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1
Gouveia, Viviane de Araújo. "Impacto do metotrexato na reestenose após implante de stent coronariano convencional." Universidade Federal de Pernambuco, 2015. https://repositorio.ufpe.br/handle/123456789/16384.
Testo completoAbstract (sommario):
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Previous issue date: 2015-05-26<br>Introdução: O advento dos stents convencionais e daqueles liberadores de fármacos aboliu o recolhimento elástico provocado pela angioplastia por balão, porém, estes dispositivos apresentaram como consequência a hiperplasia neointimal, que é responsável pela reestenose angiográfica. O metotrexato, antagonista do folato, inibe a fase S do ciclo de mitose celular, reduzindo a produção de citocinas e outros mediadores inflamatórios que podem estar envolvidos na hiperplasia neointimal. Objetivo: Avaliar a segurança do Metotrexato (MTX) em pacientes com Doença Arterial Coronariana submetidos à Intervenção Coronariana Percutânea (ICP) com stents convencionais e o impacto da droga na reestenose clínica e angiográfica. Método: Estudo clínico de fase II aberto, prospectivo, não randomizado, realizado de setembro de 2011 a maio de 2014. Resultados: Foram recrutados 16 pacientes com indicação de implante de stent, sendo que estes tomaram 5 mg de MTX 15 dias antes e 30 após a ICP. Todos os pacientes foram submetidos à nova angiografia coronariana após 9 meses. A artéria coronária descendente anterior apresentou o maior número de lesões 16 (34%). O diâmetro médio dos stents foi de 3,0 ± 0,4 mm e o comprimento médio foi de 18,1 ± 5,9 mm. Não houve complicações relacionadas à ICP. As complicações do MTX foram menores e com prevalência de 18,7%. Nenhum paciente necessitou de interrupção no uso do medicamento e os sintomas desapareceram ao final do tratamento. A reestenose angiográfica foi 6,2% e a clínica foi zero (ausência de sintoma e de isquemia em cintilografia do miocárdio). Conclusão: O MTX foi seguro e gerou a hipótese de possível efeito benéfico na reestenose após implante de stent convencional.<br>Introduction: Bare metal stents (BMS) and those releasing drug abolished the elastic recoil caused by Plain Old Balloon Angioplasty (POBA), however, these devices showed the consequence of neointimal hyperplasia, which is responsible for angiographic restenosis. The methotrexate, folate antagonist inhibits S phase of mitotic cell cycle by reducing the production of cytokines and the other inflammatory mediators that may be involved in the neointimal hyperplasia. Objective: To evaluate the safety of Methotrexate (MTX) in patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI) with BMS and the impact of drugs in clinical and angiographic restenosis. Methods: Clinical phase II open, prospective, nonrandomized, held from September 2011 to May 2014. Results: We recruited 16 patients with stent implantation indication, and these took 5 mg of MTX 15 days before and 30 after PCI. All patients underwent coronary angiography after nine months. The anterior descending coronary artery had the highest number of lesions 16 (34%). The average diameter of the stents was 3.0 ± 0.4 mm and the average length was 18.1 ± 5.9 mm. There were no complications related to PCI. The MTX complications were minor and with a prevalence of 18.7%. No patient required interruption in the use of the drug, and the symptoms disappeared after the treatment. Angiographic restenosis was 6.2% and the clinic was zero (no symptoms and ischemia on myocardial scintigraphy). Conclusion: MTX was safe and led the hypothesis of possible beneficial effect on restenosis after conventional stent implantation.
2
Garramone, Samantha. "Structure-property relationships in angioplasty balloons." Link to electronic thesis, 2001. http://www.wpi.edu/Pubs/ETD/Available/etd-0430101-122300/.
Testo completo
3
Mattsson, Erney. "On vessel wall responses to balloon dilatation experimental studies in rabbits /." Lund : Dept. of Surgery, Lund University, Malmö General Hospital, 1992. http://catalog.hathitrust.org/api/volumes/oclc/39693815.html.
Testo completo
4
Smyth, David William. "The haematological determinants of angioplasty restenosis." Thesis, Queen Mary, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244764.
Testo completo
5
Brack, Michael John. "Heparin and restenosis following angioplasty : a study of the effect of subcutaneous heparin on angiographic recurrence following angioplasty." Thesis, University of Leicester, 1994. http://hdl.handle.net/2381/34223.
Testo completoAbstract (sommario):
Restenosis following percutaneous transluminal coronary angioplasty (PTCA) continues to be the major limitation of the procedure with an incidence of 30-50%. The restenotic process is characterised by myointimal hyperplasia, initiated by smooth muscle cell migration and proliferation. Work in animal models of vascular injury suggests that heparin may reduce myointimal hyperplasia and hence restenosis. I therefore evaluated the effects of unfractionated heparin, 12 500 IU, twice daily, for 4 months, on angiographic and clinical restenosis following PTCA. 339 patients were randomised to receive no heparin (n=172) or 12 500 IU of heparin twice daily (n=167), with angiographic follow-up at 4 months. Blinded quantitative angiographic analysis was undertaken to determine the minimal luminal diameter (mid) pre PTCA, post PTCA and at follow-up. 40 patients defaulted, and 39 patients underwent "early" cardiac catheterisation. A total of 260 patients underwent elective cardiac catheter (n=136 in the no heparin group, n=124 in the heparin group). The mean difference between the mld at follow-up and immediately post PTCA was -0.49 mm(0.57) in the no heparin group, and -0.41mm(0.57) in the heparin group. The treatment effect, 0.08mm, was not significant (p=0.22). The restenosis rate in the no heparin group was 48% and 39% in the heparin group (p=0.32). For early and elective patients combined, the mean difference in mld at follow-up and post PTCA was -0.55 mm(0.58) for the no heparin group, and -0.43 mm(0.59) for the heparin group. The overall treatment effect was 0.12mm, (p=0.06), restenosis rate, 51% in the no heparin group and 41% in the heparin group (p=0.09). At elective follow-up 33% of patients in the no heparin group and 32% of the patients in the heparin group complained of angina. Unfractionated heparin at a dose of 12 500IU twice daily for 4 months does not significantly reduce angiographic or clinical restenosis rates following PTCA.
6
Winkler, Bert. "Perkutane transluminale Angioplastie komplexer infrapoplitealer Gefässläsionen bei kritischer chronischer Extremitätenischämie: Restenoserate und klinische Ergebnisse." Doctoral thesis, Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-150025.
Testo completo
7
Shehab, Mostafa El-Said Nasr. "The mechanism of balloon angioplasty : an experimental and clinical study of pressure and volume curves using a computerised angioplasty system." Thesis, University of Bristol, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268836.
Testo completo
8
Nyamekye, Isaac. "Photodynamic therapy in the management of angioplasty restenosis." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294129.
Testo completo
9
Fleenor, Bradley S. "Post-angioplasty restenosis the effects of exercise training /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/6097.
Testo completoAbstract (sommario):
Thesis (Ph. D.)--University of Missouri-Columbia, 2008.<br>The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "August 2008" Includes bibliographical references.
10
Martins, Valéria Marcia. "Angioplastia transluminal percutânea: contribuição ao tratamento da hipertensão arterial renovascular e da nefropatia isquêmica." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-15102014-113147/.
Testo completoAbstract (sommario):
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<br>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
11
Rocha, Laura de Andrade da. "Caracterização do perfil dos componentes do sistema das cininas, óxido nítrico e metaloproteinases como marcadores na reestenose precoce de stents revestidos pós angioplastia transluminal percutânea periférica." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-20072016-115252/.
Testo completoAbstract (sommario):
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<br>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
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Crawley, F. A. M. "Carotid artery stenosis : the role of angioplasty and surgery." Thesis, University of Cambridge, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.598140.
Testo completo
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Oliveira, Fábio Rezende de Figueiredo. "Acurácia do teste ergométrico no diagnóstico da reestenose coronariana após angioplastia com implante de Stent convencional em pacientes assintomáticos." Universidade Federal de Uberlândia, 2012. https://repositorio.ufu.br/handle/123456789/12744.
Testo completoAbstract (sommario):
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.<br>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.<br>Mestre em Ciências da Saúde
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Longhi, Joel Alex. "Efeito do cilostazol na hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia transluminal." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/53131.
Testo completoAbstract (sommario):
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.<br>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.
15
Löfberg, Anne-Marie. "Infrainguinal percutaneous transluminal angioplasty in limbs with severe lower limb ischaemia /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5079-2/.
Testo completo
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Bourgeois, Ronald. "Détermination du type de récepteur à l'angiotensine impliqué dans la resténose post-angioplastique." Mémoire, Université de Sherbrooke, 1996. http://savoirs.usherbrooke.ca/handle/11143/3097.
Testo completoAbstract (sommario):
Une des complications qui survient chez 1/3 des patients dans les 6 mois suivant une angioplastie est la resténose, réponse myoproliférative du muscle lisse vasculaire. Cette formation néointimale (LIU et al., 1989), nécessite souvent une angioplastie ultérieure ou un pontage aortocoronarien chez l'homme. Dans un modèle animal, cette resténose a été partiellement supprimée par des doses élevées d'inhibiteurs et d'antagonistes reliées au système rénine angiotensine. Nous avons démontré récemment sur ce modèle qu'une infusion intralésionelle de Br[indice inférieur 5]Ang, un antagoniste peptidique non-sélectif de longue durée d'action de l'angiotensine II (Ang), peut prévenir une formation néointimale (LAPORTE et ESCHER, 1992). Ces résultats démontrent que l'Ang est un médiateur nécessaire mais n'identifie pas le type de récepteur par lequel cette réponse est médiée. Pour résoudre cette question, une expérience avec des antagonistes sélectifs fut effectuée. L'angioplastie des artères carotides de rats Sprague-Dawley fut suivie d'un traitement continu de 14 jours par infusion intra-artérielle de losartan (antagoniste sélectif au récepteur AT[indice inférieur 1] de l'angiotensine II), de PD123319 (antagoniste sélectif au récepteur AT[indice inférieur 2] de l'angiotensine II), d'une combinaison de losartan et de PD123319 ou d'une infusion de salin. La morphométrie des coupes histologiques des artères recueillies 14 jours après l'angioplastie a permis de calculer la lumière vasculaire et l'épaisseur néointimale moyenne. Ces calculs démontrent une réduction de la resténose dans le groupe traité avec le losartan lorsque comparé au groupe contrôle. Cette réduction de la resténose est égale à celle observée avec la combinaison de losartan et de PD123319. Le PD123319 seul n'a pas reéduit la resténose de façon significative. Il semble alors que le récepteur AT[indice inférieur 1] de l'angiotensine II soit responsable en partie de la resténose post-angioplastique chez le rat Sprague-Dawley. Le récepteur AT[indice inférieur 2] de l'angiotensine II ne semble pas être impliqué de façon significative dans ce processus.
