05). Thirteen of 26 (50%) patients with a tear >1.9 cm(2) had aortic branch malperfusion (P = .032). Ten of 14(71%) patients with a tear >4.86 cm2 (mean plus one standard deviation) had aortic branch malperfusion (P =.002). The location of tears ranged from-6 mm to +459.2 mm from the left selleck inhibitor subclavian artery orifice: 80.5% (n = 99) of these tears were above the reference origin of the celiac artery. Eight of 13 panents (62%) with a tear distal to 282 mm (the orifice of the celiac artery) had aortic branch malperfusion in
(P = .04). A classification for the location of intimomedial tears is proposed with potential clinical relevance to endovascular repair: type I has no identifiable tears; type 2 has one or more tears with no tears distal to the orifice of the celiac artery; type 3 has tears involving the branch vessels of the abdominal aorta, and type 4 has intimomedial
tears distal to the aortic bifurcation.
Conclusions. Characterization and location of intimomedial tears using see more computed tomography (CT) imaging is feasible and represents an important step in the management of type B aortic dissection. The location and surface area of tears is associated with malperfusion. Based on the proposed classification and anatomic reference data, three out of every four-patients may have a favorable constellation of intimomedial tears (type 1 or 2) that would be amenable to endovascular repair and reverse aortic remodeling. The clinical correlation will be established in upcoming studies. (J Vase Surg 2010; 52:562-8.)”
“Objectives. Octogenarians and even patients over
70 years old have unexplained poor outcomes with carotid angioplasty and stenting (CAS). We sought to evaluate whether older patients may have compromised intracramal collaterals and cerebral reserve and be intolerant to otherwise clinically silent emboli generated during CAS.
Methods: One thousand twenty-four cerebral blood flow (CBF) studies performed between 1991 and 2001 with stable xenon computed Ribonucleotide reductase tomography scans (Xe/CT) were reviewed. CBF. was measured before and after 1 gm intravenous acetazolamide (ACZ), a cerebral vasodilator. The normal response to ACZ is an increase in CBF. In areas of significant compromise of cerebral reserve (CR), CBF drops, representing a “”steal”" phenomenon. CBF changes were categorized as normal or abnormal and correlated with age, gender, cerebral symptoms, and with intracranial, carotid, or vertebral artery disease. Logistic regression was used to determine the effect of age on CR in the entire group and a subgroup of 179 patients with significant carotid stenosis of >50%.
Results: Nine hundred sixteen studies were suitable for analysis. Carotid occlusion was predictive of decreased reserve (OR, 3.9; P = .03) regardless of age.