Objetivo: Avaliar se a administração sistêmica de cilostazol reduz a hiperplasia neointimal nas artérias ilíacas de suínos submetidas a angioplastia com cateter balão. Métodos: O trabalho foi desenvolvido na Unidade de Experimentação Animal do Hospital de Clínicas de Porto Alegre. Vinte suínos foram submetidos a angioplastia com cateter balão 6 x 40 mm na artéria ilíaca comum direita, guiada por ultrassonografia com Doppler. Os animais foram randomizados em dois grupos: grupo 1 (n = 10), no qual foi administrado cilostazol 50 mg em duas doses diárias, e grupo 2 (n = 10), considerado controle. Após 30 dias, os animais foram sacrificados, e as artérias ilíacas preparadas para análise histológica. Os cortes histológicos foram digitalizados e analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student e o de Mann-Whitney. Resultados: Comparando as artérias ilíacas submetidas a angioplastia com as não submetidas a angioplastia, houve hiperplasia neointimal significativa (0,228 versus 0,119 mm2; p = 0,0001). Nas artérias submetidas a angioplastia, não houve diferença entre o grupo 1 (cilostazol) e o grupo 2 (controle) na área do lúmen (2,277 versus 2,575 mm2; p = 0,08), área da íntima (0,219 versus 0,237 mm2; p = 0,64), área da média (2,262 versus 2,393 mm2; p = 0,53) e no percentual de obstrução neointimal (8,857 versus 9,257 %; p = 0,82). Conclusão: O uso de cilostazol 50 mg em duas doses diárias não reduziu a hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia com cateter balão. / Objective: To evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in the iliac arteries of pigs after balloon angioplasty. Methods: This study was conducted in the Experimental Animal Unit of Hospital de Clínicas de Porto Alegre, Brazil. Twenty pigs underwent angioplasty of the right common iliac artery under Doppler ultrasound guidance using 6x40-mm balloon catheters. The animals were randomized to one of two groups: group 1 (n = 10) received 50 mg cilostazol in two doses a day; and group 2 (n = 10) was the control group. After 30 days, the animals were killed and their iliac arteries were prepared for histological analysis. Histological images were digitalized and analyzed using digital morphometry. The Student t and the Mann-Whitney tests were used for statistical analyses. Results: Iliac arteries that underwent angioplasty had significantly more neointimal hyperplasia than those with no angioplasty (0.228 versus 0.119 mm2; p = 0.0001) Group 1 (cilostazol) and 2 (control) had no significant differences in lumen (2.277 versus 2.575 mm2; p = 0.08), intima (0.219 versus 0.237 mm2; p = 0.64) or media (2.262 versus 2.393 mm2; p = 0.53) area, or in percentage of neointimal obstruction (8.857 versus 9.257 %; p = 0.82). Conclusion: The use of 50 mg cilostazol in two doses a day did not reduce neointimal hyperplasia in iliac arteries of pigs that underwent balloon angioplasty.

Objetivo: Avaliar se a administração sistêmica de cilostazol reduz a hiperplasia neointimal nas artérias ilíacas de suínos submetidas a angioplastia com cateter balão. Métodos: O trabalho foi desenvolvido na Unidade de Experimentação Animal do Hospital de Clínicas de Porto Alegre. Vinte suínos foram submetidos a angioplastia com cateter balão 6 x 40 mm na artéria ilíaca comum direita, guiada por ultrassonografia com Doppler. Os animais foram randomizados em dois grupos: grupo 1 (n = 10), no qual foi administrado cilostazol 50 mg em duas doses diárias, e grupo 2 (n = 10), considerado controle. Após 30 dias, os animais foram sacrificados, e as artérias ilíacas preparadas para análise histológica. Os cortes histológicos foram digitalizados e analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student e o de Mann-Whitney. Resultados: Comparando as artérias ilíacas submetidas a angioplastia com as não submetidas a angioplastia, houve hiperplasia neointimal significativa (0,228 versus 0,119 mm2; p = 0,0001). Nas artérias submetidas a angioplastia, não houve diferença entre o grupo 1 (cilostazol) e o grupo 2 (controle) na área do lúmen (2,277 versus 2,575 mm2; p = 0,08), área da íntima (0,219 versus 0,237 mm2; p = 0,64), área da média (2,262 versus 2,393 mm2; p = 0,53) e no percentual de obstrução neointimal (8,857 versus 9,257 %; p = 0,82). Conclusão: O uso de cilostazol 50 mg em duas doses diárias não reduziu a hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia com cateter balão. / Objective: To evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in the iliac arteries of pigs after balloon angioplasty. Methods: This study was conducted in the Experimental Animal Unit of Hospital de Clínicas de Porto Alegre, Brazil. Twenty pigs underwent angioplasty of the right common iliac artery under Doppler ultrasound guidance using 6x40-mm balloon catheters. The animals were randomized to one of two groups: group 1 (n = 10) received 50 mg cilostazol in two doses a day; and group 2 (n = 10) was the control group. After 30 days, the animals were killed and their iliac arteries were prepared for histological analysis. Histological images were digitalized and analyzed using digital morphometry. The Student t and the Mann-Whitney tests were used for statistical analyses. Results: Iliac arteries that underwent angioplasty had significantly more neointimal hyperplasia than those with no angioplasty (0.228 versus 0.119 mm2; p = 0.0001) Group 1 (cilostazol) and 2 (control) had no significant differences in lumen (2.277 versus 2.575 mm2; p = 0.08), intima (0.219 versus 0.237 mm2; p = 0.64) or media (2.262 versus 2.393 mm2; p = 0.53) area, or in percentage of neointimal obstruction (8.857 versus 9.257 %; p = 0.82). Conclusion: The use of 50 mg cilostazol in two doses a day did not reduce neointimal hyperplasia in iliac arteries of pigs that underwent balloon angioplasty.

Objetivo: Avaliar se a administração sistêmica de cilostazol reduz a hiperplasia neointimal nas artérias ilíacas de suínos submetidas a angioplastia com cateter balão. Métodos: O trabalho foi desenvolvido na Unidade de Experimentação Animal do Hospital de Clínicas de Porto Alegre. Vinte suínos foram submetidos a angioplastia com cateter balão 6 x 40 mm na artéria ilíaca comum direita, guiada por ultrassonografia com Doppler. Os animais foram randomizados em dois grupos: grupo 1 (n = 10), no qual foi administrado cilostazol 50 mg em duas doses diárias, e grupo 2 (n = 10), considerado controle. Após 30 dias, os animais foram sacrificados, e as artérias ilíacas preparadas para análise histológica. Os cortes histológicos foram digitalizados e analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student e o de Mann-Whitney. Resultados: Comparando as artérias ilíacas submetidas a angioplastia com as não submetidas a angioplastia, houve hiperplasia neointimal significativa (0,228 versus 0,119 mm2; p = 0,0001). Nas artérias submetidas a angioplastia, não houve diferença entre o grupo 1 (cilostazol) e o grupo 2 (controle) na área do lúmen (2,277 versus 2,575 mm2; p = 0,08), área da íntima (0,219 versus 0,237 mm2; p = 0,64), área da média (2,262 versus 2,393 mm2; p = 0,53) e no percentual de obstrução neointimal (8,857 versus 9,257 %; p = 0,82). Conclusão: O uso de cilostazol 50 mg em duas doses diárias não reduziu a hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia com cateter balão. / Objective: To evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in the iliac arteries of pigs after balloon angioplasty. Methods: This study was conducted in the Experimental Animal Unit of Hospital de Clínicas de Porto Alegre, Brazil. Twenty pigs underwent angioplasty of the right common iliac artery under Doppler ultrasound guidance using 6x40-mm balloon catheters. The animals were randomized to one of two groups: group 1 (n = 10) received 50 mg cilostazol in two doses a day; and group 2 (n = 10) was the control group. After 30 days, the animals were killed and their iliac arteries were prepared for histological analysis. Histological images were digitalized and analyzed using digital morphometry. The Student t and the Mann-Whitney tests were used for statistical analyses. Results: Iliac arteries that underwent angioplasty had significantly more neointimal hyperplasia than those with no angioplasty (0.228 versus 0.119 mm2; p = 0.0001) Group 1 (cilostazol) and 2 (control) had no significant differences in lumen (2.277 versus 2.575 mm2; p = 0.08), intima (0.219 versus 0.237 mm2; p = 0.64) or media (2.262 versus 2.393 mm2; p = 0.53) area, or in percentage of neointimal obstruction (8.857 versus 9.257 %; p = 0.82). Conclusion: The use of 50 mg cilostazol in two doses a day did not reduce neointimal hyperplasia in iliac arteries of pigs that underwent balloon angioplasty.