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Lalli, Dominic. "Cycle-to-cycle control of the angioplasty balloon fabrication process." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=98984.
Testo completoAbstract (sommario):
The development of a new angioplasty balloon from a new material can be a long and arduous process that may take months. These balloons must meet some very stringent requirements such as high rated burst pressure with minimal wall thickness. The purpose of this thesis is to help reduce the amount of time invested in the experimental development stages of these medical balloons. This can be achieved with the aid of a cycle-to-cycle controller. The controller presented here may be simplistic, but it has shown that with further testing and modeling, it has the potential to completely replace the trial-and-error method of balloon development in use today.
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Lima, Fernanda Maria Alves [UNESP]. "Avaliação de qualidade de vida de pacientes submetidos à angioplastia coronariana e elaboração de material educativo." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/108570.
Testo completoAbstract (sommario):
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000755387.pdf: 1160194 bytes, checksum: 3145a576f405187837125d87e9f158ba (MD5)<br>As doenças cardiovasculares permanecem como a principal causa de mortes no mundo, com destaque para a doença arterial coronariana. A angioplastia coronariana transluminal percutânea é um dos métodos mais comumente utilizados para o tratamento da mesma. Avanços tecnológicos possibilitaram a realização de procedimentos mais seguros e com reduzida permanência no ambiente hospitalar. Entretanto, ainda há a necessidade de intervenções educativas em relação aos fatores de risco modificáveis que contribuam para mudanças comportamentais, adesão ao tratamento e melhoria da qualidade de vida relacionada à saúde. Este estudo buscou avaliar a qualidade de vida relacionada à saúde em pacientes submetidos à angioplastia coronariana transluminal percutânea, utilizando-se as variáveis do questionário SF-36, e desenvolver folhetos explicativos sobre a angioplastia coronariana e sobre hábitos saudáveis de vida. Foram incluídos 45 pacientes internados na enfermaria de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP e que realizariam o procedimento pela primeira vez. A coleta de dados ocorreu em dois momentos no período de Janeiro a Maio de 2012. Os pacientes foram avaliados quanto à qualidade de vida antes (M1) e 30 a 40 dias após a angioplastia coronariana (M2). Foram elaborados folhetos explicativos sobre ACTP e sobre hábitos saudáveis de vida, que auxiliaram na orientação destes pacientes. Os participantes tinham em média 60,8 anos, eram predominantemente do sexo masculino (60%) e possuíam baixa escolaridade (média de 5,1 anos de estudo). Dentre os principais fatores de risco e comorbidades destacaram-se a hipertensão arterial sistêmica (77,8%), sedentarismo (71,1%) e dislipidemia (60%). As medianas dos escores do SF-36 foram maiores no M2, com diferenças estatisticamente significantes em todos os domínios, exceto Aspectos Emocionais. Os pacientes referiram que as orientações ...<br>Cardiovascular diseases remain as the leading cause of death worldwide, especially the coronary artery disease. Percutaneous transluminal coronary angioplasty (PTCA) is one of the most commonly used methods for treating such disease. Technological advances have made possible to perform safer procedures with reduced stay in the hospital. However, educational interventions are still needed concerning modifiable risk factors that lead to behavioral changes, treatment adherence, and better quality of life in terms of health. This study aimed at assessing the quality of life in terms of health in patients submitted to percutaneous transluminal coronary angioplasty by using the variables of the SF-36 questionnaire and developing leaflets on coronary angioplasty and healthy lifestyles. Forty-five patients hospitalized in Botucatu Medical School Hospital – UNESP who were undergoing the procedure for the first time were included in the study. The data collection occurred twice from January to May 2012. The patients were evaluated regarding their quality of life before the coronary angioplasty (M1) and from 30 to 40 days after it (M2). Leaflets on PTCA and healthy lifestyles were designed to assist guiding such patients. The participants were in average 60.8 years old, mainly male (60%), and had low educational backgroun (in average, 5.1 years of study). Among the key risk and comorbidity factors were systemic hypertension (77.8%), sedentarism (71.1%), and dyslipidemia (60%). The average scores of the SF-36 were higher at M2, with statistically significant differences in all domains except in the Emotional Aspects. The patients related that the guidance offered, together with the leaflets, were highly important because not only did they clarify many doubts, but they also aided in several changes in their health habits, such as reduction in their intake of deep-fried foods/fatty meat (53.3%) and reduction of salt in their food ...
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Braga, André Felipe Farias. "Estudo do tratamento endovascular para a estenose de artéria renal em rim transplantado." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-29032018-102832/.
Testo completoAbstract (sommario):
Introdução: O transplante renal é a terapia substitutiva de escolha para a insuficiência renal crônica. O número absoluto de transplantes renais vem aumentando mundialmente e consequentemente as complicações deste procedimento têm sido evidenciadas com maior recorrência, dentre elas a estenose na artéria renal transplantada. A técnica endovascular vem mostrando bons resultados iniciais, com boa taxa de perviedade e baixa taxa de complicações pósoperatórias quando comparadas a técnica aberta para tratamento da estenose. O objetivo deste estudo foi avaliar os resultados primários da angioplastia da artéria renal do rim transplantado secundário a processo de re-estenose. Métodos: Realizado estudo retrospectivo no período de setembro de 2009 a outubro de 2015, baseado em protocolos de seguimento pós-transplante com perfil dos pacientes submetidos a tratamento por estenose em artéria de rim transplantado e o seguimento em curto prazo com critérios clínicos, laboratoriais e ultrassonográficos. Resultados: Dentre um total de 391 transplantes, 19 pacientes foram diagnosticados com Estenose na Artéria renal transplantada. Evidenciado um tempo médio entre o transplante e o diagnóstico de 172,6 dias. As estenoses ou acotovelamentos com alterações hemodinâmicas foram evidenciadas na anastomose (47%), no terço proximal (35%) e terço médio (18%) da artéria transplantada. Todos os pacientes foram submetidos a angioplastia com balão e posicionamento de stent metálico com sucesso técnico de 94,7 %. A creatinina média evoluiu de 3,63 mg/dl para 2,69 mg/dl em 24h e para 1,81 mg/dl em 30 dias (p<0.05). A taxa de filtração glomerular melhorou de 32,66 ml/min para 41,61 ml/min após 24 horas e 51,05 ml/min após 30 dias (p<0.05). Os critérios ultrassonográficos avaliados de velocidade da artéria renal e índice reno-iliaco (368,9 cm/seg e 3,71 pré angioplastia) normalizaram e se estabilizaram durante o período estudado (211,45 cm/seg e 1,69 90 dias pós angioplastia; p<0.05). Conclusão: A abordagem endovascular utilizando de angioplastia primária e colocação de stent metálico foi segura com boa uma taxa de sucesso técnico. O procedimento foi efetivo na melhora da função renal do enxerto transplantado e na correção das alterações ultrassonográficas evidenciadas no pré-operatório.<br>Introduction: Renal transplantation is the substitutive therapy of choice for chronic renal failure. The absolute number of renal transplants has increased worldwide and consequently the complications of this procedure have been evidenced with greater recurrence, among them stenosis in the transplanted renal artery. The endovascular technique has shown good initial results, with good patency rate and low rate of postoperative complications when compared to the open technique for stenosis treatment. The aim of this study was to evaluate the primary results of ATP from the renal artery of the transplanted kidney secondary to the restenosis process. Methods: A retrospective study was carried out from September 2009 to October 2015, based on post-transplant follow-up protocols with a profile of patients submitted to stenosis in a transplanted kidney artery and a short-term follow-up with clinical, laboratory and ultrasonographics criteria. Results: Out of a total of 391 transplants, 19 patients were diagnosed with transplanted renal artery stenosis. An average time between transplantation and the diagnosis of 172.6 days was evidenced. Stenting or flexing with hemodynamic changes were evident in the anastomosis (47%), in the proximal third (35%) and the middle third (18%) of the transplanted artery. All patients underwent balloon angioplasty and metallic stent placement with technical success of 94.7%. Mean creatinine increased from 3.63 mg / dL to 2.69 mg / dL in 24 hours and to 1.81 mg / dL in 30 days (p <0.05). The glomerular filtration rate improved from 32.66 ml / min to 41.61 ml / min after 24 hours and 51.05 ml / min after 30 days (p <0.05). The ultrasound criteria evaluated for renal artery velocity and reno-iliac index (368.9 cm / sec and 3.71 pre angioplasty) normalized and stabilized during the study period (211.45 cm / sec and 1.69 Angioplasty, p <0.05). Conclusion: The endovascular approach using primary angioplasty and stent placement was safe with good technical success rate. The procedure was effective in improving the renal function of the transplanted graft and in correcting the ultrasound changes evidenced in the preoperative period.
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Ignacio, Daniela Sarreta. ""Ansiedade e angioplastia coronária transluminal percutânea (ACTP): uma contribuição para a enfermagem"." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-11082004-131822/.
