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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We compared duplex scanning and cerebral angiography in patients with hemispheric ischemia, testing the premise that carotid endarterectomy (CEA) or medical management may be recommended on the basis of duplex scanning alone. Charts of 152 patients who had both studies were reviewed. A positive study (implying an operable lesion) showed any ulcerated plaque or stenosis of 50% to 99% on the symptomatic side. A positive duplex scan correctly predicted the need for CEA (with no additional essential information gained from angiography) more than 98% of the time. Equally important, patients with a negative duplex or patients in whom carotid occlusion is suspected ought to have angiography.
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PMID:Evaluation of focal carotid ischemia: will duplex scanning suffice, or is angiography needed? 828 65

Acute ischemia of the lower extremity is associated with reduced blood flow to muscle, nerve, subcutaneous tissue and skin. This condition may be caused by thrombosis on an atherosclerotic plaque or embolus or by the occlusion of a previously placed arterial bypass graft. The difficulties in differentiating embolic arterial occlusion from acute thrombotic arterial occlusion are discussed. Although balloon catheter thrombectomy has been the traditional approach to treatment of patients with acute ischemia, this method has several disadvantages: it may not remove all of the thrombus, the thrombus may be inaccessible, it may damage vessels and atherosclerotic plaque and it does not identify or correct the underlying cause of the thrombosis. The advantages of catheter-directed thrombolysis are discussed, including its use as a diagnostic tool. Detailed techniques are presented along with data from extensive studies.
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PMID:Arterial diagnosis and management of acute thrombosis of the lower extremity. 837 16

Thrombolytic therapy, through the restoration of coronary arterial blood flow and myocardial perfusion significantly improves outcome among patients with acute myocardial infarction. Despite its widely appreciated benefits, however, thrombolysis removes only a small portion of existing thrombus at the site of atheromatous plaque rupture. Further, thrombogenic substrate is frequently exposed and may even be generated to the extent that rethrombosis occurs, causing recurrent ischemia, reinfarction, and coronary reocclusion. The mechanisms underlying this important event are discussed.
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PMID:Reocclusion following successful thrombolysis. Emerging concepts. 840 53

To date, application of laser angioplasty in acute myocardial infarction (MI) has not been reported. In nine patients with acute myocardial infarction complicated by continuous or recurrent severe ischemia and chest pain, a mid-infrared, solid-state, pulse-wave holmium/thulium:YAG coronary laser was applied. In six of these patients the laser was specifically utilized for the purpose of coronary thrombolysis. In each case a guidewire was placed across the stenosis and a multifiber laser catheter was utilized, emitting 250-600 mJ/pulse at 5 Hz, followed by adjunctive balloon angioplasty. Laser success (defined as ability to cross the lesion, reduction of > or = 20% in stenosis and thrombolysis when a thrombus is present) was achieved in all patients. Final angiograms revealed residual stenosis < or = 30%, adequate thrombolysis and no major complication (MI, perforation, emergency CABGS, CVA, death) in each patient. Clinically, all nine patients improved, survived the acute infarction and were discharged. This initial clinical experience demonstrates the feasibility and safety of holmium/thulium:YAG laser application in thrombolysis and plaque ablation in selected patients who experience acute myocardial infarction complicated by prolonged or recurrent ischemia and chest pain.
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PMID:Laser facilitated angioplasty and thrombolysis in acute myocardial infarction complicated by prolonged or recurrent chest pain. 841 36

The authors report their experience relative to 102 patients evaluated with carotid duplex-scanner. Ultrasonographic data of atherosclerotic carotid changes have been correlated with the outcome of the tested series. In fact, echographic images of vascular changes with high thromboembolic risk (ulcerated plaque) have been associated with cerebrovascular injuries in 25% of the cases. Furthermore, the duplex-scanner showed the need for surgical treatment (TEA) in 32 patients with asymptomatic carotid stenosis. Therefore, this noninvasive diagnostic tool seems to play an essential role in the prevention of cerebrovascular ischemia.
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PMID:[Predictive value of the echo-Doppler test in relation to the development of carotid arteriosclerotic plaques]. 845 Oct 26

