Thesis (M.S.)--University of Wisconsin-Madison, 1988. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves: 28-32).

Orientador: Winston Bonetti Yoshida / Resumo: Objetivo. A presente revisão se propõe a comparar a eficácia e segurança da angioplastia com stent versus angioplastia percutânea transluminal nas lesões sequenciais através dos desfechos: taxa de abertura do vaso (TICI 2b/3), evolução neurológica (mRs < 2) e taxa de hemorragia sintomática (hematoma grau II). Método. Utilizando como base de dados o PubMed, Scopus, Embase, SciELO/LILACS e outros, a presente revisão sistemática foi realizada até setembro de 2017 com base no PICO: (P) Pacientes com oclusão sequencial da carótida na fase aguda do AVCi tratados ou não com fibrinolítico endovenoso, (I) Angioplastia com stent, (C) Angioplastia percutânea transluminal, (O) TICI, mRs e hemorragia sintomática. As seguintes palavras chaves foram utilizadas: Stroke, Carotid Artery Injuries, Angioplasty, Stent and Safety. Aos artigos encontrados, os critérios de seleção do PRISMA foram aplicados, sendo realizada a análise qualitativa através do cheklist do NIH for before-after studies with no control group e a análise quantitativa através do programa Statdirect. Resultados. Identificados 228 artigos que após ajustes e exclusões restaram 29 para a análise qualitativa e quantitativa. TICI após CAS 0,76 (95% CI = 0,72 a 0,79); I2 = 36,9% versus PTA 0,71 (95% CI = 0,61 a 0,81); I2= 28,5%. mRs < 2 em 90 dias após CAS 0,47 (95% CI = 0,43 a 0,51) ); I2 = 3% versus PTA de 0,46 (95% CI = 0,36 a 0,57) ); I2 = 18,7%. Taxa de hemorragia sintomática após CAS 0,08 (95% CI = 0,06 a 0,10); I2 = 5,3%) ver... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: Compare carotid angioplasty and stent (CAS) versus percutaneous transluminal angioplasty (PTA) measuring the efficacy and safety through Thrombolysis in Cerebral Infarction scale (TICI 2b/3), modified Rankin scale (mRs <2) and symptomatic haematoma (PH2). Method: Using the PubMed and others database, we searched for articles publish until setember 2017. The PRISMA criteria was used and rigorous eligibility were applied. The article quality was assessed by a checklist of “Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group published" by NIH and proportional meta-analysis was performed by Statdirect software. Results: 228 articles were identified from the databases, after adjustments due to duplicates and submitted to the eligibility criteria, 29 articles with 1339 patients remained for the qualitative and quantitative analysis. TICI 2b/3 value after CAS was 0,76 (95% CI = 0,72 to 0,79); I2 = 36,9% versus PTA 0.71 (95% CI = 0.61 to 0.81); I2= 28,5%, mRs < 2 in 90 days after CAS 0.47 (95% CI = 0.43 to 0.51) ); I2 = 3% versus PTA 0.46 (95% CI = 0.36 to 0.57) ); I2 = 18,7% and symptomatic haematoma 0,08 (95% CI = 0,06 to 0,10) ); I2 = 5,3% versus PTA 0,06 (95% CI = 0,02 to 0,13); I2 = 35,5% showed no statistical difference. Other analyses of subgroups were done, including the effect of tPA with antiplatelet drugs. Conclusion: CAS is effective and safe when compared to PTA in the outcomes TICI 2b/3, mRs < 2 and PH2. A randomized clinical ass... (Complete abstract click electronic access below) / Doutor

As lesões estenóticas ou oclusivas das artérias renais podem levar à isquemia do parênquima renal com conseqüente hipertensão arterial (hipertensão arterial renovascular) e perda de função renal (nefropatia isquêmica). Estas duas entidades podem ser tratadas por medicamentos, cirurgia ou angioplastia transluminal percutânea. O objetivo deste trabalho foi avaliar o sucesso técnico e funcional da angioplastia em lesões estenóticas ou oclusivas das artérias renais em doentes portadores de hipertensão arterial renovascular e nefropatia isquêmica. Tratamos 131 doentes hipertensos com ou sem alteração da função renal (55 do sexo masculino e 76 feminino), que apresentavam 191 artérias renais comprometidas (148 estenoses e 43 oclusões) e com média de idade de 45,83 ± 17,4 anos (4 a 77 anos). A etiologia da lesão da artéria renal foi a aterosclerose em 65 doentes (49,61%), displasia fibromuscular em 41 (31,29%), arterite de