Abstract The purpose of this prospective, clinical longitudinal survey was to describe, explain and understand the subjective quality of life and life course of patients with coronary artery disease. The study subjects' quality of life was assessed at the time of the onset of coronary artery disease, during the treatment process and during rehabilitation. Altogether 280 patients participated, of whom 80 were treated with medication, 100 with transluminal angioplasty, and 100 with bypass surgery. The study population consisted of 189 men and 91 women. At the baseline, the study subjects' self-care agency was measured with the Self-As-Carer Inventory (SCI). The subjects health-related quality of life was assessed with the Nottingham Health Profile (NHP) at the baseline as well as at 6 and 12 months after the procedure. The qualify of life of coronary artery disease patients was compared to the quality of life of an age- and sex-matched Finnish adult population (N = 3600) by using a previous standardisation of the NHP instrument. One year after the treatment, 19 patients who had undergone either bypass surgery or angioplasty attended thematic interviews at their homes. Triangulation of methodologies, methods and data collection was used in the study. The qualitative analysis of personal experiences was carried out using the method of phenomenological psychology described by Amedeo Giorgi based on Husserl's descriptive phenomenology. Before the treatment procedures, the quality of life of the coronary artery disease patients was significantly poorer than that of the age-matched adult population on the dimensions of energy, pain, emotional reactions, sleep and mobility. Moreover, the female patients with coronary artery disease had poorer health-related quality of life than the corresponding male patients, especially on the dimensions of energy, sleep, emotional reactions and mobility. The quality of life of the patients who had undergone angioplasty or bypass surgery was statistically significantly better one year after surgery on the dimensions of energy, pain and mobility. Their quality of life had, however, deteriorated on the dimensions of emotional reactions and social isolation. The thematic interviews revealed two kinds of life course: one with an active attitude towards treatment and a re-orientation of life course and another with a passive attitude towards treatment and a maintenance of the old principles in one's life course. A need for rehabilitation was indicated by an onset of the illness suddenly at a relatively young age, termination of an active working career, financial problems, dissatisfaction with the outcome of treatment, problems in family relations, and a desolate view of the future. An increased need for psychosocial support was especially common among women, subjects with recurrence and both male and female subjects in the youngest age group. According to the subjects, after-care failed to meet their needs or to address their problems. No continuous and confidential therapeutic relationships emerged. The problems included inadequate knowledge of one's condition and a lack of detailed instructions concerning the permissible degree of exertion after treatment. The patients felt they needed rehabilitation groups with coronary artery disease patients similar to themselves. The study yielded new knowledge about the health-related quality of life of coronary artery disease patients, the connections between the treatment methods and the changes in the patients' quality of life during one year and the patients' experiences at the time of the diagnosis and during the periods of treatment and after-care. This evidence-based knowledge can be used to develop the treatment and rehabilitation of coronary artery disease patients and to plan further research.

Purpose. The primary objective was to compare primary and secondary patency, number of percutaneous transluminal angioplasty (PTA) interventions and cost-effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts. The secondary objective was to compare the residual diameter at the site of dialysis shunt stenosis using sonography and digital subtraction angiography (DSA). Methods. Sixty patients were randomly assigned to either PTA, placement of a stent or stent graft. Follow-up angiography was scheduled at 3, 6, and 12 months or when requested by the physician. Residual diameter of a dialysis shunt stenosis was measured in 20 patients with significant stenosis by ultrasonography and on an angiogram from DSA. Results. During a median follow-up of 22.4 months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0%, 18%, and 65% at 12 months and 0%, 18%, and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures was €7,900±€3,300 in PTA group, €8,500±€4,500 in stent group, and €7,500±€6,200 in stent graft group (P=0.45). The mean residual diameter measured by ultrasonography and DSA was...

