Gabrielle Sarlon-Bartoli

Plasmatic Level of Leukocyte-Derived Microparticles Is Associated With Unstable Plaque in Asymptomatic Patients With High-Grade Carotid Stenosis

OBJECTIVES This study sought to analyze whether the plasmatic level of leukocyte-derived microparticles (LMP) is associated with unstable plaques in patients with high-grade carotid stenosis. BACKGROUND Preventive carotid surgery in asymptomatic patients is currently debated given the improvement of medical therapy. Therefore, noninvasive biomarkers that can predict plaque instability are needed. The LMPs, originating from activated or apoptotic leukocytes, are the major microparticle (MP) subset in human carotid plaque extracts. METHODS Forty-two patients with >70% carotid stenosis were enrolled. Using a new standardized high-sensitivity flow cytometry assay, LMPs were measured before thromboendarterectomy. The removed plaques were characterized as stable or unstable using histological analysis according to the American Heart Association criteria. The LMP levels were analyzed according to the plaque morphology. RESULTS The median LMP levels were significantly higher in patients with unstable plaque (n = 28; CD11bCD66b+ MP/μl 240 [25th to 75th percentile: 147 to 394], and CD15+ MP/μl 147 [60 to 335]) compared to patients with stable plaque (16 [0 to 234] and 55 [36 to 157]; p < 0.001 and p < 0.01, respectively). The increase in LMP levels was also significant when considering only the group of asymptomatic patients with unstable plaque (n = 10; CD11bCD66b+ MP/μl 199 [153 to 410] and CD15+ MP/μl 78 [56 to 258] compared with patients with stable plaque (n = 14; 20 [0 to 251] and 55 [34 to 102]; p < 0.05 and p < 0.05, respectively). After logistic regression, the neurologic symptoms (odds ratio: 48.7, 95% confidence interval: 3.0 to 788, p < 0.01) and the level of CD11bCD66b+ MPs (odds ratio: 24.4, 95% confidence interval: 2.4 to 245, p < 0.01) independently predicted plaque instability. CONCLUSIONS LMP constitute a promising biomarker associated with plaque vulnerability in patients with high-grade carotid stenosis. These data provide clues for identifying asymptomatic subjects that are most at risk of neurologic events.

Adrenal venous sampling is crucial before an adrenalectomy whatever the adrenal-nodule size on computed tomography.

Objective To assess the additional value of adrenal venous sampling (AVS) to diagnose primary aldosteronism sub-types in patients who have a unilateral nodule detected by computed tomography (CT scan) and who should undergo an adrenalectomy. Methods A retrospective study to assess consecutive patients with primary aldosteronism undergoing an adrenal CT scan and AVS. Criterion for selective cannulation was an equal or higher cortisol level in the adrenal vein compared to the inferior vena cava. An adrenal-vein aldosterone-to-cortisol ratio of at least two times higher than the other side defined lateralization of aldosterone production. Results Sixty-seven patients (mean age 52 years, 39 men) underwent a CT scan and AVS. In nine patients (13%), cannulation of the right adrenal vein led to a technical failure. Both procedures led to diagnosis of 29 patients with adenoma-producing aldosterone (APA; 50%), 23 bilateral adrenal hyperplasias (40%), and six unilateral adrenal hyperplasias (10%). Of the 45 patients with a nodule detected by CT, subsequent AVS showed bilateral secretion in 16 patients (36%). Compared to the strategy of coupling CT scans with AVS to diagnosis APA, a CT scan alone had an accuracy of 72.4% (P < 0.001). Among patients with a macronodule detected by CT, 13 (37%) had bilateral secretion as assessed by AVS. The patients with a macronodule detected by CT alone had the same risk of a discrepancy as those with a small nodule (P = 0.99). Conclusion AVS is essential to diagnose the unilateral hypersecretion of aldosterone, even in patients in whom a unilateral macronodule is detected by CT, to avoid unnecessary surgery.

Vena Cava Filter Migration: An Unappreciated Complication. About Four Cases and Review of the Literature

Inferior vena cava filter placement is performed to prevent pulmonary risk secondary to deep venous thrombosis. Indications for this treatment are limited to patients experiencing recurrences under well-managed anticoagulant treatment or presenting with contraindication to anticoagulant treatment. Nowadays, as these clinical situations are rare, this device is less and less used, all the more since, for several years now, thrombosis, fracture, or infectious complications as well as filter migration have been reported. Filter migrations are responsible for atypical and varied clinical presentations likely to defer diagnosis. To treat them, the filter is extracted, which is very risky in patients with a thromboembolic history. In our center, during a period of 14 years, we retrospectively collected and studied partial or complete vena cava filter migration cases that had been treated by extraction. We are reporting four very different clinical cases and, more specifically, the second published case of migration to a renal vein, which mimicked a systemic disease. Because of its very atypical clinical presentations, cava filter migration is an unappreciated and certainly underdiagnosed complication. However, this complication must not question cava filter placement when it is justified. In contrast, it prompts early filter extraction or long-term radiological surveillance.