Takayasu em 13 (9,92%) e outras causas em 12 (9,16%). O nível sérico de creatinina era normal em 70 (53,43%) e alterado em 61 (46,58%). O sucesso técnico foi obtido em 93 doentes (70,99%) e em 123 artérias renais (75,46%). O seguimento foi, em média, de quatro anos (2 a 8 anos), sendo que ao final deste período houve redução de 37,80 ± 33,46 mmHg e 28,66 ± 24,74 mmHg nos níveis da PA sistólica e diastólica, respectivamente. Houve cura da hipertensão arterial em nove doentes (11,25%), melhora em 59 (73,75%), permaneceu inalterada em oito (10%) e piorou em quatro (5%). A função renal ficou normal em 36 doentes (45%), melhorou em 11 (13,75%), manteve-se em 26 (32,5%) e piorou em sete (8,75%). Houve recidiva em 14 casos (17,5%), sendo 11 casos (78,57%) tratados com sucesso com nova angioplastia. Conclusão: consideramos que a angioplastia transluminal percutânea pode ser indicada como opção para o tratamento das lesões estenóticas e/ou oclusivas das artérias renais nos doentes com hipertensão renovascular e nefropatia isquêmica / The occlusive and stenotic lesions of the renal arteries can lead to a renal parenchyma ischemia with vascular hypertension resultant (reno vascular hypertension) and loss of renal function (nephropathy ischemic). These two conditions can be treated by medications, surgery or Percutaneous Transluminal Angioplasty (PTA). The objective of this work was assessing the technical and functional success of PTA in stenotic or occlusive lesions of renal arteries in patients having renovascular hypertension and nephropathy ischemic. We treated 131 hypertensive ill people with or without alteration in the renal function (55 males and 76 females) who presented 191 damaged renal arteries (148 stenosis and 43 occlusions) and age range of 45.83+ 17.4 years old (4 to 77 years old). The etiology of the lesion in the renal artery was atherosclerosis in 65 ill people (49.61%), fibro muscular dysplasia in 41 (31.29%), Takayasu\'s disease in 13 (9.92%), and other causes in 12 (9.16%). The plasma creatinine level was normal in 70 (53.43%) and altered in 61 (46.58%). The technical success was obtained in 93 ill people (70.99%) and in 123 renal arteries (75.46%). The follow-up lasted in average for 4 years (2 to 8 years), in which the end of the period there was a decrease of 37.80+33.46 mmHg and 28.66+24.74 mmHg in the systolic and diastolic blood pressure levels respectively. There was a cure of artery hypertension in 9 ill people (11.25%), better results in 59 (73.75%), no alteration in 8 (10%) and worsening in 4 (5%). The plasma creatinine level increased in 10% (SD), although the renal function remained normal in 36 ill people (45%), better in 11 (13.75%), remained the same in 26 (32.5%) and got worse in 7 (8.75%). There was a reoccurrence in 14 cases (17.5%), in which 11 cases (78.57%) were treated successfully with new PTA. Conclusion: it was considered that PTA can be indicated as an option for the treatment of stenotic and occlusive lesions of the renal arteries in ill people with renovascular hypertension and nephropathy ischemic

The detection of in-stent restenosis is important in clinical practice by providing useful information to guide therapy. The objectives of this study were to evaluate the effectiveness of the exercise test (ET) in the detection of restenosis after percutaneous transluminal coronary angioplasty with stent conventional implantation (Stent-ATC) and, as a gold standard, coronary angiography. We studied 25 asymptomatic patients, aged between 44 and 83 years, who underwent PTCA-Stent for at least six months. The patients underwent TE employing the Bruce protocol. The positivity criteria for ischemia was ST segment depression > 1mm, measured at the J point and with horizontal or descending. The results obtained in TE were compared with those of coronary angiography is considered the in-stent restenosis lesions with obstruction > 50%. We estimated the sensitivity and specificity and positive predictive value and negative procedure. Of the individuals studied, 10 (40%) had in-stent restenosis by angiographic criteria, and only 3 (12%) had positive TST tests for ischemia. The