Testo completoAbstract (sommario):
Estudo descritivo, desenvolvido por método de estudo de caso, de múltiplos casos, enfocando o fenômeno da ansiedade. Objetivos: identificar a presença e quantificar o nível de ansiedade em cardíacos isquêmicos antes e após, dez minutos, das orientações ao procedimento de angioplastia coronariana transluminal percutânea (ACTP); mensurar o nível de ansiedade desses clientes, dez minutos antes do indivíduo entrar em sala de procedimentos para sua realização, e identificar a presença de sintomas de ansiedade. Aprovado pelo Comitê de Ética em Pesquisa, com coleta de dados realizada por demanda espontânea conforme conveniência do pesquisador. A amostra compôs-se de vinte sujeitos cardíacos isquêmicos, adultos, encaminhados via Sistema Único de Saúde ao primeiro procedimento de ACTP. Composto por observação participativa e três momentos de mensuração da pressão arterial, freqüência cardíaca e respiratória e aplicação do Inventário de Ansiedade TraçoEstado de Spielberger (IDATE) para Estado, no primeiro momento também foi aplicado o IDATETraço. Para obtenção dos resultados aplicou-se métodos de análise estatística simples. Os resultados encontrados foram que a pressão arterial sistólica se manteve acima dos valores limites, segundo a Sociedade Brasileira de Cardiologia, nas três etapas em mais de 60% dos casos, sendo realizado o tratamento anti-hipertensivo; os padrões observados para freqüência cardíaca se mantiveram na faixa de normalidade para 85% dos casos, porém, em 70% dos casos faziam-se uso associado de betabloqueadores; a freqüência respiratória mostrou-se ascendente durante o evoluir das etapas, com taquipnéia em 50% dos casos no segundo momento e em 70% no terceiro momento. Os valores, segundo categorização do IDATE, tiveram as médias do estado de ansiedade em faixa moderada nos três momentos, sendo que entre o segundo e terceiro momentos houve variação de, mais ou menos, seis pontos, levando alguns clientes ao nível elevado. Para ansiedade traço a faixa também foi moderada. As orientações de enfermagem realizadas por cinco profissionais diferentes produziu, em 60% dos clientes, aumento da pontuação do IDATE, sendo percebido e relatado por alguns como aumento do nervosismo após as orientações. O conteúdo das observações demonstra que comportamentos característicos à ansiedade foram mantidos em todos os clientes, tendo maior número e variedade sem relação ao tempo de espera. Conclui-se que a ansiedade, provocada pela ACTP, já vem alterada (moderada), mantendo-se ou agravando-se ao longo da espera, e as orientações de enfermagem não produzem a redução da ansiedade, em alguns casos a eleva mais. Mesmo utilizando medicações anti-hipertensivas, os clientes desenvolvem hipertensão leve a severa, acompanhada por elevação da freqüência respiratória e manutenção da freqüência cardíaca na normalidade nos três momentos. O ambiente ao qual o indivíduo é exposto contribui para desencadear ansiedade, agravando-a também. Considera-se a amostra do estudo pequena, permitindo apenas a generalização naturalística. Expôs-se a realidade vivida pelo cardíaco, suscitando novos questionamentos e demonstrando a necessidade de intervenções ambientais locais. Espera-se com este trabalho o desencadear de outros estudos com populações maiores, aprofundando-se na compreensão da ansiedade.<br>This descriptive study was developed by mens of the case study method, of various cases, focusing the anxiety phenomena. Goals: identify the presence and qualify the level of anxiety in ischemic cardiac patients before and after (ten minutes) giving out instructions about the procedure of the percutaneous transluminal corornary angioplasty (PTCA); measure the level of anxiety of these clients ten minutes before they entered in the procedure room for itscompletion. The Research EthicsCommittee approved this study, and data collection was performed through spontaneous demand according to researchers convenience. The sample: considered of twenty ischemic cardiac patients, all adults, which had been forwarded by the Single Health Sistem for the first PTCA proceduce. The study was compound which a structured partivipative observation and three moments for measuring arterial pressure, cardiac and respiratory frequency, and the application of Spielbergers (STAXI) State-Trait Anxiety Inventory. In the first moment there was also the application of the STAXI-Trait. Methods of simple statistical analisys were used to obtain the results. Results: showed that the sytolic arterial pressure was maintained above limit values, according to the Cardiology Brazilian Society, in all threee moments for more than 60% of the cases, anti-hypertensive treatment was performed; the observed satandarts for cardiac frequency were kept within the normality rank for 85% of the cases, however, 70% of the individuals form the sample made use of beta-blockers; the respiratory frequency showed to rise during the evolutionof the moments. With increased respitation rate in 50% of the cases in the second moment and 70% in the third. The values, according to the score and categorization of STAXI, had the measures of state of anxiety in a moderate rank in the three moments, being that there was a variation between the sencond and third moments of up to approximately six points, whichled some clientsto wrong level. For trait anxiety, the rank was also moderate. The nursing instructions were performed by five different professionals and produced an increase of STAXI pontuaction in 60% of the clients. This was obseved and reported by someas an increase of nervousness after the instruction. The content of the observations shows that the characteristic behaviors related to anxiety were maintained in all clients, with a higher number and variety disproportional to the waiting time. The study allows us to conclude that the anxiety caused by PTCA is already altered (moderate), and is kept at this level or worsens during the waiting period, and the nursisng instructions do not make this anxiety decrease, and, in some cases, it even increase. Despite using anti-hypetensive medication, the clientdevelop slight to severe hypertension accompained by an elevation of respiratory frequency and maintenance of cardiac frequency at normal rates from the first to the third moment. The environment to which the individual is exposed contributes to the manifestation of anxiety, worsening it was well. The studys sample is considerate to be small, allowing only the naturalistic generalization. The realy experienced by cardiac patient has been exposed, raising new questionings and showing the need for local environmental interventions. It is hoped to, throught this study, incite new studieswith larger populations, increasing the comprehension of anxiety.
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Guimarães, Thiago Adriano Silva. "Estudo do perfil inflamatório de pacientes submetidos à angioplastia transluminal percutânea periférica com stents de nitinol revestidos de politetrafluoretileno através das citocinas séricas IL-1b IL-6, IL-8, IL-10, TNF-a e TGF-b." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-26042018-154751/.
Testo completoAbstract (sommario):
Introdução: A angioplastia transluminal periférica com o uso de stents revestidos tem se tornado uma opção viável para o tratamento da doença arterial obstrutiva em casos específicos, principalmente na região fêmuro-poplítea, apesar da incidência significativa de reestenose com papel importante do processo inflamatório. As citocinas são proteínas secretadas pelas células da imunidade natural e adquirida e participam de forma fundamental no processo inflamatório local e sistêmico. Objetivo: Avaliar as concentrações séricas de IL-1?, IL-6, IL-8, IL-10, TNF-?, TGF-?1e PCR, além do colesterol total e leucometria antes e após o implante de stents revestidos e a possível associação com a reestenose precoce em pacientes com doença arterial periférica fêmoropoplítea. População e método: Foram recrutados 38 pacientes consecutivos do ambulatório de Cirurgia Vascular e Endovascular do HCFMRP-USP com indicação de angioplastia transluminal periférica nos quais foram utilizados stents revestidos no segmento fêmoro- poplíteo para tratamento de doença arterial obstrutiva periférica aterosclerótica. Todos os pacientes foram acompanhados com exames clínicos e de ultrassom Doppler durante até seis meses após o procedimento com dosagens séricas de citocinas, além da proteína C reativa, colesterol total e hemograma. Foi considerado reestenose estreitamentos maiores que 50% do lúmen do vaso, mensurados, inicialmente, pelo ultrassom e confirmado através da arteriografia. Resultados: Dentre os 27 pacientes que foram incluídos no estudo, 23 não apresentaram reestenose (85,2%) e quatro casos evoluíram com reestenose precoce (14,8%). Nenhuma das citocinas estudadas - IL-1?, IL-6, IL-8, IL-10, TNF-? e TGF-? - mostrou correlação com a reestenose (p>0.05). Também não houve correlação do processo de reestenose com a proteína C reativa, colesterol total ou a leucometria (p>0.05). O índice tornozelo-braquial mostrou boa correlação com a evolução clínica dos pacientes. Conclusão: O perfil inflamatório de pacientes submetidos à angioplastia transluminal percutânea periférica com stents de nitinol revestidos de politetrafluoretileno avaliado através das citocinas séricas IL-1?, IL-6, IL-8, IL-10, TNF-? e TGF-? mostrou significativo aumento das citocinas pró-inflamatórias logo após o procedimento. Não houve correlação de nenhuma das interleucinas estudadas ou ainda da proteína C reativa com o processo de reestenose.<br>Introduction: The peripheral transluminal angioplasty with the use of coated stents has become a viable option for the treatment of obstructive arterial disease in specific cases, mainly in the femoral-popliteal region, despite the significant incidence of restenosis with important role of the inflammatory process. Cytokines are proteins secreted by cells of natural and acquired immunity and participate in a fundamental way in the local and systemic inflammatory process. Objective: To evaluate the serum concentrations of IL-1?, IL-6, IL-8, IL-10, TNF-?, TGF-?1 and PCR, as well as total cholesterol and leucometry before and after the implantation of coated stents and the possible association with early restenosis in patients with peripheral femoralpopliteal arterial disease. Population and method: 38 consecutive patients from the outpatient clinic of vascular and endovascular surgery of the HCFMRP-USP were recruited with indication of peripheral transluminal angioplasty in which the stent was coated in the femoropopliteal segment for the treatment of atherosclerotic peripheral obstructive arterial disease. All patients were followed up with clinical examinations and Doppler ultrasound for up to six months after the procedure with serum levels of cytokines, as well as C-reactive protein, total cholesterol and hemogram. It was considered restenosis narrowings greater than 50% of vessel lumen, measured, initially, by the ultrasound and confirmed by arteriography. Results: Of the 27 patients included in the study, 23 did not present restenosis (85.2%) and four cases evolved with early restenosis (14.8%). None of the cytokines studied - IL-1?, IL-6, IL-8, IL-10, TNF-? and TGF-? - showed a correlation with restenosis (p> 0.05). There was also no correlation of the restenosis process with the C-reactive protein, total cholesterol or leucometry (p> 0.05). The ankle-brachial index showed a good correlation with the clinical evolution of the patients. Conclusions: The inflammatory profile of patients undergoing peripheral percutaneous transluminal angioplasty with polytetrafluoroethylene-coated nitinol stents evaluated through the serum cytokines IL-1?, IL-6, IL-8, IL-10, TNF-? and TGF-? showed a significant increase in proinflammatory cytokines soon after the procedure. There was no correlation of any of the interleukins studied or the C-reactive protein with the restenosis process.
