Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report describes intravascular ultrasound imaging of a localized 81% stenosis in the left common iliac artery of a 52-year-old woman. The lesion was dilated using an 8 mm balloon and was imaged pre- and post-dilation using arteriography and a 5F, 30 Mhz intravascular ultrasound catheter. The same site was imaged again intraoperatively at two months following the initial procedure using an 8F, 20 Mhz intravascular ultrasound catheter when the patient had a femoropopliteal bypass for continuing ischemia. Intravascular ultrasound imaging allowed accurate, sequential, on-line calculation of the cross-sectional area and volume of the lesion both, acutely and following healing of the site. The morphology of the fractured arterial plaque was clearly defined, demonstrating distribution of calcification, and intraluminal flaps not apparent on arteriography. The case demonstrates the unique potential of intravascular ultrasound in assessing the immediate effect of interventions and evaluating the long-term healing.
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PMID:Sequential intraluminal ultrasound evaluation of balloon angioplasty of an iliac artery lesion. 153 81

Graft arteriosclerosis is the major limitation to long-term survival after heart transplantation. In this study, myocardial pathologic changes, especially those that might permit early diagnosis, were characterized in endomyocardial biopsy specimens and hearts obtained at retransplantation or autopsy from nine orthotopic heart transplant recipients. All had severe diffuse proliferative arterial stenoses without plaque rupture or coronary thrombi. Eight patients died with and one underwent retransplantation because of graft arteriosclerosis less than 12 months (six patients) or greater than 46 months (three patients) after operation. Six patients had antecedent symptoms of congestive heart failure and six had angiographically demonstrated epicardial coronary artery graft arteriosclerosis; four had both. Myocardial ischemic lesions included subendocardial myocyte vacuolization (seven patients) and microfocal to regional coagulation necrosis and granulation tissue or scar, or both (seven patients). Subendocardial myocyte vacuolization (indicative of sublethal ischemic injury) was diagnosed at prior right ventricular biopsy in two patients and was noted at autopsy in areas accessible to right-sided biopsy in three additional patients. Three patients had pathologic changes diagnostic of acute infarction on right or left ventricular biopsy, or both. Thus, all nine patients had lesions, of which five had biopsy-identified myocardial abnormalities caused by graft arteriosclerosis. It is concluded that graft arteriosclerosis yields not only myocardial pathologic changes similar to those associated with typical coronary atherosclerosis, but also lesions resulting from focal or diffuse ischemia caused by small vessel obstructions. This is manifest as subendocardial myocyte vacuolization or microfocal infarction. Recognition of these biopsy-accessible myocardial changes associated with graft arteriosclerosis may allow early recognition and appropriate therapeutic intervention.
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PMID:Myocardial changes in cardiac transplant-associated coronary arteriosclerosis: potential for timely diagnosis. 153 14

Coronary angioplasty is an effective treatment for subgroups of patients with unstable angina. The procedure has a high initial success rate but there is an increased risk of major complications resulting from a higher incidence of acute closure presumably related to additional injury of the underlying plaque with augmented platelet and clotting activity, and ensuing spasm. Newer agents that inhibit platelet aggregation or thrombin may provide a safer use of coronary angioplasty in patients with unstable angina. Coronary angioplasty is indicated if a stenosis, technically suitable for dilation, is found to be responsible for the unstable state. The decision in favor of coronary angioplasty in patients with single-vessel disease is easy to make. Patients with left main stem disease or severe multivessel disease should primarily be scheduled for bypass surgery. In the presence of other multivessel disease, uncertainty remains. However, in selected patients with multivessel disease, one might prefer dilation of the ischemia-related vessel "the culprit vessel" only, rather than total revascularization by multiple dilatations or bypass surgery, since this can be performed faster and thus shorten the hospital stay. Thrombolytic treatment in the management of patients with unstable angina may be indicated in patients with pre-existing intracoronary thrombi or when procedural acute closure occurs associated with intracoronary thrombus formation.
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PMID:Coronary angioplasty for unstable angina. 154 49

