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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical angiographic and prognostic features of 13 patients with symptomatic stenosis of the middle cerebral artery (MCA) admitted between 1970-81 were reviewed. The etiology of the stenosis was probably atherosclerosis, except in 1 case which was due to fibromuscular dysplasia, 1 to postradiation angiopathy, and 2 related to oral contraceptives. 2 main clinical groups were delineated: 1) transitory and minor ischemic accidents arising in the same arterial area (usually in older patients with multiple atheromatous lesions along the carotid artery); and 2) progressive or stepwise strokes occurring in younger patients, mainly females, with isolated MCA stenosis. These cerebrovascular symptoms and signs, in the absence of carotid bruit, doppler ultrasonography abnormality, or evidence of cardiac embolism should suggest intracranial stenosis and require appropriate therapy to avoid complete occlusion. This study shows that early medical attention--1st with anticoagulation and then antiaggregation provides a suitable alternative to EC/IC bypsas. This is suggested by evidence for microembolization in addition to hemodynamic mechanisms. (author's modified)
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PMID:[Symptomatic stenoses of the middle cerebral artery]. 666 87

Sixteen consecutive patients with renovascular hypertension were treated by transluminal dilatation and observed during 6 - 39 months (mean 21.8 months). Poststenotic renal artery pressure increased (p less than 0.001) and the renal arteries were patent on angiograms taken immediately after dilatation. In 13 patients, angiography was repeated 2 - 9 months later; at that time the selective renal vein renin ratio had decreased (p less than 0.001). At the end of the follow-up, blood pressure was improved or normal in 14 cases. One of the eight patients with atherosclerosis was normotensive without treatment, compared with five of six patients with fibromuscular dysplasia (p less than 0.05). The results in two cases with vasculitis are uncertain. The four patients with relapses, one after intimal catheter dissection, were treated successfully by redilatation. Thus, renovascular hypertension can be improved by transluminal dilatation in patients with atherosclerosis and in patients with fibromuscular dysplasia with lasting success and a low morbidity rate.
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PMID:Lasting improvement of renovascular hypertension by transluminal dilatation of atherosclerotic and nonatherosclerotic renal artery stenoses. A follow-up study. 703 92

In a 10-year period, 7200 of 19,000 black hypertensive adults in the University of Cincinnati Medical Center were referred to the Hypertension Service. In selected patients, intravenous urograms (1038) and renal arteriograms (238) were performed; 47 cases of renovascular hypertension (0.65% of the referred group and 0.25% of the entire sample) were identified. Atherosclerosis (32 patients) and fibromuscular dysplasia (11) were the most common causes of renal artery obstruction. Other lesions included traumatic thrombosis (2), Leriche syndrome (1), and postrenal transplant anastomotic thrombosis (1). Twenty-four patients were operated on (6 cured, 14 improved, 4 dead) and 23 treated medically (18 improved, 2 unimproved, 3 dead). Surgical mortality was 0. Follow-up exceeded 5 years in 25 patients. Extrarenal vascular lesions were found in 30 patients and accounted for six of seven deaths. Renal vein renin ratios greater than 1.5:1 (affected to unaffected side) predicted successful surgery in 14 patients, but eight of nine operated patients with ratios less than 1.5:1 also had favorable results. Factors in addition to renin assay were weighed before surgery was recommended. Since renovascular hypertension is rare in adult blacks, intensive investigation for this entity is justified only in patients with distinct suggestive findings. Treatment results in blacks are similar to those in white cohorts.
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PMID:Renovascular hypertension in black patients. 704 Feb 33

A 54 year old man without pathologic past history but mild hypertension, obesity and gastric ulcer, presented with a syndrome of Wallenberg. He had complained for five days of progressive and diffuse headache. The neurological condition improved initially, but the patient died suddenly two weeks later. Pathological examination showed no significant alteration except for left ventricular enlargement and mild arteriosclerosis. There was a hemodissection (dissecting aneurysm) of the left vertebral artery next to the inferior oliva. It induced a lateral infarct and a limited dorsal infarct at the middle third level of medulla oblongata. Although the location of the arterial changes is usual, their nature is exceptional. The cause of the arterial hemodissection could not be ascertained: fibrous arterial dysplasia, atherosclerosis or congenital abnormalities of internal elastic layer may be discussed. But no definite conclusion can be reached.
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PMID:[Wallenberg's syndrome due to a dissecting aneurysm of the vertebral artery]. 713 26

Three young autopsy and four temporal artery biopsy cases with an arteriographically typical moyamoya syndrome were studied by histologic, electron microscopic, and immunofluorescence methods. In all autopsy cases the intracranial segment of the internal carotid arteries showed concentric intimal thickening with severe stenosis or obstruction of the lumen, folding of the internal elastic lamina, and shrinkage of the external diameter of the vessel. Inflammatory infiltration was absent. Abnormal networks of thin-walled vessels, interpreted as secondary collaterals, were seen at the base and on the convexity of the brain. Degenerative changes, including a ruptured coronary aneurysm in one case, were also noted in the coronary and temporal arteries. In both the intra- and extracranial arteries repeated endothelial damage was indicated by the presence of redundant subendothelial basement membrane-like material. Lipid or calcium deposits were exceptional, and no evidence for the presence of immunoglobulins or components of the complement could be obtained by immunofluorescence. These pathologic alterations, distinct from atherosclerosis, fibromuscular dysplasia, and the established types of arteritis, seem to be identical in children and adults, in spite of different clinical manifestations of the moyamoya syndrome in these age groups. We suggest that a humoral factor, associated with infections, may induce repeated endothelial damage and intimal thickening in the intracranial arteries of genetically predisposed children in analogy with recent observations made in the coronary arteries of young subjects.
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PMID:Spontaneous occlusion of the circle of Willis (moyamoya syndrome). 716 15