relationship between the TE and coronary angiography was not significant (p = 0.315), indicating that the tests are independent. The concordance between the diagnoses was low (Kappa coefficient: 0.151), the same occurring with the sensitivity (20%). The specificity of the test was high (93%) and positive predictive value 65.56% and negative predictive value 63.63%. The overall efficiency of the test is estimated with accuracy low 63.98%. We conclude that the TE has low sensitivity and high specificity in detecting in-stent restenosis in asymptomatic patients. The overall efficiency of ET is low. / A detecção da reestenose intrastent é importante na prática clínica fornecendo informações úteis para a orientação terapêutica. Os objetivos deste estudo foram, avaliar a eficácia do teste ergométrico (TE) na detecção de reestenose após angioplastia transluminal coronariana com implante de stent convencional (ATC-stent), comparando este método com os resultados obtidos com a cineangiocoronariografia. Foram estudados 25 pacientes assintomáticos, com idade entre 44 e 83 anos, que realizaram ATC-stent há, no mínimo, seis meses e no máximo um ano. Os pacientes foram submetidos ao TE empregando-se o protocolo de Bruce. O critério de positividade para isquemia foi o infra-desnivelamento do segmento ST > 1mm, aferido no ponto J e com morfologia horizontal ou descendente. Os resultados obtidos no TE foram comparados com aqueles da cineangiocoronariografia sendo considerada como reestenose intrastent a presença de lesões com obstrução >50%. Foram estimadas a sensibilidade e especificidade e o valor preditivo positivo e negativo do procedimento. Dos indivíduos estudados, 10 (40%) apresentaram reestenose intrastent pelo critério angiográfico e apenas 3 (12%) tiveram TE positivo para isquemia. A relação entre o TE e a cineangiocoronariografia não foi significativa (p=0,315), indicando que os testes são independentes. A concordância entre os diagnósticos foi baixa (coeficiente Kappa: 0,151), o mesmo ocorrendo com a sensibilidade (20%). A especificidade do TE foi elevada (93%), sendo o valor preditivo positivo 65,56% e o valor preditivo negativo 63,63%. A eficiência global do teste é baixa com acurácia estimada em 63,98%. Em conclusão, nas condições estudadas o TE tem baixa sensibilidade e alta especificidade na detecção de reestenose intrastent em pacientes assintomáticos. A eficiência global do TE é baixa. / Mestre em Ciências da Saúde

Introdução: A reestenose pós tratamento endovascular de lesões ateroscleróticas em artérias periféricas é a principal desvantagem desta técnica minimamente invasiva. A inflamação vascular após angioplastia com balão e/ou implante de stent desempenha um papel importante na proliferação de células do músculo liso vascular e posterior crescimento de uma neoíntima, e vários marcadores inflamatórios têm sido referidos como potenciais preditores dessa complicação, porém os fatores que contribuem para a estenose intra-stent no segmento vascular periférico não foram completamente elucidados. Recentemente, tem-se sugerido que a superfície revestida de stents recobertos possa impedir a reestenose de forma mais eficaz do que os stents convencionais. Objetivo: Avaliar o papel do sistema calicreína-cinina (SCC), do óxido nítrico (NO) e das metaloproteinases (MMP), mediadores inflamatórios importantes e que contribuem ativamente para a reparação de tecidos, no processo de reestenose arterial devido a hiperplasia intimal, pós angioplastia com stent recoberto no segmento fêmoro-poplíteo, com a intenção de contribuir com novas medidas terapêuticas. Método: Foi realizado um estudo prospectivo envolvendo 27 pacientes submetidos à angioplastia com stent revestido no segmento fêmoro-poplíteo, selecionados no Ambulatório de Cirurgia Vascular e Endovascular do HCFMRP/USP. Foram estudados os seguintes marcadores: sistema calicreína-cininas - com quantificação dos substratos (cininogênio de alto e baixo peso molecular - CAPM / CBPM) e da atividade das enzimas (calicreína plasmática e tecidual e cininase II); a determinação dos níveis de nitrito e nitratos para a avaliação de óxido nítrico; dosagem das MMPs 2 e 9 e dos