight trials with 2942 patients (1462 with CEA, 1480 with CAS) were analyzed. The pooled relative risk (RR) after CEA for stroke/death 30xa0days or 1xa0year was similar to that for CAS. Thirty-day RRxa0=xa00.69, 95% confidence interval (CI)xa0=xa00.45–1.07, pxa0=xa00.10. One-year RRxa0=xa00.88, 95% CIxa0=xa00.43–1.79, pxa0=xa00.72. The rates of death, disabling stroke, and nondisabling stroke at 30xa0days did not differ significantly between CEA and CAS in the subgroup analysis. Compared with CEA, the relative risk of disabling stroke/death within 30xa0days was not significantly less for CAS with embolic protection devices (EPDs). The relative risk of myocardial infarction within 30xa0days, myocardial infarction within 1xa0year, and cervical/peripheral nerve injury within 30xa0days were significantly higher after CEA; the relative risk of bradycardia/hypotension within 30xa0days and the 1-year restenosis rate were significantly higher after CAS.ConclusionsCAS is equal to CEA with regard to the incidence of stroke/death. These procedures may be considered complementary rather than competing modes of therapy, each of which can be optimized with careful patient selection. CAS with an EPD may be appropriate in certain patients, and in general CAS should be considered cautiously in symptomatic patients.

Endovascular therapy for stanford type B aortic dissection in 102 cases.

OBJECTIVEnTo share our experience of 102 cases of endovascular therapy for Stanford type B aortic dissection.nnnMETHODSnMultiple imaging diagnostic modalities were used preoperatively to obtain the anatomical parameters of the aortic dissection. Stent grafts were implanted using digital subtraction angiography and intravascular ultrasound guidance. Follow-up computed tomography angiography 1 week and 1 year postoperatively was used to evaluate treatment efficacy and reveal complications such as endoleak, migration and fracture of the stent graft.nnnRESULTSnClinical success was achieved in 101 cases (99.0%); one patient (1.0%) died within the perioperative period. Neither postoperative paraplegia nor conversion occurred. Endoleak occurred in 18 cases (17.6%).nnnCONCLUSIONnEndovascular therapy for Stanford type B aortic dissection is less invasive and leads to less severe complications and shorter hospital stay compared with traditional surgery. The short- and mid-term efficacy are persuasive, but further follow-up is required to determine long-term efficacy.

Comparison of beraprost and ticlopidine in Chinese patients with chronic peripheral arterial occlusion: a multicenter, single-blind, randomized, controlled study

BACKGROUNDnChronic peripheral arterial occlusion (CPAO) is a progressive disease that is associated with a variety of symptoms, the 4 most common being a sensation of coolness in the limbs, intermittent claudication (in which pain occurs on walking), limb pain (which occurs spontaneously at rest), and ischemic leg ulcers. Beraprost sodium is an oral prostaglandin I2 analogue that may ameliorate these symptoms.nnnOBJECTIVEnThe aim of this study was to compare the efficacy and tolerability of beraprost sodium and ticlopidine hydrochloride in the treatment of patients with CPAO in China.nnnMETHODSnIn this multicenter, single-blind, controlled study, patients with CPAO were randomly assigned to receive beraprost 120-μg tablet TID or ticlopidine 500-mg tablet BID, both administered orally. The clinical efficacy of the drugs was assessed using the 4 main symptoms of CPAO. Ankle-brachial index (ABI) also was measured as a clinical pharmacologic procedure. Adverse events were assessed throughout the study.nnnRESULTSnA total of 124 patients (96 men, 28 women; mean [SD] age, 65 [12] years) were enrolled in 3 hospitals. Data from 119 patients (93 men, 26 women; mean [SD] age, 65 [12] years) were included in the efficacy analysis (64 and 55 patients in the beraprost and ticlopidine groups, respectively). Although all 4 symptoms of CPAO were ameliorated after 3 and 6 weeks of treatment with both drugs, only the cool sensation was significantly improved with beraprost compared with ticlopidine at 6 weeks (P<0.05). ABI was significantly increased with both beraprost and ticlopidine at 6 weeks versus baseline (P<0.001 and P<0.01, respectively), suggesting that this pharmacologic action may have led to their beneficial effect on various symptoms. The tolerability analysis included 123 patients (65 and 58 patients in the beraprost and ticlopidine groups, respectively). The numbers of patients who (1) experienced adverse events (AEs), (2) experienced adverse drug reactions, and (3) withdrew due to AEs were significantly smaller in the beraprost group than in the ticlopidine group (P<0.001, P<0.05, and P<0.05, respectively).nnnCONCLUSIONSnIn this study population of patients with CPAO, beraprost ameliorated cool sensation in the limbs, intermittent claudication, limb pain, and ischemic/leg ulcers. Beraprost was more efficacious in relieving CPAO symptoms and was better tolerated than ticlopidine. Beraprost may be useful for the treatment of patients with CPAO, but more studies are needed.

Is It Worthwhile To Operate on Patients with Infrarenal Abdominal Aortic Aneurysms in China? A Review of 30 Years’ Experience at Zhongshan Hospital

During the 30 years between 1960 and 1989, 100 patients with atherosclerotic infrarenal abdominal aortic aneurysms (AAA) were admitted into Zhongshan Hospital. Twenty-eight were treated nonsurgically and 72 surgically. The operation was resection of AAA with prosthesis replacement. The operative mortality was 2.78%. Sixty-two surgical patients are in the postoperative follow-up group. The 5-year survival rate is 83.98% ± 1.71%. Eighteen nonsurgical patients are in the follow-up group. Eight of them died directly from ruptured AAA. The nonsurgical 5-year survival rate is 47.74% ± 12.96%. Ten surgical patients died from ruptured anastomotic false aneurysms. This mortality is higher than what has been reported in the English literature. It may relate to the durability of the prostheses that were inserted. Even so, if all postoperative late deaths from ruptured aorta and other causes are taken into consideration, the 5-year survival rate of the surgical group, 77.51% ± 6.21%, is still higher than that of the nonsurgical group. The data in this paper show that the operation for AAA in this hospital is safe and the postoperative long-term results are comparable to what has been reported in the literature.