From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two patients had one or more symptoms related to the stenosis of the brachiocephalic trunk: right-sided upper limb ischemia (n = 7), transient ischemic attacks (n = 8), vertebrobasilar insufficiency (n = 6), left sided minor stroke (n = 1). Only two patients were asymptomatic before operation. Angiography revealed a tight stenosis (n = 14) or an occlusion (n = 3); in one patient it concerned an ulcerated non-stenotic plaque of the brachiocephalic artery. Eleven patients had coexistent involvement of other supraaortic vessels. Angiographically, clinically and intraoperatively, there was evidence of Takayasu arteritis in three female patients. All patients had direct repair by trans-sternal approach. Six patients with short lesions had thromboendarterectomy with patch angioplasty of the innominate artery. In eleven cases, aorto-brachiocephalic bypass grafting was performed. In one patient, aortic calcification precluded proximal anastomosis, and a carotid-to-carotid bypass was done. In five patients, simultaneous revascularization of subclavian (n = 3), left common carotid (n = 2) or internal carotid artery (n = 2) completed the procedure. In one patient, concomitant coronary revascularization was done. There was no operative mortality. Postoperative morbidity was limited to pulmonary infection (n = 2), transient neurologic deficit (n = 1) and renal insufficiency (n = 1). All patients had relief of symptoms. Duplex echo scan confirmed patency of all reconstructions at a mean follow-up of 46 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Brachiocephalic arterial reconstruction. 155 48

The natural history of patients with acute myocardial infarction treated with thrombolytic therapy includes two distinct phases: the initial or acute phase is characterized pathologically by atheromatous plaque rupture and thrombotic coronary arterial occlusion, and clinically by the abrupt onset of symptoms. Prompt restoration of coronary blood flow and myocardial reperfusion during this phase, achieved in a majority of patients given thrombolytic therapy, limits myocardial necrosis, preserves ventricular function, and lowers mortality. Although the thrombus can be pharmacologically removed, an unstable anatomic substrate persists. Therefore following thrombolytic therapy, a subacute phase occurs, during which patients are at risk for recurrent ischemic events. More than a theoretical concept, experience has shown that recurrent ischemia and reinfarction develop in 20% to 30% and 5% of patients, respectively. Morbidity and mortality are elevated considerably in these patients, dictating an aggressive diagnostic and treatment approach.
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PMID:Recurrent myocardial ischemia following thrombolytic therapy: guidelines for practicing clinicians. 161 4

We evaluated 183 patients with brain ischemia for an embolic source, using transesophageal echocardiography with extensive imaging of the thoracic aorta. There were mobile, frond-like projections of aortic plaque in seven (4%) patients. The plaque originated on a wide base on the posterior aspect of the ascending aorta at its junction with the transverse arch in six patients, and on the aortic root in one. The acute event was a cerebral infarction in five patients, and a transient ischemic attack in two. This type of aortic plaque could be a previously underdiagnosed source of cerebral embolism that is now easily visualized by transesophageal echocardiography.
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PMID:Aortic plaque in patients with brain ischemia: diagnosis by transesophageal echocardiography. 164 Nov 58

The tissue-protective effect of the calcium antagonists is a complex phenomenon that needs to be considered at the cellular as well as the organ level, and with respect to both the vasculature and myocardium. As far as the vasculature and the myocardium are concerned, hypertension is a major risk factor. The dihydropyridine-based calcium antagonists are protective under these circumstances, not only because of their blood pressure-lowering effect but also because of their ability to slow plaque formation and possibly to provide some protection against oxyradical-induced injury. With regard to the myocardium, tissue protection in the presence of hypertension involves not only a reduction in hypertrophy, but also a reduction in ischemia-induced injury and the incidence of damage due to lipid peroxidation.
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PMID:Calcium antagonists and tissue protection. 172 45