Hospital and out-of-hospital mortality in 670 hypertensive emergencies and urgencies

Long‐term mortality in patients with acute severe hypertension is unclear. The authors aimed to compare short‐term (hospital) and long‐term (12 months) mortality in these patients. A total of 670 adults presenting for acute severe hypertension between January 1, 2015, and December 31, 2015, were included. A total of 57.5% were hypertensive emergencies and 66.1% were hospitalized: 98% and 23.2% of those with hypertensive emergencies and urgencies, respectively (P = .001). Hospital mortality was 7.9% and was significantly higher for hypertensive emergencies (12.5% vs 1.8%, P = .001). At 12 months, 106 patients died (29.4%), mainly from hypertensive emergencies (38.9% vs 8.9%, P = .001). Median survival was 14 days for neurovascular emergencies and 50 days for cardiovascular emergencies. Patients with hypertensive emergencies or urgencies had bad long‐term prognosis. Short‐term mortality is mainly caused by neurovascular emergencies, but cardiovascular emergencies are severe, with high mortality at 12 months. These results justify better follow‐up and treatment for these patients.

Monocentric Comparative Study of Conventional Surgery and Endovascular Treatment with Fenestrated Stentgrafts to Treat Juxtarenal and Pararenal Aneurysms of the Abdominal Aorta

Materials and Methods: Between January 2005 and December 2014, we retrospectively included all the patients electively treated in our center for a JRA by excluding the type IV thoraco-abdominal aortic aneurysms. JRAs were classified in three anatomical categories according to a classification described in the literature. We compared the clinical and radiological data of the patients treated by fenestrated stentgraft (ENDO group) with those treated by conventional surgery (OPEN group). Preoperative surgical risk was measured by the ASA score and the clinical score of Lee.We then compared the surgical risk, the morbi-mortality at 30 days, and the survival at 5 years.

Dissection artérielle : un même nom, plusieurs entités

Spontaneous arterial dissection is a disease whose prevalence is difficult to know and which varies according to the affected artery territory. It can affect the aorta and all medium caliber peripheral arteries including cerebrovascular arteries, coronary arteries and renal arteries. The pathophysiology is common, it is a bleeding in the media. The causes are diverse and vary by territory. Affected patients have few cardiovascular risk factors. Fibromuscular dysplasia is the condition to look for in these few presentations. The vital and functional prognosis may be engaged. Treatment varies depending on territory, severity, and etiology. Conservative treatment is the first-line treatment.

[PP.09.15] ASSESSMENT OF RENAL ARTERY FIBROMUSCULAR DYSPLASIA: FROM DIAGNOSIS TO TREATMENT. THE DYSART STUDY

Objective: Define quantitative duplex ultrasound criteria and multidetector computed tomography (MDCT) for renal artery stenosis in fibromuscular dysplasia (FMD). Systemic arterial hypertension due to renal artery stenosis is a frequent complication of FMD and renal angioplasty effectively treats renal symptomatic FMD with a rate of hypertension cure of 36% with no consensus on the stenosis severity criteria in FMD. Primary Objective: Assessments of quantitative duplex ultrasound criteria to hemodynamically quantify renal artery stenosis severity in symptomatic FMD with trans stenotic pressure gradient measurements as standard of reference Design and method: Adults patients with confirmed hypertension in ambulatory BP 24H with renal artery multifocal FMD severe stenosis (defined using CT scan or duplex ultrasound), will be included in this study. Angiography with trans stenotic gradient will be performed. All patients will be recruited in a reference center for FMD care and included if clinical and para-clinical information suggest that the hypertension might be caused by the renal stenosis and will require intravascular revascularization in reference of the standard procedures in FMD. Considering a two-side 95% confidence interval, with a precision of 10%, it is necessary to include at least 43 patients. Our study associates 4 reference centers of the French network. Patients will be evaluated for a period of 7 month after angioplasty for an inclusion period of 2 years. Efficacy of angioplasty will be assessed during follow-up visit using several parameters: decrease of the resting gradient at rest, decrease of degree of stenosis on IVUS, renal function and systemic hypertension. Results: The results are expected in 2018. Conclusions: Primary end point of DYSART Study: Assessments of quantitative duplex ultrasound criteria to hemodynamically quantify renal artery stenosis severity in symptomatic FMD, with trans stenotic pressure gradient measurements at rest as standard of reference.

Educ-HTA : mise en place et résultats préliminaires d’un programme d’éducation thérapeutique chez le patient hypertendu

internes, la recherche doit intéresser les quatre territoires, c’est pourquoi nous privilégions la voie haute. Une varicographie permet souvent de retrouver les points de fuite en cas d’échec ou d’insuffisance des voies cave ou fémorales. Les résultats sont bons et se maintiennent dans le temps en cas de SC, de VV. En cas varices des membres inférieurs, 25 % des patientes sont insatisfaites, 7 % ont à nouveau un reflux pelvien. Les coils peuvent migrer même à distance du geste, sans conséquence grave. L’irradiation pelvienne et la dose de produit iodé (moyenne : 20000 mGycm2/75 ml hexabrix 200) sont des critères à prendre en compte chez la femme jeune.