Intracoronary stenting was designed to handle acute vessel closure after balloon angioplasty and to reduce the rate of restenosis. In three cardiology centers the implantation of 200 balloon-expandable Palmaz-Schatz stents was attempted in 179 patients. The implantation was successful in 170 patients (95%). During bail-out implantation for acute vessel closure or symptomatic dissections after balloon angioplasty, implantation succeeded in 60 (91%) of 66 attempted patients, who recovered immediately from ischemia. Three patients received emergency bypass surgery and three patients were kept on medical therapy. Restenosis after 4 to 6 months, defined as > 50% diameter reduction, was documented angiographically in 18 (15.3%) of 118 presently controlled patients. Patients with single stent implantation (n = 106) presented a late restenosis rate of 10.4% in contrast to patients with multiple stent implantation (n = 12), who presented a restenosis rate of 58.4%. Similar results on restenosis were found for patients with elective and bail-out stent implantation. Acute thrombotic stent occlusion occurred in three patients (1.8%) during the first 24 h after stenting. Three to 9 days after implantation subacute stent thrombosis occurred in 15 (8.8%) of 170 patients. Despite adequate therapy including thrombolysis, balloon angioplasty or emergency bypass surgery in 14 of 15 patients Q-wave myocardial infarction was documented in six patients and non Q-wave myocardial infarction in five patients. The following parameters were identified as risk factors for the development of subacute stent thrombosis: bail-out indication, unstable angina, type C lesion, stenosis length > 1.5 cm, plaque area > 3.5 mm2, symptomatic dissection after balloon angioplasty, incomplete wrapping of the dissection after stenting and residual distal vessel irregularities after stenting. Bleeding complications occurred in 12.4% of the patients and were related to the anticoagulation and antiaggregation therapy. In conclusion, the implantation of Palmaz-Schatz stents is an excellent bail-out device to treat acute vessel closure or symptomatic dissections after angioplasty. Elective and bail-out single stent implantation is associated with a reduced rate of restenosis when compared to conventional balloon angioplasty. At present, subacute stent thrombosis and bleeding complications are the major limitations with a combined rate of 15.9%.
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PMID:[Multicenter results of coronary implantation of balloon expandable Palmaz-Schatz vascular stents]. 846 69

This study reports the results of routine evaluation to detect coronary and carotid atherosclerosis in 200 asymptomatic and hypercholesterolemic patients (48 +/- 10 years: 72.5% men). All patients underwent physical examination, blood lipid profile, an exercise test and cervical echo-doppler. If the exercise electrocardiogram was abnormal, a thallium isotope scan and/or coronary arteriography were performed. Hypercholesterolemia was severe (3.03 +/- 0.52 g/l). 77.5% of patients had pure hypercholesterolemia. Carotid atherosclerosis in the form of plaque (27.5%) or stenosis (3.5%) was found in 31% of patients. This carotid atheroma was commoner in older patients (51.9 +/- 9 years as against 47 +/- 10 years, p < 0.01). Twenty patients (10%) had electrical signs of ischemia provoked by exercise. Six of them had a normal thallium isotope scan and did not undergo coronary arteriography. Coronary arteriography was abnormal in 10 patients (5%): 7 had stenotic lesions and 3 showed evidence of spasm during the methylergometrine test. In total, the hypercholesterolemic patients investigated here were characterised by subclinical atherosclerosis which was frequent but certainly underestimated by non-invasive studies. The existence of an atherosclerotic lesion is an additional argument in favour of starting cholesterol-lowering treatment.
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PMID:[Systematic cardiovascular evaluation and hypercholesterolemia. Results in 200 asymptomatic patients]. 849 98