The radiological signs of collateral blood flow were studied in 254 patients with vasorenal hypertension, 142 of whom had atherosclerosis, 59 had fibrous dysplasia, and 53 had aortoarteritis. The collaterals were found to be more pronounced in the two forms of hypertension mentioned last (55.9 and 58.5%, respectively). The patients' age and the sharp degree of renal artery stenosis are the main factors determining the development of collaterals. The collateral blood flow prevents the development of ischemic atrophy of the kidney to a certain measure, but does not protect the patients from hypertension. The specific features of the collateral channels are revealed more fully by using various methods of renal vasography, which is important in assessment of the character of the pathological condition and the choice of the therapeutic tactics.
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PMID:[X-ray study of the collateral blood flow in vasorenal hypertension]. 735 23

An example of a large, jejunal branch aneurysm is presented along with a review of 39 other cases of superior mesenteric artery branch aneurysms. current theories of etiology, including atherosclerosis, arterial dysplasia, necrotizing arteritis, and infections, are discussed. Common modes of presentation-pain, intraabdominal hemorrhage, and gastrointestinal bleeding-are reviewed. Emphasis is placed on the role of arteriography in diagnosis and management of branch aneurysms.
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PMID:Superior mesenteric artery branch aneurysms. 743 2

1. We have treated 25 patients with renovascular hypertension with balloon catheter dilatation. 2. In 17 patients, surgical treatment was thought to be either risky or difficult due to the presence of a serious medical condition or because of the peripheral location of the lesion. 3. Seventeen patients had atherosclerotic lesions, six patients had fibromuscular dysplasia and one patient had neurofibromatosis and one had stricture of an aorto-renal bypass graft. 4. Of the total group, six in the atherosclerotic group, three patients with fibromuscular dysplasia and the one with neurofibromatosis are normotensive without medications. 5. Five patients with atherosclerosis, two patients with fibromuscular dysplasia and the patient with aorto-renal bypass graft are either normotensive or have reasonable control of blood pressure with medication. 6. Four technical and treatment failures and three major medical complications were encountered. Recurrence of stenosis occurred in eight patients but none of these was in the fibromuscular dysplasia group.
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PMID:Transluminal balloon dilatation of renal artery stenosis causing hypertension: 18 months' experience. 744 4

During a 12 year period, 110 patients were submitted to surgery for correction of renovascular hypertension. The pathologic process was atherosclerosis in 65, fibrodysplasia in 28, aneurysms in 6 abdominal coarctation in 5, aortoarteritis in 2 and 3 miscellaneous lesions. Operative procedures used on 148 renal arteries have been: nephrectomy (12), reconstructive surgery (133). Among them: endarterectomy (89), aorto-renal grafts (20) venous, dacron or arterial autografts, resection and anastomosis (10), direct reimplantation (8), angioplasty (5), arterial spleno-renal anastomosis (1). Postoperative arteriograms have been obtained in 98% of the patients, 4 occlusions occurred in aorto renal grafts, no thrombosis in endarterectomy. Progression of dysplasia and atherosclerosis was observed in 5 patients. The overall clinical results show: cure 55%, improvement 34% and no change 11%. With a difference between atherosclerosis (45% cured, 40% improved, 15% no change) and fibrodysplasia (63% cured, 29% improved and 8% no change). Several parameters are studied correlated with the surgical result. This series support interest to treat operatively renovascular hypertension: 89% of patients benefited from surgery.
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PMID:Results following surgical correction of renovascular hypertension. 745 57

This study evaluated the long-term effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function in patients with renovascular hypertension. Seventy-eight patients with hypertension and unilateral or bilateral stenoses of the renal arteries (16 with fibromuscular dysplasia and 62 with atherosclerosis) were studied. All patients with fibromuscular dysplasia (group A) had normal renal function, while 27 of the 62 patients with atherosclerosis (group B) presented with various degrees of renal failure. PTRA was technically successful in 87.5% patients of group A. The overall technical success rate (complete plus partial) was 72.3% (55/76 renal arteries) in group B. Mean follow-up (range) in months was 42 (12-108) for group A and 39 (13-106) for group B. After successful PTRA, the overall benefit rate (cure plus improved) for hypertension was 100% in group A; 10 of 14 patients were cured and 4 of 14 were improved. In group B, the overall benefit rate was 70.8%; 9 of 48 were cured and 25 of 48 were improved. PTRA was technically successful in 18 of 27 patients with renal failure. Renal function improved in 4 of 18 patients, remained stable in 9 of 18, and deteriorated in 5 of 18 patients. The above results suggest that PTRA is an effective method for the long-term management of patients with renovascular hypertension, although the results were less favorable in the presence of bilateral renal artery stenoses: in addition to improved control of blood pressure, PTRA might improve renal function or delay its progressive deterioration.
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PMID:Percutaneous transluminal renal angioplasty in patients with renovascular hypertension: long-term results. 758 6


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