published_or_final_version / Medicine / Master / Master of Philosophy

Die Thrombozytenaktivierung ist von zentraler Bedeutung für die Pathogenese der Arteriosklerose und wird bei Patienten mit instabiler Angina pectoris, Myokardinfarkt und TIA sowie nach koronarangioplastischen und operativen Eingriffen als Verursacher okklusiver vaskulärer Ereignisse in Betracht gezogen. Wir gingen der Frage nach, ob ein Zusammenhang zwischen peripherer arterieller Verschlußkrankheit (PAVK) und der Aktivierung zirkulierender Thrombozyten besteht und ob die intraarterielle digitale Subtraktionsangiographie (DSA) sowie die perkutane transluminale Angioplastie (PTA) im Bereich der unteren Extremitäten die Aktivierung zirkulierender Plättchen beeinflussen. Unsere Studie schloß 16 Kontrollprobanden mit PAVK, 25 gesunde Kontrollprobanden und 36 Patienten ein, von denen 14 einer DSA, 12 einer PTA und 10 beiden Eingriffen unterzogen wurden. Wir entnahmen Blutproben aus einer peripheren Vene oder aus Einführungsbestecken in der Arteria und Vena femoralis vor, direkt nach und 4 h nach den Interventionen. Die Plättchenaktivierung wurde anhand durchflußzytometrischer Messungen der Expression aktivierungsspezifischer Antigene (CD62 und CD63) bestimmt, die Sensibilität der Thrombozyten analysierten wir mittels einer zusätzlichen in-vitro-Aktivierung. Wir beobachteten 4 h nach der DSA einen Abfall der Aktivierung und eine erhöhte Sensibilität von Plättchen im arteriellen und venösen Strombereich (p < 0,02). Wir sehen diese Wirkungen als Kontrastmittel(KM)-induziert an und führen die Abnahme der Relativzahl aktivierter Thrombozyten hauptsächlich auf ihre verkürzte Lebensdauer zurück. 4 h nach der PTA kam es arteriell und venös zu einem Abfall der Relativzahl aktivierter Thrombozyten (p < 0,02). Weiterhin beobachteten wir unmittelbar nach der PTA eine Verringerung des prozentualen Anteils aktivierter Plättchen in der arteriellen Zirkulation (p = 0,021) in Korrelation mit zunehmenden Dilatationszeiten und Ballonlängen (p < 0,03). Diese Beobachtungen führen wir auf eine geringe Anlagerung bzw. reduzierte Lebensdauer aktivierter Thrombozyten zurück. Von geringer quantitativer Bedeutung waren Einflüsse des Heparins und KM. Die Wirkung der DSA und PTA auf die Thrombozytenfunktionen schien sich in den 4 postinterventionellen Stunden abzuschwächen. Unsere Ergebnisse zeigen, daß die Angioplastie in peripheren Gefäßen eine Aktivierung und vermutlich geringe Anlagerung bzw. verkürzte Lebensdauer zirkulierender Plättchen unmittelbar nach der PTA und 4 Stunden später verursacht. Diese Prozesse führen wir in erster Linie auf Endothelläsionen als Folge der Dilatation zurück. Die DSA führt 4 h nach dem Eingriff zu einer Aktivierung, Sensibilisierung und in wahrscheinlich sehr geringem Umfang zu einer Anlagerung bzw. verringerten Lebensdauer der Plättchen. PAVK-Patienten im Stadium II nach Fontaine mit kardiovaskulären Risikofaktoren wiesen im Vergleich zu gesunden Probanden eine höhere Relativzahl aktivierter und sensibilisierter Plättchen auf (p = 0,0001). Deshalb vermuten wir, daß präinterventionell aktivierte Plättchen besonders in die Prozesse Aktivierung, Sensibilisierung und Anlagerung involviert bzw. von einer verkürzten Lebensdauer betroffen sind. / Platelet activation plays a crucial role in the pathogenesis of artherosclerosis. Circulating activated platelets are thought to trigger thrombotic events in patients with instable angina pectoris, myocardial infarction and transient ischaemic attacks as well as after coronary angioplasty and surgery. We studied the effect of peripheral arterial disease (PAD) on activation of circulating thrombocytes and evaluated the influence on platelet activation of intraarterial digital subtraction angiography (DSA) and percutaneous transluminal angioplasty (PTA) in the area of the lower extremities. Our study included sixteen control subjects with PAD, twenty-five healthy control subjects and thirty-six patients, fourteen of whom were undergoing DSA, twelve were undergoing PTA and ten we examined during both interventions. Blood samples were obtained from a peripheral vein or from the arterial and venous catheter introducer before and directly and four ours after the procedures. To characterize platelet activation, the expression of activation-dependent platelet antigens (CD62 and CD63) was measured using flow cytometry. Platelet sensibility