A dual-laser system (helium-cadmium and pulsed dye) capable of continuous computer analysis of spectroscopic characteristics of tissue fluorescence, which can distinguish atherosclerotic plaque from components of normal arterial wall, was used to deliver laser energy to ablate plaque. During a 1-year period this system was used to facilitate balloon angioplasty of short (3 to 17 cm) total occlusions of the superficial femoral or popliteal arteries only when standard angioplasty techniques were ineffective. During the year of the study, in one institution 415 patients were subjected to arteriography of the lower extremities for leg ischemia (397 for limb salvage indications). Standard angioplasty techniques were used in 94 of these patients; 218 patients were unsuitable for standard angioplasty, did not fulfill criteria for "smart" laser treatment, and underwent standard bypass operations. Only 11 patients (plus six others in the second institution) requiring treatment fulfilled the criteria for use of the "smart" laser. In 10 patients the occluding lesion was traversed by the laser wire (diameter 0.021 inch), and luminal patency was effectively restored by balloon angioplasty to greater than or equal to 70% of the most normal-appearing segment of that artery. Satisfactory luminal patency has persisted for 2 to 12 months (mean 6 months) in nine patients; the lesion in the tenth patient restenosed at 3 months. The laser procedure was unsuccessful in all three patients with occlusions greater than 10 cm and in four others. Although there were three microperforations with the laser wire, there were no clinically significant complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early experience with the smart laser in the treatment of atherosclerotic occlusions. 182 7

In this study we investigated the efficacy of percutaneous transluminal angioplasty (PTA) and laser percutaneous transluminal angioplasty (LPTA) as an adjunct to surgery in patients with peripheral vascular disease. We report 84 cases of the simultaneous association of direct arterial surgery and angioradiological procedures to treat 82 patients with arterial occlusive disease of the lower limbs. Sixty-five patients (79.2%) were affected by severe claudication and 14 (19.6%) presented with rest pain or gangrene. One patient (1.2%) had signs of acute ischemia. PTA or LPTA were utilized as an inflow procedure in 41 cases (48.8%), as an outflow procedure in 24 (28.6%) and in 19 cases (22.6%) to recanalize an arterial occlusion in the contralateral limb opposite to surgical interventions. Immediate postoperative patency was achieved in 79 cases (94.0%), while in 5 cases (6.0%) it was impossible to perform a satisfactory balloon dilatation. The complication rate was 16.6%: 10 perioperative thromboses, 1 plaque dissection, 1 peripheral embolus, 1 haemorrhage and 1 femoral nerve lesion. No perioperative mortality occurred in this group of patients. Long term patency, analyzed with the life-table method (mean follow-up: 28 months) was respectively 78.0%, 76.3% and 78.9% at 5 years. These data indicate that the combined revascularization technique should always be recommended in properly selected patients because it is less invasive, the surgical risk and operative time are reduced and associated with early and long term cumulative patency rates comparable to those of extensive surgery.
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PMID:PTA and laser assisted PTA combined with simultaneous surgical revascularization. 183 Aug 82

After successful thrombolytic treatment for acute myocardial infarction, recurrent ischemia and infarction may occur with little warning. Coronary lesion morphology was analyzed from angiograms performed in 72 consecutive patients at 1 to 8 days after streptokinase treatment for acute myocardial infarction and the data were evaluated in relation to the subsequent clinical course. All patients were clinically stable at the time of angiography and continued to receive heparin infusion for greater than or equal to 4 days after thrombolysis. The infarct-related artery was patent in 55 patients (76%). In the 10 days after angiography, 15 patients developed prolonged episodes of angina at rest; the condition of 4 stabilized with medical treatment, but 11 required urgent medical intervention (coronary angioplasty in 8 and bypass surgery in 3). There were no differences in age, gender, left ventricular function or extent of coronary artery disease between those patients who developed unstable angina and those who had a stable in-hospital course. However, the median plaque ulceration index of the infarct-related lesion was 6.7 (95% confidence limits 6.3, 10) in the 15 patients with an unstable course versus 3.3 (2, 4.4) in those with a stable course (p less than 0.001). There were no differences between the two patient groups in the severity of stenosis, length of diseased segment, symmetry/eccentricity, presence of a shoulder, location at branch point or bend, presence of globular or linear filling defects, contrast staining or collateral supply. These data show that after thrombolysis, the degree of irregularity of the infarct-related artery is a critical determinant of early clinical instability.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Irregular coronary lesion morphology after thrombolysis predicts early clinical instability. 186 30


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