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Lima, Fernanda Maria Alves. "Avaliação de qualidade de vida de pacientes submetidos à angioplastia coronariana e elaboração de material educativo /." Botucatu, 2013. http://hdl.handle.net/11449/108570.
Testo completoAbstract (sommario):
Orientador: Janete Pessuto Simonetti<br>Banca: Silmara Meneguin<br>Banca: Rosana Aparecida Spadoti Dantas<br>Resumo: As doenças cardiovasculares permanecem como a principal causa de mortes no mundo, com destaque para a doença arterial coronariana. A angioplastia coronariana transluminal percutânea é um dos métodos mais comumente utilizados para o tratamento da mesma. Avanços tecnológicos possibilitaram a realização de procedimentos mais seguros e com reduzida permanência no ambiente hospitalar. Entretanto, ainda há a necessidade de intervenções educativas em relação aos fatores de risco modificáveis que contribuam para mudanças comportamentais, adesão ao tratamento e melhoria da qualidade de vida relacionada à saúde. Este estudo buscou avaliar a qualidade de vida relacionada à saúde em pacientes submetidos à angioplastia coronariana transluminal percutânea, utilizando-se as variáveis do questionário SF-36, e desenvolver folhetos explicativos sobre a angioplastia coronariana e sobre hábitos saudáveis de vida. Foram incluídos 45 pacientes internados na enfermaria de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP e que realizariam o procedimento pela primeira vez. A coleta de dados ocorreu em dois momentos no período de Janeiro a Maio de 2012. Os pacientes foram avaliados quanto à qualidade de vida antes (M1) e 30 a 40 dias após a angioplastia coronariana (M2). Foram elaborados folhetos explicativos sobre ACTP e sobre hábitos saudáveis de vida, que auxiliaram na orientação destes pacientes. Os participantes tinham em média 60,8 anos, eram predominantemente do sexo masculino (60%) e possuíam baixa escolaridade (média de 5,1 anos de estudo). Dentre os principais fatores de risco e comorbidades destacaram-se a hipertensão arterial sistêmica (77,8%), sedentarismo (71,1%) e dislipidemia (60%). As medianas dos escores do SF-36 foram maiores no M2, com diferenças estatisticamente significantes em todos os domínios, exceto Aspectos Emocionais. Os pacientes referiram que as orientações ...<br>Abstract: Cardiovascular diseases remain as the leading cause of death worldwide, especially the coronary artery disease. Percutaneous transluminal coronary angioplasty (PTCA) is one of the most commonly used methods for treating such disease. Technological advances have made possible to perform safer procedures with reduced stay in the hospital. However, educational interventions are still needed concerning modifiable risk factors that lead to behavioral changes, treatment adherence, and better quality of life in terms of health. This study aimed at assessing the quality of life in terms of health in patients submitted to percutaneous transluminal coronary angioplasty by using the variables of the SF-36 questionnaire and developing leaflets on coronary angioplasty and healthy lifestyles. Forty-five patients hospitalized in Botucatu Medical School Hospital - UNESP who were undergoing the procedure for the first time were included in the study. The data collection occurred twice from January to May 2012. The patients were evaluated regarding their quality of life before the coronary angioplasty (M1) and from 30 to 40 days after it (M2). Leaflets on PTCA and healthy lifestyles were designed to assist guiding such patients. The participants were in average 60.8 years old, mainly male (60%), and had low educational backgroun (in average, 5.1 years of study). Among the key risk and comorbidity factors were systemic hypertension (77.8%), sedentarism (71.1%), and dyslipidemia (60%). The average scores of the SF-36 were higher at M2, with statistically significant differences in all domains except in the Emotional Aspects. The patients related that the guidance offered, together with the leaflets, were highly important because not only did they clarify many doubts, but they also aided in several changes in their health habits, such as reduction in their intake of deep-fried foods/fatty meat (53.3%) and reduction of salt in their food ...<br>Mestre
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Kunadian, Babu. "Evolution of treatment for patients with acute myocardial infarction : a single centre experience of thrombolysis with rescue angioplasty moving to a comprehensive primary angioplasty service." Thesis, University of Newcastle Upon Tyne, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.576647.
Testo completoAbstract (sommario):
Early restoration of infarct-related artery (IRA) blood flow and myocardial perfusion in patients with acute STEMI is associated with preservation of left ventricular function, myocardial salvage and reduction in mortality (GUSTO, 1993, FTT -Group, 1994, Berger et al., 1999, Cannon et al., 2000, De Luca et al., 2004, Shavelle et al., 2005, Brodie et al., 2006). Wider implementation of PPCI in the UK is limited by different geography and demography of the patients presenting with STEMI. There are difficulties in initiating a PPCI service and delivering therapy within recommended timelines. This has been due mainly to lack of facilities and trained staff, uncertainties about the cost-effectiveness of the strategy and difficulties in changing established practice. The widespread introduction of PPCI would have major implication for the reorganisation of health care provision. The primary aim of this thesis is the evaluation of a reorganisation of service from one based on thrombolysis (including a rescue angioplasty service) to a PPCI service at The lames Cook University Hospital for patients with acute myocardial infarction. The long-term outcomes of rescue PCI (rPCI), its use in high-risk groups, and an analysis of the predictors of failed rPCI procedures, form the basis of the first part of this thesis. Additional analysis reflects the change from one pathway of service delivery to another with the development of a PPCI service.
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Löfberg, Anne-Marie. "Infrainguinal Percutaneous Transluminal Angioplasty in Limbs with Severe Lower Limb Ischaemia." Doctoral thesis, Uppsala University, Department of Oncology, Radiology and Clinical Immunology, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1419.
Testo completoAbstract (sommario):
<p>Infrainguinal bypass grafting is an established method in the treatment of patients with femoropopliteal and crural occlusive disease leading to critical lower limb ischaemia (CLI). However, complications related to surgical procedure are not negligible and percutaneous transluminal angioplasty (PTA) has emerged as an alternative. The present thesis covers some aspects of infrainguinal PTA in patients with chronic severe lower limb ischaemia.</p><p>The records of 217 patients undergoing 272 PTA procedures at various infrainguinal arterial segments were analysed. The indication for intervention was subcritical ischaemia in 76 limbs and critical ischaemia in 177 limbs. The role of duplex ultrasound examination in the selection of patients for PTA was retrospectively evaluated following a prospective validation of the method against angiography.</p><p>A technically successful PTA was achieved in 89%. The overall 30-day mortality was 2.7%. No patient underwent amputation directly related to failed PTA. The primary success rates at 12 and 60 months following femoropopliteal PTA were 40% and 27% compared, to 51% and 36% in limbs undergoing crural artery PTA. Primary success rate in limbs with SFA occlusion longer than 5 cm was only 12% after 5 years, compared to 32% if the occlusion was equal or less than 5 cm in length (p<0.01). In patients undergoing distal PTA through patent infrainguinal grafts, the primary and primary assisted patency rates at 3 years were 32% and 53%, respectively. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared to the superficial femoral arteries.</p><p>In conclusion, the results of infrainguinal PTA performed for treatment of subcritical or CLI seemed to be inferior to the results of surgical interventions reported in the literature. However, due to the fact that the PTA procedure does not preclude the performance of bypass grafting, it might be an alternative to surgical intervention in limbs with stenotic or short occlusive lesions.</p>
25
Jensen, Jens. "On-line vectorcardiography during coronary angioplasty and unstable coronary artery disease /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4357-5/.
Testo completo
26
Patel, Billal. "The contribution of inflammatory mechanisms to microvascular injury in coronary angioplasty." Thesis, University of Liverpool, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569257.
Testo completoAbstract (sommario):
Coronary angioplasty is established as the most common form of revascularisation in IHD, yet despite major advances, failure of microvascular revascularisation is associated with poor prognosis. Inflammation is important in the natural progression of atherosclerosis from early stages through to progression to plaque rupture and acute myocardial infarction. In addition inflammatory mechanisms have a role in mediating adverse clinical outcomes during coronary reperfusion and revascularisation, although the underlying mechanisms remain unknown. The objective of this research was to assess the microvascular response to percutaneous coronary intervention (PCI) in patients with stable angina, and this study aimed to assess the relationship between changes in microvascular function in response to PCI with markers of systemic inflammation and endothelial activation. Also we aimed to detect localised myocardial inflammation in response to PCI in those patients who have microvascular injury following PCI. We measured fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in both the vessel undergoing PCI and an adjacent vessel, before and after PCI. We assessed the inflammatory response to PCI and the relationship between markers of systemic inflammation and microvascular function. A subgroup of 9 patients underwent radiolabelling of leukocytes and myocardial SPECT scans before and after PCI to detect areas of localised inflammation. A total of 39 patients were included in the study. Patients demonstrated a heterogenous response on IMR following PCI. There was an increase of microvascular resistance in the vessel undergoing PCI in a third of subjects. There was a reduction of IMR in the reference vessel in response to PCI in the target vessel (23.7[15.8-31.4] vs. 17.9[12.4-24.1] n=34 p<0.01) Basal inflammation was not predictive of microvascular dysfunction but the inflammatory response as measured by CRP and ET -1 was associated with microvascular dysfunction (R=0.42 p<O.05, R=O.34 p<O.05 n=35) respectively. A low pre procedural IMR was strongly predictive of an increase in microvascular resistance post PCI (R=0.73 P<0.001). Finally no areas of increased inflammation were detected on myocardial SPECT scanning. In summary it is the inflammatory response rather than basal levels of inflammation which seem to be associated with microvascular dysfunction and we see a novel reduction in IMR in the reference vessel in response to PCI in the target vessel.
27
Benn, Lisa. "Psychological recovery following coronary angioplasty : illness cognitions, coping and well-being." Thesis, University of Leicester, 2006. http://hdl.handle.net/2381/7936.