was analysed by an additional in-vitro-activation. Four hours after DSA, we observed a decrease in activation and an increase in sensibility of thrombocytes in both arterial and venous circulation (p < 0.02), most likely due the contrast medium (CM). We assume, that the relative decrease of platelet activation is caused by a reduced life-time. The relative number of activated thrombocytes decreased in both arterial and venous circulation (p < 0.02) four hours after PTA. Furthermore, we observed reduced amounts of activated platelets in the arterial circulation (p = 0.021) immediately after PTA, in correlation with increased times of dilatation and larger ballon-catheters (p < 0.03). This could be explained by slight migration or shortened life-time of activated thrombocytes. The amount of CM and heparin did not have a pronounced effect. The influence of both interventions on the platelet features and functions seemed to attenuate in the four postinterventional hours. Our results show that angioplasty in peripheral vessels causes activation and presumably slight migration or reduced life-time of circulating thrombocytes immediately and four hours after PTA. We postulate that this is mainly induced by dilatation. DSA was also found to be associated with platelet activation, sensibilisation and presumptive minor migration or shortened life-time of circulating platelets. More activated and sensitized thrombocytes circulated in patients with PAD (clinical stage II according to Fontaine) with cardiovascular risk-factors compared to healthy control subjects (p = 0.001). This supports our assumption that preactivated platelets are particularly involved in activation, sensitizing and migration processes or affected by a reduced life-time.

Introduction: Internal Carotid Stump Syndrome may be one of the possible causes of ischemic stroke (iCMP), as well as retinal infarction (RI). Syndrome of the occluded internal carotid (ACI) (stump syndrome) is a nosological unit, which is characterized by an onset of ipsilateral iCMP or RI of thromboembolic ethiology in patients with occlusion of ACI via the externa carotid or arteria ophthalmica. In my thesis, I have concentrated upon the specification of the stump syndrome, its diagnostics and treatment; furthermore I have assessed the appropriateness of surgical approach in comparison with conservative approach. Material and methods: A total of 621 patients with occlusion were treated in two centres in the course of five years. In a group of 40 patients, the ACI occlusion was detected sonographically, the length of the occluded ACI being >5 mm, with normal vasoreactivity based upon SPECT CO2 and excluded cardiogenic cause of iCMP. The patients were divided in two groups - surgical and conservative. Patients were monitored in 6-month intervals for the total period of four years. Results: No RI or iCMP were detected in the surgical group; one patient died six months after surgery. We observed one case of amaurosis fugax in the conservative group. Conclusion: Ultrasound examination is a fully sufficient...

Introduction: Internal Carotid Stump Syndrome may be one of the possible causes of ischemic stroke (iCMP), as well as retinal infarction (RI). Syndrome of the occluded internal carotid (ACI) (stump syndrome) is a nosological unit, which is characterized by an onset of ipsilateral iCMP or RI of thromboembolic ethiology in patients with occlusion of ACI via the externa carotid or arteria ophthalmica. In my thesis, I have concentrated upon the specification of the stump syndrome, its diagnostics and treatment; furthermore I have assessed the appropriateness of surgical approach in comparison with conservative approach. Material and methods: A total of 621 patients with occlusion were treated in two centres in the course of five years. In a group of 40 patients, the ACI occlusion was detected sonographically, the length of the occluded ACI being >5 mm, with normal vasoreactivity based upon SPECT CO2 and excluded cardiogenic cause of iCMP. The patients were divided in two groups - surgical and conservative. Patients were monitored in 6-month intervals for the total period of four years. Results: No RI or iCMP were detected in the surgical group; one patient died six months after surgery. We observed one case of amaurosis fugax in the conservative group. Conclusion: Ultrasound examination is a fully sufficient...