níveis circulantes de seus inibidores (inibidores teciduais das metaloproteinases - TIMPs [1 e 2]). Amostras de sangue foram coletadas antes do implante do stent, 24 horas e seis meses após o procedimento. Foi realizado ultrasson Doppler após seis meses, e, na presença de alterações, realizada angiografia para comprovação da presença de reestenose. Resultados: Quatro (14,8%) dos vinte sete pacientes estudados desenvolveram reestenose (>= 50%) em seis meses. Esses pacientes tiveram níveis significativamente mais baixos de CAPM (24h, P <0,05) e de CBPM (antes - P <0,05; 24 horas P <0,01; 6 meses P <0,05); níveis mais baixos de TIMP 2 ( seis meses P<0,05) comparados ao grupo sem reestenose. As atividades da calicreína plasmática e tecidual, da cininase II, NO e MMPs tiveram comportamento semelhante entre os pacientes com e sem reestenose. Conclusão: As taxas de reestenose foram baixas com o uso de stents revestidos no segmento fêmoro-poplíteo comparativamente aos índices publicados de stents não revestidos. Os pacientes que desenvolveram reestenose mostraram níveis reduzidos de cininogênios e de TIMP-2 (seis meses após a angioplastia). Por outro lado, não foi possível demonstrar a participação do óxido nítrico e das metaloproteinases no processo de reestenose / Background: Restenosis after endovascular treatment of atherosclerotic lesions in the peripheral circulation is the major drawback of this minimally invasive technique. Vascular inflammation after balloon angioplasty or stent implantation plays an important role in smooth muscle cells proliferation and subsequent neointima growth, and various inflammatory markers have been reported as potential predictors of this complication, but the factors that contribute to the in-stent stenosis in peripheral vascular segment have not been fully elucidated. Recently, it has been suggested that the coated surface of stents grafts can prevent restenosis more effectively than conventional stents. Objective: The aim of this study was to evaluate the role of the kallikrein-kinin system (KKS), nitric oxide (NO) and metalloproteinases (MMPs), wich are important inflammatory mediators and actively contribute to tissue repair, in the process of arterial restenosis due to intimal hyperplasia, with the aim of developing new interventions. Method: Single-center prospective study with 27 patients with peripheral artery disease (PAD) requiring percutaneous transluminal angioplasty (PTA) and stenting, in the femoropopliteal segment, using coated stents grafts, was performed. The following markers were studied: kallikreinkinin system using the quantification of proteins (high and low weight Molecular kininogen HMWK / LMWK), verification of enzyme activity (tissue kallikrein, plasma kallikrein and kininase II), determination of nitrite and nitrates levels for evaluation of nitric oxide, MMPs 2 and 9 circulating levels and their inhibitors (tissue inhibitors of metalloproteinases [TIMPs 1 and 2]). Serum samples were collected before stent implantation, 24 h and six months after the procedure. Doppler ultrasound was performed after six months, and in the presence of any changes, an angiography was performed to prove the presence of restenosis. Results: Four (14,8%) of the treated patients developed restenosis (>50%) within 6 months. These patients had significantly lower levels of HMWK (24 hours, P < .05), LMWK (before - P < .05; 24 hours - P < .01; 6 months - P < .05) and lower levels of TIMP 2 (6 months < .05) compered to no restenosis group. The activities of plasma and tissue kallikrein, kininase II, NO and MMP had similar behavior among patients with and without restenosis. Conclusion: Restenosis rates were low with the use of coated stents in the femoropopliteal segment compared to published bare metal stents results. Patients with restenosis showed reduced levels of kininogens and TIMP-2 (six months after angioplasty) in patients who developed restenosis. Moreover, it was not possible to demonstrate the involvement of nitric oxide and metalloproteinases in the restenosis process