Testo completoAbstract (sommario):
Aim: To investigate the nature of psychological adjustment following angioplasty and to assess the relative contributions of illness cognitions and coping in the context of the Self-Regulation Model (Leventhal, Meyer & Nerenz, 1980). Design: A longitudinal, prospective within-groups, multi-factorial study. Method: 120 participants were recruited from an opportunity sample of patients approached during admission to the Manchester Heart Centre for angioplasty. Questionnaires addressing illness beliefs, coping and psychological outcomes were presented at two time points; during admission and three months post-procedure. Results: Analysis revealed that angioplasty is followed by clinically and statistically significant psychological gains. Perceptions of the illness as serious, and having a cyclical time-course, together with a general difficulty in making sense of the illness, were associated with increased anxiety at the time of treatment, and in most cases also at three months. Higher levels of emotional representation were also strongly associated with anxiety and quality of life outcomes at both time points. Problem-focused and maladaptive coping also showed associations with psychological outcome at treatment and at three months. Illness beliefs were demonstrated to significantly predict psychological well-being, explaining a substantial proportion of variance, with emotional representation the strongest independent predictor. Coping was not found to mediate the relationship between illness beliefs, and psychological distress and quality of life. Conclusion: This research has demonstrated the utility of illness beliefs, and to an extent the Self Regulation Model in predicting psychological outcome in angioplasty. Cognitive factors may therefore serve as useful clinical indicators to help identity those patients at greatest risk of impaired recovery, which in the future may enable targeting with further support, and evidence permitting, psychological interventions. [Abstract taken from Section B: Research Report (Option 1)]
28
Saxena, Vishal 1971. "The dynamics of angioplasty : effects of vascular bed and lesion morphology." Thesis, Massachusetts Institute of Technology, 2001. http://hdl.handle.net/1721.1/89310.
Testo completo
29
Pai, Mahesh Laxman. "Endovascular photodynamic therapy for preventing post-angioplasty and in-stent restenosis." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1445860/.
Testo completoAbstract (sommario):
Cardiovascular disease is the commonest cause of death in the western world and atherosclerosis is the commonest cause of cardiovascular disease. It is characterised by the deposition of intra-luminal plaque leading to arterial stenosis. Balloon angioplasty offers a minimally invasive method of dilating peripheral and coronary arterial stenosis. The results of angioplasty are improved by stenting. However, a significant percentage of these patients have restenosis of their arteries with clinical and resource implications. Restenosis is caused by neointimal hyperplasia (NIH) and negative remodelling the combined effects of which result in vessel re-narrowing. It has previously been shown in animal models that photodynamic therapy (PDT) reduces the restenosis when used as an adjuvant to angioplasty. PDT involves the interaction of light at a particular wavelength with a pre-administered photosensitive agent to produce cell death by apoptosis in the presence of oxygen. The aims of this thesis are two fold. 1. to optimise the effects of PDT in preventing in-stent restenosis 2. to conduct a randomised controlled trial to show the clinical benefits of PDT in preventing post-angioplasty restenosis.
30
Craft, Judy Ann. "Potential involvement of Platelet-Derived microparticles during percutaneous transluminal coronary angioplasty." Thesis, Queensland University of Technology, 2004. https://eprints.qut.edu.au/15946/1/Judy_Craft_Thesis.pdf.
Testo completoAbstract (sommario):
Coronary artery disease is a leading cause of morbidity and mortality in developed countries. Percutaneous transluminal coronary angioplasty (PTCA) is an important treatment option when intervention is required; namely for patients with relatively severe occlusions. However, adverse events including recurrence of angina pectoris and restenosis of the treated artery limit patient prognosis, with subsequent re-vascularisation often necessary. Platelet activation accompanies PTCA, with platelet adhesion and aggregation involved in thrombus formation during restenosis. During platelet activation, highly coagulant platelet-derived microparticles (PMPs) are formed, and it is likely that these PMPs will also be produced during PTCA. While platelet aggregation inhibitors used during PTCA limit platelet aggregation and decrease the incidence of restenosis, they do not prevent PMPs being formed. PMPs are capable of adhesion and aggregation, and adhere to PTCA treated arteries in an animal model. Therefore, in order to understand the phenomenon of restenosis and its improved limitation, it is necessary to investigate PMP formation during PTCA.
The field of PMP study is in its infancy, with conflicting results from the substantial inequities in methods of PMP measurement, which may be exacerbated by PMP heterogeneity. The current literature on this topic is reviewed in Chapter 2, where the PMP surface and possible functions are considered, and the PMP size and morphology examined. To conclude, the relationship between PMPs and PTCA is explored, with a focus on the potential role of PMPs in restenosis. The knowledge deficiencies in this field are highlighted at the conclusion of this chapter.
Very little is known regarding the production of PMPs with PTCA. The level of PMPs during PTCA was monitored in paired arterial blood samples obtained from seventy-five patients undergoing the procedure (Chapter 3). A significant increase in PMPs from baseline to completion of PTCA was clearly demonstrated for the first time. This indicated that procoagulant PMPs are produced during PTCA and may contribute to subsequent restenosis. Furthermore, administration of the platelet aggregation inhibitor abciximab to a group of thirty-eight high risk patients limited PMP formation; given that abciximab patients required more rigorous PTCA, the protective benefit of this medication for PMP production is underlined. Although few patients in this study experienced restenosis, it is interesting to note that of those treated with abciximab, all patients suffering subsequent restenosis were revascularised using PTCA. This demonstrates that their occlusions were comparatively mild as the need for coronary artery bypass grafting was avoided, and suggests that minimisation of PMP levels may assist in limiting the progression of severe restenosis.
The increased peripheral level of PMPs predicated investigation of the coronary circulation to determine local events. Although the level of PMPs increased significantly within the coronary arteries of PTCA patients, there was no corresponding increase in the coronary sinus (Chapter 4). This important finding indicated that significant levels of PMPs remained within the coronary circulation, where their ability to adhere, aggregate and accelerate haemostasis may allow them to contribute directly to restenosis. During the time when increased levels of PMPs were being formed, there was no evidence of platelet lysis, which refuted the hypothesis that PMPs are merely membrane fragments of lysed platelets.
A wide variation in reported PMP sizes has contributed to the hypothesis that PMPs are heterogeneous. As morphological information can assist in understanding physiology, the final study was designed to investigate platelet morphology from PTCA patients (Chapter 5). Most platelets were activated prior to and following PTCA, with a slight decrease in body size occurring due to PTCA, presumably due to loss of cytoplasm in PMPs being shed as reported in the previous chapter. Importantly, platelet distal pseudopod buds were observed, and these did not alter significantly with PTCA. These buds were probably unformed PMPs, although the exact mechanism of PMP formation remains undetermined. The platelet pseudopods were longer and significantly thinner distally with PTCA, which may be due to movement of cytoplasm into these terminal swellings. In addition, buds or swellings directly on the platelet body were smaller following PTCA, and it is likely these may also be PMPs prior to detachment from the parent platelet.
This work has contributed substantially to knowledge of PMPs produced during PTCA. The level of PMPs increased significantly in peripheral arterial samples, with the platelet aggregation inhibitor abciximab preventing this occurrence. This may indicate that functional aggregation receptors are an essential requirement for PMP formation under these conditions. However, it is possible for PMPs to be formed when aggregation is inhibited, and therefore the molecular mechanisms of PMP formation remain unconfirmed. The examination of PMPs from the coronary circulation provided valuable data indicating that PMPs are produced during PTCA but remain within the coronary circulation. As PMPs are capable of adhesion and aggregation, this strongly suggests that PMPs within the coronary circulation would contribute directly to pathogenesis of restenosis, although further investigation on PMPs with PTCA is necessary to confirm this association. The examination of platelet morphology during PTCA indicated that platelets possessed terminal pseudopod swellings, and cell surface swellings. Importantly, the terminal swellings, which are likely to be unformed PMPs, were observed for the first time during PTCA.
31
Craft, Judy Ann. "Potential involvement of Platelet-Derived microparticles during percutaneous transluminal coronary angioplasty." Queensland University of Technology, 2004. http://eprints.qut.edu.au/15946/.