Patients with carotid atherosclerosis have an increased risk of coronary events and an increased prevalence of echocardiographic left ventricular hypertrophy. However, little is known regarding the association between electrocardiographic abnormalities and carotid atherosclerosis. The relationship of electrocardiographic evidence of myocardial ischemia and left ventricular hypertrophy to the presence of carotid atherosclerosis was prospectively studied in 349 asymptomatic subjects who underwent echocardiography and carotid ultrasonography. Myocardial ischemia on the electrocardiogram was defined by the presence of localized T-wave inversions, and electrocardiographic hypertrophy was defined by the product of Cornell voltage and QRS duration. Carotid atherosclerosis was present in 21% (72/ 349) of subjects and was associated with older age, higher systolic and pulse pressures, and greater left ventricular mass. Both ischemia and hypertrophy on the electrocardiogram were strongly associated with carotid plaque. Carotid atherosclerosis was more than three times more prevalent in subjects with electrocardiographic ischemia (69% [11/16] versus 18% [61/333], P < .0001) or electrocardiographic left ventricular hypertrophy (78% [7/9] versus 19% [65/340], P = .0003) than in subjects without these findings. Logistic regression analysis, including standard risk factors, revealed that both ischemia and hypertrophy on the electrocardiogram remained significant independent predictors of the presence of carotid atherosclerosis, along with age and echocardiographic left ventricular mass. These findings suggest that the associations of ischemia and left ventricular hypertrophy with carotid atherosclerosis may contribute to the increased incidence of coronary events in patients with carotid atherosclerosis.
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PMID:Association of carotid atherosclerosis with electrocardiographic myocardial ischemia and left ventricular hypertrophy. 867 59

It is almost twenty-five years since stress myocardial perfusion imaging was first described for the detection of ischemia. Since that time, significant refinements have occurred in the technology of making the measurements, and in the range of clinical indications to perform these measurements. In parallel with the growth of radionuclide techniques, other imaging technologies have developed substantial tools to examine the heart. Although radionuclide imaging remains unique in its ability to visualize the regional distribution of perfusion, the value of perfusion imaging is being called into question by practitioners of the competing technologies. To address these comments, every facet of the examination should be reviewed, and the examination tailored to answer the specific clinical question raised by the patients condition. Particular attention should be paid to data interpretation and the specific choice of words used to describe the images in the report. In addition, the information provided by the examination can be enriched by adding measurements of ejection fraction, regional wall motion and regional wall thickening to the procedure. This combination of additional data and a clear, clinically focussed report make the information more valuable to the referring clinician. Several new techniques are on the horizon, including 99mTc glucarate imaging, to identify acute myocardial necrosis, and direct identification of myocardial hypoxia with 99mTc labeled nitroimidazoles. Initial studies in humans with glucarate suggest that acute necrosis can be identified with one hour of onset of chest pain. Experimental studies with the nitroimidazoles suggest that they will be valuable to identify myocardial ischemia as a zone of increased uptake. Both techniques may be useful in the evaluation of patients presenting with chest pain syndromes in the emergency room. Other areas of potential promise include the possibility of detecting residual clots following thrombolytic therapy and identifying macrophages in unstable plaque.
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PMID:Myocardial perfusion imaging: perspectives from a turbulent twenty-five years. 868 Oct 9

Three consecutive periods in the natural history of atherosclerosis are amenable to medical treatment. Plaque development is the main target of prevention, which also aims at slowing the progression of already existing plaques. The control of several established risk factors (high blood cholesterol, high blood pressure, diabetes mellitus, tobacco smoking) has already yielded encouraging benefits, especially in the field of secondary prevention. More efficient prophylaxis is to be expected, either from the further improved control of these classic risk factors with earlier, stronger, and longer interventions or from the correction of newly established causal determinants of atherosclerosis. A plaque manifests itself clinically through progressive or abrupt obstruction of the arterial lumen, which can be avoided or retarded by interventions aimed at reducing thrombosis, at controlling plaque instability (the major cause of thrombosis), and at enhancing arterial remodeling (which allows compensatory enlargement of the arterial lumen). When ischemia has occurred, a third wave of palliative treatments aims at improving energy supply to the organ with compromised vascularization. Classic treatments reduce oxygen consumption or improve oxygen extraction by ischemic tissues. In addition, the design of drugs to enhance the development of collateral channels appears to be promising therapeutic approach.
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PMID:Pharmacologic approaches to the treatment of atherosclerotic arterial obstruction. 869 60


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