Aproximadamente 5% dos pacientes com infarto agudo do miocÃrdio tÃm idade inferior a 45 anos. As caracterÃsticas especÃficas, epidemiolÃgicas e clÃnicas desta populaÃÃo ainda nÃo estÃo bem esclarecidas. O objetivo do presente estudo à caracterizar a apresentaÃÃo clÃnica, epidemiolÃgica e cinecoronariogrÃfica em jovens submetidos à angioplastia coronariana primÃria (ATC). Foi realizada uma anÃlise retrospectiva de 150 prontuÃrios de pacientes com idade inferior a 45 anos submetidos à ATC entre janeiro de 2006 e dezembro de 2010. Foram analisados os fatores de risco, a apresentaÃÃo clÃnica e eletrocardiogrÃfica, a funÃÃo ventricular esquerda, caracterÃsticas da anatomia coronariana, o tratamento mÃdico e a evoluÃÃo hospitalar. Observou-se que a idade mÃdia dos pacientes foi de 40,1 Â5 anos, com predominÃncia do sexo masculino (68,7%). Os fatores de risco mais associados com o IAM foram o tabagismo (65%), a hipertensÃo arterial sistÃmica (50%), a histÃria familiar de doenÃa arterial coronariana (40%) e os baixos nÃveis de HDL - colesterol (60%). A prevalÃncia de diabetes mellitus foi de 19,3%. O acometimento da artÃria descendente anterior (DA) ocorreu em 53% dos indivÃduos e em 75% foi observada doenÃa em uma Ãnica artÃria. O tempo mÃdio de chegada ao hospital apÃs o inÃcio dos sintomas (delta T) foi de 5,5  3,4 horas e a permanÃncia hospitalar foi de 10,36  14,1 dias. Em 58% dos pacientes, a fraÃÃo de ejeÃÃo do ventrÃculo esquerdo foi superior a 55%. Houve apenas um Ãbito. A taxa de sucesso da ATC foi de 91%. Quanto ao tratamento do IAM, os pacientes receberam globalmente Ãcido acetilsalicÃlico (99,3%), clopidogrel (98%), inibidores da enzima de conversÃo da angiotensina (IECA) (85,3%), betabloqueadores (66%), estatinas (97,3%) e a prescriÃÃo de inibidores da glicoproteÃna IIb-IIIa foi observada em somente 10% dos pacientes. ConcluÃmos que o IAM em jovens apresenta-se como uma entidade tipicamente masculina e de bom prognÃstico na evoluÃÃo precoce, desde que instituÃdo tratamento adequado em tempo hÃbil. O tratamento mÃdico destinado a estes pacientes no Hospital de Messejana Dr. Carlos Alberto Studart Gomes contempla o que à proposto pela IV Diretriz Brasileira para tratamento do IAM com supradesnivelamento do segmento ST. / Approximately 5% of patients with acute myocardial infarction under the age of 45 years. The specific characteristics, clinical and epidemiological this population are not well understood. The aim of this study is to characterize the clinical, epidemiological and coronary cineangiography in young people undergoing primary coronary angioplasty (PTCA). We performed a retrospective analysis of 150 medical records of patients under the age of 45 years who underwent PCI between January 2006 and December 2010. We analyzed the risk factors, clinical presentation and electrocardiographic left ventricular function, characteristics of the coronary anatomy, medical treatment and hospital course. It was observed that the average age of patients was 40.1  5 years, predominantly male (68.7%). The risk factors associated with AMI were smoking (65%), hypertension (50%), family history of coronary artery disease (40%) and low levels of HDL - cholesterol (60%). The prevalence of diabetes mellitus was 19.3%. Involvement of the anterior descending artery (AD) occurred in 53% of individuals and 75% was observed in the disease in a single vessel. The average time of arrival at the hospital after symptom onset (delta T) was 5.5  3.4 hours and hospital stay was 10.36  14.1 days. In 58% of patients, the ejection fraction of left ventricle was greater than 55%. There was one death. The success rate of PTCA was 91%. Regarding the treatment of AMI patients received aspirin overall (99.3%), clopidogrel (98%), angiotensin-converting enzyme inhibitors (ACEI) (85.3%), beta blockers (66%), statins ( 97.3%) and prescription of glycoprotein IIb-IIIa was observed in only 10% of patients. We conclude that in young AMI presents itself as an entity typically masculine and good prognosis in early evolution, provided that appropriate treatment instituted in a timely manner. Medical treatment for these patients at the Hospital of Messejana Dr. Carlos Alberto Studart Gomes contemplates what is proposed by the IV Brazilian Guideline for the treatment of AMI with ST-segment elevation