Testo completoAbstract (sommario):
Coronary artery disease is a leading cause of morbidity and mortality in developed countries. Percutaneous transluminal coronary angioplasty (PTCA) is an important treatment option when intervention is required; namely for patients with relatively severe occlusions. However, adverse events including recurrence of angina pectoris and restenosis of the treated artery limit patient prognosis, with subsequent re-vascularisation often necessary. Platelet activation accompanies PTCA, with platelet adhesion and aggregation involved in thrombus formation during restenosis. During platelet activation, highly coagulant platelet-derived microparticles (PMPs) are formed, and it is likely that these PMPs will also be produced during PTCA. While platelet aggregation inhibitors used during PTCA limit platelet aggregation and decrease the incidence of restenosis, they do not prevent PMPs being formed. PMPs are capable of adhesion and aggregation, and adhere to PTCA treated arteries in an animal model. Therefore, in order to understand the phenomenon of restenosis and its improved limitation, it is necessary to investigate PMP formation during PTCA. The field of PMP study is in its infancy, with conflicting results from the substantial inequities in methods of PMP measurement, which may be exacerbated by PMP heterogeneity. The current literature on this topic is reviewed in Chapter 2, where the PMP surface and possible functions are considered, and the PMP size and morphology examined. To conclude, the relationship between PMPs and PTCA is explored, with a focus on the potential role of PMPs in restenosis. The knowledge deficiencies in this field are highlighted at the conclusion of this chapter. Very little is known regarding the production of PMPs with PTCA. The level of PMPs during PTCA was monitored in paired arterial blood samples obtained from seventy-five patients undergoing the procedure (Chapter 3). A significant increase in PMPs from baseline to completion of PTCA was clearly demonstrated for the first time. This indicated that procoagulant PMPs are produced during PTCA and may contribute to subsequent restenosis. Furthermore, administration of the platelet aggregation inhibitor abciximab to a group of thirty-eight high risk patients limited PMP formation; given that abciximab patients required more rigorous PTCA, the protective benefit of this medication for PMP production is underlined. Although few patients in this study experienced restenosis, it is interesting to note that of those treated with abciximab, all patients suffering subsequent restenosis were revascularised using PTCA. This demonstrates that their occlusions were comparatively mild as the need for coronary artery bypass grafting was avoided, and suggests that minimisation of PMP levels may assist in limiting the progression of severe restenosis. The increased peripheral level of PMPs predicated investigation of the coronary circulation to determine local events. Although the level of PMPs increased significantly within the coronary arteries of PTCA patients, there was no corresponding increase in the coronary sinus (Chapter 4). This important finding indicated that significant levels of PMPs remained within the coronary circulation, where their ability to adhere, aggregate and accelerate haemostasis may allow them to contribute directly to restenosis. During the time when increased levels of PMPs were being formed, there was no evidence of platelet lysis, which refuted the hypothesis that PMPs are merely membrane fragments of lysed platelets. A wide variation in reported PMP sizes has contributed to the hypothesis that PMPs are heterogeneous. As morphological information can assist in understanding physiology, the final study was designed to investigate platelet morphology from PTCA patients (Chapter 5). Most platelets were activated prior to and following PTCA, with a slight decrease in body size occurring due to PTCA, presumably due to loss of cytoplasm in PMPs being shed as reported in the previous chapter. Importantly, platelet distal pseudopod buds were observed, and these did not alter significantly with PTCA. These buds were probably unformed PMPs, although the exact mechanism of PMP formation remains undetermined. The platelet pseudopods were longer and significantly thinner distally with PTCA, which may be due to movement of cytoplasm into these terminal swellings. In addition, buds or swellings directly on the platelet body were smaller following PTCA, and it is likely these may also be PMPs prior to detachment from the parent platelet. This work has contributed substantially to knowledge of PMPs produced during PTCA. The level of PMPs increased significantly in peripheral arterial samples, with the platelet aggregation inhibitor abciximab preventing this occurrence. This may indicate that functional aggregation receptors are an essential requirement for PMP formation under these conditions. However, it is possible for PMPs to be formed when aggregation is inhibited, and therefore the molecular mechanisms of PMP formation remain unconfirmed. The examination of PMPs from the coronary circulation provided valuable data indicating that PMPs are produced during PTCA but remain within the coronary circulation. As PMPs are capable of adhesion and aggregation, this strongly suggests that PMPs within the coronary circulation would contribute directly to pathogenesis of restenosis, although further investigation on PMPs with PTCA is necessary to confirm this association. The examination of platelet morphology during PTCA indicated that platelets possessed terminal pseudopod swellings, and cell surface swellings. Importantly, the terminal swellings, which are likely to be unformed PMPs, were observed for the first time during PTCA.
32
Hagemann, Rodrigo [UNESP]. "Efeito da revascularização renal sobre a evolução da disfunção renal na nefropatia isquêmica aterosclerótica." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/95180.
Testo completoAbstract (sommario):
Made available in DSpace on 2014-06-11T19:27:28Z (GMT). No. of bitstreams: 0
Previous issue date: 2013-02-01Bitstream added on 2014-06-13T20:36:03Z : No. of bitstreams: 1
000749110.pdf: 265185 bytes, checksum: beeca52368123635c1b6c8f7734321f5 (MD5)<br>A doença renal crônica (DRC) é caracterizada por uma perda progressiva da função renal e suas principais causas são hipertensão arterial sistêmica (HAS) e diabete melito. Entre as causas de HAS podemos destacar a doença renal aterosclerótica (DRA), que acomete principalmente idosos e muitas vezes não é diagnosticada. Existe uma alta incidência de complicações cardiovasculares em pacientes com DRA quando comparados com indivíduos da mesma idade, mas com artérias renais normais. Uma explicação seria a presença de aterosclerose em outros vasos, como artérias coronarianas e cerebrais. Outra hipótese seria o efeito deletério causado pela ativação do sistema renina angiotensina aldosterona secundária à isquemia renal. O desenvolvimento de DRC nos pacientes com DRA parece ser decorrente não apenas do acometimento das artérias renais principais, mas também da microcirculação renal, o que pode justificar o fato de o sucesso do procedimento não garantir uma melhora da evolução da DRC. Até o presente momento não existe evidência de benefício da angioplastia em relação ao tratamento clínico exclusivo nos pacientes com DRA. O presente trabalho procurou identificar algum subgrupo de pacientes com DRA que se beneficiaria da angioplastia com implante de endoprótese. Foram incluídos inicialmente 136 pacientes com diagnóstico arteriográfico de estenose de artéria renal superior a 60% do diâmetro do vaso uni ou bilateralmente, com idade superior a 18 anos identificados no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os critérios de exclusão foram: pacientes com menos de cinco medidas de creatinina antes ou após o procedimento, pacientes com estenose não aterosclerótica e aqueles submetidos a mais de uma angioplastia renal. Foi calculado o coeficiente de inclinação da reta de regressão do inverso da creatinina antes e após o procedimento angiográfico. Oitenta e quatro pacientes...<br>Chronic kidney disease (CKD) is characterized by an irreversible loss of kidney function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension, atherosclerotic renal disease (ARD) is one of them, which mainly affects the elderly and is often not diagnosed. There is a high incidence of adverse cardiovascular events in patients with ARD compared with individuals of the same age but with normal renal arteries. One explanation is the presence of atherosclerosis in other vessels. Another hypothesis is the deleterious effects caused by activation of the rennin angiotensin aldosterone system secondary to renal ischemia. The development of CKD in patients with ARD happens not only by the involvement of the main renal arteries, but also by the involvement of the microcirculation, what may explain the fact that the success of the procedure does not guarantee an improvement in the development of CKD. To date there is no evidence of benefit of angioplasty compared to medical treatment alone in patients with ARD. This study sought to identify a subgroup of patients with ARD that would benefit from angioplasty with stent implantation. We included 136 patients initially diagnosed with arteriographic renal artery stenosis greater than 60% of the vessel diameter uni-or bilaterally, aged over 18 years identified in the hospital of Botucatu Medical School. Patients with less than five measures of creatinine before or after the procedure, patients with no atherosclerotic stenosis and those subjected to more than one renal angioplasty were excluded from the study. Among the 136 patients, 52 were selected and divided into two groups. Group 1 consisted of patients with progressive worsening of renal function and group 2 patients with stable renal function. Patients from group 1 who underwent renal angioplasty formed the subgroup 1A and patients who didn’t formed the subgroup 1NA. The same ...
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Oliveira, Germano da Paz 1982. "Análise comparativa dos parâmetros adquiridos com o US doppler transcraniano durante a endarterectomia carotídea por semi-eversão e a angioplastia carotídea." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312480.
Testo completoAbstract (sommario):
Orientador: Ana Terezinha Guillaumon<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-24T11:44:57Z (GMT). No. of bitstreams: 1
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Previous issue date: 2014<br>Resumo: Objetivos: Analisar a distribuição temporal de sinais de microembolias (SM) ao longo de diferentes estágios da endarterectomia carotídea (EC) e da angioplastia carotídea (AC) e as variáveis associadas com a ocorrência destes sinais, além de avaliar as mudanças na velocidade média aferida na artéria cerebral média (ACM) durante os dois tipos de intervenção. Material e métodos: Trinta e três pacientes com estenose carotídea foram submetidos ou a EC (17) ou a AC (16). Os SM bem como as velocidades médias na ACM foram adquiridas utilizando o US doppler transcraniano (DTC) e esses dados então analisados e associados a diferentes estágios cirúrgicos (pré-proteção, durante a proteção e pós-proteção), tipos de intervenção (EC ou AC) e diferentes variáveis para encontrar potenciais fatores de risco para embolização. Para análise estatística, foram usados os testes de Qui-quadrado, de Fisher e de Mann-Whitney, além de análise por medidas repetidas das variâncias com transformação por postos (ANOVA), seguido de teste de perfil por contrastes e análise de regressão linear múltipla ajustada para o grupo. Resultados: Uma diferença significativa foi encontrada para o número de SM em ambos os grupos. Houve, em média, 89,8 (± 171,4) sinais por procedimento no grupo EC, enquanto a média no grupo AC foi de 597,5 (± 343,3) sinais por procedimento. A média da velocidade média na ACM foi, em ambos os grupos, significantemente menor no estágio durante a proteção. Anestesia local correlacionou-se positivamente (p=0,003) com aumento dos SM, e, associado a isso, o histórico de tabagismo importante (desde que houvesse a cessação do vício há mais de um ano) correlacionou-se negativamente (0,014) com a ocorrência de SM. Conclusão: EC por semi-eversão, à luz do DTC, provocou uma menor incidência de SM por procedimento do que AC com filtro distal, em todos os estágios cirúrgicos. A média da velocidade média na ACM se comportou de maneira similar em ambos os grupos (EC e AC). Anestesia geral e histórico de tabagismo importante (desde que o paciente houvesse cessado por menos um anos antes da intervenção) foram as únicas duas variáveis no estudo que se correlacionaram significativamente (negativamente) com a ocorrência de SM<br>Abstract: Objectives: To analyze the temporal distribution of microembolic signals throughout the different stages of both the semi-eversion carotid endarterectomy (CEA) and the carotid artery stenting (CAS) procedures and the variables associated with occurrence of them and to evaluate changes in mean blood flow velocity, for both CAS and CEA, within the ipsilateral middle cerebral artery (MCA). Methods: Thirty three patients with carotid stenosis underwent either a CEA (17) or a CAS (16). Microembolic signals, as well as mean blood flow velocity, were acquired using a Transcranial Doppler scan (TCD) and these data were then analyzed and associated to different surgical stages (pre-protection, during protection, and post-protection), types of procedure (CAS or CEA) and different variables to find potential risk factors. To statistical analysis, chi-squared test, Fisher test, Mann-Whitney test, repeated measures analysis of variance with rank transformation (ANOVA) followed by contrast test and multiple linear regression analysis were used. Results: A significant difference was found for the number of microembolic signals in both groups. There were, on average, 89.8 (± 171.4) signals per procedure in the CEA group, while the average in the CAS group was 597.5 (± 343.3) signals per procedure. The average blood flow in the MCA was, in both groups, significantly lower during the stage of protection. Local anesthesia correlated positively (p= .003) with increase in microembolic signals and history of prolonged tobacco use having dropped the addiction for over a year correlated negatively (p= -.014) with the frequency of microembolic signals. Conclusion: Semi-eversion CEA, in light of our TCD findings, evoked a smaller incidence of hyperintense microemboli per procedure than CAS with a distal filter in all the protection stages. The average of the mean blood flow velocity within the MCA has behaved similarly between both groups (CAS and CEA). General anesthesia and the history of tobacco use (as long as the patient had quit for a year or more prior to surgery) were the only two variables in the study that correlated significantly (negatively) with the frequency of microembolic signals<br>Mestrado<br>Fisiopatologia Cirúrgica<br>Mestre em Ciências
34
Hagemann, Rodrigo. "Efeito da revascularização renal sobre a evolução da disfunção renal na nefropatia isquêmica aterosclerótica /." Botucatu, 2013. http://hdl.handle.net/11449/95180.
Testo completoAbstract (sommario):
Orientador: Luis Cuadrado Martin<br>Coorientador: Vanessa dos Santos Silva<br>Banca: José Nery Praxedes<br>Banca: Fábio Cardoso de Carvalho<br>Resumo: A doença renal crônica (DRC) é caracterizada por uma perda progressiva da função renal e suas principais causas são hipertensão arterial sistêmica (HAS) e diabete melito. Entre as causas de HAS podemos destacar a doença renal aterosclerótica (DRA), que acomete principalmente idosos e muitas vezes não é diagnosticada. Existe uma alta incidência de complicações cardiovasculares em pacientes com DRA quando comparados com indivíduos da mesma idade, mas com artérias renais normais. Uma explicação seria a presença de aterosclerose em outros vasos, como artérias coronarianas e cerebrais. Outra hipótese seria o efeito deletério causado pela ativação do sistema renina angiotensina aldosterona secundária à isquemia renal. O desenvolvimento de DRC nos pacientes com DRA parece ser decorrente não apenas do acometimento das artérias renais principais, mas também da microcirculação renal, o que pode justificar o fato de o sucesso do procedimento não garantir uma melhora da evolução da DRC. Até o presente momento não existe evidência de benefício da angioplastia em relação ao tratamento clínico exclusivo nos pacientes com DRA. O presente trabalho procurou identificar algum subgrupo de pacientes com DRA que se beneficiaria da angioplastia com implante de endoprótese. Foram incluídos inicialmente 136 pacientes com diagnóstico arteriográfico de estenose de artéria renal superior a 60% do diâmetro do vaso uni ou bilateralmente, com idade superior a 18 anos identificados no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os critérios de exclusão foram: pacientes com menos de cinco medidas de creatinina antes ou após o procedimento, pacientes com estenose não aterosclerótica e aqueles submetidos a mais de uma angioplastia renal. Foi calculado o coeficiente de inclinação da reta de regressão do inverso da creatinina antes e após o procedimento angiográfico. Oitenta e quatro pacientes ...<br>Abstract: Chronic kidney disease (CKD) is characterized by an irreversible loss of kidney function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension, atherosclerotic renal disease (ARD) is one of them, which mainly affects the elderly and is often not diagnosed. There is a high incidence of adverse cardiovascular events in patients with ARD compared with individuals of the same age but with normal renal arteries. One explanation is the presence of atherosclerosis in other vessels. Another hypothesis is the deleterious effects caused by activation of the rennin angiotensin aldosterone system secondary to renal ischemia. The development of CKD in patients with ARD happens not only by the involvement of the main renal arteries, but also by the involvement of the microcirculation, what may explain the fact that the success of the procedure does not guarantee an improvement in the development of CKD. To date there is no evidence of benefit of angioplasty compared to medical treatment alone in patients with ARD. This study sought to identify a subgroup of patients with ARD that would benefit from angioplasty with stent implantation. We included 136 patients initially diagnosed with arteriographic renal artery stenosis greater than 60% of the vessel diameter uni-or bilaterally, aged over 18 years identified in the hospital of Botucatu Medical School. Patients with less than five measures of creatinine before or after the procedure, patients with no atherosclerotic stenosis and those subjected to more than one renal angioplasty were excluded from the study. Among the 136 patients, 52 were selected and divided into two groups. Group 1 consisted of patients with progressive worsening of renal function and group 2 patients with stable renal function. Patients from group 1 who underwent renal angioplasty formed the subgroup 1A and patients who didn't formed the subgroup 1NA. The same ...<br>Mestre
35
Kurbaan, Arvinder Singh. "The utility of coronary scoring systems in assessing the influence of immediate post revascularisation coronary disease and its interplay with coronary restenosis on the one year outcome of coronary revascularisation." Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343803.
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Bose, Jolly. "Percutaneous transluminal coronary angioplasty (PTCA) in the treatment of coronary artery disease in Hong Kong : procedural success, complications and long-term follow-up /." Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2084282X.
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Grainger, A. Patricia. "Perception of health, social support, and health-promoting behaviours of angioplasty patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq25846.pdf.
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Gray, Timothy J. "Inhibitory mechanisms by which suramin may attenuate neointimal formation after balloon angioplasty." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0028/MQ33951.pdf.
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Chen, Yan 1982. "Modeling and cycle-to-cycle control of the angioplasty balloon forming process." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112564.
Testo completoAbstract (sommario):
The development of a new angioplasty balloon is a time consuming process. This thesis aims at reducing the amount of time and materials spent on the experimental stage of the development of new angioplasty balloons. This can be achieved by building a nonlinear neural network model of the balloon forming process and implementing an off-line cycle-to-cycle controller. The controller can learn from the previous experiments and provide better input parameters for improving the quality of the next balloons formed in the process. It is shown in the experimental test results that the neural network model can provide accurate estimates of the process outputs. The neural network model combined with a cycle-to-cycle control strategy has the potential to replace the trial-and-error approach to balloon development that is commonly applied today.
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Groves, Peter H. "The influence of exogenous nitric oxide on the pathophysiology of angioplasty injury." Thesis, University of Newcastle Upon Tyne, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308763.
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Olbrich, Tom. "Measurement of mechanical wall properties from percutaneous transluminal coronary angioplasty balloon catheters." Thesis, University of Newcastle Upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248308.
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Smith, Elliot J. "Optimising coronary reperfusion in acute myocardial infarction : the role of primary angioplasty." Thesis, Queen Mary, University of London, 2007. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1791.
Testo completoAbstract (sommario):
Thrombolysis remains the predominant reperfusion strategy for ST segment elevation myocardial infarction (STEMI) in the United Kingdom. Although primary angioplasty may offer superior outcomes, the logistics of delivering this therapy in the UK have not been investigated. This thesis describes the development of a pilot primary angioplasty service in North East London. Outcomes are compared with the thrombolytic strategy, and platelet activation is explored as a possible biological mechanism determining reperfusion. The impact of the thrombolytic strategy on revascularisation following STEMI in North East London was first investigated. Thrombolytic delivery was effective, but necessitated frequent early revascularisation, leading to prolonged hospital stay. A primary angioplasty service was developed at the cardiac centre, and expanded to serve six network hospitals. Within the limitations of a daytime pilot, the service improved clinical outcomes, and was associated with a substantial reduction in hospital stay. Two admission strategies were compared - direct access to the cardiac centre following pre-hospital diagnosis by ambulance crews, and transfer of patients presenting to network emergency (A&E) departments after upstream administration of abciximab and clopidogrel. Direct access significantly reduced reperfusion times. Upstream anti-platelet therapy improved angiographic reperfusion prior to primary angioplasty, possibly compensating for inter hospital transfer delays. A subgroup of STEMI patients underwent platelet activation studies. Lower baseline platelet monocyte aggregate (PMA) levels predicted improved angiographic reperfusion following primary angioplasty, supporting the concept that PMAs may reflect plaque rupture severity, and may promote microvascular 2 dysfunction. Early anti-platelet therapy reduced PMAs following intervention, which may explain the benefit of early abciximab observed in clinical trials. In summary this thesis has demonstrated that primary angioplasty can be del ivered safely and eff ectively in North East London. The eff icacy of reperf usion may be determined by mechanisms involving platelet activation. Delivery of a 24 hour seven day service should now be addressed.
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Grainger, Patricia. "Perception of health, social support, and health-promoting behaviours of angioplasty patients /." St. John's, NF : [s.n.], 1997.
Cerca il testo completo
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Campos, César Presto. "Estudo da perviedade e do perfil sérico de marcadores inflamatórios com uso de stents impregnados de carbono no território vascular periférico." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-25072018-103058/.