M.Cur. / Patients with coronary artery disease are forced as a result of physiological changes, to make life style adjustments, whether by means of diet, or by adjusting their activities. Only if the patient's attitude toward his illness is of such a nature that he himself takes responsibility for this state of health, life style adjustments can be effective. The objective of this study is to determine the life style adjustments of angioplasty patients, in order to establish guidelines with regard to a patients education programme for nursing professionals. Literature study has brought to light the risk factors which influence coronary artery disease, as well as the crucial need for life style adjustments, which are investigate and described in this study. From this, criteria were derived for use in the further phases of data compilation. The research model is based on retrospective ex-post-facto correlation, to compare the adjustment of patients after angioplasty, with their life style before the procedure. A contextual-descriptive record regarding education given to patients before discharge, is included in the design. A descriptive survey was made of the structure and effectiveness of the educational programme of the chosen unit. Despite reveal results part of the fact that the analyses indicates that the majority of patients a positive tendency regarding life style adjustment, the expected are not achieved, because of a lack of sufficient knowledge on the the patients. The major recommendation evolving from this study, is, that all institutions where angioplasty is performed, should include an educating programme, which should be executed under supervision and which should from part of the rehabilitation process.

No description available.

Background: Early post-percutaneous coronary intervention chest pain (EPPCP) appears to be a common clinical phenomenon. EPPCP has not been fully explained or studied in the literature despite the abundance of clinical trials on percutaneous coronary intervention (PCI). The objective of this questionnaire-based survey is to assess the current perception of EPPCP among practicing interventional cardiologists nationwide. Methods: A survey questionnaire was designed utilizing the Survey Monkey tool to address the perceptions and current practices regarding key aspects of EPPCP among interventional cardiologists. The survey was sent to the interventional cardiologists via email. Results: The survey questionnaire regarding EPPCP was provided to 2615 practicing interventional cardiologists and resulted in 623 total survey responses, with 503 of those respondents completing all eight survey questions. A total of 50.2% of the interventional cardiologists perceive that the incidence of EPPCP is 5–10%, and 57.5% consider that repeat angiography or PCI is rarely needed (1 in 1000 cases). A total of 47.1% of the participants think that EPPCP is due to transient microvascular dysfunction, while 39% perceive it as a different entity requiring a different approach. When asked about developing a standardized labeling for the phenomenon of EPPCP, 34.8% of responders indicated that they believe EPPCP should be labeled as a benign form of chest pain/angina, and 28% preferred to describe EPPCP in non-standardized terms. Among interventional cardiologists, 80% thought that the treatment of this entity is a combination of reassurance and vasodilators and, without ischemic ECG changes, medical management is appropriate. Conclusion: A total of 72% of interventional cardiologists in our survey preferred to label EPPCP as standard nomenclature to facilitate communication between healthcare providers, patients and families in a consistent way. There is a diversity of opinion regarding EPPCP, no standard nomenclature, and no guideline to standardize practice. Further large-scale prospective studies are needed to better understand the pathophysiological mechanisms, optimal management strategies, prognostic implications, and clinical reporting of EPPCP.

published_or_final_version / Community Medicine / Master / Master of Public Health