Testo completoAbstract (sommario):
Introdução: Um dos fatores mais comuns de falha do procedimento das angioplastias vasculares periféricas é a estenose recorrente (reestenose). A inflamação vascular após angioplastia e implante de stent desempenha papel importante na proliferação de células do músculo liso vascular e posterior crescimento de neoíntima hipertrófica. Diversos estudos têm sugerido que a superfície dos stents, quando impregnada com determinadas moléculas, pode limitar a reestenose de forma eficaz. O carbono diamante, polímero de hidrocarboneto amorfo, pode ser usado para essa finalidade, reduzindo liberação de íons metálicos e a trombogenicidade. Diversos mediadores têm sido implicados na resposta inflamatória vascular, como o sistema calicreína-cinina (SCC), as citocinas, proteína C reativa (PCR) e o óxido nítrico (NO). Portanto, estudos clínicos específicos correlacionando o implante do stent aos níveis séricos destes possíveis marcadores podem contribuir no entendimento desse processo. Objetivo: Estudar a perviedade do dispositivo e a evolução clínica de doentes submetidos a angioplastia com stents impregandos de carbono no território vascular periférico, assim como o comportamento de mediadores séricos envolvidos nas fases mais precoces do processo inflamatório pós angioplastia. População e Método: Estudo prospectivo envolvendo 32 pacientes submetidos à angioplastia com stent no segmento ilíacofêmoro-poplíteo, selecionados no Ambulatório de Cirurgia Vascular e Endovascular do HCFMRP/USP. Foram tratadas lesões estenosantes ou oclusivas com angioplastia e colocação de stents de nitinol, com superfície impregnada de carbono (Carbostent®). Foram estudados os seguintes marcadores: SCC - com quantificação dos substratos (cininogênio de alto e baixo peso molecular - CAPM / CBPM) e das enzimas calicreína plasmática e tecidual, além da quantificação da cininase II; a determinação dos níveis de nitrito e nitratos para a avaliação de óxido nítrico; dosagem sérica de PCR e citocinas (IL-1 beta, IL-6, IL-8, IL-10, TNF-alfa e TGFbeta). Também foi realizado a dosagem dos leucócitos. Amostras séricas foram coletadas antes, 24 horas e 6 meses após o implante do stent. Os pacientes foram seguidos por um ano, para avaliação da perviedade nesse período. Resultados: Dos 27 pacientes que completaram seis meses de estudo, houve apenas uma reestenose (3,7%) e nenhuma oclusão (96,3% de perviedade). No período de um ano, quatro pacientes perderam seguimento e todos os 23 doentes avaliados, mantiveram a perviedade dos stents, com exceção do paciente no qual houve reestenose no tempo seis meses. Houve redução significativa das concentrações das citocinas inflamatórias (IL-1 beta, IL-6, IL-8 e TNF-?) no tempo 24 horas e seis meses quando comparado com o pré-procedimento (p<0,05); exceto a IL-8 no tempo 24 horas. As citocinas anti-inflamatórias (IL10 e TGF-beta) comportaram-se de maneira antagônica, com elevação do TGF-beta no tempo 24 horas e elevação, tanto do TGF-beta quanto da IL-10, no tempo 6 meses versus pré-tratamento e 6 meses versus 24 horas (P<0,05). A PCR apresentou queda no tempo seis meses em relação ao tempo 24h (p<0,05). Os níveis de NO não se alteraram entre os tempos; os de leucócitos elevaram-se no tempo 24 horas e reduziram-se no tempo seis meses em relação ao tempo 24 horas (p<0,05). Conclusão: No presente estudo a taxa de reestenose precoce foi de 3,7% nos primeiros 6 meses e 5% em 12 meses de seguimento. O comportamento dos marcadores inflamatórios evidenciou sua correlação direta com o processo de angioplastia e implante de carbostent, em especial o SCC, as citocinas, PCR e os leucócitos. Contudo, não foi possível relacionar a variação dos seus níveis séricos com o processo de reestenose.<br>Background: One of the most common factors of failure of the peripheral vascular angioplasty procedure is recurrent stenosis (restenosis). Vascular inflammation following angioplasty and stent implantation plays an important role in vascular smooth muscle cell proliferation and subsequent hypertrophic neointimal growth. Several studies have suggested that the surface of stents, when impregnated with certain molecules, can limit restenosis effectively. Diamond carbon, amorphous hydrocarbon polymer, can be used for this purpose, reducing release of metal ions and thrombogenicity. Several mediators have been implicated in the vascular inflammatory response, such as the kallikrein-kinin system (SCC), cytokines, C-reactive protein (CRP) and nitric oxide (NO). Therefore, specific clinical studies correlating stent implantation with serum levels of these possible markers may contribute to the understanding of this process. Objective: To study the patency of the device and the clinical evolution of patients undergoing angioplasty with carbon-impregnated stents in the peripheral vascular territory, as well as the behavior of serum mediators involved in the earlier stages of the inflammatory process after angioplasty. Population and Method: Prospective study involving 32 patients submitted to angioplasty with stent in the iliac-femoro-popliteal segment, selected at the HCFMRP / USP Outpatient Vascular and Endovascular Outpatient Clinic. Stenosis or occlusive lesions were treated with angioplasty and placement of nitinol stents with a carbon impregnated surface (Carbostent®). The following markers were studied: SCC - with quantification of substrates (high and low molecular weight cincinogens - HMWC / LMWC) and plasma and tissue kallikrein enzymes, besides quantification of kininase II; determination of nitrite and nitrate levels for the evaluation of nitric oxide; serum levels of CRP and cytokines (IL-1 beta, IL-6, IL-8, IL-10, TNF-a and TGF-b). Leucocytes were also dosed. Serum samples were collected before, 24 hours and 6 months after stent implantation. The patients were followed for one year to assess the patency in this period. Results: Of the 27 patients who completed six months of study, there was only one restenosis (3.7%) and no occlusion (96.3% of patency). In one year, four patients lost follow-up and all 23 patients evaluated, maintained stent patency, with the exception of the patient who had restenosis over time for six months. There was a significant reduction in the concentrations of inflammatory cytokines (IL-1 b, IL-6, IL-8 and TNF-a) in the time 24 hours and six months when compared with the pre-procedure (p <0.05); except for IL-8 in the 24 hour time. Anti-inflammatory cytokines (IL10 and TGF-b) behaved in an antagonistic manner, with TGF-b elevation in the 24 hour time and elevation of both TGF-b and IL-10, at 6 months versus pre- treatment and 6 months versus 24 hours (P <0.05). CRP showed a decrease in time six months in relation to time 24h (p <0.05). NO levels did not change between the times; the leukocytes increased in time 24 hours and reduced in time six months in relation to time 24 hours (p <0.05). Conclusion: In the present study, the rate of early restenosis was 3.7% in the first 6 months and 5% in 12 months of follow-up. The behavior of the inflammatory markers showed its direct correlation with the angioplasty and carbostent implantation process, especially SCC, cytokines, CRP and leukocytes. However, it was not possible to relate the variation of their serum levels to the restenosis process.
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Wong, Lai-ting. "Is failure to achieve smoking cessation before treatment related to the patency of lower extremity after angioplasty?" View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887079.
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Nowinski, Karolina J. "Ventricular repolarization in the human heart : effects of pharmacological and non-pharmacological interventions /." Stockholm : [Karolinska institutets bibl.], 2001. http://diss.kib.ki.se/2001/91-7349-069-5/.
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Konneh, Matthew Kwame. "An investigation of the mechanisms in the intimal response to balloon injury." Thesis, Queen Mary, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244030.
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Kop, Willem Johan. "The predictive value of vital exhaustion in the clinical course after coronary angioplasty." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1994. http://arno.unimaas.nl/show.cgi?fid=7910.
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Azarnoush, Hamed. "Modeling and control of angioplasty balloon deployment based on intravascular optical coherence tomography." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=107712.
Testo completoAbstract (sommario):
Cardiovascular disease is the leading cause of death in industrialized nations. Angioplasty is performed on millions of patients every year. It is, therefore, essential to constantly explore and investigate new approaches to study and improve the outcomes of this minimally-invasive procedure. In this thesis, novel applications of intravascular optical coherence tomography (IVOCT) are proposed, namely, monitoring, characterization, simulation, and control of balloon inflation.High-resolution IVOCT images lead to a detailed assessment of microstructures. Using image analysis techniques, IVOCT characterization of balloon deformation is presented as a method to validate the performance of balloons. IVOCT characterization of the deformation of artery phantoms is proposed as a method to study the tissue's response to various balloon sizes, various balloon folding strategies and various inflation strategies.In addition, IVOCT characterization of deformation is proposed as a method to validate simulation results. This thesis provides a comparison between finite-element simulation results and experimental results for two case studies, which investigate the effects of variation of mechanical properties as well as balloon unfolding and inflation process.Finally, in this thesis, methods are proposed to control the balloon inflation. During balloon inflation, the luminal diameter of an artery could be estimated in real-time and used in a feedback loop to control the inflation. The experimental relevance of this method is demonstrated when the balloon is inflated in an artery phantom, in an artery of an excised porcine heart and in an artery of a beating porcine heart.The methods and the results, provided in this thesis, could benefit the developers of angioplasty devices, cardiovascular research, and clinical users.<br>Les maladies cardiovasculaires sont la principale cause de décès dans les pays industrialisés. L'angioplastie est réalisée sur des millions de patients chaque année. Il est donc essentiel de constamment explorer et étudier de nouvelles approches pour étudier et améliorer les résultats de cette procédure peu invasive. Dans cette thèse, de nouvelles applications de la tomographie par cohérence optique intravasculaire (IVOCT) sont proposées, à savoir, la surveillance, la caractérisation, la simulation et le contrôle du gonflement du ballon.Des images haute résolution IVOCT mènent à une évaluation détaillée des microstructures. En utilisant des techniques d'analyse d'image, la caractérisation de la déformation du ballon est présentée comme une méthode pour valider la performance de ballons. La caractérisation de la déformation des fantômes est proposée comme une méthode pour étudier la réponse des tissus à des tailles différentes de ballons, et diverses stratégies de pliage et de gonflement du ballon. En outre, la caractérisation de la déformation est proposée pour valider les résultats de simulation. Une comparaison est fournie entre les résultats de la simulation par éléments finis et des résultats expérimentaux pour les deux études de cas, qui étudient les effets de la variation des propriétés mécaniques ainsi que le processus de déploiement et de gonflement du ballon. Enfin, dans cette thèse, des méthodes sont proposées pour contrôler le gonflement du ballon. Pendant le gonflement du ballon, le diamètre luminal de l'artère peut être estimé en temps réel et utilisé dans une boucle de rétroaction pour contrôler le gonflement. La pertinence expérimentale de cette méthode est démontrée lorsque le ballon est gonflé dans un fantôme, dans les artères porcines d'un cœur excisé et d'un cœur battant. Les méthodes et les résultats fournis dans cette thèse pourraient bénéficier aux développeurs de dispositifs d'angioplastie, à la recherche cardiovasculaire et aux utilisateurs cliniques.
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Gunn, J. P. G. "Restenosis after coronary angioplasty : an early and local approach to prediction and prevention." Thesis, University of Cambridge, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.599781.
Testo completo